I (virtually) attended the Yale - NEABPD conference on PTSD and BPD on May 4.
If you are interested in seeing the program of events, here is a link:
https://medicine.yale.edu/psychiatry/education/conferences/bpdconference/program/I was asked to share my impressions. Overall, I'm glad I participated, although if the organizers were to ask me for feedback, I would say that not enough of the professional presenters spoke specifically about BPD, and of the 3 that did, 2 of those had a very narrow focus and a broader focus might help more people. Also, all of the speakers were researchers. I would like to have heard from practitioners actively treating BPD patients, and I would also like to have seen a presentation on DBT. Since DBT has absolutely revolutionized treatment and outcomes for BPD, and this conference didn’t have one, to me that was a significant gap.
The presentation that I found most relevant to my own personal situation was given by Judith Herman, MD, about the causal relationship between Complex PTSD and BPD. I understand that she conducted the first study that linked CPTSD to BPD. She has written several books, so if this topic interests you, you might check them out. I didn't know the difference: complex PTSD is repeated and/or sustained trauma, such as child abuse, as opposed to one incident of trauma, like a plane crash, which would be (non-complex) PTSD. I understood her to say that a study released in 1989 found that 81% of individuals diagnosed with BPD have suffered complex PTSD, and all other psychiatric disorders "didn't even come close" to that. My understanding is that BPD can result when one or more of the following are present for an individual: (1)genetic vulnerability to stress, (2)poor quality of attachment with caregiver in early childhood (ie, the caregiver didn't respond to the child's needs consistently and/or sufficiently), and/or (3)trauma, especially prolonged or repeated trauma. This rang true for me in that my daughter, who is dx with BPD, was repeatedly subjected to long-lasting and intense incidents of rage and shaming directed solely at her as a child and teen by her both her father and stepmother (together, ganging up on her at the same time). I was not just imagining that this was life-changingly harmful to my kid; even her child psychologist, who I now see did not intervene enough, told us and both our lawyers that it was not safe for her to go to her dad's home unless he and his wife agreed to and complied with a safety plan devised by the psychologist. However, I feel like that psychologist didn't familiarize herself well enough with the effects of trauma on children, because she never got blunt and direct with my child's father. She never said, E**** is being traumatized and this has to stop right now. She never said, it is harmful to this child to spend time with the father without another adult there to keep it from being traumatic for the child. And because of that, my efforts to restrict his possession went nowhere in the ignorant, understaffed, Texas family courts. Even before therapists started telling me she had suffered trauma (recently), I could see my daughter was flashing back to those experiences of being ganged up on by her dad and stepmother when she was triggered by something in the present that reminded her of it (even if not discernably similar), so I knew it! And now that I have finally found a great psychiatrist and therapist (it took YEARS and 2 misdiagnoses), they and my own therapist all say that trauma is almost always the cause of BPD. (Why didn't my child's CHILD psychologist recognize the severity of the harm being done to my child?) Back to the presentation: Dr. Herman clarified that this sustained trauma that can cause BPD is always a terrifying situation in which the child is helpless and feels trapped. Dr Herman also talked about a coercive-control relationship usually being present during childhood development for most people that are dx with BPD. She noted that it is often made worse by later coercive control relationships chosen by the individual that suffers from BPD. (we choose what we know. argh.) She emphasized how very much BPD sufferers need relationships that are based on mutuality, ie, that are respectful, equal and have no violent actions or speech, as these are relationships that heal. (My experience in life is that we all need this!) I see this with my daughter, as she has chosen a partner with whom she has a very unequal relationship. Her partner is always in control and blames my daughter for everything, even when it is not her fault (it's so easy to do when a person has acted out a lot - they become the scapegoat for everything, even when it is not justified) and she does not respect her wishes or feelings. Granted, my daughter's feelings can be overwhelming and considered abnormal at times, but not always, and all people deserve respect. But I have always known she deserved respect, even if she was hard to be with and manage, and she always deserved love, and always deserved mutuality (as in: when i make a mistake, i have to own up to it and make it right if i expect her to ever do that). And so I realized I have the power to help her heal by continuing to give these things to her consistently while she lives with me, even if she isn't getting that from other relationships. This realization was very meaningful and encouraging to me, and I have been feeling feel very worn down and discouraged, so thank you Dr. Herman. She also mentioned a landmark European study about DBT that was published in 2020 and that the results were outstanding, so I intend to look that up. I finally found a DBT group my daughter is comfortable with, and she is starting to participate some, but the thought has crossed my mind, if DBT is what can "cure" BPD, does she still need individual therapy? (although I would never say it out loud, LOL) and Dr. Herman at one point mentioned how important it is that BPD patients be in individual therapy so they can talk about & work out their trauma. She also mentioned how powerful groups are - I understood her to say that in group therapy, the individuals validate each other and feel and express compassion for each other, and this is very powerful to resolve shame.
There were two "lived experience" speakers. I appreciated their courage in sharing their personal stories.
The other two presentations that I found most fascinating and powerful were not about BPD, but were about trauma and race in the US.
Jennifer Gomez, PhD shared her research about the trauma induced by cultural betrayal, in which individuals in a marginalized community are victimized by other members of that marginalized community, who were supposed to be the people that could be most trusted because the society at large had rejected and holds significant prejudice against that community - so other members of the community should be and are thought to be the safe harbor. She spoke about how this trauma is especially profound, as it adds to and exacerbates the trauma that comes from being a minority/being invalidated (and worse) by society at large. She explored the complexities of all of this as well as how the white-biased mental health provider community and research affects black people. Since she didn’t speak specifically about BPD, I won't share all my notes from this presentation, but she wrote a book, "The Cultural Betrayal of Black Women and Girls" (Jennifer Gomez, PhD.) If she writes like she presents, it will be an excellent book, full of data and insight. There were some very good questions from practitioners at the end about white therapists working with black clients. Dr. Gomez gave answers that I thought were very insightful and useful (although I’m not a therapist).
Nathalie Edmond, PsyD is the author of "Race in the Therapy Room." In addition to exploring the effect of race disparity in therapy, she pointed out that trauma residual remains in the body. She conducted a brief mindfulness exercise and noted that we need to be attentive of what the body is telling us because somatic sensations affect how we organize our experience. This helped me understand that the mindfulness practices are probably one of the reasons that DBT is so much more effective for BPD than other methodologies. She also posited that the effects of trauma can be passed on for 14 generations and pointed out that culture can be an adaptation to severe trauma, as can personality. I never realized how color-blind therapy must be (I’m white) until I heard these two researchers’ presentations. And color-blindness, it seems to me, actually means solely based on white peoples’ viewpoint or experience of the world…. not useful when researching or trying to understand or treating individuals from a BIPOC community. Unfortunately there wasn't a Q&A after Dr. Edmond's presentation, and I'm sure there were therapists in the room that wanted to pick her brain since she was specifically addressing race and therapy, and therapists had asked questions about race at the end of Dr. Gomez' presentation.
The other two speakers were researchers on BPD, and their areas of study were marriage and motherhood. I picked up one tidbit that I will remember: in a study group of mothers with BPD that had received DBT, when their children’s mental health was evaluated, it turned out to be about the same as the study control group. For me this was very hopeful to hear, because my daughter thinks she wants to have children someday.
Well that’s probably a lot more than you ever wanted to know!
Keep learning and growing!
