Category Archives: Borderline Personality Disorder

The Therapeutic Alliance: The Essential Ingredient for Psychotherapy

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umbrellas

 I am currently writing on the ‘therapeutic alliance’ – its relation to mindfulness, psychotherapy, understanding, and ‘being listened to…’   What follows is an interesting article that I came across that may interest some of you…

Excerpt:

Have you ever tried to change the way you do something? It could be anything — the way you hold your tennis racket, blow into a flute, meditate — you name it. If so, think about that experience. No matter how motivated you were to change, and no matter how much you knew that it would help your serve, musicality, or sense of inner peace, it can be difficult and scary to change even the smallest thing. In order to change, you have to give up your old way of doing something first and then try the new way. That means that for a while you’re in a free fall — you no longer have your old habit to rely on and you don’t yet have the new one.

The anxiety of trying to change something as complex and entrenched as how you relate to people close to you or manage stress takes the feeling to a whole new level. Yet, that’s just what you do when you enter psychotherapy. Just as you had to put yourself into the hand of your teachers and coaches, in therapy you need to gradually do just that with your therapist to help you through what can be a harrowing adventure. The foundation for therapy is called the therapeutic alliance (1, 2). When it’s there, you know that your therapist is there to help you, no matter how hard the going gets.

The therapeutic alliance might be the most important part of beginning a psychotherapy. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome (3-5).

See entire article:

http://www.huffingtonpost.com/deborah-l-cabaniss-md/therapeutic-alliance_b_1554007.html

 

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A mad world A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

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Unfortunate Events

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

Men with BDP

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"She'll be sorry."

“She’ll be sorry.”

The Predator

Most people are familiar with the characteristics of violent men, either by first-hand experience or through news and true crime books and TV shows. We all know what they look like: fearless, callous, thrill- and pleasure seeking guys who take what they want and who get easily frustrated if someone gets in their way. It’s the familiar antisocial person ranging from the neighbourhood thug who gets into fights when he is drunk, to the full-fledged psychopath that entirely lacks empathy and uses other people for money, sex or other benefits.

And the Prey?

People with Borderline Personality Disorder (BPD) are a completely different breed. Their core features are their desperate need for love and lack of interpersonal skills. They fall head over heels in love with people they don’t know the first thing about and then become disillusioned and deeply resentful when the other person fails to match their fantasies. They are emotionally unstable and vulnerable and they feel very hurt and betrayed when people, as they see it, let them down. They fear being abandoned and often threaten to kill themselves. Another typical behavior is self-harm, cutting or burning themselves.

Borderlines can often come across as poor and misunderstood – perhaps because they genuinely feel that way – and being vulnerable they hardly evoke any fear in others. Their melodramatic gestures are sometimes pathetic or tragic, but again, nothing that will scare anyone. But it should.

Emo

Despite of the soap opera-type behavior found in psychiatric literature, between 25-50 percent of people with borderline are boys and men, and males who are angry, jealous and hateful tend to be dangerous. Women may think these guys, with their frailness and tragic personas are intriguing and good projects for improvement. A typical example of what they may look like comes from the musical genre called Emo. As the name suggests it deals with emotionally intense feeling of romantic nature, often tragic and bitter themes. And like borderlines they are often interested in self-harm and suicide.

But bitterness and hate isn’t just expressed by self-destructive gestures. In the emo lyrics you can often find passages that would suggest violence towards partners as well. Here are some excerpts from one of the more popular emo bands Fall Out Boy’s song Chicago Is So Two Years Ago,

My heart is on my sleeve
Wear it like a bruise or black eye
My badge, my witness
Means that I believed
Every single lie you said

You want apologies
Girl, you might hold your breath
Until your breathing stops forever, forever
the only thing you’ll get
Is this curse on your lips:
I hope they taste of me forever

With every breath I wish your body will be broken again, again
With every breath I wish your body will be broken again, again
With every breath I wish your body will be broken again, again
With every breath I wish your body will be broken again

Lashing Out

While the emo isn’t the only borderline male it seems like a pretty good example. And like the lyrics above suggest, borderline violence isn’t just directed at the self. A study on correlates of personality disorders conducted by clinical psychologist Joshua Miller and colleagues confirms this violent aspect of BPD. They had students fill in self-measures of personality disorders as well as other measure of for instance crime and violence. As expected, they found that crime was most strongly associated with psychopathy (which is a dimensional trait that to some extent can be found in the normal population). Also as expected, borderline was linked to self-harm. But perhaps more surprisingly, borderline was also strongly correlated with intimate partner violence, even more so than for psychopathy and narcissism.

Self-measures may of course be exaggerated, especially when we are talking about people with a taste for drama. But other research confirms that this is for real. One study from 2007 by psychiatrist Donald Black found that around 30 percent of new inmates in Iowa met the criteria for borderline and another study from this year by psychiatrist Marc Schroeder and colleagues, again looking at actual offenders, found a similar pattern with borderline being the second most common personality disorder after antisocial personality disorder. Of offenders who had committed both sexual and non-sexual violent crime half were antisocials and a third were borderlines as compared to third most common category of narcissistic disorder at a mere 3 percent. Given that borderline is rare in the general population, around 1-2 percent, it’s clear that these individuals are very violent.

The Hidden Threat

So it seems the borderline personality is a large and rather hidden threat to women (and probably some men too although women are usually less violent). No one seems to talk about these men. They rarely feature in the media or public debate. Maybe it’s just because they are so fragile and look more like victims than perpetrators. Pointing the finger at these guys may feel like kicking on someone w-ho is already lying down. But they are not victims of anything but their own shaky grip on reality, and excusing them or looking the other way will only make for more violence.

Reblogged from:

Staffan’s Personality Blog

 

How the brain works in Borderline Personality Disorder

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 Brain photo by Andrew MasonNew work by University of Toronto Scarborough researchers gives the best description yet of the neural circuits that underlie a severe mental illness called Borderline Personality Disorder (BPD), and could lead to better treatments and diagnosis.

The work shows that brain regions that process negative emotions (for example, anger and sadness) are overactive in people with BPD, while brain regions that would normally help damp down negative emotions are underactive.

People with BPD tend to have unstable and turbulent emotions which can lead to chaotic relationships with others, and which put them at higher risk than average for suicide. A number of brain imaging studies have found differences in the function of brains of people with BPD, but some of the studies have been contradictory.

A team led by Anthony C. Ruocco, assistant professor in the Department of Psychology and program in neuroscience, analyzed data from 11 previously published studies and confirmed a number of important differences between people with BPD and those without.

On the one hand, a brain area called the insula – which helps determine how intensely we experience negative emotions – is hyperactive in people with BPD. On the other hand, regions in the frontal part of the brain – which are thought to help us control our emotional reactions – are underactive.

 

“It’s not just that they have too much drive from their emotions,” Ruocco says. “They seem to have less of the ‘brakes’

The invisible child

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The Invisible Child

I’ve always struggled with the term attachment, used in my profession to denote the relationship that is supposed to develop between mother and infant during the earliest months of life. I may be too concrete, but it makes me think of those poor monkeys in Harlow’s experiment, clinging to that cloth-covered metal skeleton; it seems to imply a kind of behind the mirrorphysical connection when in fact, it’s all about the emotional relationship. In his video on attachment theory, Allan Schore brings that relationship to life when he speaks about the complex interactions between mother and baby — the role of eye contact, physical interaction and facial expresions in creating secure “attachment” — but it still seems to me to be the wrong word.

I’ve had a similar problem with Kohut’s word, mirroring, because to my concrete mind, it suggests that what the mother does is behave like a physical object (a mirror), though lately, I’ve been feeling better about it. In my work with several different clients, I’ve been struck anew with the role of our parents’ attention in creating our sense of self, how important it is that we feel that we are seen. In a fundamental way, we come to know who we are by witnessing our parents’ responses to us; in particular, the joy and love we see in our mother’s face convey to us that we are beautiful and important. Allan Schore has shown how the infant comes with a set of inbuilt expectations and behaviors geared to elicit those parental responses; when the reality of an engaged and loving mother meets those expectations, the result is a secure “attachment” (ugh).

It also results in a secure sense of self, the basis for later self-confidence and self-esteem. But when those expectations are disappointed, as I have explained elsewhere, it leaves the infant with a sense of intrinsic defect and basic shame. This is particularly true when the environment is highly traumatic or abusive. Lately, I’ve also been thinking about a parenting style that isn’t overtly abusive but vacant or largely withdrawn instead. In such a case, though basic shame is an invariable result, the person also develops a sense of unreality, as if he were invisible. It’s as if she looked into the mirror of her mother’s face and found no reflection whatsoever.

In a recent session, my client Alexis was speaking about her boss, with whom she has had an intense and problematic working relationship for many years. Lately, she has “woken up” to the rather nasty ways he sometimes treats her; in this particular session, she told me that she felt as if her boss wanted nothing to do with her or her actual emotional experience. As a result, she had come to feel like a “ghost” at work; this made her want to retreat from their relationship in turn, becoming an impersonal function and discharging her duties in an efficient, detached way. I linked this to her relationship with her father, a college professor who had largely ignored her and her sister, warning them to be silent as he retreated into his study with the graduate students who came for their tutorials. She had felt invisible to her father, and desperate to be noticed by him.

1e6f0c21138bf6ebac99cb1538aa4dd7Alexis also linked this feeling to her mother, a woman who had felt over-burdened by her children and very much wanted to be left alone. Alexis recounted a story recently told to her by her sister Adrienne. Around the age of 8, Adrienne had begun suffering panic attacks in the evenings. Their mother’s response was to give her an over-the-counter sleeping pill and put her to bed with Alexis (age 10), who was then responsible for moving Adrienne to her own bed whenever she felt able to sleep. This “hands off” approach to mothering was typical. Whenever the girls were fighting (as they often did) she would tell them she preferred not to get involved or play referee.

I suggested to Alexis that she felt her mother had wished her to go away, which left Alexis feeling like a ghost, scarcely real. Rather than discovering her sense of self in her mother’s joyful expression, when she looked for a reflection in that mirror, she found it a blank. This discussion helped me understand yet another reason why she has resisted the idea that she’d ever finish treatment and go it alone. Over the long years of our relationship, my bearing witness to her experience and taking a deep interest in her as a person has felt precious to her, an important source of the sense of self she has developed through our work together. On some level, she’s afraid that without me and my attention, she would cease to exist. As a child, she must have felt that way in the absence of parental involvement: as if she were invisible, a ghost child without physical substance.

We ended the session by talking about the importance of being seen and known by others, how at the end of the day, it’s a very small universe of people who “get” you, who are capable of actually seeing you for who you are. It seemed important to acknowledge that I have felt seen and known by her, as well, and that our long relationship has been important to me. How many people understand the work that I do and the psychological issues I consider most important as deeply as Alexis? In a weird way, you’d have to say she knows me better than many of my friends. I also derive a sense of who I am through the mirroring Alexis and my other clients provide to me, just as there’s a kind of reciprocal mirroring that goes on between mother and child.

I wonder if this is why therapists sometimes find it hard to let go of their clients. Maybe they can’t bear to lose that mirroring; they might feel that when a client of long-standing terminates, they lose a little bit of themselves, too.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

Inspiration: Movies about mental illnesses

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Black Swan (2010), Darren Aranofsky

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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Stigma of being a woman with Borderline Personality Disorder

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This is from a girl with borderline personality disorder. She writes of her experiences with society and therapy. If anyone has other experiences, feel free to comment! Thank you Stephanie, for contributing. We need people who dare to speak up, like you do.

Livingonborderlines
 · 35 like this

July 19 at 2:49am

I wrote this a while ago on the stigma of being a woman with borderline personality disorder, and want to dedicate this to “For free psychology
I DON’T LIKE TO TELL PEOPLE MY DIAGNOSIS. I’LL TELL PEOPLE I’M SICK, I’LL TELL PEOPLE I SEE A THERAPIST, I’LL TELL PEOPLE I HAVE “EMOTIONAL PROBLEMS” BUT I’M ASHAMED OF “BORDERLINE.” SOMETIMES I JUST SAY I HAVE SOME OTHER MENTAL DISORDER BECAUSE THE STIGMA ATTACHED TO IT IS LESS THAN THE STIGMA OF BEING BORDERLINE. YES, MENTAL DISORDERS, ALL MENTAL DISORDERS HAVE A STIGMA BUT I FEEL SOME ARE WORSE THAN OTHERS. BORDERLINE IS ONE OF THE MOST STIGMATIZED DISORDERS, THAT ALONG WITH DRUG ABUSE (WHICH ISN’T A MENTAL DISORDER BUT IS USUALLY RELATED TO IT) IT’S SEEN AS OUR FAULT. IT’S NOT A “CHEMICAL IN-BALANCE.” YOU CAN’T SEE THE REASONS FOR WHY WE DO WHAT WE DO ON A BRAIN SCAN.
  • borderlYOU CAN’T EXPLAIN OUR FEARS, OUR RAGE AND OUR DESPAIR WITH NEUROTRANSMITTERS AND SYNAPSES. WE CAN’T PULL OUT THE LATEST EDITION OF THE DSM-V AND POINT TO A DESCRIPTION THAT INVOKES SYMPATHY, THE VERY DEFINITION OF OUR ILLNESS FURTHER INCRIMINATES US. WE HAVE “INTENSE EMOTIONAL OUTBURSTS.” WE HAVE “UNSTABLE RELATIONSHIPS.” WE ARE NOTORIOUSLY “PROMISCUOUS.” WE ARE IMPULSIVE. WE ARE DEMANDING. WE DRIVE TOO FAST. WE ARE LOUD. WE ARE ANGRY. WE ARE AGGRESSIVE. WE WANT YOUR ATTENTION. 
  • THERAPISTS AND PSYCHIATRISTS DO NOT UNDERSTAND US. WE DON’T BEHAVE THE WAY THEY EXPECT US TO. WE DON’T SIT ON THEIR SOFT LEATHER COUCHES, DESCRIBING OURSELVES AS THE PASSIVE, HELPLESS VICTIMS THEY’RE USED TO SEEING. WE AREN’T THE GIRLS HIDING IN OUR CLOSETS ALL DAY, WE ARE THE WOMEN WHO WRITE OUR RAGE ON THE WALLS. WE ARE NOT SITTING BY THE PHONE WAITING, WE ARE SCREAMING AT YOU IN THE PARKING LOT AT 2:00 AM. WE DON’T STAY IN OUR HOSPITAL BEDS CRYING, ZONED OUT ON AMBIEN, WE ARE THE WOMAN AT THE FRONT DESK CUSSING OUT THE NURSE. WE ARE THE CRAZY BITCHES THAT MEN SPEAK OF.WE ARE TRAUMATIZED. WE ARE ABUSED. WE HAVE DARK PASTS AND WE DON’T LET GO AND WE DON’T HIDE OUR SCARS. SOME OF US EVEN WEAR THEM ON OUR ARMS. UNLIKE MANY OTHER WOMEN WHO HAVE SUFFERED TRAUMAS, WE DON’T GO TO OUR SADNESS, WE GO TO OUR ANGER.

     

    OUR FRUSTRATION IS INTENSE. IN THERAPY WE ARE TAUGHT TO CONTROL OUR “RESPONSES” TO OUR RIGHTEOUS ANGER. WE ARE TOLD THAT OUR REACTIONS ARE “EXTREME.” WE TRY NOT TO “DOMINATE THE CONVERSATION” BUT WE WANT IS TO BE HEARD. WE ARE TIRED OF BEING TOLD TO CONTROL OUR TONE, THE VOLUME OF OUR VOICES. OUR RAGE IS RAW AND WE KNOW THAT IT IS REAL.

    Rage is our comfort zone, the emotions we are not allowed to express “in public”. WE HAVE LEARNED HOW TO TAKE THAT RAGE AND PUT INTO OUR OURSELVES.

  • WE HAVE HURT OURSELVES SO MUCH MORE THAN WE WILL EVER HURT YOU. OUR RAGE IS OUR DRUG ABUSE AND OUR BINGE DRINKING. OUR RAGE IS OUR OVERDOSES AND OUR ALCOHOL POISONING. OUR RAGE IS OUR CUTTING. OUR RAGE IS OUR SHATTERED MIRRORS, OUR RAGE IS THE HOLES WE PUNCHED IN OUR OWN WALLS. OUR RAGE IS OUR BROKEN ROMANCES; OUR RAGE IS OUR BROKEN DREAMS. 

     

    soulBut we are more than what people see of us. Behind our HOUR-GLASS FIGURES, OUR SULTRY SWAGGER THAT ATTRACTS MEN’S STARES, IS THE GIRL WHO NO ONE ASKED TO PROM. UNDERNEATH OUR TUBE TOPS AND OUR MINISKIRTS IS A BODY THAT WAS ABUSED. INSIDE THE TOPLESS PICTURE WE SENT YOU, IS THE MESSAGE THAT WE WANT TO BE LOVED. THE SUBTITLES THAT YOU CAN’T READ, TO OUR SASSY MOUTHY COMMENTS, IS OUR FEAR THAT WE AREN’T GOOD ENOUGH FOR YOU. NEXT TO THE SMASHED BEER BOTTLES, IS OUR FRUSTRATION THAT WE DISAPPOINTED YOU. AGAIN. OUR DESPAIR OVER US ROLLS LIKE LIQUID OVER CONCRETE, WASHING AWAY WITH THE RAIN. 


    WHAT YOU DON’T KNOW IS THAT WE INHALE OUR SHAME WITH THE SMOKE OF OUR CIGARETTES. OF ALL THE “RECKLESS” ACTIONS WE SO RIGHTEOUSLY DEFEND, WE ARE ASHAMED OF EVERY LAST ONE OF THEM. WE ARE ASHAMED OF ALMOST EVERYTHING WE DO AND ALMOST EVERYTHING WE DON’T DO. ALL OF THOSE ANGRY TEXTS WE SENT YOU IN THE MIDDLE OF THE NIGHT, EVERY SINGLE ONE OF THEM READS, “PLEASE DON’T LEAVE.” WE HATE THE STIGMA OF OUR ILLNESS MORE THAT YOU CAN EVER IMAGINE, BUT WE’RE HERE IN THIS CAMP FOR A REASON. AT SOME POINT IN OUR LIVES WE WERE LEFT ALONE. YES, SOME WOMEN IN OUR SAME SHOES WOULD HAVE BEEN ABLE TO “HANDLE IT” OR “MOVE ON.” BUT WE DIDN’T. BECAUSE WE COULDN’T.

    This is all I have left to say: Please don`t leave us. Please don`t leave us alone again.