TREATMENT: Cures and remission?

[BPDFamily.com]

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.

[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.

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[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

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[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