Further fueling the stigma attached to BPD is the assumption that nearly all individuals who engage in self-cutting, such as wrist slashing, are so-called borderlines. In fact, in a 2006 study of 89 hospitalized adolescents who engaged in cutting and related forms of nonsuicidal self-injury, Harvard psychologist Matthew Nock and his colleagues found that 48 percent did not meet criteria for BPD. The lion’s share of these individuals exhibited other personality disorders, such as avoidant personality disorder, which is associated with a pronounced fear of rejection.
Once Borderline Always Borderline?
Two allied myths about BPD are that patients virtually never improve over time and are essentially untreatable. Yet a number of recent studies indicate that many patients with BPD shed their diagnoses after several years. In a 2006 investigation, for example, psychologists C. Emily Durbin and Daniel N. Klein, both then at Stony Brook University, found that although 16 percent of 142 psychiatrically disturbed adults initially met criteria for BPD, only 7 percent did after a decade. Moreover, the average levels of BPD symptoms in the sample declined significantly over time. Work by psychologist Timothy J. Trull and his colleagues at the University of Missouri–Columbia similarly suggests that many young adults who display some features of BPD do not exhibit these features after only a two-year period, indicating that early signs of BPD often abate.
BPD is not easy to treat. Yet Linehan has shown that an intervention she calls “dialectical behavior therapy” (DBT) is modestly helpful to many sufferers of the condition. DBT encourages clients to accept their painful emotions while acknowledging that they are unhealthy and need help. It teaches patients specific coping skills, such as mindfulness (observing their own thoughts and feelings nonjudgmentally), tolerating distress and mastering negative emotions. Controlled studies, reviewed by Duke University psychologist Thomas R. Lynch and his colleagues in 2007, indicate that DBT somewhat reduces the suicidal and self-destructive behaviors of patients. Lynch and his collaborators also found that DBT may lessen feelings of hopelessness and other symptoms of depression. Still, DBT is not a panacea, and no clear evidence exists that DBT can stabilize patients’ identity or relationships. Preliminary but promising data suggest that certain medications, including such mood stabilizers as Valproate, can alleviate the interpersonal and emotional volatility that characterize BPD, according to a 2010 review by psychiatrist Klaus Lieb of University Medical Center in Mainz, Germany, and his colleagues.
A Continuing Challenge
Not all BPD patients improve on their own or with treatment, and even those who do typically continue to battle the demons of emotional and interpersonal volatility. Nevertheless, the extreme negative views of this condition are undeserved, as is the mislabeling of a wide swath of the psychiatric population as borderline. It is also undeniable that many clinicians must become more judicious in their use of the BPD label and avoid attaching it to virtually any patient who is oppositional or unresponsive to treatment.
Fortunately, there is room for cautious optimism. As psychiatrist Len Sperry of Barry University noted in a 2003 review, BPD is the most researched of all personality disorders, a fact that remains true today. The fruits of that work promise to yield an improved understanding of BPD, which may reduce the stigma surrounding this widely misunderstood diagnosis. If so, perhaps the day will soon come when successful people who once struggled with BPD, such as Marsha Linehan, are no longer perceived as exceptions that prove the rule.
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14 Comments
Add CommentSo much to discover when reality is what society imposes at various times and place. A psychotic in one era may exist as closer to normal in another.
Reply | Report Abuse | Link to thisThe impossibility of knowing everything in a persons head, the severity and relevance. All of us are inconsistent to some degree, and all play to each others personality that situations are unique to each individual we encounter.
The BPD/EDD personality may be affected more intensely, that they perceive more acutely the inconsistency in others and (possibly themselves) the change is too drastic for them to handle calmly.
Marsha M. Linehan was healed by a power that gave her the ability to love herself, to see herself as worthy. Previously, she was self-detesting and felt undeserving of life. There is no drug that can do that, no therapy. The power of love is one thing, thank God, that Psychiatry can't mess up.
Reply | Report Abuse | Link to thisI'm just saying...
Marsha wrote an incredible book regarding DBT (Dialectical Behavioural Therapy), which has been found to be an effective treatment for Borderline Personality Disorder.
Reply | Report Abuse | Link to thisSorry Rosabw, but although I agree that drugs are often used too liberally, I disagree with your ideas of therapy assisting with helping one see themselves as worthy.
I'm not sure if you know much about DBT, but it's all based around being mindful of your life, and learning how to regulate your emotions, communicate with others effectively and tolerate extreme bouts of distress, anxiety, pain - any exteme emotion - which come along with the diagnosis of Borderline Personality Disorer.
Unlike Freud's classic psychodynamic therapy, DBT does not merely exist as a tool for one to analyse another's thoughts, from their own perspective. It is a more give and take role between client and therapist.
I suggest you check it out, it makes good reading - not just for those with BPD, but for anyone who struggles with their emotions (i.e everyone.)
Both authors are professors of psychology but neither mention 'high functioning borderline' a term which is current in the literature on the subject. The fact that someone is able to perform at a high intellectual level does not mean that they do not have BPD or that their BPD is under controlled or cured. In fact the very reason that so many BPD people of both genders are able to run companies and even countries is part of why this disease is of such interest. BPD are driven by an overwhelming need to control, fear of abandonment and they seldom give up. Their ability to empathise can wholly deceptive, spilling tears over emotional ephemera while meeting death with ice cold indifference.
Reply | Report Abuse | Link to thisI wholly disagree with the tenet of this article that BPD is really not that bad. Of course misdiagnosis is a problem in physical and mental health but overall the problem is that we do not pay nearly enough attention to the damage caused in society by BPD. It is precisely because BPDs are so skilled at hiding their destructive behaviour and sowing confusion that they pose such a threat to everyone around them.
To say "Nevertheless, the extreme negative views of this condition are undeserved..." is, in my view, nonsense. It is the elite view of a mental health insider constantly reading the literature and discussing the condition with colleagues. In society at large not nearly enough is known this 'personality disorder', diagnoses are woefully missing and the sheer horror of living with a BPD mother or boss or partner are massively underestimated.
I agree with you, "massively underestimated" is too polite.
Reply | Report Abuse | Link to thisDeath is probably their only stopper.
WARN other people...even if they think "your wrong about the person", this might alert them enough to think ahead and protect themselves.
Learn the warning sign, get help, and take appropriate legal action if needed. These people are Tough!
First off, Valproate is rarely used as a mood stabilizer these days. Lamotrigine and other newer anti-seizure medications are used.
Reply | Report Abuse | Link to thisSecondly, there is a LOT of research data out there that substantiates DBTs usefulness in changing BPD behaviors, and helping Borderlines to live fairly normal lives. In fact, the data is so strong toward the usefulness of DBT that it is being used extensively in treating addicts.
Thirdly, @ Rosabw: Marsha Linehan had to work just as hard and practice, practice, practice as any of us who have BPD, to learn to accept and love herself. This is not to discount God's graciousness and kindness. But God doesn't change our personalities. Believe me, I've begged him to change mine for decades, even before I knew of personality disorders.
And lastly, regarding the citation, "Work by psychologist Timothy J. Trull and his colleagues at the University of Missouri–Columbia similarly suggests that many young adults who display some features of BPD do not exhibit these features after only a two-year period, indicating that early signs of BPD often abate." It is well known that many adolescents (or "young adults") exhibit "some features of BPD" throughout their adolescence, and for most of them, those behaviors diminish as their brains become fully developed.
However, a person with a true Borderline personality does not improve on his or her own - it is part of their personality! It takes medications and years of hard work through therapy and practice. The work to change one's behavior so that is is socially acceptable and as close to "normal" as possible can be exhausting. Yes, the outward signs of BPD diminish with age, but we're talking about improvement showing up in one's 40's and 50's.
Yes, as Camera5 said: "...the sheer horror of living with a BPD mother or boss or partner are massively underestimated."
Reply | Report Abuse | Link to thisAnd yes, as Cheri74evr notes: "It is well known that many adolescents (or 'young adults') exhibit 'some features of BPD' throughout their adolescence, and for most of them, those behaviors diminish as their brains become fully developed."
That means...those adolescents and young adults didn't have BPD. They didn't have a personality disorder.
If someone "gets better" from BPD it means he or she was misdiagnosed. I've known many people with "real" BPD and although they might -- might! -- mellow a bit with age, they do not as a rule "get better" -- they don't even think there's anything wrong with the way they behave, so they have no motivation to change.
If someone with BPD-ish symptoms thinks she has a problem and wants to change, then she doesn't have a "personality disorder" -- that's part and parcel of the definition of "personality disorder."
I had a strongly negative response to this article -- almost an angry response (!) -- because often, the people who find themselves at the mercy of people with BPD -- the spouse, the kids -- have a false belief that the person with BPD can change. It's not going to happen. And it's so much work for these folks -- it takes so much time for them -- to realize that it's not going to happen -- and then an article like this waltzes in -- with the seal of approval of a respectable scientific publication -- and it says "Heck it's not so bad, and Linehan experienced a miracle cure, and you know, maybe people with BPD can get better."
As a general rule, they do not. That's what the scientific evidence shows. They do not.
Thanks a lot, Scientific American.
Dolly I agree. This article flies in the face of so much research and literature on the subject that it calls into question the reliability of the authors and their motives. Why are these guys trying to downgrade BPD when we need to increase our vigilance over this serious illness which is a destroyer of lives - sometimes on a vast scale? Hitler, Stalin, Mao, Gaddafi - its abstract when its tens of millions but its hyper real when its one person in your immediate family!
Reply | Report Abuse | Link to thisPlease cite the source for your statement. I found nothing in the article supporting your statement.
Reply | Report Abuse | Link to thisWay to promote stigmatizing stereotypes, Camera5. Why not add Count Dracula, Cruella deVil, and Wile E. Coyote while you're at it?
Reply | Report Abuse | Link to thisPlease cite the source of your claim that, in the pool of people who have been diagnosed with BPD, "many" of them are running companies or countries... and also your statement that 2 of the characteristics of BPD are an overwhelming need to control, and tenacity.
Experts have NEVER come to a consensus about what, if anything, was Hitler's diagnosis. Of the 9 criteria for BPD, per the DSM IV, the only one that Hitler even came close to exhibiting was paranoia (and it wasn't transient and delusional). He did not have intense relationships; he kept his emotions hidden; he had a strong sense of identity, and well thought-out long-range plans (expect for a period of trying to "find himself" as a young adult); and by all reports he showed a pretty stable disposition. There was no impulsive or harmful behavior; he stuck to "clean" living (except for prescription meds from an overzealous doctor.)
Remember, BPD is a disorder of hurting inside, and not of wanting to hurt others. BPD didn't kill tens of millions of people-- power-crazed dictators did.
We can speculate all we want, but I'm betting that people who actually have BPD could tell us that they DO know they have a disorder, and DO want to change. Plus, unless you're a minor child of a PD parent, you're not at anyone's mercy. If you feel like a victim, leave.
For those of you who are doing things like comparing people with a BPD diagnosis to Hitler, saying they pose a huge threat to society, and the only thing that will stop them is death: Did it occur to you that someone with a BPD diagnosis may have read this article because they are searching for hope that they can get well, and that they might have seen your comment? Please understand that people with BPD do feel pain and that most of them can read. You have done exactly what you are accusing BPD sufferers of doing: you have inflicted great pain. Don't throw stones if your house is glass, as they say.
Reply | Report Abuse | Link to thisDuva306, you and Cluetrain mean well but it's a waste of time talking to these bigots. They don't know what they're talking about and what's that old adage about "a little knowledge is a dangerous thing"? Altho I'm not sure such wonderful, caring people as Camera5, Bops, and Dolly13 have even a LITTLE knowledge about BPD--their mud-slinging ignorance would indicate that actually they have NO knowledge, which is the most dangerous thing of all.
Reply | Report Abuse | Link to thisAfter all, Camera5 informs us that ppl dx'd with BPD "pose a threat to everyone around them", Dolly13 shares her wisdom that if someone thinks she has a problem and wants to change, that is proof that she does NOT have a personality disorder...excuse me while I catch my breath, I'm laughing too hard to type. I wonder where dear Dolly got her psychology degree? Definitely not where I got mine, she would never have made it thru the program!! And then there's old Bops, who so kindly tells us that "Death is probably their only stopper." (I guess he means death is the only way to stop "them"--you know,those dangerous borderlines-- but it's hard to translate such mangled grammar.) What do you suggest, Bops? Line all ppl with BPD up against a wall and shoot them? Or, since "they" are apparently no different from Hitler, Stalin, Saddam etc, how about a good old Nazi gas chamber? That would show 'em! Of course it would be a bit of a problem, since YOU then would be behaving exactly the way Hitler etc. took care of HIS little problems...but I doubt if any of you would lose much sleep over something that insignificant. After all, you're doing it to protect society, right? So that makes it okay. Hitler would be so proud of you all: Camera5, Bops, Dolly13 and the rest of your ilk. Just a couple of closing thoughts:(1) have any of YOU ever been tested for Borderline Personality Disorder? I'm noting several worrying traits....(2) Re: Hitler, Stalin, Saddam etc, besides looking up the usual suspects (sociopath, Antisocial PD, psychopath) try looking up something called MALIGNANT NARCISSISM. With a lot of luck and even more effort, you just MIGHT learn something.
Bucket: I just saw your comment today. It was here: http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all&_moc.semityn.www
Reply | Report Abuse | Link to thisYou might see Alsta's comment above, regarding DBT and Dr. Linehan.
As a woman of "limited" faith, who believes the universe is not set out to destroy us, who also was labeled...I find it refreshing that mindfulness is healing.
I'm really disappointed by some of the comments here. BDP is basically a condition that makes one extremely sensitive. How someone handles those intense emotions is a reflection of their own awareness, moral judgement, and perception rather than to be blamed on the condition itself. I was recently diagnosed with this condition and am a very kind person that just feels a tremendous amount of emotional pain. I am a survivor of horrific abuse and am trying to be healthy. To survive something so horrible is unbearable at times, but the lack of compassion many have for people with emotional problems is beyond disturbing. Just because one person you knew had this condition was a horrible person doesn't mean that everyone else with this condition will be the same.
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