 |
|
|
 |
|
| From: NAMI Advocate, Winter 2007 |
Borderline Personality
Disorder:
A
Most Misunderstood Illness
|
by Perry D. Hoffman, Ph.D.,
President, National Education
Alliance for Borderline Personality Disorder |
|
| Introduction |
by
Joyce Burland, Ph.D.
Director,
NAMI Education, Training and Peer Support
Center |
There is perhaps no serious mental
illness more maligned and misconstrued than
borderline personality disorder. Years ago,
when I started my clinical career, I was
warned to "stay away from 'Borderlines'."
Being of a suspicious nature, I began to
search out information about this dread
diagnosis, which was primarily attached to
women, and carried with it such a blatantly
stigmatizing reputation.
As I began working with people with this
disorder, I became aware of the enormous
strength and resiliency they brought to the
daily struggle of coping with the disruptive
symptoms of the condition, and of the
patience and loyalty shown by the families
who loved and supported them.
Bringing this diagnosis out of the darkness
is long overdue. Individuals and families
living with the illness deserve current and
correct information, and we must all
advocate to dispel the myths which have made
borderline personality disorder a "leprosy"
of psychiatric diagnoses.
As part of the formal inclusion of
borderline personality disorder in its list
of priority populations in NAMI's public
policy platform, NAMI has invited Perry D.
Hoffman, Ph.D., to write the article that
follows. She is a pioneer in educating
families about this disorder, and a prime
mover in forming a collaborative effort with
NAMI to increase visibility and
understanding of this treatable mental
illness. |
|
|
| What is borderline personality disorder? |
Borderline personality disorder (BPD) is
a complex and challenging illness. A
disorder that is often prompted by and
occurs in the context of relationships, BPD
can wreak havoc not only on those with the
disorder but on their loved ones as well.
The symptoms of the disorder are: 1. fears
of abandonment; 2. intense mood shifts; 3.
impulsivity; 4. problems with anger; 5.
recurrent suicidal behaviors or
self-injurious behaviors; and 6. patterns of
unstable and intense relationships. The
symptomatology is pervasive, encompassing
five areas of dysregulation: emotion
dysregulation, behavioral dysregulation,
cognitive dysregulation, interpersonal
dysregulation and self dysregulation. Those
afflicted with borderline symptoms very
often experience sudden shifts in emotion
that frequently leave both the individual
with BPD and those close to them in their
environment in a state of intense
disruption. To meet official DSM- IV
criteria for the disorder, a person must
have at least five of the nine symptoms.
Needless to say, experiencing even a few of
the behaviors can create a life of pain and
suffering.
|
| |
| How common is BPD? |
The prevalence of BPD in the general
population continues to be debated. While
estimates variously range from 0.7 percent
to 2 percent, there is agreement that 11
percent of people that come for out patient
psychiatric treatment and 20 percent of
psychiatric hospital admissions meet DSM-IV
criteria for this disorder.
|
| |
| Why is BPD so misunderstood? |
Borderline personality disorder,
historically and even presently, is a
disorder that has met with widespread
misunderstanding. There are many reasons for
the confusion. With the nine possible
symptoms there exist over 200 different ways
for the disorder to present itself, and this
heterogeneity is further complicated by the
fact that BPD rarely stands alone. A high
rate of co-occurrence exists with other
disorders, which typically include major
depression, bi-polar disorder, substance
abuse, eating disorders, and anxiety
disorders.
To compound the problems, unfortunately
another diagnosis is often assessed instead,
BPD is often missed or ignored. Data
indicate, on average, that five years elapse
before BPD is accurately diagnosed in a
patient. Lastly, medications are often a
source of confusion. It is not uncommon for
an individual with BPD to be on three, four,
five, six or more medications. To date, no
one medication has been specifically
researched and approved for BPD. |
| |
| Surplus stigma |
Even
among other mental illnesses, BPD is
surrounded by a phenomenon that maybe termed
"surplus stigma."
Issues that promote stigma and, thus,
further the BPD misunderstanding include: 1)
theories on the development of the disorder,
with a suspect position placed on parents
similar to the erstwhile
schizophrenogenic-mother concept; 2)
frequent refusal by mental health
professionals to treat BPD patients; 3)
negative and sometimes pejorative web site
information that projects hopelessness; and
4) clinical controversies as to whether the
diagnosis is a legitimate one, a controversy
that leads to the refusal of some insurance
companies to accept BPD treatment for
reimbursement consideration. |
| |
| A sense of hope |
Over the past decade, various groups
have formed to help move the BPD agenda
forward and to bring hope to individuals
with BPD and their family members. First,
the National Institute of Mental Health
(NIMH) has worked intensively to augment the
focus on BPD research.
Also, the Borderline Personality Disorder
Research Foundation (BPDRF), a private
foundation, has joined the research effort
and provided funding for projects both in
the United States and abroad. Further, the
National Education Alliance for Borderline
Personality Disorder (NEABPD) with support
from NIMH and in partnership with local NAMI
affiliates, NARSAD and major medical
institutions, has convened five national and
14 regional conferences on BPD. To date, it
has also hosted a researched-based family
program, "Family Connections," across the
country as well outside the United States.
In addition, Treatment and Research
Advancements, TARA, located in New York, has
made excellent strides in the area of
advocacy. And lastly, the BPD Resource
Center (BPDRC) provides a free service to
callers and has developed and maintains a
list of treatment referrals as well as
informational brochures on the disorder.
Signs of hope include longitudinal research,
done by Mary Zanarini, Ed,D. and colleagues,
which includes data documenting that persons
with BPD do get better. Most importantly,
research findings demonstrate the
effectiveness of several treatment
modalities. The most prolific, in terms of
available literature, and most sought–after,
is Dr. Marsha Linehan's Dialectical Behavior
Therapy (DBT).
|
| |
| Next steps |
The inclusion of BPD under the NAMI
umbrella marks a major turning point in the
historical trajectory of this illness, which
lags decades behind other mental illnesses
in its recognition. It will be a major step
in propelling the disorder into its next
chapter of development. NAMI plans to
prioritize steps in its BPD initiative and
set an agenda in the areas of support,
education, research, and advocacy.
To help accomplish these first efforts, a
session of an invited panel of experts is
being held at the NAMI National Office. With
financial support from NIMH, this group of
stakeholders, which includes family members,
clinicians and research scientists, is
meeting and providing their perspective to
help guide NAMI's work.
Current research and evidence-based
treatments are showing great promise for
recovery. The recognition by NAMI of BPD as
a major mental illness opens a new way of
action to overcome this illness.
Learn more about BPD from NAMI's Fact Sheet
and BPD Resources
|
| |
From: NAMI
Advocate, Winter 2007
|
| |
|
|
| |
 |
|
|
|
|
|
The National
Education Alliance for Borderline Personality Disorder does not provide
medical advice. The contents are for informational purposes only and are not
intended to substitute for professional medical advice, diagnosis or
treatment. Always seek advice from a qualified physician or health care
professional about any medical concern, and do not disregard professional
medical advice because of anything you may read on this web site. |
|
|