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HELPLINE
1- 888- 4-TARA APD
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BORDERLINE
PERSONALITY DISORDER
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español
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Understanding
Borderline Personality Disorder
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| WHAT
IS PERSONALITY DISORDER? |
| Personality
includes those aspects of a person's thinking,
moods and behavior which affect his or her
relationship with others. Differences in personality
style (traits) add color and variety to relationships
but may become too extreme, inflexible or
maladaptive. These traits can significantly
impair a person's ability to function. When
a person is not able to deal with people or
problems constructively or not able to adapt
to changing demands of the environment, he
or she is said to have a Personality Disorder. |
| WHAT
IS BORDERLINE PERSONALITY DISORDER? |
| BPD
is a disorder in which a person is unable
to regulate emotions or control impulses.
Their behavior can be seen as maladaptive
methods of coping with constant emotional
pain. The DSM IV, which is a manual used by
psychiatrists to diagnose all mental disorders,
describes BPD as an AXIS 11 disorder of impulsivity
and emotional dysregulation including at least
five of the following (See Gray Box Below): |
| HOW
COMMON IS BPD? |
| BPD
is estimated to affect 2-3% of the general
population, 11% of the patients seen in outpatient
clinics and as many as 20% of the hospitalized
psychiatric patients (inpatients). About 8-10%
of people with this disorder die by suicide.
BPD worsens the outcome and complicates the
treatment of any other co?occurring (comorbid)
disorder such as Major Depression, Bipolar
Disorder (Manic Depression), Eating Disorders
and Substance Abuse. BPD, difficult to diagnose,
is often misdiagnosed as schizotypal or schizo-affective
disorder, depression, bipolar disorder or
anti-social personality disorder. |
| BPD
plays a major role in many issues of public
health such as substance abuse, domestic violence,
gambling shop lifting, sex addiction, AIDS,
homelessness, child abuse, and adult and adolescent
suicides. A significant number of people with
BPD can be found in forensic settings (such
as prisons or jails). Those with BPD are heavy
users of mental health services because of
frequent hospitalizations and emergency room
visits due to suicide attempts. Persons with
BPD are difficult to treat, frustrate clinicians
and are the "Grand Repeaters" in the mental
health system. |
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For
Brochure
Understanding
Borderline Personality Disorder
Call 1-888-4-TARA APD
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Frantic
efforts to avoid abandonment, going
in extremes to keep someone from leaving
(In extremes, "stalking") |
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Frequent
interpersonal conflict, unstable, stormy
relationships. Black-White thinking.
Difficulty seeing the gray in situations
or compromising. |
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Unstable
self image, shifting from feeling confident
about who you are to feeling like you
are evil or don't exist. |
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Self-damaging,
impulsive behavior such as substance
abuse, binge eating, anorexia-bulimia,
reckless spending, gambling, reckless
driving (road rage) or behaviors that
can lead to serious consequences. |
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Frequent
suicidal thoughts, threats or attempts,
or self hurting, self-mutilating behavior
such as cutting or burning. |
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Intense
emotional instability, rapid changing
short term moods and anxiety. |
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Chronic
feelings of emptiness, sadness, or depression. |
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Intense
inappropriate anger that may lead to
physical fights or destruction of property
(e.g. domestic violence). |
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Stress
related dissociative symptoms such as
paranoia; feeling as though they are
losing touch with reality; feeling victimized;
unable to accept responsibility. |
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BPD
is extremely painful to the patients,
to those who live with them and to society.
People with BPD experience emotions
intensely and are very vulnerable. They
are among the most intensive and extensive
utilizers of mental health services.
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| WHY
DO SOME PEOPLE DEVELOP BPD? |
| Latest
research indicates that BPD is a biologically
based disorder of the emotional regulation
system which may be due to genetic, the environment
or a combination of these two factors. These
biological "vulnerabilities" may place a person
at increased risk for developing BPD given
certain developmental factors such as prenatal
stresses, infections, nutritional deficits
or stressful events in the early family environment
Other family members may often have BPD, Major
Depression, Bipolar Illness, or problems with
addiction. |
| Serotonin,
a chemical messenger (neurotransmitter) in
the brain, is important in regulating mood
and aggressive, impulsive, and suicidal behavior.
Abnormal brain serotonin function appears
to be related to a diminished ability to control
one's impulses and to a heightened risk for
attempting suicide. |
| Dopamine,
a neurotransmitter in the brain, is involved
in regulating awareness of the environment
and other higher information processing tasks.
Abnormal brain dopamine function may be involved
in difficulties in relating to other people,
social isolation and sometimes in distorted
perceptions of the world. |
| HOW
IS BPD TREATED? |
| Medications
may reduce symptoms of depression, anxiety,
irritability, and paranoid thoughts. A single
"one-size-fits-all" medication for BPD does
not exist yet. Symptom relief can be obtained
when medication is closely monitored as BPD
symptoms may constantly change. Recent research
studies have demonstrated the effectiveness
of individual cognitive behavioral therapy
along with group psychoeducation and skills
training that teach emotional regulation skills,
distress tolerance, improved interpersonal
relationship behaviors and awareness (mindfulness).
This, combined with careful medication management,
may allow the patient to achieve significant
progress. When taught skills to regulate their
emotions and tolerate distress, people with
BPD can do better. Traditional psychotherapy,
a long term process, may have uncertain results.
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is imperative that the person with BPD be motivated
to change life long ways of behaving and be able
to tolerate uncomfortable feelings during treatment
where new problem solving and communication skills
are taught. Appropriate treatment methods with a
proven outcome studies should be utilized. |
| WHY
IS BPD SO STIGMATIZED? |
| Patients
with BPD are currently the most stigmatized
in the mental health system. Many clinictians
will not treat BPD patients. According to
Dr. Joel Dvoskin former Comm. of the New York
State Office Of Mental Health, "Why would
psychiatry and psychology turn so viciously
against people they call mentally disordered?
Apparently the greatest sin a client can commit
is poor response to treatment. What is apparently
so wrong about these unfortunate souls is
that they have yet to demonstrate the ability
to get better in response to our treatment.
Thus, they don't make us feel very good. With
a few notable exceptions, we have simply given
up on helping people who desperately need
us to do a better job of helping them"(CAMI
Journal on BPD, Vol 8) |
| WHAT
FAMILIES CAN DO TO HELP |
| Recognizing
signs and symptoms is not always easy. Sometimes
symptoms can go unnoticed or are misunderstood.
Persons with BPD may often be thought of as
manipulative or as attention-seeking. They
can sometimes "act as if" they are okay. People
with BPD need validation and acknowledgement
of the pain they struggle to live with as
well as compassion without blame or judgements.
Always take suicidal statements and threats
seriously. Alert a mental health professional
as soon as possible. The value of education
for family members cannot be stressed enough.
Families need to learn all they can about
BPD so that they can advocate for appropriate
treatment for their loved ones. Informed families
are then better able to deal with the stigma
often encountered from mental health professionals. |
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Join
TARA APD and help advocate for
BPD nationally. |
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Join
TARA APD and help us raise funds
for BPD research. |
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Organize
TARAAPD affiliate in your area.
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FACTS
ABOUT BPD
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BPD
makes up at least 2% of
the general population,
(6 million people in North
America) |
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BPD
comprises 20% of the inpatient
psychiatric population.
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BPD
makes up 11% of the outpatients
in the mental health system.
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As
a comparison, BPD affects
50% more people than Alzheimer's
disease and nearly as
many as schizophrenia
and bipolar combined (2.25%).
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An
estimated 10% of BPD patients
die by suicide. |
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Approximately
20% of men who batter
have BPD. |
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Males
with BPD are often sent
to jail or prison for
violent outbursts resulting
from a biological inability
to control impulsivity. |
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BPD
generally co-occurs with
depression, an anorexia-bu1imia,
and other problems resulting
from impulsivity (drunk
or reckless driving, gambling,
sex addiction or shoplifting). |
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BPD
patients have replaced
schizophrenics in the
revolving door of psychiatric
treatment. |
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Parents
of those with BPD have
replaced the "schizophrenogenic
mothers" and the "ice-box
mothers'' of autistic
children as the family
group who are now blamed
for a psychiatric illness.
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Treatment
is available. It should
include carefully monitored
psycho-pharmacology
for symptom reduction
and cognitive behavioral
therapy including psychoeducation
and skills training.
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BPD
&
SUBSTANCE ABUSE
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Between
21-67% of people with
BPD meet the criteria
for substance abuse. |
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Of
the MICA (menially ill/chemical
abusers) population, 50-67%
meet criteria for BPD. |
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TREATMENT
FOR SUBSTANCE ABUSE THAT
DOES NOT RECOGNIZE THE
CRITICAL LINK WITH BPD
IS BOUND TO FAIL. |
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