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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
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