Q: Could you first of all talk a little about you and your experience in mental health research and / or in the BPD treatment?
Thank you for talking with us here at BPD411. At BPD411, we don't work with people who have the disorder, rather we work with the other members of their families and other close associates. While there are many organizations focused on the needs of those with the disorder, there are only a few groups, all online, that focus on the needs of the other family members. When we can help the family members to understand the disorder, this often creates a situation where they stop enabling the poor behavior of those with the disorder. This results in the borderline getting help, or more commonly, it results in the family member getting the help they need.

In a few words very simple to everyone (not DSM)
Q: "What is the Borderline personality disorder ?"
In our minds, there are actually two things called borderline personality disorder. There are the low functioning borderline patients that are hospitalized, that cut themselves, and who are the primary focus of many of the studies and more effective therapies.

Then there are the high functioning borderline patients that to all the world seem normal, or even saintly. Princess Diana is reputed to be one of these high functioning borderlines as is Martha Stewart. High functioning borderlines are seldom hospitalized, and create a situation of unbearable suffering for their families. The reason for this is that the families are not believed when they tell friends about the suffering they go through. This leads to further isolation and an unbearable feeling of being alone. In addition, since it most often goes undiagnosed, there is no therapeutic support in most cases for high functioning borderlines, so they most often never get better.

The online groups have found a niche in helping the family members of the high functioning borderline. That's because online, you can get validation, and share the experience of living with someone with traits of the disorder without the judgement that so often faces these people in the real world. Online, your friends are not subjected to the distortion campaign that so often is part of the disorder.

Q: What differentiates it from other diseases and personality disorders?
There are many "rote" answers, but one of the issues that differentiates it is that it's almost a part of the disorder itself to deny responsibility. Therefore, any and all problems in the lives of the borderline are the fault and responsibility of their loved ones. This makes the disorder particularly difficult to treat because many months of therapy are necessary simply to break through the wall of denial that is the first aspect that must be dealt with in the treatment of anyone with the disorder.

Q: A lot of specialist suggest that the "childish" side of the adult borderline totally essential in the illness? (including Black and White thinking - All good - All bad - No middle)
One way of looking at borderline personality disorder is to look at them as being a two year old trapped in an adult body. The throwing of tantrums, oppositional defiance, black and white thinking and so forth that are normal in a two year old are in the arrested personality of many with borderline traits.

Q: Same comment about the sudden rage ?
Dysphoria (sudden raging) is such an integral part of the disorder that some have suggested renaming the disorder in honor of this trait.

Q: How to be sure that it is borderline disorder and not another mental illness ?

• not a depression

 
• not a bipolar disorder

 
• not an attention deficit disorder

 
• not asperger's disorder

The other thing that interferes (at least in the United States) with the diagnosis of BPD is that many insurance companies won't pay for treatment. This is because the companies believe (rightly or wrongly) that BPD is not treatable. The pervasive belief that BPD is not treatable may also interfere with the treatment of the patient if they are aware that this is their diagnosis. After all, why try if what you have is not curable? Therefore, many therapists will misdiagnose their patients both for therapeutic and insurance purposes.

Do you think that brain imaging can help to an accurate diagnosis for BPD ?
(question not asked)

When we are in the circle of one person potentially borderline.
Q: What are the behaviors, the alert signs to tell "this time it is not normal, it would be necessary to him/her to consult a therapist"
It's not a single incident. It's a pervasive pattern of behavior over many years. All people have behaviors that could be interpreted as borderline behaviors to some minor extent. The difficulty in dealing with a borderline, particularly in a primary relationship, is that these behaviors are frequent and pervasive.

Q: At which age can we start to see the first signs and worry about ?
Borderline personality disorder is widely believed to be often caused by abuse of very small children (under two years of age). Nevertheless, BPD is not typically diagnosed until the patient enters adulthood. So if the seeds of BPD are present throughout childhood and the adolescent years, then where do these patients hang out in the mental health system? The answer often is that they are classified as RAD (Reactive Attachment Disorder) sometimes with a secondary diagnosis of ADD or ADHD. Someday, we hope that these disorders will be more understood as being related, and perhaps will be thought of as being directly related.

The people having this disorder "used to be" like this from all their life and it is "the way they are"
Q: why in that case don't leave them and let them continuing to live their life ?
That is often a reasonable solution for those in the borderline's life. The codependent dance of the borderline and the non-borderline is often very highly enmeshed, so it is very difficult for the non-bpd to see their part in the disfunction.

Precisely about this illness
Q: "is there a cure ?"
DBT (Dialectical Behavioral Therapy) is the most promising treatment available today, but it is primarily focused towards the low functioning borderline population. Treatment of high functioning borderlines remains largely intractable. Some limited successes have also been achieved through application of NLP (Neuro Linguistic Programming) techniques.
 

Treatment
*********

Q: Is using medication (almost during a time) necessary or a "simple" therapy can be enough ?
Drugs can assist with secondary issues such as depression, but it is our experience that drugs are not terribly helpful in directly attacking BPD.

Q: Same question but only medication without therapy
Absolutely worthless.

Q: Is that mean that only a psychiatrist therapist doctor is able to cure a borderline patient ?
No.

Q: Again about médication: Selective Serotonin Reuptake Inhibitors (5 hydroxytryptamine) seems to be very important. A lot lot of patients (and studies) are talking about Fluoxetine as a "miracle drug".
What is your opinion ?
(question not asked)

Really a disease
****************

Q: Is the word "Borderline" suitable, borderline means "not really"
No.

In France, some peoples, and even psychiatrist are saying, "we are all borderline", to be clear that this illness doesn't exist
Q: what is your opinion about this point of view ?
They should try living with one of these people. It is a very real disorder with very real victims. Both those with the disorder and those around them. In fact, because each person with the disorder affects their spouse, children and potentially others, there are more people suffering at the hands of the disorder than suffer directly from having the disorder.

The question is certainly not but I ask
Q: Is each / every psychiatrist has the training and experience to treat borderline patient ?
If you mean can most mental health professionals deal with those having borderline traits, then the answer is certainly not. Many mental health care professionals in fact avoid signing up borderline patients. Many who do will limit their borderline practice to three or less patients because they are so impactful on the therapist's personal life. In DBT, for example, the therapist has a secondary therapist to keep them from falling into the disorienting world of the borderline.

Q: Do you think that there is actually some deficiency in this domain ? (training and education of mental health providers)
Of course. Much training needs to be done. Particularly with respect to the family dynamic. Treatment is almost never offered to the other family members.

In France, mental illness is a taboo like cancer was some years ago
In everybody mind, someone going to consult a psychiatrist is "mad" or "retarded"
Q: what could you say about this ?
It used to be this way in America. It's not such a big stigma here anymore. Perhaps France will eventually learn this too.

About this subject, we often associate the "cure" with the "willing" to
"Please stop to do, acting like this and do what it is necessary !"
A kind of "if you want, you can" and "if you are not doing, that's mean that you don't want"
Q: what is your opinion ?
This gets back to the question of denial which is such an important part of understanding the disorder.

Q: What do you think about the idea to create an association to promote knowledge of this illness and help peoples ?
It's been done in the US. It's been done on the Internet. It's a good thing.

Q: What do you think about the principle of "diagnosis obligation" when we know that all over the world there are thousands of sick peoples, which don't know that they are sick, and which think that it is the "way they are" to suffer
I don't have an opinion on this.

(Only if you think that it is not a good idea)
Q: In that case, don't you think that there is an high risk for the borderline patient to think
"I suffer, I know, but I'm unique, it's my nature" and not thinking "I'm not alone like this, I'm just sick" ?
(question not asked)

Question without answer I suppose
Q: "how to convince the patient to consult a specialist ?"
There is a book that addresses this:
I'm Not Sick: I Don't Need Help: Helping the Severely Mentally Ill Seek Treatment
Xavier Amador
ISBN: 0967718902

The BP Distortion Campaign
"When a BP deliberately tries to convince others that the Non (the one who know) is the one who is sick"
Q: is it a common data ?
Very much so. We have more information on this on our website at:
http://www.bpd411.org/distortioncampaign.html

Q: how to manage this ?
The NonBP can achieve personal health by
        A) Creating a Safety Plan,
        B) Creating Emotional Distance,
        C) Setting and Enforcing reasonable Boundaries,
        D) Joining an online support group such as a mailing list,
        E) Establishing a Firm Grasp on their own view of reality to counteract the "oz" effect of being with the borderline,
        F) Working on communication techniques that disarm such as Verbal Judo,

and by working on personal self esteem issues in a therapeutic setting if possible. A good book on these topics is:
Stop Walking On Eggshells : Coping When Someone You Care about Has Borderline Personality Disorder
by Paul T. Mason, M.S. and Randi Kreger
ISBN: 157224108X

There are legal answers as well which can be addressed. These are explained in this book:
Love and Loathing : Protecting Your Mental Health and Legal Rights When Your Partner has Borderline Personality Disorder
by Randi Kreger and Kim A. Williams, et al.

The borderline seems to have a childish emotional IQ
Q: Is it "sensible" to ask a "children like" to take such a decision ?
(consult or not, treat or not)
Unfortunately, in the US, mental health of the individual is in the hands of the individual. Thus we have homeless people with very serious Axis I disorders. Similarly, this makes it difficult to get borderlines the help they need. This doesn't mean that the answer is going back to forced institutionalization, as many NonBPs would end up being forced by their borderline significant others into institutionalized care due to the projection which is part of the disorder.

Q: Is it not totally utopian and even cruel to ask them taking such a decision ?
I'm unsure of the question, but it is clear that there are significant social issues surrounding the disorder.

Q: What is your experience about this ?
How borderline people "come to you" ?
Again, we primarily deal with the NonBP. They come to us willingly, seeking answers to the chaos in their lives. In therapeutic practice, it is often the NonBP that first seeks treatment, and their partner gets brought in later.

Origin of the disease
*********************

The origin of the illness seems to be really complicated when we talk about borderline disorder, but it seems that trauma during early age are the main reason
Q: What do you think about this?
It isn't the only reason, but it is clearly a major contributor. We believe there are both nurture and nature components to the disorder. Certain brain chemistry may make a person more susceptible to becoming full blown borderline. It may work similarly to alcoholism, that is, there is a genetic component, but there are necessary environmental triggers to establish the disorder. More research in this area is clearly indicated.

Q: Could Childhood Epilepsy Cause the BPD ?
(question not asked)

Q: Opposite question. Could Bpd cause epilepsy ?
(question not asked)

Q: This illness could have genetic and / or biologic origin, what is your opinion ?
(question not asked)

The family could be a great help to support the patient.
But when one of the parents has some part of "responsibility" (even not conscious) in the illness of her own children,
Q : How is it conceivable for this parent to open yes about the reality of the situation ?
Many parents do face this. Most of the parents that we have been involved with have not abused nor neglected their children, so it is clear that many borderlines develop for other reasons. It should also be pointed out that children of borderlines have a three or four times higher incidence of the disorder themselves.

It seems that mental illness is passed down through generations like a child of an alcoholic would become alcoholic at the adult age
Q: Is it true ?
Precisely.

Q: Is it the same with borderline disorder ?
The borderline mother is going to make her daughter borderline ?
We have good evidence that this is so.

Q: How to break this infernal circle ?
Adoption?

Latest questions
Q: Is there one question you would like to answer and I didn't ask ?
Perhaps what web site would you recommend to a family member of someone with borderline personality disorder? to which the answer would be http://www.bpd411.org.

Q: Is the last word "hope" ?
We believe there is a great deal of hope for the NonBP. For the borderline themselves, particularly the high functioning borderline, the prognosis is much more bleak.
 

Thanks for your help

Questions answered with the kindness of Mr kelly Anderson, from bpd411 organisation