People with borderline personality disorder (BPD) experience extreme emotions. Once a powerful emotion is triggered, it is very hard for them to calm down. Because of this, they often have unstable relationships. They also engage in self-destructive behavior, including suicide attempts.
In the past, traditional therapy hasn’t been very effective in helping people with BPD. But there is now new understanding of the disorder and more effective treatments available. With the right support. most people with BPD can learn to manage overwhelming emotions and improve their lives.
Another important change is that BPD is now diagnosed and treated in teenagers. When kids get the right treatment, sooner, they’ll do better in the future.
Some kids with BPD have a history of abuse or neglect. But the disorder can also occur in ordinary, loving families when parents ignore or minimize kids’ big emotional reactions. This might seem like a normal part of parenting, and in most cases, it is. But highly sensitive or emotional kids can end up feeling painfully alone. When these children’s big feelings are brushed off by adults, they often fail to learn the important skills they need to control their emotions.
People with BPD are often overwhelmed by anger and feelings of abandonment, shame and self-loathing. These feelings take a toll on relationships. Small problems easily become big blow-ups, causing fights with friends, parents and partners. Problems with friends or breakups with partners can trigger self-harm or suicide attempts. Other dangerous behaviors can include substance abuse, risky sex, and recklessness.
The gold-standard treatment for BPD is called dialectical behavioral therapy, or DBT. The treatment helps patients practice more effective ways to manage and respond to their feelings, and it is very successful in treating this disorder.
Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships, and self-destructive behavior, including suicide attempts.
But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising. With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior, and improve their lives.
“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” says Alec Miller, PsyD, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”
Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence or even earlier. Now experts stress that treating BPD as early as possible leads to better long-term outcomes as well as lowering the risk of dangerous or suicidal behavior.
What is BPD?
Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination that is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.
BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate their feelings — that is, acknowledge them, make them feel understood, and help them handle painful emotions. In many cases, kids who develop BPD have been abused or neglected. But the disorder can also come about in children whose loving, well-meaning parents minimize or discount their emotional reactions because they seem exaggerated or inappropriate.
Dismissing what seems like an overreaction is a fairly typical parental response. But for highly reactive kids, the chronic sense of not feeling understood or supported leads them to feel painfully alone and disconnected, explains Blaise Aguirre, MD. Dr. Aguirre is the founding medical director of 3East, a continuum of care using dialectical behavior therapy (DBT) to treat borderline personality disorder at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things. For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.
Emotional dysregulation
When a child’s powerful feelings aren’t validated by the adults in their life, it becomes difficult for them to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us, they teach us how to soothe and calm ourselves down.
“Take a person with extremely strong, intense emotions who is constantly told that they’re overreacting, they shouldn’t feel the ways they feel,” explains Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “As a result, they don’t learn how to regulate and modulate their emotions. “
People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing.
These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging — that they drive partners away.
Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.
Self-destructive behavior
Why does BPD lead to self-destructive behavior?
Without the skills to manage painful feelings in a more effective way, people with BPD often find unhealthy alternatives, including substance abuse, risky sex, and reckless thrill-seeking.
Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City. “The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”
One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.
“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”
In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.
Criteria for diagnosing BPD
These are the criteria mental health professionals use to diagnose borderline personality disorder:
Frantic efforts to avoid abandonment, real or imagined
A pattern of unstable and intense relationships
An unstable self-image or sense of self
Dangerous impulsivity such as unsafe sexual encounters, substance abuse
Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
Emotional instability due to high reactivity
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger
Transient, stress-related paranoia or severe dissociative symptoms
Diagnosing teenagers
In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.
But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes. Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”
Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence. One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.
The lead author of the study, Mary Zanarini, began to call borderline personality disorder a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.
Why early diagnosis is crucial
If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”
This is particularly important as young people are developing their identity and sense of self, which is difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”
Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression, and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.
“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”
BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.
Treatment for BPD
There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.
First, a patient’s feelings need to be validated, or accepted without judgment, in order for them to learn more effective ways to manage and respond to them.
“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”
Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real. It doesn’t mean agreeing with the thoughts or feelings. When people feel accepted and understood, it has a calming effect and allows them to learn skills to regulate emotions and develop safer, more effective alternatives to the self-destructive behaviors they have been using.
“It’s essentially a skills-based approach which says that if our patients could do better, they would, but they’re lacking skills,” explains Dr. Miller, who is the author of Dialectical Behavioral Therapy with Suicidal Adolescents. “It’s so easy for us to tell people to stop problematic behaviors but it’s better to teach them new skills.”
DBT skills are very effective for getting patients to stop self-injury and suicidality, Dr. Aguirre notes. It’s tougher to change the self-loathing and self-hatred that can become fused with a borderline person’s identity.
He also notes that availability of DBT and other treatment for BPD is limited, which means that a lot of teenagers who should get treatment aren’t getting it. “The number of people with emotion regulation problems is outstripping the number of DBT providers,” he says, “and we know that because suicide rates in adolescents continue to go through the roof.”
Dr. Miller stresses the urgency of getting teens with BPD into treatment: “If you throw yourself into treatment, you can be a very successful, highly functional adult.”
Dr. Emanuele adds that she’s seen many patients dramatically improve their lives. “Over the years, I have repeatedly seen DBT give participants the hope and reality of a ‘life worth living,’ ” adds Dr. Emanuele. “And that’s something they had not been able to imagine or experience before.”
#James Donaldson notes: Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes. Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use. Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.#http://bit.ly/JamesMentalHealthArticle Find out more about the work I do on my 501c3 non-profit foundation website www.yourgiftoflife.org Order your copy of James Donaldson’s latest book, #CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
Symptoms of BPD (borderline personality disorder) usually develop during the teenage years. How old do you have to be to be diagnosed with BPD?
Please follow and like us:
James Donaldson is a Washington State University graduate (’79). After an outstanding basketball career with WSU, he went on to play professional basketball in the NBA with the Seattle Supersonics, San Diego/L.A. Clippers, Dallas Mavericks, New York Knicks, and Utah Jazz. He also played for several teams in the European Leagues in Spain, Italy, and Greece, and he toured with The Harlem Globetrotters to wrap up his career. James was an NBA All-Star in 1988 while playing center for the Dallas Mavericks. In 2006, James was inducted into the Pac-10 Sports Hall of Fame and also the Washington State University Athletic Hall of Fame. In 2010, James was elected as a board member for the NBA Retired Players Association.
James frequently conducts speaking engagements (motivational, inspirational, educational) for organizations, schools, and youth groups.
In 2010, James was the recipient of the NBA Legends of Basketball ABC Award, awarded for outstanding contributions in Athletics–Business–Community.
He believes in being a role model for success and professionalism to the scores of young people to whom he devotes so much of his time. He currently serves on several boards and committees and is a member of many organizations.
James believes in developing relationships that create a “Win-Win” environment for everyone involved, and in being the best he can be!
For more information about James Donaldson or to request he speak at your event, contact him at:
James Donaldson is the author of “Standing Above The Crowd” and “Celebrating Your Gift of Life” and founder of the Your Gift of Life Foundation which focuses on mental health awareness and suicide prevention, especially pertaining to our school aged children and men.
If you’re interested in having James come and speak to your group of young adults, business entrepreneurs, aspiring political and community leaders, and athletic teams, please contact him at [email protected] and or leave a personal message for him at 1-800-745-3161. Keep up with him and read about how he is reaching out and making a difference in the lives of so many around the world at www.yourgiftoflife.org
Related
READ LATER - DOWNLOAD THIS POST AS PDF >> CLICK HERE <<
