TREATMENT: Cures and remission?

[BPDFamily.com]

I see BPD as an enduring condition, kind of like addiction is, where one can live in recovery, but at this time in our world, cannot be cured.  

Molls.

[Mollyd]

I see BPD as an enduring condition, kind of like addiction is, where one can live in recovery, but at this time in our world, cannot be cured.  

Molls.

[warrior]

I like Molly's post.  I have alcoholism and I treat it on a daily basis, either here, a 12 step program and a men's group I am in.  No matter how good I appear, it waits for me to screw up.  It is cunning, baffling, powerful and patient.  My point, like Molly's, is that I will always have it.  How that appears to people around me depends entirely how hard I work on myself.  

I am hoping that my SO's BP will respond in the same way.  We'll see.

[WABT]

For those in a position to comment, how long did it take for the person with BPD to noticeably improve once they had actually committed themselves to improvement and treatment?

www.BPD.about.com/od/faqs/f/PrognosisFAQ.htm

Question:

What is the Borderline Personality Prognosis.  I have been diagnosed with BPD. Does this mean I will have it for the rest of my life?

Answer:  Most likely, no, you will not have BPD for the rest of your life. At one time, experts did believe that BPD was a life sentence; they thought that BPD was not likely to respond to treatment and that BPD was always chronic and lifelong.

Now, we know that this is a complete myth. Research has shown that almost half of people who are diagnosed with BPD will not meet the criteria for diagnosis just two years later. Ten years later, eighty-eight percent of people who were once diagnosed with BPD no longer meet criteria for a diagnosis.

In addition, there are now a number of treatments that have been proven to be effective for reducing the symptoms of BPD. So, with treatment, the disorder may remit much more quickly.

Source: Amarine, MC, Frankenburg, FR, Hensen, J, Reich, DB, and Silk, KR. "Predictions of the 10-year course of borderline personality disorder." American Journal of Psychiatry, 163:827-832, 2006.

[Skip]

The treatments are focused on the behavior - but I'm not sure I would say "only".  You and I often moderate our behavior when our instinctual thinking is different.

For example, last year someone said something on the boards that really upset me. My instinct was to respond to it - but instead I closed my laptop and went to lunch with a friend.  When I came back, I discussed privately and with a third party what had upset me and why and we talked through it - I purged it.  I then let it go.  In the coming weeks I came to understand what triggered me.

That is a behavioral change.  This is how they work a person with borderline personality.

From what I've read, people with BPD are weak  in terms of "executive control", which is our ability to pull back and moderate our behavior consistent with our long term goals.  In the case of above, my long term goal - the respect of my friends - is why I took "executive control" over my gut reaction.

So it's a long process of learning behavioral modification.  Treatment may start with medication to calm the mood swings and help deal with the trauma that caused the person to seek treatment.  You might notice immediate improvement... .but the real test is how they handle stressful or triggering situations over time... .and thats sort of a "failure, re-evaluate, more work, and improve" process.

Maybe its like learning to ski.  Nothing is intuitive.  Some takes lessons for life and never go very far.  Some become excellent skiers -usually because the really wanted it and worked at it.

Its probably more about motivation than time.

Anyway, some thoughts... .

Skippy

[WABT]

From what I've read, people with BPD are weak  in terms of "executive control"

Yes, I've seen that too.  I read something mentioning that people with BPD have a reduction in activity of the prefrontal cortex - the center for executive control.  

Certainly makes sense, in light of the capriciousness of their behaviors.  It also is consistent with the whole idea of them being a "child trapped in an adult's body."  Children do not have the same structural and functional capabilities within the frontal lobes as an adult.  

[Skip]

Here is an editorial on STEPPS, a 20 week program that can be used in additional to DBT or other behavioral therapies. DBT programs are often a year (once a week).   Usually there is some general talk therapy too... .no question that this is expensive and intensive process.

This editorial reports 40% of patients with borderline personality disorder remit (remission) after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years



Editorial

Augmenting Psychotherapy for Borderline Personality Disorder: The STEPPS Program

Kenneth R. Silk, M.D.

The diagnosis of borderline personality disorder conjures up thoughts of helplessness and hopelessness. The helplessness and hopelessness reside not only in the patient but often in the treatment providers as well. A widespread belief that continues to exist among mental health professionals is that treatment does very little for borderline personality disorder patients. Yet they are very difficult to disengage from treatment. Therapists shy away from informing the patient that she has the diagnosis because to pronounce the diagnosis not only would be equivalent to a type of "death sentence" (as we used to be afraid of telling patients that they had cancer or schizophrenia), but it would also cause fear of the rage that the therapist is certain to encounter from the affectively dyscontrolled patient.

Much has changed in the last 10–15 years, but unfortunately too many therapists still feel that borderline personality disorder is untreatable and is a lifelong drain on the energy of the therapist, the psychopharmacologist, and the entire mental health system. While it is true that people with borderline personality disorder utilize mental health resources to a far greater extent than their 1%–2% prevalence would suggest (1), the idea that these patients never change or improve needs revision.

Substantial research now sheds light on many of these mythical assumptions. There is strong evidence from the McLean Study of Adult Development that 40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years (2). The temporal stability (or lack of it) in a borderline personality disorder diagnosis has also been examined in the Collaborative Longitudinal Personality Disorders Study, and findings suggest that about one-half of those who meet borderline personality disorder on intake no longer meet DSM-IV criteria 24 months later (3).

Even more surprising and myth-debunking is the number of well-designed controlled studies in support of effective treatment for borderline personality disorder patients. These studies, for the most part, are randomized controlled trials of therapies that range from cognitive behavior, such as dialectical behavioral therapy (4) and other more straightforward cognitive behavioral therapies (5), to psychodynamic and psychoanalytically based therapies, which include mentalization-based therapy (6) and transference-focused psychotherapy (7), to the blend of cognitive and dynamic therapies in schema-focused therapy (8 ). And not surprisingly, as therapies that appear to be effective emerge, there are now articles urging that patients be informed of their borderline personality disorder diagnosis (9). It is interesting that most of these interventions are in the nonpharmacologic arena, while psychopharmacologic treatment of borderline personality disorder remains unclear, uncertain, and in general unimpressive.

The article by Blum et al. in this issue of the Journal is another step along the path of developing and testing more useful and reasonably successful psychotherapeutic interventions for borderline personality disorder. What is intriguing about the study by Blum et al. is that this nonpharmacologic intervention called Systems Training for Emotional Predictability and Problem Solving (STEPPS) is essentially an augmentation of or adjunct to treatment that is already occurring for the borderline personality disorder patient. It combines 20 weekly sessions of cognitive behavior and skills training elements with a systems component or approach that involves family members, significant others, and health care professionals with whom the patient interacts regularly. The randomized controlled trial study design measured STEPPS plus treatment as usual (N=65) or treatment as usual alone (N=59) every 4 weeks through the 20 weeks of treatment. The study found that the STEPPS intervention affords greater improvement in the affective, cognitive, interpersonal, and impulsive domains of borderline personality disorder; greater improvement in mood and impulsivity; decreasing negative affect; and greater overall global improvement when compared with treatment as usual without STEPPS. STEPPS is brief, adjunctive, and easy to use by a wide range of mental health professionals.

While the STEPPS intervention did not lead to significant between-group differences for suicide attempts, self-harm, or other measures of crises, the importance of the intervention should not be diminished. There are a number of treatments for borderline personality disorder that do decrease suicidal attempts or self-destructive behavior, but some of those that improve suicide do not necessarily improve depression any more significantly than the control intervention (4, 5, 7). It would appear sensible to use STEPPS as an adjunct, particularly to an intervention in which effectiveness is limited in areas where STEPPS has been shown to have beneficial impact. Perhaps as we study the impact of specific and different psychotherapeutic interventions, we may be able to combine or sequence various interventions to get a greater degree of the effectiveness of psychotherapy. For example, in the case of dialectical behavioral therapy, where impact on depressed mood is not impressive, the strategy of augmenting the treatment with STEPPS might provide more extensive overall benefit.

In addition, STEPPS has what the authors label as a "systems" component. By systems, the authors expect that there is involvement of a friend or relative who is willing to learn about borderline personality disorder and who participates in psychoeducational sessions to help him or her respond better to some of the dysfunctional and certainly confusing and affect-provoking behaviors displayed by the patient. There is a need for more interventions that involve the systems that surround the patient with borderline personality disorder, since it is often the people who interact with the patient who remain perplexed and stymied in knowing how to respond to their patient, friend, or relative with the disorder. STEPPS then provides another systems-based treatment available to families and significant others, along with interventions such as the Family Connections Program of the National Education Alliance for Borderline Personality Disorder (www.neaBPD.com). In addition, the patient is expected to be in ongoing therapy and have a mental health professional available to STEPPS in the event of a crisis.

The STEPPS study is a well-designed effectiveness study and was carried out in a thoughtful way, although with a high dropout rate, which is unfortunately not uncommon in such studies. In addition to the randomization, the study is also naturalistic in that outside psychotherapeutic and psychopharmacologic treatments were not controlled other than the requirement of having an outside therapist. It is to the researchers’ credit that they were able to combine the best elements of a randomized controlled trial with this naturalistic aspect of ongoing "outside" treatment.

In an editorial in the June 2007 issue of the Journal, Glen O. Gabbard, M.D. (10), referring to a point made by Daniel X. Freedman many years ago, suggested that we should be cautious not to pit one therapy against another in an attempt to find the very best. What is so helpful about having STEPPS in our therapeutic black bag is that it complements other therapies and need not replace or compete with them. To paraphrase what Marsha Linehan said in her keynote address to the International Society for the Improvement and Teaching of Dialectical Behavior Therapy in Philadelphia in the Fall of 2007, we should derive great satisfaction in knowing that there are a number of different types of interventions that appear effective for borderline personality disorder. The greater the number of available effective interventions, the better the chance that a patient may be able to improve to a degree where she feels that life is once again, if it ever was, worth living. Then we will have more evidence to erase the myth that borderline personality disorder is untreatable and that the diagnosis relegates the patient to a life of helplessness and hopelessness.


Dr. Silk, University of Michigan Health System, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109-5769; ksilk@umich.edu (e-mail). Editorial accepted for publication January 2008 (doi:10.1176/appi.ajp.2008.08010102).

[red12049]

As the subject asks... .Ex has recently told me that her therapist told her that she was probably BPD years ago, during a series of suicide attempts, but she is not now.  In all the reading I have done, have not heard of this.  I understand that sometimes symptoms can lessen with age, but the whole illness disappear?  And, FWIW, I know that listening to the ex tell me what her therapist said can be "misleading"... .  Thanks in advance for any help.

Red

[arjay]

Everything I read suggests they "BPD suffers" learn to "cope" just like the rest of us... .but they have to really work at it.

I read more and more that medication and Dialectic  treatment has shown good success rate.

[JoannaK]

I think that some show many of the BPD traits but not really have BPD... . They may have substance abuse problems, learning deficiencies, mood disorders, or simply be emotionally immature.  

I think that people who have less severe cases (like high functioning), good family systems, and no co-morbidities - are more likely to respond to treatment.

About symptoms lessening with age... . many of those who treat those with BPD feel that is true, but that hasn't been the experience of people here, but it may be a biased sample here.

[dramacat]

I have read anecdotal accounts of BPD behaviors mellowing or dissipating with age.  That said, having read the stories on these boards of people who have been married for 20/30/40 years to a BPD-sufferer, I'm not sure how accurate those accounts are.  It seems to me that the disorder never really disappears.  It's effects can simply be ameliorated through treatment/personal work and the development of healthy coping skills.

[snwelsh]

Do BPD people ever get better?

Is this something they can just wake up from and begin behaving humanely?  With or without treatment?

Or does medication just make them slightly more tolerable without getting rid of the abhorent behaviors?

Will they always be untrustworthy, chaos causing people?

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[JoannaK]

Many people with BPD can recover.  There are some studies that show that as many as 80+% can recover to the point that they are not longer diagnosable with BPD traits.  The key is that the person with BPD needs to be very committed to recovery.  We have had some people here who are experiencing great joy with their recovered/recovering BPD partners.

They can't just wake up and begin behaving humanely... it takes commitment, treatment, and often medications in the early stages of recovery.

Medication can help with some of the symptoms of BPD, but it isn't a cureall.  Appropriate therapy, usually Dialectical Behavioral Therapy, is the gold standard in treatment.

"Untrustworthiness" is not a diagnostic trait of BPD, but many here have reported untrustworthy BPD loved ones.  Sometimes tbe person may be more antisocial p.d. instead of BPD... .  It's often hard to tell the difference as some of the patterns of behavior can cross.

[Christy2]

The statement you will hear echoed over and over when you ask this question is yes, they can, but THEY must be committed to it

As Joanna said:

The key is that the person with BPD needs to be very committed to recovery.

Note - "the person with BPD" - not the spouse of the BPD, the parent of the BPD or the child of the BPD.  We can be committed to assisting them through recovery, but they must recognize they have a problem and do something about it.

And sometimes, they can SEEM recovered, but when a big stressor in life hits they fall off the wagon (which is what my story has been lately with my uBPDh.)  Of course - I guess I expected that to happen someday when I told him about the success of Dialectical Behavior Therapy but that it was pretty intense and he laughed and said "yeah right - like I'm going to do something really intense."  Hmmm - note the lack of committment there?

This is one reason why you will find alot of emphasis put on working on ourselves here on the board.  Ultimately, that is something we have so much more control over.

[snwelsh]

So this would explain why 6 years of Zoloft didn't "cure" my mother, but made her tolerable?  And why when she discontinued her Zoloft she became just as bad - if not worse - than before... .because she never addressed the problem, just medicated the symptoms?

But none of that means she can't get better one day - just that it will be a long, hard journey to change 68 years of behavior?  And only then if she ever decides to?

[Girl Friday]

As a BPD suffer I can say this,

BPD is something you are. You can medicate some symptoms (my meds have saved me and made me able to deal with therapy) Dialectic Behavioral therapy teaches you vital skills to living with this disorder!

These together can offer you a way to manage BPD and live a normal life but it never leaves. It's something you have to accept and learn to live with.

[arjay]

Note - "the person with BPD" - not the spouse of the BPD, the parent of the BPD or the child of the BPD.  We can be committed to assisting them through recovery, but they must recognize they have a problem and do something about it.

I've read that a supportive family is a very significant factor in helping someone in getting BPD under control.

[Christy2]

... .Girl Friday , thank you for the insight... .

and thank you for the guts, commitment and effort you made in going through DBT.  That says many positive things about your character. 

So this would explain why 6 years of Zoloft didn't "cure" my mother, but made her tolerable?  And why when she discontinued her Zoloft she became just as bad - if not worse - than before... .because she never addressed the problem, just medicated the symptoms?

But none of that means she can't get better one day - just that it will be a long, hard journey to change 68 years of behavior?  And only then if she ever decides to?

Yes, that is pretty much it.  My husband is on meds and they do help keep things tolerable, but he has never gotten "well" because he doesn't care to do the work involved in that.  In his mind, tolerable is good enough.  I've compared it to someone with a serious injury who considers themself okay once the Emergency Room gets them stabilized so they leave the hospital, when in reality they are far from being healthy.  But getting healthy takes alot more work than just taking a pill.  Work that at this point in time anyway, my husband is not willing to do. 

[Desert]

Substantial research now sheds light on many of these mythical assumptions. There is strong evidence from the McLean Study of Adult Development that 40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years (2). The temporal stability (or lack of it) in a borderline personality disorder diagnosis has also been examined in the Collaborative Longitudinal Personality Disorders Study, and findings suggest that about one-half of those who meet borderline personality disorder on intake no longer meet DSM-IV criteria 24 months later (3

My reading of "no longer meeting Diagnostic Interview for Borderlines - Revised or DSM III-R criteria" simply means that these individuals meet LESS than the five out of nine requirement.  To infer that it means that they have been "cured" would be completely unwarranted.

[Steph]

I have a 100% success story.   My husband was diagnosed BPD several times... .rages, suicide attempts, road rage, verbally and emotionally controlling and abusive, dissociative, emotionally VERY labile, impulsive... you name it.

He eventually got into  :)BT and stayed for 3.5 yrs. I went into codependancy therapy and DBT for family members.

He has been 100% symptom free now since last August. Period. He is able to identify his emotions, regulate them, he is not at the mercy of them... he functions on a normal and healthy level. Our relationship is VERY happy and healthy. He graduated from "advanced DBT" and his DBT therapist pronounced him well. Our DBT skilled marital therapist pronounced us well.

He did change a bit... he is not impulsive, he is better organized, he is thoughtful and very insightful into himself. He can talk about the hard stuff of the past, he doesnt melt down, implode, explode... In short, all is very, very well.

Steph

[arjay]

My reading of "no longer meeting Diagnostic Interview for Borderlines - Revised or DSM III-R criteria" simply means that these individuals meet LESS than the five out of nine requirement.  To infer that it means that they have been "cured" would be completely unwarranted.

So does this mean that anyone that has ANY traits of BPD are mentally ill?

These mental disorders are comprised of common human traits taken to the extreme.   Unstable relationships?  Half of all people that marry get divorced. I'm divorced.  Impulsiveness is seen in many people. My mother is impulsive.  We all feel some level of abandonment. You, yourself, struggle with this one.

People with BPD coming out of treatment are no longer suicidal, cutting, unemployable. These are success stories and the first steps in reclaiming their lives.

[Wanda]

I believe in todays world that pwBPD can fully recover if they go through treatment.

Then for others you have those who learn the skills and tools that really improved their relationships.

Things can change if you change what you can and that is you.

For me my husband is undiagnosed, and for 11 years i have been using the tools and skills. stopped using it after a while, then when i came on here back in sept his rages were four months apart. That was good they use to be three times a week.

Now since i have been on here they are going on six months since last rage back in November.

So my story isn't a 100% cured , but he has improved and things are so much better... .does he still have BPD oh yea.

My husband is on no meds of any sort for this, but yet he improved over the years  by 85% due to me changing the way i reacted to things and dealt with things and set some strong boundaries for my self!

I will say my husband is a recovered alcoholic of 24 years so with him going to meeting that really helps with his thinking.

[joiesophie]

I didn't read everybody's responses, but here's my question:  (did anyone ask this - sorry if I'm repeating)

If BPD could go into remission, then wouldn't therapists be jumping at the chance to help them?  I've read some stuff, but I know that one of the things that stuck in my head was that therapists have concerns about being re-engaged... .

If there are 17 million BPD sufferers, wouldn't somebody have gotten lots of recognition in some research study in "finding a cure" - or at least putting it at bay.

Just a thought.

js

[arjay]

I didn't read everybody's responses, but here's my question:  (did anyone ask this - sorry if I'm repeating)

If BPD could go into remission, then wouldn't therapists be jumping at the chance to help them?  I've read some stuff, but I know that one of the things that stuck in my head was that therapists have concerns about being re-engaged... .

If there are 17 million BPD sufferers, wouldn't somebody have gotten lots of recognition in some research study in "finding a cure" - or at least putting it at bay, or unplugging the re-engagement?

Insurance doesn't pay much for the long-term treatment which can run $20,000 or more (several years of treatment).  My 'ex' had spent $6,000 and quit after a year.  She went to so many being diagnosed with PTSD, depression, Bi-polar. etc, until finally diagnosed with BPD.

Of all those diagnosed, only a small percentage are willing to accept the long-term treatment or to even accept they do have it.

From what my "T" told me, it takes a very compassionate and skilled counselor.  It is difficult work for both the patient and the therapist.

[nothingupmysleeve]

This is interesting because my SD (UBPD- Dxd with "emerging mood disorder/personality disorder nos) had a breakthru about her rages toward me almost 2 weeks ago, and is still amazingly putting her best foot forward with me (though is still baiting my husband a ton, but now that seems lopsided since she used to target me more than him.)

I don't dream she is in recovery without ever even knowing she has a problem, BUT I hit a rock bottom with her, and my husband (without my knowledge) shared with her that if she didn't cooperate in finding a solution to her anger then they may be moving to where he works (over an hour away and out in the middle of nowhere) to live at an apartment his employer provides if he wants to stop the long commute. She told me when he told her that she was mad, and then she raged at me over something she knows she did wrong and it all made her realize she gets mad at me for no reason, and takes her anger toward herself (or dad or mom) out on me even though it's not my fault. THAT was huge and is the first time she's made any such amends with her hatred toward me in over 2 years. I'll take it

I think it showed she is capable of growth, and I have been around enough to know that she is sincere in her efforts right now, though of course they will not last forever I'm sure. I also think that my rock bottom, and DH's ultimatum helped her to know that she has to step up to the plate or she will have no one to blame but herself. And for a 14 yo UBPD mind, that's a pretty heavy weight to bear and own up to, even if it is only temporary.

So I don't know if they can all recover, or what contributes or detracts from recovery, but I do think it's possible if they want it to be so.

[DeeEsse]

it stands to reason that we CANNOT change the brain structures.

My understanding of how all cognitive therapy modalities work is that people actually can change their brain to a certain extent. The process of actively thinking through all those excercises and doing that self talk--like, "when I feel x, I know that really it's y, because I have z, p, d, q evidence to support it"--actually does grow new nerve pathways.

I just googled this link sort of randomly to find something to back up the above and found a pretty interesting article and NPR interview on CBT. www.beckinstituteblog.org/?p=171

It remains true that you "have to want to"--and then you have to be able to afford to and/or have a health insurance plan that will let you. Very real obstacles, all.

[Mermaid7seas]

I have a 100% success story.

My husband was diagnosed BPD several times... .rages, suicide attempts, road rage, verbally and emotionally controlling and abusive, dissociative, emotionally VERY labile, impulsive... you name it.


He eventually got into  DBT and stayed for 3.5 yrs. I went into codependancy therapy and DBT for family members.

He has been 100% symptom free now since last August. Period. He is able to identify his emotions, regulate them, he is not at the mercy of them... he functions on a normal and healthy level. Our relationship is VERY happy and healthy. He graduated from "advanced DBT" and his DBT therapist pronounced him well. Our DBT skilled marital therapist pronounced us well.

He did change a bit... he is not impulsive, he is better organized, he is thoughtful and very insightful into himself. He can talk about the hard stuff of the past, he doesnt melt down, implode, explode... In short, all is very, very well.

Steph

Steph, What exactly is DBT?

[peacebaby]

I believe that BPD can be "cured". The person in question just needs to really want it and be able to stick with treatment.

My DBPDSO is presently in a 5-day a week DBT program that includes all kinds of therapies and classes and groups, and she's doing amazingly well. In under two months I see so many changes in her ability to think more clearly, to examine and control her emotions, and to generally be more mature.

I think a lot of the "cure" is about the power of positive thinking. Training the mind towards positive behaviors and thoughts, and away from destructive behaviors and thoughts.

And I don't know for sure what "cured" will mean for my partner, and I think it means different things for different people. I don't know if all of it will totally "go away" but as long as she feels better in general and can handle life better in general, even with some symptoms, that's "cured" to me.


Peacebaby

[Steph]

 DBt stands for Dialectical Behavioral Therapy. It is a long term therapy that literally will "rewire" the way someone with emotional dysregulation issues processes emotions... as well as coping skills for life. In my H's case, he was pronounced cured and he functions normally now and has for many months. It is a group milieu... a year to teach basic skills, then they usually recommend another year and then the advanced group which is less structured, but more practical. Its tricky because the BPD symptoms work against someone starting DBT. Most often, tho, the person with BPD will get into a group and, for the " first time in my life, I feel like someone 'gets' me" and they feel accepted and understood. And they are.

  There are often family classes, too, to address OUR issues... and we have MANY... and ways to relate and communicate. We do teach some of those skills right here on our boards and workshops.

Does this help?

Steph

[justrealized]

IMHO, no I don't believe BPD's can be cured.  I am just going on the basis of my mother, a few other people I have observed, and the dozens of stories I have read on this board.

You mention the necessity of the BPD to accept diagnosis in order for there to be any possibility of improvement. Indeed, but thats the catch-22, these people won't accept that anything at all is wrong with them, or that they are ever in the wrong, so why would they accept this diagnosis?

If they do go to therapy alone, or with family, it is usually under duress, and their goal will be prove their case that the other people in their life are "crazy" or the ones at fault.  The minute the therapist reveals that they are onto them, its all over.  Either the therapist is incompetant (according to the BPD) or therapy in general " just doesn't work for them" etc.     

Someone mentioned an individual who was "relieved" to receive the diagnosis because at least it gives them a starting point to work on what's wrong with them.  Again, someone who has at least that much insight, to genuinely accept that they have an emotional problem or challenge does not at all sound like a BPD.  This unfortunate indvidual is someone who really wants to work on their behaviour and perceptions, and has obviously been misdiagnosed.

Lets remember that BPD is currently a "popular" or "hot" diagnosis for therapists to apply, much as bipolar  and manic depressive was for several years.

Also I think your choice of the word "remission" is an unfortunate one.  We are not working with a disease model in this instance. The complete lack of compassion or fairness that the average BPD demonstrates, originates in some experience which creates a physiological condition that has affected the particular part of the brain that houses these concepts.

Yes, there are many cases of BPDs "slowing" down as they get older, but much of that could just be attributed to diminishing physical energy or health etc.  The same reason that older people retire from their worklife at a certain point, or don't pursue their hobbies with the same enthusiasm they did when younger.

The "projects" a BPD pursues ( in general creating havoc and drama and mucking up the works for those nearest to them) is something that does require time and energy and enthusiasm, which may diminish in their elder years, hence the idea that " they're getting better".       

[lbjnltx]

dear justrealized,

my BPD(12) has in the last month said to me several things that indicate that she does know that she has something wrong with her.  i see this as very promising and an open door to move forward with therapy.  just as some people are dx with cancer in certain stages, so can BPD be experienced to certain degrees in individuals.  not all cancer is fatal, some do recover with treatment, and the sooner you catch it and address it, the better your chances of recovery are.

the power of positive thinking, search engine run by love.,

lbjnltx

Edit: my daughter, now 16, has made a remarkable progress.

[nothingupmysleeve]

IMHO, no I don't believe BPD's can be cured.  I am just going on the basis of my mother, a few other people I have observed, and the dozens of stories I have read on this board.

You mention the necessity of the BPD to accept diagnosis in order for there to be any possibility of improvement. Indeed, but thats the catch-22, these people won't accept that anything at all is wrong with them, or that they are ever in the wrong, so why would they accept this diagnosis?

If they do go to therapy alone, or with family, it is usually under duress, and their goal will be prove their case that the other people in their life are "crazy" or the ones at fault.  The minute the therapist reveals that they are onto them, its all over.  Either the therapist is incompetant (according to the BPD) or therapy in general " just doesn't work for them" etc.     

Someone mentioned an individual who was "relieved" to receive the diagnosis because at least it gives them a starting point to work on what's wrong with them.  Again, someone who has at least that much insight, to genuinely accept that they have an emotional problem or challenge does not at all sound like a BPD.  This unfortunate indvidual is someone who really wants to work on their behaviour and perceptions, and has obviously been misdiagnosed.

Lets remember that BPD is currently a "popular" or "hot" diagnosis for therapists to apply, much as bipolar  and manic depressive was for several years.

Also I think your choice of the word "remission" is an unfortunate one.  We are not working with a disease model in this instance. The complete lack of compassion or fairness that the average BPD demonstrates, originates in some experience which creates a physiological condition that has affected the particular part of the brain that houses these concepts.

Yes, there are many cases of BPDs "slowing" down as they get older, but much of that could just be attributed to diminishing physical energy or health etc.  The same reason that older people retire from their worklife at a certain point, or don't pursue their hobbies with the same enthusiasm they did when younger.

The "projects" a BPD pursues ( in general creating havoc and drama and mucking up the works for those nearest to them) is something that does require time and energy and enthusiasm, which may diminish in their elder years, hence the idea that " they're getting better".       

From all I have read there are several degrees of BPD, including high and low functioning, internalizing and externalizing behaviors, as well as a combo of these. I can understand why you would have the misconception that all BPDs fall into the "refuse to acknowledge" category, but that is not in fact a diagnosis criteria. My UBPD SD and her mom fall into the high functioning category. Meaning they are exceptionally intelligent and thrive scholastically. SD is an honor student on several sports teams at a time, BM has 2 degrees- journalism and nursing. They do their best in black and white/win/lose/cause/effect classes and in BMs case professions. BM has always had a job, or 20 of them. She is always interviewing according to SD, b/c she doesn't like the people she works with or deserves more money is unappreciated etc. SD is always switching friends and then smothers them til they push her away. BM has no friends, just two different BFs the past 5 years, that she juggles back and forth, seeing one behind the other's back. Not sure what's up with the two men who seem normal (co-dependents perhaps?) putting up with it. BM has once or twice admitted she had a problem to DH while they were still married, then when he tried to encourage her to get help she went back into denial.  She conceded custody after a nine month dragged out case, the night before court. This was likely because SD's Dr loaded her interview with the GAL with symptomatic language, suggesting BM has a psych issue. This meant that the judge would then likely allow our psych eval if BM pursued the case into trial. So I think she's that afraid of therapists b/c she knows something's up but prefers denial.

SD is the same way, though she will admit she has anger/temper issues, she is terrified and angered by us having her in therapy.

Then several months ago a young friend of mine, a former addict who tends to float in and out of my life, showed up out of the blue after a year MIA. We talked awhile and I shared some of our dilemma with SD and BM. Then a week or so later my friend came to see me again and let me know she was devastated that the week after we spoke she had a relapse and checked herself into a treatment facility. They did a psych work up and told her she was BP/BPD. She couldn't believe that after just having spoken to me about it.

She is very interested in receiving help and recovery. She already goes to recovery meetings for addicts, so she was open to the diagnosis and working on a treatment. She also offered to someday talk with my SD, should she ever be ready.

I thought to myself, there's NO WAY my friend, who has always dug deep and sought answers for her behavior issues, could be BPD! BUT then I read more books, Eggshells, and the newer ones for families, as well as stuff on here in the articles, AND other sites etc, and read about the different types of borderline personalities.  My friend fits the combo criteria- highly intelligent, but low functioning. And she rather than project her pain she turns it all inward.

So unlike the BPD way of thinking, I really believe now that we cannot lump them into black and white categories either. There are too many circumstances that influence this disorder, not just genetics.

[Steph]

 I think another factor is that BPD can be complicated with alcoholism, drug addiction, other personality disorders and mental illnesses, or not even be BPD at all, but be others like antisocial or even psychopathic, which are entirely different and quite hard to treat.

In my H's case, he was definately diagnosed with BPD, was extremely hgh functioning,  yet had no other diagnosis and no addictions.

Steph

[JoannaK]

There is a Workshop on this subject:

https://bpdfamily.com/message_board/index.php?topic=76487.0

[Major_Dad]

I think in the case of High Functioning Acting Out BPD's, the behaviors are truly opportunistic. My BPDW can easily turn if off in public and around friends and extended family, even in stressful situations. Before we had kids, there were few signs of what would be to come. And if there were no kids here for her to use to control me, I am pretty confident she would have to watch her step. The best analogy (although I hate to use it cause it is extreme) is to a pedophile. They are usually model prisoners, and will be model citizens if confined to the presence of adults. But put them in a space where there are kids around, that is another story. HF BPD's with history of major childhood trauma will focus their behaviors on spouse and kids. Once they lose their leverage, they will likely sublimate their behaviors to avoid abandonment

[hesh]

I was reading the post in the 50 top questions about whether or not BPD can be cured. As I understand it they have meds to get through the crises times to help deal with the therapy which mostly focuses on dealing with behaviors and triggers. What about dealing with the underlying issues like childhood abuse. Does that ever happen and does it make a difference?

[dados76]

Treatment can help a lot... and can help to deal w/childhood issues too... slow process... but my partner has been in T for a couple of years and its made a big difference...

[ShadesofGray]

Can someone please explain why those in the mental illness profession think that people with BPD are impossible to treat? And how come many refuse to treat them?

Does this apply to all 4 types, the witch, queen, waif, and hermit?

Does this apply to those who just have traits, too?

I don't understand this. I've been in therapy for way too many years and I wouldn't be there if I didn't truly want to get better. There's certainly many other things I'd rather do with my time and money. Why, then, do therapists think we go for treatment?

If those with full-blown BPD never think that there is anything wrong with them, and that THEY don't need therapy, then those aren't the ones who ever seek it. I, on the other hand, was raised by a BPD and seem to have some traits so I do fall somewhere on the spectrum. However, I keep struggling in therapy. I now see that most likely my past 2 psychologists figured out I had BPD traits and they were not comfortable treating me, but did me a disservice and didn't say so, because I never felt like I got anywhere with them. I am now with a LCSW who likes to help those with BPD or those who were raised with BPD, and it's much different. But I am still confused over exactly why the stigma exists from mental health professionals, if there are people who are trying to get help.

Thanks in advance.

[lbjnltx]

some patients w/BPD are very needy and use up therapists' energy for attention/through attention seeking behaviors.

dbt therapists give their patients phone access 24/7... .they also meet w/other therapists weekly for support.

some patients w/BPD are also very difficult to deal w/and drain the therapist... .they also sometimes are sporadic in attendance.

hope that helps shed some light.

lbjnltx

[Oldsoldier2411]

Can anyone tell me HOW you can tell if the sufferer is going into remission of the symptoms. This may sound like a negative question but it is meant to find a positive outcome. As some sufferers look to DBT for help with their condition, do they learn to cope better or learn to hide the syptoms? I have heard that some suffers start to go into remission in time. With DBT taking approx 3 years, how can the therapists be sure that it is the DBT or the time frame that changes the diagnosis?

My take on the treatment/time frame is that the outcome is a massive positive but their is a lingering doubt that some will adapt and start to hide the condition so leading to problems "behind closed doors". I hope someone may be able to give an answer to this concern.

Ian

[lbjnltx]

How do you define remission?  Recovery?  Cure?

For me:

remission= a decrees in symptomology

recovery=  a permanent change in thinking patterns/belief systems and behaviors

cure= (specific to BPD) no longer an emotional/black/white/all or nothing thinker, no

          having abandonment fears, no longer having an unstable sense of self... . etc... .

DBT teaches skills to deal with the feelings... . it doesn't change the feelings... . over time, when the patient uses the skills new neuropathways of the brain are created and older neuropathways become culled... . this is time+skills=change.  They are both important.  Consistancy of the use of the skills is important as well as it affects how long it will take to form the new neuropathways.   

Going "underground" with acting out behaviors means what exactly? 

Does it mean they are coping in the moment (good)? or does it mean they self harm in secret? (bad)  or that they are engaging in other self harm behaviors... . like shoplifting or drugs? 

   

[Oldsoldier2411]

How do you define remission?  Recovery?  Cure?

For me:

remission= a decrees in symptomology

recovery=  a permanent change in thinking patterns/belief systems and behaviors

cure= (specific to BPD) no longer an emotional/black/white/all or nothing thinker, no

          having abandonment fears, no longer having an unstable sense of self... . etc... .

DBT teaches skills to deal with the feelings... . it doesn't change the feelings... . over time, when the patient uses the skills new neuropathways of the brain are created and older neuropathways become culled... . this is time+skills=change.  They are both important.  Consistancy of the use of the skills is important as well as it affects how long it will take to form the new neuropathways.   

Going "underground" with acting out behaviors means what exactly? 

Does it mean they are coping in the moment (good)? or does it mean they self harm in secret? (bad)  or that they are engaging in other self harm behaviors... . like shoplifting or drugs? 

   

Thank you for your answer. I was not trying to disrespect the work of Marsha Linehan with her fabulous work in reducing suicide rates due to the therapy that comes from DBT. Having always been a supporter of reducing the stigma of mental health conditions. I am sure that we ALL would applaud the work that is being done. The tools that the therapists use should be made available to friends and families of the sufferer after completing the course of treatment. This would help to deal with residue of the condition, if any was to remain or resurface. Perhaps I am frustrated by the fact that I was ignorant of the condition, which I suspect many others are equally in the same position. My wife had a brain tumour removed several years ago and I am a firm believer in your explanation of the new pathways, thank you.

Many sufferers hide their condition due to the feelings of shame with regards to things such as shoplifting, as my daughter was also using drugs to self medicate for her depression. I know of a person called Stephen Fry(actor) who suffers from Bipolar and he has his taken faith in his sister to keep an eye on his finances.

Thank you again for your help to answer my concerns.

[Scout99]

If one takes into consideration the fact that Borderline is categorized as a disorder and not a disease, like for instance bipolar, then it might be easier to get a perspective on what treatment can achieve... . When we talk in terms of symptoms, remission and cure, it implies that it ist something that has to leave the person like a cancer that can be removed... . and that can be a bit misleading, I think... .

Yes there are perhaps some inherited aspects in play, like maybe a genetic vulnerability, and there are some neurological "symptoms" with an over production in the center for feelings in the cortex of the brain that can be seen in some patients when studying pw diagnosed BPD. But most of what BPD consists of is a learned coping behavior that stems from acquired core beliefs, or schemas created about the self at a very early stage in life, usually due to trauma or growing up in an environment where parents or other important care taker may carry traits of disorder, substance abuse, or other mental health problems or as a result of an in other way, for the child dysfunctional or destructive environment. So it is mostly a combination of a genetic vulnerability a lesser ability to grow a thicker skin so to speak and then small or big or consistent traumas that occur during important early developmental stages in life that together create a disordered mind... .

So treatment is often about acceptance of the disorder, willingness to explore to the person painful and hidden memories and learning to cope with remaining in discomfort while doing so, and then unlearning old behavioral and thought patterns and schemas and dare to create and learn new and more constructive core beliefs about a self that they usually have lost along the way... . So it is a long process, and one that challenges everything they know to be true about themselves, facing tremendous fears and daring to remain in the discomfort.

And the success or failure of treatment lies much in how strong the willingness and the motivation is and how successful the person is in holding back the instinct to want to run away from it to avoid the pain... .

Really all therapeutic work is about learning to cope with different levels of discomfort... . But to a person with a disorder which core issue is discomfort and abandonment, which is the most painful thing there is to a human, is tough work, and it takes the mobilization of other skills to go all the way, which some people have and some don't... . Like the Navy SEAL programs... . Some can handle it, while others can't.

Some part lies also in the skill of the therapist or the team working with the person. And also in the trust and alliance that really is key to maintaining motive to go through such a tough transformation of self, that it means to bring order into a disordered mind... .

Now I am no expert here, but from all the things I have read about treatments and the contents of what a disorder really means, this is where I have arrived so far in my understanding of it... .

[Oldsoldier2411]

If one takes into consideration the fact that Borderline is categorized as a disorder and not a disease, like for instance bipolar, then it might be easier to get a perspective on what treatment can achieve... . When we talk in terms of symptoms, remission and cure, it implies that it ist something that has to leave the person like a cancer that can be removed... . and that can be a bit misleading, I think... .

Yes there are perhaps some inherited aspects in play, like maybe a genetic vulnerability, and there are some neurological "symptoms" with an over production in the center for feelings in the cortex of the brain that can be seen in some patients when studying pw diagnosed BPD. But most of what BPD consists of is a learned coping behavior that stems from acquired core beliefs, or schemas created about the self at a very early stage in life, usually due to trauma or growing up in an environment where parents or other important care taker may carry traits of disorder, substance abuse, or other mental health problems or as a result of an in other way, for the child dysfunctional or destructive environment. So it is mostly a combination of a genetic vulnerability a lesser ability to grow a thicker skin so to speak and then small or big or consistent traumas that occur during important early developmental stages in life that together create a disordered mind... .

So treatment is often about acceptance of the disorder, willingness to explore to the person painful and hidden memories and learning to cope with remaining in discomfort while doing so, and then unlearning old behavioral and thought patterns and schemas and dare to create and learn new and more constructive core beliefs about a self that they usually have lost along the way... . So it is a long process, and one that challenges everything they know to be true about themselves, facing tremendous fears and daring to remain in the discomfort.

And the success or failure of treatment lies much in how strong the willingness and the motivation is and how successful the person is in holding back the instinct to want to run away from it to avoid the pain... .

Really all therapeutic work is about learning to cope with different levels of discomfort... . But to a person with a disorder which core issue is discomfort and abandonment, which is the most painful thing there is to a human, is tough work, and it takes the mobilization of other skills to go all the way, which some people have and some don't... . Like the Navy SEAL programs... . Some can handle it, while others can't.

Some part lies also in the skill of the therapist or the team working with the person. And also in the trust and alliance that really is key to maintaining motive to go through such a tough transformation of self, that it means to bring order into a disordered mind... .

Now I am no expert here, but from all the things I have read about treatments and the contents of what a disorder really means, this is where I have arrived so far in my understanding of it... .

Thanks again scout for your input. I can follow your reasoning. This is why as a person that, I hope, I have always tried to think logically or rationally. However, we can see somethings that give us hope but we also have to have compassion, this is what makes the human beings that we are unique from others creatures on this planet. As for DBT as I have said is a tool that shows a massive outcome, but as Marsha Linehan would agree, is not perfect. If it was then there would be a cure. There is so much that we as parents are trying to get clarity on this condition but life is not perfect. My father often told me that we cannot see through other peoples eyes.

With so many people trying to gain as mch info about this condition soetimes we can be mislead by "the experts". Here in the UK many doctors are very relutant to give a diagnosis as this would place a "label" on the sufferer. This would account for the many sufferers failing to get the help they deserve and need. In the meantime the sufferer continues suffering and the parents and loved one still hunting down the answers they need to help. Here our experts go along the acceptance road that what the sufferer has seen is the truth.

Thank you again scout.

Ian

[Scout99]

With so many people trying to gain as mch info about this condition soetimes we can be mislead by "the experts". Here in the UK many doctors are very relutant to give a diagnosis as this would place a "label" on the sufferer. This would account for the many sufferers failing to get the help they deserve and need. In the meantime the sufferer continues suffering and the parents and loved one still hunting down the answers they need to help. Here our experts go along the acceptance road that what the sufferer has seen is the truth.

Thank you again scout.

Ian

I agree with you on this, since it is a problem we have in my country too, (one of the scandinavian countries), we are like an underdeveloped country completely when it comes to mental health... . Too hard to get help the normal way through the medical system and too expensive if you choose to pay for it by yourself. And like in your case a very strange fear of labeling that in my opinion only increases the prejudice about these disorders! And yes at the end of the day there are so many people both with the disorders or close to one that do suffer immensely... .

A shame really... .

In my country you can't almost come in question for DBT unless you are a young girl and have several suicide attempts, cut yourself and have an eating disorder at the same time... . For men with BPD there is virtually nothing... .

Just a note on the efficiency of treatment, it is my understanding that if looking at therapeutic treatment of any sort as a cure, per se, or like popping a pill and it all goes away, I still want to stress out that is a bit misleading... . DBT, could of course and will probably also improve and newer techniques will emerge. But in the end as with all training or learning really, some will excel and some achieve medium and some lower results. Just like with grades in school... . It is not a disease, but a disorder that consists of wrong learning  due to experiences in early in life, that in turn create disordered and or distorted coping patterns and views on situations, and that in turn will become the (bad) tools used when facing new situations in life... . We all have some "distorted" patterns that are a result of bad experiences from childhood or whatnot that we too recycle... . The difference is when reaching the level of being able to be diagnosed with BPD you have a lot of them and they work in synergy... . But even for us, when we sometimes choose to work on our issues or distorted patterns in therapy or something else, the results there too will vary from person to person, regardless of the efficiency of the treatment used... .

Glad I could be of help! Keep posting, venting and learning about the disorder, but also don't forget YOU! 

Best Wishes

Scout99

[Oldsoldier2411]

Many thanks again scout. Again I can understand your feelings and relate to them. Many years ago our mental hospitals were closed down. This was due inpart to many being largely unchanged from the 19th century, bleak and desolate places. I am in agreement that these places were a form of abandonement and cruel in there use. However, I believe that the real motive was for financial reasons. As time has passed the only change from governments come in the limited places that are available for treatment with so many health care trusts and GP's fighting for a few beds. Further, many treatment centres are under time and financial pressure to resolve the few cases they deal with. As DBT has an average duration of 3 years but CBT is much shorter in duration. This leads to failures because CBT is found to be ineffective with regards to BPD. This is shown with the figures for drop-outs from therapy. Perhaps the politicians are the real culprits by burying their heads in the financial sand.

www.nimh.nih.gov/news/science-news/2006/targeted-therapy-halves-suicide-attempts-in-borderline-personality-disorder.shtml

I am enclosing a link to a research article that I recently came across with regards to DBT and other therapies.

Thaks again scout for your help and input.

Ian

[Junknown]

Can someone post this study you talk about in here? Or link it?

It would be really interesting to read it all and check out what were the criteria (inclusion and exclusion) they used to select their sample, its size, time the study took, kind of behavioural parameters analysed on the sample studied and so on than to talk in a theoretical way about wether or not they can recover (without even knowing what is the definition of recovery implied on this study).

Thanks to anyone who can provide the study.

[clydegriffith]

Is the recovery rate really that high? I thought the concencus was that they typically don't get better as most of them don't even think they have a problem.

[Junknown]

Is the recovery rate really that high? I thought the concencus was that they typically don't get better as most of them don't even think they have a problem.

Yeah, my psychiatrist tutor, when i was in psychiatry during a month during my internship (im a young doctor), even told me she hated them. That they gave her an inner feeling of repulse. So, if she could she avoided them. And said that if i ever was near one would feel something like that.

Guess what, i didn't feel that. In fact when she said that i was already dating a borderline which lasted almost 2 years. Quite ironic, the person she said would repulse me actually actracted me. Thats got to say something about my self and my inner problems. I got attracted by someone which most normal people don't feel atracted to.

Mine at the end went to therapy. But guess what, so far has had 2 boyfriends, and got pregnant of the last, having a miscarriage while she was already married and living with her husband (this after i ended it with her, she went to therapy and got herself a new boyfriend in 1 week). Not much success rate on her therapy, .

Anyone got the study? Please share if you do!

[Skip]

I thought the concencus was that they typically don't get better as most of them don't even think they have a problem.

Those closest and most experienced with the disorder see this as more of the problem than insight.  This is not uncommon with evolving fields of medicine.  As Junknown can attetest, sat one time it was consensus that everyone with Aids will die even know there was evidence to the contrary of emerging effective treatments. The same was true of hepatitis at one time.

This is pretty well explained here: https://bpdfamily.com/content/treatment-borderline-personality-disorder

It would be really interesting to read it all and check out what were the criteria (inclusion and exclusion) they used to select their sample, its size, time the study took, kind of behavioural parameters analysed on the sample studied and so on than to talk in a theoretical way about wether or not they can recover (without even knowing what is the definition of recovery implied on this study).

It was a prospective cohort study sponsored by the NIMH.  The purpose was to elucidate the natural history of the disorder.

These participants were the worst of the worst - 3/4 had multiple breakdowns/hospitalizations.  This was not a measurement of a 12 year regimen of therapy - rather it was akin to putting transmitters on wild bears and tracking their natural explorations over a period of years.

Here is the 6 year interval report: https://bpdfamily.com/pdfs/Zanarinietal2005.pdf

[Junknown]

Those closest and most experienced with the disorder see this as more of the problem than insight.  This is not uncommon with evolving fields of medicine.  As Junknown can attetest, sat one time it was consensus that everyone with Aids will die even know there was evidence to the contrary of emerging effective treatments. The same was true of hepatitis at one time.

This is pretty well explained here: https://bpdfamily.com/content/treatment-borderline-personality-disorder

Yes, its true. There was a lot of evolution on many medical disorders in the past which changed the way those diseases naturally evolved during the course of time. From acute eventually fatal diseases on the short, medium term we switched to long term/almost chronic diseases. Altough dependent on drugs which come with side effects of their own.

With a disorder like borderline the main problem i see is their recognition of the problem. My girlfriend in some of her "lucid" times said to me she had a dark side, hurt people, that i was better without her, that she was manipulative and knew how to hurt others, that she couldn't be faithful.

But, after those times passed by, she would be back to the same she was before. She couldn't admit her problem to the root. She said it had to do with her rape by her brother, that she had trouble with men but she couldnt admit the problem as it really was. At this time i had discovered all the truth about her lies and cheating and i knew i couldn't be with her anymore (i didn't knew what was true or a horrible distortion of reality/lie).

She lacked insight... .And it's horrible not to have insight for a disease she had, that hurted her and the ones closest to her so badly.

There are other mental disorders which give the person affected a lack of insight. If this lack of insight is bypassed i agree there must be an extremely high percentage of borderlines on the way to their cure.

As it's said on the link you provided "There is a significant difference between the number of those who would benefit from treatment and the number of those who are treated.". I understand this is a huge problem. They need to aknowledge their problem and seek help and really commit to it on the long term.

If those people studied on those papers were borderlines who recognized their problem to the root, looked for help and really commited to it i would agree that such a high treatment sucess rate would be probable. But i guess those would be the minority.

The worst cases wouldnt be on that group that looked for help and was studied. Like my GF they would probably deny the problem, refuse to accept it, paint you black if you suggested it and even if they asked for help they would go there not being sincere to their therapeut about what the problem really was making it difficult for him to spot their disease.

Im merely speculating as i just read this article you linked and haven't read the bibliography yet. But its a plausible (i think) possibility i put here. Maybe those were the borderlines more prone to reabilitation.

Thanks for sharing the link you all were debating.

[Skip]

If those people studied on those papers were borderlines who recognized their problem to the root, looked for help and really committed to it i would agree that such a high treatment success rate would be probable.

Wasn't anything like this.  

These were 290 people that had a crisis/meltdown large enough to end up at McLeans Hospital in Boston. They might have been brought there by police after attempting a suicide or brought in by a family members because they were melting down, etc.  Where they went after that fateful night was random and not controlled.

This was not a study of a regimen of  therapy or of dedicated individuals.  

She lacked insight... .And it's horrible not to have insight for a disease she had, that hurted her and the ones closest to her so badly.

There are other mental disorders which give the person affected a lack of insight. If this lack of insight is bypassed i agree there must be an extremely high percentage of borderlines on the way to their cure.

We talk about anosognosia, abnegation, and minimisation here and we have a good video of how to approach a person in denial:

https://bpdfamily.com/content/how-to-get-borderline-into-therapy

[Junknown]

If those people studied on those papers were borderlines who recognized their problem to the root, looked for help and really committed to it i would agree that such a high treatment success rate would be probable.

Wasn't anything like this.  

These were 290 people that had a crisis/meltdown large enough to end up at McLeans Hospital in Boston. They might have been brought there by police after attempting a suicide or brought in by a family members because they were melting down, etc.  Where they went after that fateful night was random and not controlled.

This was not a study of a regimen of  therapy or of dedicated individuals.  

She lacked insight... .And it's horrible not to have insight for a disease she had, that hurted her and the ones closest to her so badly.

There are other mental disorders which give the person affected a lack of insight. If this lack of insight is bypassed i agree there must be an extremely high percentage of borderlines on the way to their cure.

We talk about anosognosia, abnegation, and minimisation here and we have a good video of how to approach a person in denial:

https://bpdfamily.com/content/how-to-get-borderline-into-therapy

In that case those are quite surprising results, as its a really high success rate. Im surprised they got so favorable results on that study as the mental health professionals i contacted with so far had such a negative view on the prognosis of this personality disease. Ill read the whole study as this seems quite interesting. Thanks for sharing.

[Junknown]

Finished reading it. Its an interesting study that seems to have obtained some quite interesting results. They explain well the tools used for assessment, the sample size, points of measurement and their results.

I just didnt find very elucidative the kind of intervention on these patients. It seems they didnt use a protocol of some sort on their treatment or did they? I dont understand if this institution has some sort of standard of care on the treatment of those patients or if the treatment plan is left to the criteria of the professionals who work there. Just found there a reference about the percentage of patients on psychoterapy and or medication after six years (70%). They also dont specify the kind of psychoterapy applied to them (i guess it probably was dbt but no reference there).

If they got these results with a study where they simply measured the end points with follow up using the standard of care provided by the mental health professionals on that institution i wonder what a more structured intervention couldnt do.

I just question if this study couldnt be prone to biases as the patients at the beginning and six year measure point fill out a self report. As we discussed above they lack insight. And use psychological tools to defend theirselves by denying their disease. If they get to a point in time where they feel "better", they could mask their disease by denying some symptoms that would constitute the core of the disorder. I guess they should also interview their closest relatives to try to get over this possible bias. Im sure if, for example, they were evaluating my girlfriend and they asked me or my GFs husband about some of her behaviours it would be totally different than just interviewing my GF and applying some measurement tools to her. Dunno about the reliability of the tools used tough and if they already have some sort of counter measure for a bias of this kind.

[Skip]

I just question if this study couldnt be prone to biases as the patients at the beginning and six year measure point fill out a self report. As we discussed above they lack insight.

This type of questionnaire has to be demonstrated as reproachable when compared to a face to face interview and history.  They do comparative check studies to rove reproducibility.

[antonio1213]

My T told me that there is nothing that can be done about BPD and that the pwBPD never change, stay the same, never get better, and she really emphasized this. And she has worked with BPD for 20+ years. And on the other hand some pretty reliable sources on the web say that people with BPD normally don't meet all the symptoms within 2 years of being diagnosed. And paints a much more optimistic picture for BPD sufferers.

So which is true?

And for the Nature vs Nurture argument here is why I am confused. My mother is a suspected BPD and had a terrible childhood with a drunk abusive father. And she is very BPD. My exBPDgf is relatively young but she said that she had, in her words "always been a b**ch and emotional" ever since she was tiny. But she also had a abusive childhood too. And her father has problems too. So it seems like BPD is based off of both and not just one.

[enlighten me]

In the majority of cases I would say nature is the underlying factor. Depending on the severity of the genetic side depends on how large a trigger is needed to set it off. If they have a severe genetic predisposition then something as minor as the parents having another child can trigger their abandonment fears. If they are genetically predisposed but not as severe then a more severe trama can kick it off.

I do also believe that due to nurture someone can develop BPD as being in a prolonged abusive situation can rewire the brain into a BPD brain.

There is no real evidence of hoa a pwBPD's brain develops as you would have to have scans from birth to show if the abnormality was present at this time. Brain scans of pwBPD do show there is a difference.

[Tim300]

There are some nature versus nurture threads on here.  I think it's nature.  

Regarding recovery from BPD, I lean heavily towards the viewpoint of your T.  This is based on (1) my experience in dealing with a couple pwBPD, (2) my understanding of how the disorder works, and (3) all the BPD stories I've read.  

I haven't seen these 2-year studies.  I've read about the 10-year study, which noted that half of observed patients did not display symptoms after 10 years.  There are some significant potential shortcomings with any such studies.  For example, consider how high the percentage on non-recovered pwBPD there is (50%!); consider that the pwBPD in the study were open to acknowledging their illness and trying to change (which is not so for all pwBPD); consider that the study likely relies on observable measures like suicide attempts and cutting, but that other symptoms of BPD would be much more difficult to measure.

I suspect that DBT could at times marginally help in low-stakes/low-stress situations for a pwBPD, perhaps in fleeting moments of self awareness (this is how DBT seemed to help my BPDex-fiancee).  I would not bank on DBT actually preventing the self sabotaging of an engagement, marriage, etc.    

[BPDTransformation]

Hi Antonio,

First of all I'm very surprised that an experienced therapist would say people with BPD cannot change or get better. That is a pretty ridiculous, overgeneralized statement if you think about it, to say that a whole class of people cannot change or get better.

In my opinion and based on a couple of people I've known, borderlines can definitely recover and get better, if they are willing to seek help, which a good number are. If you'd like to read some good case studies, you could check out books by authors like Jeffrey Seinfeld (The Bad Object) or Helen Albanese (The Difficult Borderline Patient - Not So Difficult To Treat) or Donald Roberts (Another Chance to be Real). I got these books used and read them when I wanted to get a sense of how long-term therapy could work for a borderline individual, when they are willing to seek treatment.

My T told me that there is nothing that can be done about BPD and that the pwBPD never change, stay the same, never get better, and she really emphasized this. And she has worked with BPD for 20+ years. And on the other hand some pretty reliable sources on the web say that people with BPD normally don't meet all the symptoms within 2 years of being diagnosed. And paints a much more optimistic picture for BPD sufferers.

Regarding nature or nurture, the way the question is asked really makes it impossible to answer. The dynamic interaction between the internal and external world of a person are so complex that the proportion of contribution from each really can't be measured meaningfully. Matt Ridley wrote well about this in "Nature Via Nurture" and Evelyn Fox Keller wrote a beautiful little book about the distortions around this issue, in her book "The Mirage of a Space Between Nurture and Nature."

Nevertheless, if I had to answer this question, I would say that nurture and life experience is far more important than nature, in most cases. Of course, both nature/nurture contribute in every case, in the sense that every person has a level of vulnerability to stress that can be set off by sufficient traumatic or neglectful experience. But, that is different than BPD being caused by genes, which there is as yet no convincing evidence for, despite many years of research. That may relate to how BPD itself is not a reliable construct, being subjective and based on descriptive observations, rather than physical evidence.

The Bad Object: Handling the Negative Therapeutic Reaction in Psychotherapy

By Jeffrey Seinfeld

The Difficult Borderline Personality Patient Not So Difficult to Treat ... .

By Helen Albanese

The Mirage of a Space Between Nurture and Nature.

Evelyn Fox Keller

Nature Via Nurture

Matt Ridley

Another Chance to be Real

Donald Roberts

[Skip]

I got these books used and read them when I wanted to get a sense of how long-term therapy could work for a borderline individual, when they are willing to seek treatment.

What did you learn?

[Reforming]

I think it's fair to say that historically many therapists have struggled to treat BPD.

However over the last twenty years it seems that  newer therapies, DBT, Schema and Compassion have proved much more effective at treating the disorder.

it's still worth considering what is defined as a successful outcome. Someone may no longer exhibit the required number of traits to be diagnosed as Borderline, but they can still struggle with intimacy - the primary trigger of the disorder - and this is bound to have a pretty profound effect on their romantic relationships

They've also missed out on years of emotional development which present another challenge.

I also think many if not most BPDs avoid getting help - one of the posters here described it as a disorder defined by denial.

The ones who get help are at least willing to acknowledge the problem but I wonder what is the real percentage of BPDs out there who actually diagnosed and treated.

If you are in a relationship with a BPD who is willing and committed to getting the right treatment it's still seems to be an incredibly challenging and difficult process without any guarantee that they will still want to be with you at the end.

And to have any real chance of success both of you need to change so you need to be willing work on yourself as well.

Some of the traits that drew you to them are shaped by their disorder and you may find yourself with a very different person who wants to be with someone different too

There some members here who have worked through this successfully but from what I've read it took huge amount of courage, effort and commitment from both partners.

As far as the nature v nurture debate goes I believe that the truth is somewhere in the middle. There seems to be a very high incidence of childhood abuse in many of those suffering from BPD

BPD, Adverse childhood experiences

There is a strong correlation between child abuse, especially child sexual abuse, and development of BPD. Many individuals with BPD report a history of abuse and neglect as young children.Patients with BPD have been found to be significantly more likely to report having been verbally, emotionally, physically or sexually abused by caregivers of either gender. They also report a high incidence of incest and loss of caregivers in early childhood.

Individuals with BPD were also likely to report having caregivers of all sexes deny the validity of their thoughts and feelings. Caregivers were also reported to have failed to provide needed protection and to have neglected their child's physical care. Parents of all sexes were typically reported to have withdrawn from the child emotionally, and to have treated the child inconsistently. Additionally, women with BPD who reported a previous history of neglect by a female caregiver and abuse by a male caregiver were significantly more likely to report experiencing sexual abuse by a non-caregiver.

It has been suggested that children who experience chronic early maltreatment and attachment difficulties may go on to develop borderline personality disorder."

www.en.wikipedia.org/wiki/Borderline_personality_disorder

According to Jeffrey Young - the inventor of Schema Therapy which was primarily developed to treated PDs - 70% of those he treated with BPD had suffered childhood abuse but he also noted marked lability of temperament which probably has a genetic cause.

Wiki "Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood)[1] or mood swings."

www.en.wikipedia.org/wiki/Emotional_dysregulation

I think it seems reasonable that those with a genetic disposition towards emotional volatility are more vulnerable to the disorder, but nurture certainly plays a big part.

I'd recommend reading up about the disorder as well as reading the posts of those who chose to stay

Good luck

Reforming

[BPDTransformation]

Hi Skip et al,

First let me say I read through the whole thread now and like a lot of the thoughtful responses.

My approach from reading these books is not scientific and can be considered opinion. But, over the years I've read many books which each include several long case studies of people diagnosed with BPD. Some other examples would be James Masterson (Treatment of the Borderline Adult), Gerald Adler (Borderline Psychopathology and Its Treatment), Jeffrey Seinfeld (The Bad Object - this one has the best case studies, IMO), Vamik Volkan (Six Steps in the Treatment of Borderline Personality Organization), Peter Giovacchini (Borderline Patients, The Psychosomatic Focus, and the Therapeutic Process), David Celani (The Treatment of the Borderline Patient), and the books by Helen Albanese and David Roberts already mentioned.

These writers are in the psychodynamic camp of psychotherapy. They have worked a lot with borderlines, and they are realistic and pragmatic about how difficult therapy can be and how long the process can take. But they are also mostly optimistic, that if the person is willing to seek help and has the resources, outcome can be very good. I like their writing because there are many case studies, often about 10-20 pages long, where you get an individual borderline's full life-history, details on the course of treatment, analysis of their functioning socially and in work toward the end of treatment, and you really get a feel for the "borderline" as a person (in these books alone, there would be several dozen of these cases). Since these cases usually involve borderlines being in therapy for several years, it's hard to study things scientifically as with shorter term treatment. But, these writers have many cases which show borderlines, both lower and higher level, improving to the point that they are no longer remotely diagnosable as BPD - they often come to have good relationships, to stop being difficult and manipulative, to be able to regulate their mood pretty normally, to function well, etc. In medical language, they are cured, or in normal language, recovered and well.

I also know that this is possible (at least in my experience) because I was once borderline myself, but am not any longer. I went to intensive therapy for 6 years to get better, and I function and feel much better now than I used to, have better relationships, and am no longer manipulative or difficult to around (most of the time!). I have two friends who have severe BPD symptoms and who I try to help (and they found me because they were looking for help), and that's why I sometimes come onto online forums like this, to see what people are saying about the condition. I still feel there's a lot of misinformation out there, and a lot of pessimism that is unwarranted (in my opinion), although in some cases, yes the person is not willing to get help or acknowledge the problem, and at that time nothing can be done. But for BPD people who want help, I certainly would say the condition is fully curable, although those are overly medicalized terms. In the way I think about it, a borderline can gradually emotionally "grow up" and become an adult in an adult's body, rather than a child in an adult's body.

[Reforming]

Hi BPDTransformation

I don't know your circumstances, but from what you've said you deserve huge credit and respect for what you have achieved.

I think it takes great courage and effort to face up to a disorder like BPD and really work to overcome it.

Speaking for myself, and I think there are others here who have similar experience, being in a relationship with a suspected but undiagnosed BPD partner exposed my own issues and weaknesses and ultimately made me realise that I need to work on myself.

Over time I've come to realise how difficult it can be to take responsibility for my behaviour and do the work on changing myself.

Change is not impossible, but it's hard and frustratingly slow at times

I cannot really imagine how difficult it must be to live with a disorder like BPD, but I do feel real sympathy for sufferers.

i do have some experience of how devastating it can be for partners and family members and I think one of the things which makes it so heartbreaking is it is often untreated, whether through inaccurate diagnosis or resistance from sufferers to getting and persisting with an appropriate therapy.

I think the new therapies offer more hope because they have a lower fall out rate and they seem to be more effective over shorter time scales, though Young reckons that it takes 2-3 years of schema therapy to treat the disorder and also suggests that some patients may need to continue therapy for longer

As you're probably aware this site is a resource for partners and families so you'll probably read posts that you may find distressing

I would also say that I think one of BPD Family's greatest strengths is the objectivity and quality of it's information and resources. I think it works very hard to educate its members about BPD and avoiding stigmatising the disorder.

Reforming