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HELPLINE
1- 888- 4-TARA APD
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BORDERLINE
PERSONALITY DISORDER
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| Personality
disorders
are deeply ingrained, inflexible, maladaptive
patterns of relating, perceiving, and thinking
of sufficient severity to cause either impairment
in functioning or distress. Personality disorders
are generally recognizable by adolescence or earlier,
continue throughout adulthood, and become less
obvious in middle or old age. Some personality
disorders cited in DSM III-R are: |
| Antisocial:
A lack of socialization along with behavior patterns
that bring a person repeatedly into conflict with
society; incapacity for significant loyalty to
others or to social values; callousness; irresponsibility;
impulsiveness; and inability to feel guilt or
learn from experience or punishment. Frustration
tolerance is low and such people tend to blame
others or give plausible rationalizations for
their behavior Characteristic behavior appears
before age 15, although the diagnosis may not
be apparent until adulthood. |
| Borderline:
Instability in a variety of areas, including interpersonal
relationships, behavior, mood and self-image.
Interpersonal relationships are often intense
and unstable with marked shifts of attitude. Frequently
there is impulsive and unpredictable behavior
which is potentially physically self-damaging.
Mood is often unstable with marked shifts from
normal mood to dysphoric mood or with inappropriate
intense anger or lack of control of anger. A profound
identity disturbance may be manifested by uncertainty
about self-image, gender identity, long-term goals
or values. There may be chronic feelings of emptiness
or boredom or brief episodes of psychosis.. |
| Compulsive:
Restricted ability to express warm and tender
emotions; preoccupation with rules, order, organization,
efficiency, and detail; excessive devotion to
work and productivity to the exclusion of pleasure;
indecisiveness. |
| Dependent:
Inducing
others to assume responsibility for major areas
of one's life; subordinating one's own needs to
those of others on whom one is dependent to avoid
any possibility of independence; lack of self-confidence. |
| Histrionic:
Excitability, emotional instability, overreactivity,
and attention- seeking and often seductive self-dramatization,
whether or not the person is aware of its purpose.
People with this disorder are immature, self-centered,
vain, and unusually dependent. Sometimes referred
to as hysterical personality. |
| Narcissistic:
Grandiose sense of self-importance or uniqueness;
preoccupation with fantasies of limitless success;
need for constant attention and admiration; and
disturbances in interpersonal relationships such
as lack of empathy, exploitativeness, and relationships
that vacillate between the extremes of overidealization
and devaluation. |
| Paranoid:
Pervasive
and long-standing suspiciousness and mistrust
of others; hypersensitivity and scanning of the
environment for clues that selectively validate
prejudices, attitudes, or biases. Stable psychotic
features such as delusions and hallucinations
are absent. |
| Passive-aggressive:
Aggressive behavior manifested in passive ways
such as obstructionism, pouting, procrastination,
intentional inefficiency, and obstinacy. The aggression
often arises from resentment at failing to find
gratification in a relationship with an individual
or institution upon which the individual is overdependent.
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| Schizoid:
Manifested
by shyness, oversensitivity, social withdrawal,
frequent daydreaming, avoidance of close or competitive
relationships and eccentricity. Persons with this
disorder often react to disturbing experiences
with apparent detachment and are unable to express
hostility and ordinary aggressive feelings. |
| Schizotypal:
The
essential features are various oddities of thinking,
perception, communication, and behavior not severe
enough to meet the criteria for schizophrenia.
No single feature is invariably present. The disturbance
in thinking may be expressed as magical thinking,
ideas of reference, or paranoid ideation. Perceptual
disturbances may include recurrent illusions,
depersonalization, or derealization. Often there
are marked peculiarities in communication; concepts
may be expressed unclearly or oddly, using words
deviantly, but never to the point of loosening
of associations or incoherence. Frequently, but
not invariably, the behavioral manifestations
include social isolation and constricted or inappropriate
affect that interferes with rapport in face-to-face
interactions. |
| *Definitions
from Psychiatric Glossary (American Psychiatric
Association. 198+, pp. 103-105). |
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OVERVIEW
OF
BORDERLINE
PERSONALTY DISORDER
COMPARED TO OTHER MENTAL ILLNESSES
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WHY
IS IT SO DIFFICULT TO FIND APPROPRIATE TREATMENT
FOR YOUR LOVED ONE SUFFERlNG WlTH BPD
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| RESEARCH
& TREATMENT FUNDING: Psychiatric
research and treatment fundingusually comes from
the Federal Government through the National Institute
of Mental Health (NiMH). Prevalency rates of disorders
and the advocacy efforts on behalf of a specific
disorder may be the major factors influencing
decision making at NIMH as to who gets research,
treatment or educational funding. Of course, if
a member of the Senate or the House, especially
a member on the committees that fund NIMH, has
a particular interest in a disorder, you can be
sure it will receive more attention This same
system holds true at State and local levels |
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WHY
SO LITTLE RESEARCH IS DONE ON BPD
Total NIMH Budget Fiscal Year 2001 -- 1,031,353,000
Billion
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| 13.0% |
$135.2
Million spent on AIDS Research |
| 13.7% |
$140.0
Million spent on Depression Research |
| 1.0% |
$10
Million spent on Personality Disorder Research |
| 0.5% |
less
than 5 million spent on BPD Research |
| NATIONAL
COMORBIDITY SURVEY (NGS-R)
Prevalency rates are generally based on the 1990-1992
National Comorbiditv Survev of Dr Ronald Kessler.
BPD was left out of this study. The attached ACTION
ALERT explains this matter in detail However,
we are pleased to report that, thanks to the efforts
of TARA APD, BPD js to be included in the upcoming
NCS-revision. The bad news is, it will take at
least one more year before these study results
are available. Without accurate prevalence rates,
BPD wi!l -continue to be treated like a "step-child"
in the field of mental illness. |
| EDUCATIONAL
INFORMATION:
NIMH does not include BPD in any of its public
information materials. This is despite repeated
requests made personally at on-site visits, by
letter and by phone calls by TARA APD and TARA
APD's offers of assistance in any project that
will produce public information. The only educational
brochure on BPD available from any mental health
organization is the one put out by TARA APD. NIMH
callers for information on BPD are referred to
the TARA APD HELPLINE. Other major mental health
organizations also do not acknowledge BPD. a NAMI
does not include BPD in its advocacy efforts.
Callers who want help with BPD are referred to
TARA APD. NAMI claims BPD is not a Brain disorder
This is despite the numerous scientific studies
showing BPD as a biologically based mental illness
that TARA APD has sent NAMI. NAMI has never acknowledged
receiving these studies b The National Mental
Health Association does not provide callers with
information on BPD |
| SURGEON
GENERAL'S REPORT ON SUlCIDE:
The Surgeon General has launched an ANTI-SUICIDE
crusade that focuses on the Public Health implications
of suicide, stressing suicide prevention. This
program excludes consideration of BPD in its advocacy
for suicide prevention despite the fact that the
suicide rate for BPD is greater than the combined
total of suicides from schizophrenia and bi-polar
disorder. BPD suicides are usually impulsive in
nature and are distinct enough to merit attention.
Omission from this ANTI-SUICIDE effort flies in
the face of the research findings regarding violent
suicides Suicide is not just about depression.
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| STIGMA:
Doctors
and the psychiatric community continuously trivialize
BPD or deem these patients non-treatable, often
refusing to treat them. A national educational
campaign to raise awareness of the latest research
findings on etioiogy, genetic studies, neurobiological
findings and treatment options for BPD is desperately
needed in order to reframe BPD as the severe,
chronic and costly mental illness that it actually
is. People with BPD can get better; outcome studies
are available demonstrating how people with BPD
improve with appropriate treatment. (Linehan).
Appropriate and effective treatment is not available
in most communities. |
| PUBLIC
AWARENESS: The
public is by and large unaware of BPD. Scant media
attention has been paid to this disorder. BPD
does not as yet have a public figure as a spokesperson. |
| ADVOCACY:
Families of people with BPD receive little or
no help in understanding BFD or in coping with
their loved ones with this disorder. There are
very few support groups available for family members
or for people with BPD. In short, BPD is the most
maligned, misunderstood and mistreated of all
mental illnesses. |
| CHILDREN
& ADOLESCENTS:
Treatment, to date, for adolescents is almost
non-existent. We know of only one program in the
Bronx, NYC using DBT for suicidal adolescents
with BPD. Outcome data is available for this program
but it has yet to be replicated at any other site.
A residence specifically for young people with
BPD utilizing treatment that teaches coping skills
such as DBT does not yet, to our knowledge, exist.
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COMORBID
CONDITION
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| DOMESTIC
VIOLENCE: Research
findings show that one out of three perpetrators
of Domestic Violence meet criteria for BPD. We
know of no treatment program that uses effective
methods for treating BPD applied to perpetrators
of Domestic Violence despite the billions of dollars
budgeted for this major public health problem. |
| SUBSTANCE
ABUSE:
Recent findings at Yale University indicate that
approximately 65% of young adult substance abusers
are comorbid with BPD. We know of no treatment
program that specifically treats Substance Abusers
suffering with BPD. |
| IMPULSIVE
AGGRESSION:
Males with BPD who exhibit symptoms of BPD, particularly
impulsive aggression, are generally incarcerated.
This forensic population presents major problems
to administrators who lack the trained staff to
cope with the impulsive aggression characteristic
of this prison population. Treatment that would
decrease recidivism including skills training
is generally not available. |
| ROAD
RAGE, STALKING, GAMBLING, ADDICTIONS: Studies
indicate that large numbers of people in these
populations meet criteria for BPD. Refer to Eric
Hollander, MD (Gambling), J. Reid Meloi, PhD (Stalking)
etc. |
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IS
THERE ANY WONDER WHY PEOPLE WITH BPD DON T GET
BETTER? UP TO NOW, A NATIONAL ORGANIZATION FOCUSED
ON ADVOCACY FOR THE BPD POPULATION HAS NOT EXISTED.
TARA APD IS THE FIRST AND ONLY NATIONAL NOT
FOR PROFIT ORGANIZATION ACTIVELY WORKING TO
CHANGE THE PROGNOSIS AND BRING HOPE TO PECPLE
SUFFERING WITH BPD & THEIR LOVED ONES.
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