BORDERLINE PERSONALITY DISORDER

Statistics on Borderline Personality Disorder can be hard to come by. But reliable estimates indicate as many as one in fifty Americans may suffer from the disorder. It was first recognized in the 1930s, but therapists still argue over how to define and treat it. In fact, many object to the name itself, since personality disorders are often seen as less "serious" than the major mental illnesses like schizophrenia, depression, and bipolar disorder.

This week on The Infinite Mind, we learn about the symptoms of BPD, why it is so frustrating for therapists to treat it, and a new form of therapy that has been effective.

First, we hear from Kathleen. Kathleen is currently studying for her master's degree in social work, and plans to be a psychotherapist. She describes her own struggle with borderline personality disorder, which resulted in her being hospitalized in Maine. Kathleen describes her overwhelming feelings of hopelessness, which led to her slashing and burning herself in order to feel relief from her anxiety and numbness.

She repeatedly overdosed on pills and thrived on the drama of being taken to the emergency room under police escort. She was angry, and aware that other people -- including therapists and other caregivers -- were afraid of her due to her rage. She had trouble forming an alliance with caregivers and didn't really want to get better. What she did want was to get rid of herself.

Then she was exposed to a new treatment using a method called Dialectical Behavior Therapy -- a type of Cognitive Behavior Therapy. She says it helped her focus on the here and now, rather then reliving the past or fantasizing about the future. She learned that she could take her feelings and embrace them and let them out constructively -- that she could use them to communicate with other people. Kathleen uses the techniques she learned in therapy in her daily life -- in classroom situations and others where there is disagreement.

Next, host Dr. Fred Goodwin speaks with Dr. Marsha Linehan and Valerie Porr. Dr. Linehan is one of the world's leading authorities on Borderline Personality Disorder. She is a professor of psychology at the University of Washington in Seattle, and director of the university's Behavior Research and Therapy clinics. She developed the Dialectical Behavior Therapy that was so useful to Kathleen.

Valerie Porr is executive director of the Treatment and Research Advancements Association for Personality Disorder, also known as TARA. The organization distributes information about the disorder and advocates for increased public funding for research on BPD.

Dr. Linehan begins by explaining the symptoms of people with BPD. They have difficulty regulating their emotions, and experience frequent emotional shifts. They are usually impulsive, and often mutilate themselves or repeatedly attempt suicide. Their interpersonal relationships are volatile, and they are motivated by a terrible fear of abandonment. They may have brief psychotic episodes, and tend to dissociate under stressful situations -- in other words, they feel that they are no longer real. Most importantly, they lack a normal sense of self.

The name "borderline" comes from a school of thought that was common in psychiatry in the 1930s. These patients were then thought to be midway, or borderline, between psychotic patients and those who were simply "neurotic," or had problems that could be easily helped by psychotherapy. In fact, the "borderline" patients at this time often seemed to get worse with psychotherapy. Many people would like the official name of the disorder to change to something that better reflects the actual difficulties people with it experience.

Some therapists won't treat patients with a BPD diagnosis. Ms. Porr and Dr. Linehan describe how many people with BPD are thrown out of residential treatment facilities because their behavior is so hard to cope with -- even though these facilities took them in because they had BPD.

We hear from one caller, Anne in California, whose daughter died by suicide. Her family learned of her BPD diagnosis only after her death. Another caller, Lee from Maryland, describes how his teenage daughter with BPD has been kicked out of a public school and a therapeutic boarding school, and may now face removal from yet another facility.

Dr. Linehan tells the callers that it is important for family and friends of those with BPD to stay involved -- to help them find effective therapy, and to help them evaluate whether their therapy is benefiting them. Through TARA, parents can also find support and share experiences with other parents. It is very important for those around the person with BPD to learn the symptoms and prognosis.

Caller Lisa from New York describes how when she was hospitalized, the staff viewed many of her more extreme behaviors as attempts to get more attention from them.

Ms. Porr and Dr. Linehan explain how people with borderline are often seen as being manipulative by mental health professionals. Both of them think this characterization is highly inacc*urate. Essentially, they say that people with BPD aren't really in control of themselves or their emotions to the point where they can be manipulative, and this misperception naturally has negative consequences for treatment.

Dr. Linehan then explains what is involved with Dialectical Behavior Therapy. People with BPD are extremely sensitive to criticism, to the point where their feelings upon being criticized are so intense that they more or less shut down -- and therapy stops. Using techniques of acceptance she gleaned from a Zen Master/Benedictine monk, Dr. Linehan emphasizes with patients such skills as observing, describing, and participating, non-judgmentally, in the moment, and with a practical attitude. They focus on how to regulate their emotions, and on techniques to cope with stress and distress, both one-on-one with a therapist and in groups.

Her work also focuses on helping therapists deal with these difficult-to-treat patients. She and Ms. Porr explain how medications are not particularly helpful in treating BPD, and how more research into the disorder is needed. For example, a large national survey on mental illness from 1992 did not include BPD -- but the next one will.

You can get more information on Dr. Linehan at the University of Washington website or you can get more information on Dialectical Behavioral Therapy.

TARA, Valerie Porr's organization, has a helpline at 1-888-4-TARA-APD (1-888-482-7227).

The National Alliance for the Mentally Ill has a fact-sheet on BPD. To view it, go to the NAMI web site or call NAMI at 703-524-7600.

Next, Dr. Goodwin speaks with Sally Bedell Smith, author of the book Diana in Search of Herself. It's a look at the troubled emotional life of the late Diana, Princess of Wales. Ms. Smith interviewed 148 people and read up on psychiatric literature to come to her conclusion that Diana exhibited most of the major symptoms of BPD, including self-mutilation, bulimia, volatile relationships, and repeated attempts at suicide. In fact, one friend of the Princess' whom Smith interviewed actually consulted both a psychologist and a psychiatrist about her behavior (without revealing who the troubled individual was) and was told it sounded like a textbook case of BPD. Ms. Smith discusses possible symptoms of BPD from Diana's childhood and teenage years and she and Dr. Goodwin also discuss the response to her book from mental health professionals.

You can get more on Diana in Search of Herself at Barnes and Noble.com.

Finally this week, a commentary by The Infinite Mind's producer June Peoples on the "stepchild" status of Borderline Personality Disorder among mental health professionals. Sadly, borderline patients' fears of abandonment are often reflected by actual abandonment at the hands of the institutions and people charges with helping them. Why is this, and how can we make things better?

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