Q:
Could you first of all talk a little about you and your experience in mental
health research and / or in the BPD treatment?
I have treated BPD within the context of a community mental health
setting for 23 years. I have been effectively using DBT for the last
7
In
a few words very simple to everyone (not DSM)
Q:
"What is the Borderline personality disorder ?"
A pervasive dysregulation of emotions leading to impulsive behaviors
Q:
Is it a "woman illness" ?
(question not asked)
Q:
What differentiates it from other diseases and personality disorders?
A different set of behaviors
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)
If you mean impulsive by childish - yes it is a defining characteristic
Q:
Same comment about the sudden rage ?
Intense anger is one of the 9 symptoms listed by the DSM-IV for BPD
Q: How to be sure that it is borderline disorder and not another mental illness ?
Q:
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"
Any set of behaviors that leads to significant social and/or occupational
functioning should be considered a target of treatment - basically all
of at some point in our life have engaged in similar behaviors to individuals
with BPD - it is a question of intensity and pervasiveness - if your behavior
continually causes you to loose friends, or your job, engage in suicidal
or other risky behaviors it is time to get help.
Q:
At which age can we start to see the first signs and worry about ?
Varies widely by individuals most show up in the mental health system
by high school but not uncommon to be earlier or later - I have treated
individuals as young as 13.
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 ?
Because they are usually very miserable and often suicidal and if treatment
is available it is the humane thing to do
Q:
Are borderlines patients more "fragile" and subject to "somatization" ?
lot
of small illnesses, some somatics illnesses (dermatological, ORL, ...)
(question not asked)
Precisely
about this illness
Q:
"is there a cure ?"
DBT has been shown to be effective at reducing and often eliminating
the behaviors that comprise BPD
Treatment
*********
Q:
Is using medication (almost during a time) necessary or a "simple" therapy
can be enough ?
Medication can be a helpful adjunct to treat specific Sxs but real
change only occurs through therapy
Q:
Same question but only medication without therapy
There is no evidence that medication without therapy is effective
Q:
Is that mean that only a psychiatrist therapist doctor is able to cure
a borderline patient ?
Best treatment results have been obtained by DBT trained therapists
- which could include psychiatrists, psychologists, social workers and
nurse practitioners - for instance I am a social worker.
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".
Q:
What is your opinion ?
(question not asked)
Q:
We talk about "low functionning" borderlines (cut, suicidal) and "high
functionning" patients (seems "normals").
Do
you believe in this ? (two illnesses)
(question not asked)
Therapy.
There
seems to be a debate. First of all a "truth" seems to be that "classical
standard therapy don't work with borderline peoples" right ?
(question not asked)
We
have read that DBT therapy "Dialectical Behavioral Therapy" is accurate
(working)
Q:
Your opinion ?
(question not asked)
We
have read that all of this doesn't work with "high functioning" borderline.
To be clear they are hopeless, condemned to suffer all their life
Q:
not really optimistic no ?
(question not asked)
Really
a disease
****************
Q:
Is the word "Borderline" suitable, borderline means "not really"
The term borderline is left over from psychoanalytic days - meaning
walking the border between psychosis and neurosis - a better descriptor
would be pervasive emotion dysregulation disorder (perhaps in the DSM-V)
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 ?
We all have the capability of acting this way usually when we are emotionally
vulnerable and are feeling invalidated - however the criteria for BPD is
quite specific and really only 1-2% of the population seem to meet criteria.
Often because of the stigma there is reluctance to give this diagnosis.
However with an effective treatment such as DBT it is better to diagnose
correctly to assure that the correct treatment will be applied.
Q:
About DSM IV. A lot of therapist in France when we say "DSM" have some
"disdain", like it was "useless"
Could
you answer this ?
(question not asked)
The
answer is certainly not but I ask
Q:
Is each / every psychiatrist has the training and experience to treat borderline
patient ?
No
Q:
Do you think that there is actually some deficiency in this domain ? (training
and education of mental health providers)
Yes
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 ?
Not much different in this country - it is why it is so very important
to have advocacy groups and to provide education - when you add together
all the mental illnesses you will find that most families are affected
in some way - it is a shame that we can talk about it more
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 ?
Without teaching individuals the necessary skills we can;t expect them
to stop the behaviors that have been effective in regulating their moods
over the years - it is often not a question of wanting to stop - they all
want to stop - it is more of a question of learning how to regulate their
emotions in other ways - which is what DBT is about
Q:
What do you think about the idea to create an association to promote knowledge
of this illness and help peoples ?
I am all for it - As I mentioned earlier there is an organization in
the US known as TARA (Treatment and research advancement) there is also
the National Alliance for the Mentally Ill (NAMI) - I very much recommend
getting in touch with Valerie Porr
It
is ethically very difficult to force something to be treated (I suppose
that it is also useless if he don't want)
But
we know that all over the world there are thousands of sick peoples, which
don't know that they are sick, and thinking that it is the "way they are"
to suffer
Q:
What do you think about the principle of "diagnosis obligation" when we
are in contact with someone potentially Bpd (or other mental illness),
to "force" him / her (i don't know how) to see a therapist, not to treat
him (her), but only to give him (her) an accurate diagnosis ?
In
that way it would be more difficult to him (her) to say "i'm not sick"
(and also to the family circle to believe the lyings)
The
second point is that perhaps it could help him (her) to become aware that
he (she) is sick
So
?
I think as a human being I have an obligation to eliminate suffering
as best I can
(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" and then never be treated ?
(question not asked)
Question
without answer I suppose
Q:
"how to convince the patient to consult a specialist ?"
DBT has a whole set of what we call commitment strategies - the first
step is to try and let the individual know that there is help for the misery
that they are experiencing
I
suppose that it is hardly more difficult to convince an high functioning
borderline to consult a therapist (if they are saying "i have nothing")
Q:
Once again what is your experience, the solution ?
(question not asked)
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 ?
When feeling defensive most anyone will turn on someone they feel is
attacking them
Q:
how to manage this ?
State a willingness to go with them to see someone who can help sort
things out
Q:
More generally, how to "manage" relationships with a borderline ?
(question not asked)
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)
Even children are able to make reasonable wise decisions at times -
It has been my experience that they really do want to improve and that
they are doing the best they can.
Q:
Is it not totally utopian and even cruel to ask them taking such a decision
?
No - ultimately they may not have caused all their own problems but
still have to take the responsibility to solve them
Q:
What is your experience about this ?
How
borderline people "come to you" ?
Usually when I first see them - they have been recently in a psychiatric
hospital and don't want to go back and are interested in getting help.
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?
I believe that BPD is a transaction between emotion vulnerability (biology)
and an invalidating environment - both elements are necessary - that being
said there is a high incidence of sexual and/or physical abuse among patients
with BPD but abuse does not account for all cases nor do all those you
have been abused develop BPD
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 ?
If all are willing we do family therapy in which e teach family members
skills as well. Just like we assume that our patients want to improve
and are doing the best that they can we make the same assumptions
about families
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 ?
Yes there is a strong genetic component
Q:
Is it the same with borderline disorder ?
The
borderline mother is going to make her daughter borderline ?
There is evidence that many patients with BPD come from families that
have affective disorders such as depression or bipolar disorder (or BPD)
Q:
How to break this infernal circle ?
Not if the mother receives adequate treatment
Latest
questions
Q:
Is there one question you would like to answer and I didn't ask ?
-
Q:
Is the last word "hope" ?
There is an effective treatment available - I hope you get an opportunity
to contact TARA and the Behavioral Technology Transfer Group to find out
more about this treatment and how to bring it to France
Questions
answered with the kindness of Mr Randy Wolbert. - MSW Clinical
Director
InterAct
of Michigan