TREATMENT: Cures and Recovery

[BPDFamily.com]

There are numerous studies out there.  Here a few;

The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder

Mary C. Zanarini, Ed.D., Frances R. Frankenburg, M.D., John Hennen, Ph.D., and Kenneth R. Silk, M.D.

Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up. Only 5.9% of those with remissions experienced recurrences.


Progress in the treatment of borderline personality disorder

PETER FONAGY, PhD, FBA

University College London and The Anna Freud Centre, London

After 6 years, 75% of patients diagnosed with borderline personality disorder severe enough to require hospitalization, achieve remission by standardized diagnostic criteria.  Recurrences are rare, perhaps no more than 10% over 6 years.

Effectiveness of Psychotherapy for Personality Disorders

J. Christopher Perry, M.P.H., M.D., Elisabeth Banon, M.D., and Floriana Ianni, M.D.

All studies reported improvement in personality disorders with psychotherapy. The mean pre-post effect sizes within treatments were large: 1.11 for self-report measures and 1.29 for observational measures. Among the three randomized, controlled treatment trials, active psychotherapy was more effective than no treatment according to self-report measures. In four studies, a mean of 52% of patients remaining in therapy recovered—defined as no longer meeting the full criteria for personality disorder—after a mean of 1.3 years of treatment. A heuristic model based on these findings estimated that 25.8% of personality disorder patients recovered per year of therapy, a rate sevenfold larger than that in a published model of the natural history of borderline personality disorder (3.7% recovered per year, with recovery of 50% of patients requiring 10.5 years of naturalistic follow-up).

[Skip]

There are numerous studies out there.  Here a few;

The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder

Mary C. Zanarini, Ed.D., Frances R. Frankenburg, M.D., John Hennen, Ph.D., and Kenneth R. Silk, M.D.

Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up. Only 5.9% of those with remissions experienced recurrences.


Progress in the treatment of borderline personality disorder

PETER FONAGY, PhD, FBA

University College London and The Anna Freud Centre, London

After 6 years, 75% of patients diagnosed with borderline personality disorder severe enough to require hospitalization, achieve remission by standardized diagnostic criteria.  Recurrences are rare, perhaps no more than 10% over 6 years.

Effectiveness of Psychotherapy for Personality Disorders

J. Christopher Perry, M.P.H., M.D., Elisabeth Banon, M.D., and Floriana Ianni, M.D.

All studies reported improvement in personality disorders with psychotherapy. The mean pre-post effect sizes within treatments were large: 1.11 for self-report measures and 1.29 for observational measures. Among the three randomized, controlled treatment trials, active psychotherapy was more effective than no treatment according to self-report measures. In four studies, a mean of 52% of patients remaining in therapy recovered—defined as no longer meeting the full criteria for personality disorder—after a mean of 1.3 years of treatment. A heuristic model based on these findings estimated that 25.8% of personality disorder patients recovered per year of therapy, a rate sevenfold larger than that in a published model of the natural history of borderline personality disorder (3.7% recovered per year, with recovery of 50% of patients requiring 10.5 years of naturalistic follow-up).

[SunflowerFields]

Skip, that was very helpful, thank you. I found all three, downloaded, and skimmed through them (will read in detail later on). From the first glance, they don't appear to include the breakdown by age, gender, etc. Are you aware of studies that reveal "demographics" on those recovered, as well as those not?

For example: Is someone who is 50 less likely to recover than someone who is 30? Does the substance abuse history matter? Does gender matter? What is the difference between success rates for DBT vs CBT?

[officer1618]

But my question is... .what percent of pwBPD get this help? My money is on not many. What's the drop out rate even if they do start therapy?

[TheSomberlain]

But my question is... .what percent of pwBPD get this help? My money is on not many. What's the drop out rate even if they do start therapy?

Now that is the real question. Look at how many of us have undiagnosed BPDs. For one to not be so narcissistic or stuck in their own ways enough to even admit to going to therapy would seem rare to me. It would appear those would be the higher functioning BPDs or those that barely meet the criteria with less co-morbidity.

[Skip]

For one to not be so narcissistic or stuck in their own ways enough to even admit to going to therapy would seem rare to me. It would appear those would be the higher functioning BPDs or those that barely meet the criteria with less co-morbidity.

Aren't there really only two important points. 

(1) If our ex-partners got into treatment and engaged that there is hope but that didn't happen on our watch (for whatever reason). 

(2) 74% of us are depressed and if got we got into treatment and engaged that the recover rate and treatment time is significantly shorter, but many of us are not seeking treatment - for whatever reason - can't afford it - don't believe in the medications - don't have time - are not motivated.

It is true - the best therapies on earth ate useless unless the people that need them are willing to engage them.

[SunflowerFields]

Aren't there really only two important points.  

(1) If our ex-partners got into treatment and engaged that there is hope but that didn't happen on our watch (for whatever reason).  

(2) 74% of us are depressed and if got we got into treatment and engaged that the recover rate and treatment time is significantly shorter, but many of us are not seeking treatment - for whatever reason - can't afford it - don't believe in the medications - don't have time - are not motivated.

It is true - the best therapies on earth ate useless unless the people that need them are willing to engage them.

It is (1) that is giving me the most grief - my ex did get diagnosed on my watch - as a result of depression and high emotional stress experienced due to US. The diagnosis happened in December. But... .3 years of mounting stresses, things getting even more worse for him, my not being willing to live with more lies and setting more boundaries didn't exactly give us the perfect time to benefit from years of therapy. We broke up by February. I cannot help but wonder... .what if I waited... .what if I had stuck somehow... .

[Skip]

I cannot help but wonder... .what if I waited... .what if I had stuck somehow... .

This is one of the top reasons members of the leaving/detaching board gravitate more toward a pessimistic view of BPD and people with BPD than say partners working on it or parents... .because it is hard to deal with the "what if".

Recovery often requires someone in the life of the pwBPD that they trust as unconditionally loving them - not a pus - but someone that has that trust.

When our relationship cratered, most likely a lot of damage was done - it would not be likely we could fill this role - or be seen as the person of trust by the pwBPD.

If I had known what I know now before the relationship started, I could have handled it much better.  But, if I had know it was BPD, I probably would have exited.

I only say this to point out that a lot of things have to align to make it work.  We have members that have done that. 

I know that I have skills now for the next relationship - and they are good skills -  and that is where I am focused.   

[Skip]

Most of us will never be so lucky to get our BPD hospitalized.

You're past the point of this being relevant, right?  How to get a BPD partner into treatment is really a topic for the Staying board.

[SunflowerFields]

Recovery often requires someone in the life of the pwBPD that they trust as unconditionally loving them - not a pus - but someone that has that trust.

Are you sure about this? Do they ever really trust someone unconditionally?

[united for now]

One of the most painful (and difficult) facts to accept - that "our" response typically enables the pwBPD to stay sick and not seek treatment.

~ Our walking on eggshells gives them a false view of life.

~ Our weak boundaries gives them a false belief that they have control and power over others.

~ Our inability to take care of ourselves (our sacrifices for love) feeds the spoiled inner child in them.

~ Our tendency to focus on them and their needs ensures that our own issues stay buried.

~ Our perpetual forgiveness after they hurt us sends the message that it is OK for them to hurt us.

~ Since their unhealthy ways of coping (emotional blackmail, raging, playing the victim/waif, etc) work, they continue to use them.


Everything in life has a action - reaction - action - reaction cycle to it. Nothing happens in a vacuum. When we change our reactions to their dysfunctional ways of behaving we are breaking our end of the cycle, thus forcing them to respond in different ways.  

The perception that age makes things worse is because like a spoiled child without rules or boundaries, it's easy to lose track of what's appropriate and what's not.

We teach people how to treat us by the behavior we accept from them

[sixspeed]

One of the most painful (and difficult) facts to accept - that "our" response typically enables the pwBPD to stay sick and not seek treatment.

~ Our perpetual forgiveness after they hurt us sends the message that it is OK for them to hurt us.

~ Since their unhealthy ways of coping (emotional blackmail, raging, playing the victim/waif, etc) work, they continue to use them.

We teach people how to treat us by the behavior we accept from them

Well written;

Yes this was 100% my side of the equation, I had no idea what sort of cycle I was working with until after our last split (finding this resource)


Sometimes it appeared  we were making communication progress after I was setting a boundary, we made a plan to avoid the conflict we both agreed on but when she would steer back into that behavior and not respect our plan of action my response would be based upon frustration (doesn't this girl respect me, we had an understanding!),  we'd have a fight (by email) then I would suggest a break, then  she would use a waif/victim/sexual promises tactics to lure me back in and my biggest mistake was to think the coast was clear then and not stick to enforcing the boundary and plan, I was expecting her to be a full adult partner and honor our arrangements for my part my angry responses to her breaking the deals (pulling myself away) activated her victimization.

The hardest thing to admit about myself and now try to correct in me is that because she often used sex as the conflict point and also the lure back (which was usually unfulfilled), I acted like a textbook male stereotype and blindly enforced bad behavior. Why, because I was afraid I wouldn't get the intimacy I wanted with her, motivated by personal desire and not the best interests of us both.




So you say "We teach people how to treat us by the behavior we accept from them"

Yes, we also teach them how we can be manipulated.

I think I could have had different not guaranteed success but better results if I followed these thoughts you've outlined.

[Skip]

Sometimes it appeared  we were making communication progress after I was setting a boundary, we made a plan to avoid the conflict we both agreed on but when she would steer back into that behavior and not respect our plan of action my response would be based upon frustration (doesn't this girl respect me, we had an understanding!),  we'd have a fight (by email) then I would... .

This is a not an uncommon problem in many marriages when the relationships is breaking down.  

Have you seen the "four horsemen" article on our blog:

Predictable Patterns of Marriage Breakdown

Mark Dombeck, Ph.D.

Source: www.mentalhelp.net/poc/view_doc.php?type=doc&id=9457&cn=289

According to Mark Dombeck, Ph.D., Director of Mental Help Net and former Assistant Professor of Psychology at Idaho State University, there is no single reason why a relationship begins to break down. However, once a relationship does start to break down, there is a predictable sequence of events that tends to occur. Highly regarded psychologist and researcher John Gottman, Ph.D. suggests that there are four stages to this sequence which he has labeled, "The Four Horsemen Of the Apocalypse".

Stage One The first stage of the breakdown process involves intractable conflict and complaints. All couples have conflicts from time to time, but some couples are able to resolve those conflicts successfully or 'agree to disagree', while others find that they are not. As we observed earlier, it is not the number or intensity of arguments that is problematic but rather whether or not resolution of those arguments is likely or possible. Couples that get into trouble find themselves in conflicts that they cannot resolve or compromise upon to both party's satisfaction. Such disagreements can be caused by any number of reasons, but might involve a clash of spousal values on core topics such as whether to have children, or how to handle money.

Frequently, couples assume that misunderstandings are at the root of their conflicts. "If my spouse really understood why I act as I do, he or she would agree with me and go along with what I want", is a commonly overheard refrain. Acting on this belief, spouses often try to resolve their conflicts by repeatedly stating and restating their respective rationals during disagreements. This strategy of repetition usually doesn't work because most of the time couple conflicts are not based on misunderstandings, but rather on real differences in values. When this is the case, stating and restating one's position is based on a mistaken premise and can only cause further upset.

Stage Two In the second stage of the breakdown process, one or both spouses starts to feel contempt for the other, and each spouse's attitudes about their partner change for the worse. For example, initially each spouse may have mostly positive regard for their partner and be willing to write off any 'bad' or 'stupid' behavior their partner acts out as a transient, uncommon stress-related event. However, as 'bad' or 'stupid' behavior is observed again and again, spouses get frustrated, start to regard their partner as actually being a 'bad' or 'stupid' person, and begin to treat their partner accordingly. Importantly, the 'bad' behavior that the spouse demonstrates doesn't have to be something he or she actually does. Instead, it could be something that he or she doesn't do, that the spouse expects them to do (such as remembering to put the toilet seat down after use).

Conflict by itself doesn't predict marriage problems. Some couples fight a lot but somehow never manage to lose respect for each other. Once contempt sets in, however, the marriage is on shaky ground. Feelings of contempt for one's spouse are a powerful predictor of relationship breakdown, no matter how subtlety they are displayed. In a famous study, Gottman was able to predict with over 80% accuracy the future divorces of multiple couples he and his team observed based on subtle body language cues suggesting contemptuous feelings (such as dismissive eye-rolling). Contempt doesn't have to be expressed openly for it to be hard at work rotting the foundations of one's relationship.

Stage Three Most people find conflict and contempt to be stressful and react to such conditions by entering the third stage of breakdown, characterized by partner's increasingly defensive behavior. Men in particular (but women too) become hardened by the chronicity of the ongoing conflict, and may react even more acutely during moments when conflict is most heated by becoming overwhelmed and "flooded"; a condition which is psychologically and emotionally quite painful. Over time, partners learn to expect that they are 'gridlocked'; that they cannot resolve their differences, and that any attempts at resolution will result in further overwhelm, hurt or disappointment.

Stage Four Rather than face the pain and overwhelm they expect to experience, partners who have reached this third 'defensive' stage, may progress to the forth and final stage of breakdown, characterized by a breakdown of basic trust between the partners, and increasing disengagement in the name of self-protection. Like a steam-valve in a pressure cooker, the partners start avoiding one another so as to minimize their conflicts. Gottman calls this final stage, "Stonewalling", perhaps after the image of a partner hiding behind a stone wall designed to protect him or her from further assault. Unfortunately, there is no way to love your partner when you are hiding behind a wall to protect yourself from him or her.

The "four horsemen" breakdown sequence plays out amongst the backdrop of partner compatibility. Basically compatible partners may demonstrate a whole lot of conflict, but they don't often become contemptuous and angry with their partners, because there are by definition few things that they will disagree upon. In contrast, partners who start out with incompatible goals, values or dreams are far more likely to get into seemingly irresolvable conflicts. Also, once the process of contempt, defensiveness and avoidance begins, small incompatibilities can become magnified as spouses pursue other interests as an alternative to conflict.

[sixspeed]

This is a not an uncommon problem in many marriages when the relationships is breaking down.  

I hadn't seen the article thank you. I don't feel like it was contempt as described here though. I've certainly experienced those stages in the non relationships I've had. This was a different sort of feeling, like the key components, goals, values were there but an inability to execute on discussed and agreed upon resolutions.

[sixspeed]

Great post, United. I think we have all experienced what happens when we change reactions, expectations, and boundaries on our end. The problem becomes, the more we begin to enforce them, the worse it gets - and if we ensist on complete enforcement and complete stop of taking BS from them, they often can't take it.

That was my experience at the end too SunflowerFrields, I called out the boundary violations and how it hurt me very calmly, the return was "When I get what I want, you'll get what you want". Unfortunately her demand was a whole leap in return for the step I was requesting (to me at least). I think scale can be a factor, working toward a goal in small steps can trigger if there is expectation it's certainly against the impulsive nature on big decisions mine displayed (like marriage/kids).

That sort of reaction of "When I get what I want, you'll get what you want", makes the relationship seem all about ends to means rather a mutual journey.

I think only a therapist could step in as a third party to resolve this sort of battle of will and restore self & mutual respect. My pwBPD could outmanuever me emotionally anytime just like I could to her rationally, very different channels.

[Whatwasthat]

Hi there

Forgive me if I am asking questions which have been covered elsewhere - and do feel free to point me to older threads - but I am curious to know if anyone has any practical or theoretical knowledge of the comparative benefits of contrasting therapeutic approaches to PDs. I had a brief relationship with a man with PD traits last year but also believe that I may have a family member who is dealing with this issue - that's where my own interest comes from.

I have read a little about DBT and my own limited understanding of it suggests that it is a form of 'deep CBT' - a kind of mental and emotional retraining that allows the brain to step in and check unhelpful emotional responses when they are triggered. But it also seems as if it works on quite a profound level and can help people learn to understand the negative emotional effects that their behaviours have on others.

I also have some acquaintance with long term analysis through the experiences of a friend. I gather that this is a process that requires multiple sessions each week - often for many years - and aims to help adults who may not have achieved full emotional development as children to actually unpick the 'false selves' that they have erected to protect their 'undeveloped' selves  - to relive their childhood emotions - and to slowly rebuild a stronger sense of adult self from that point.

I was then also musing on Buddhism. A philosophy which seems to encourage us all to let go of too strong a sense of 'self' and to engage rather in a wider 'universal' identity that goes beyond any sense of separateness.

I tend to believe that in most situations it's unwise to look for a 'one size fits all' solution to any problem. For example I gather there are as many 'ideal ways to teach literacy' as there are children in a class - we all have different 'learning styles'.

But I would be interested to know a bit more about how each of  these approaches (DBT, long term psychoanalysis and following Buddhism) have brought  help and relief to people suffering from a PD.

[patientandclear]

Thanks for kicking this off anew, WWT!

I would add to your questions: the issue of constructing a "self."  Buddhist approaches, on which aspects of DBT are modeled, seem to de-emphasize the self and the need to differentiate.  Whereas many analyses of BPD dysfunction emphasize the lack of a stable sense of self not derived from others; and when you read, e.g., The Buddha & the Borderline, it's clear that the recognition and building of a self that is generated from the inside & not borrowed from someone else is a key step toward the author's recovery (though she uses both DBT and Buddhist study).  Any thoughts on whether BPD recovery involves relinquishing the need for a separate self or defining one?  Or is there a third way?

[SeaCliff]

What do people here think of in regard to various ways for people with BPD and anxiety traits to best deal with their childhood traumas which may be the root cause of their unconscious fears today? What do you think of Hypnotherapy, ETF or EFT ("Emotional Tapping", and / or Neuro Linguistic Programming (NLP) options?

[lbjnltx]

Hello Troyman,

In regards to hypnotherapy... .  I did some research and read a book by a very successful hypnotherapist... .  wondering the same things for the pwBPD in my life.  The bottom line as I understand it... .  for hypnotherapy to work the patient must be willing and believe that the therapy will work.  If they do it with reluctance and faithlessly it won't be successful.

lbj

[SeaCliff]

Thanks, LBJ. Your points are quite valid. As with any treatment process chosen, the odds may be much higher if the patient believes it may work for them (aka "The Placebo Effect" since all forms of healing may begin first in the mind.

I have one more question in regard to this same topic:

If many top BPD specialists allege that childhood traumas (lack of bonding issues, emotional, physical, and / or sexual abuse, etc.) may be the true catalyst for a person's BPD traits later in life, then what percentage of people with ADMITTED BPD traits may truly recall their one or multiple childhood trauma events which impacted them so deeply at their core?

Obviously, we all repress conscious or unconscious childhood memories to varying degrees. I have yet to see a decent study on the percentage estimates of pwBPD traits who could clearly recall that their childhood traumas may be the true catalyst for their BPD traits as adults more so than their partner, children, parents, friends, co-workers, or others whom they "split" in present times. Are the figures closer to 25%, 50%, 75%, or higher?

[GeekyGirl]

If many top BPD specialists allege that childhood traumas (lack of bonding issues, emotional, physical, and / or sexual abuse, etc.) may be the true catalyst for a person's BPD traits later in life, then what percentage of people with ADMITTED BPD traits may truly recall their one or multiple childhood trauma events which impacted them so deeply at their core?

If I understand correctly, you're wondering how many people who have BPD traits can link them back to a definitive cause during their childhoods. Is that right? I haven't seen any studies, but I've seen many posts on the boards from children of BPD parents who can name many specific traumatic incidents that outline BPD behavior from their parents. It's more common for children of BPD parents to have BPD traits than to not have any BPD traits.

Keep in mind that even if people with BPD traits can recall single incidents where they were traumatized, for many of us who grew up with BPD parents, we were exposed to BPD behavior constantly. We may not have recognized this behavior as unusual. Some of us picked up these traits unknowingly as we grew up. It's possible that there was no single incident that brought on the BPD traits in us, but repeated and consistent BPD behavior.

I'm curious now--are you concerned about your sons' well-being?

[SeaCliff]

Thank you, Geeky Girl. You answered my question very well. I was wondering if a pwBPD traits today may recall their true childhood trauma event or events which deeply affected their Core Being even today as adults (i.e. one traumatizing abuse event, years of overwhelming anger and rage, etc.).

In regard to my own children, I have studied numerous ways to offset any anxious, controlling, blaming, or vindictive behaviors primarily to keep them healthy and happy.

Again, I help lead health support groups and my friends come to me for health advice on a weekly basis (which includes many friends with BPD and anxiety traits) as I have studied health topics in depth for well over 34 years. Since I am a lifelong "Bookworm" too who played lots of sports, I grew up reading lots of "Power of Positive Thinking" type books from people such as Norman Vincent Peale, Og Mandino, Dale Carnegie, Anthony Robbins (he uses a lot of NLP teachings), Dr. Wayne Dyer, and many others.

This positive mindset that obstacles are just temporary challenges which we either run over or around makes dealing with people with BPD traits so absolutely frustrating because I believe that ANYTHING may be cured or overcome by both our Immune System and our Mind. I know several terminal cancer patients who were cured back when their own Oncologists sent them home to die after they followed some of the natural health treatments which I base half of my diet on today for prevention and overall good health.

My Dad instilled in me as a very young boy to just "go for it, learn as I go, and that failure will just be a form of teaching for me" (or "I fail if I don't try something new" which is about the exact opposite of people with BPD traits.

Fortunately, I have yet to see any BPD traits with my children. Yet, I clearly see it in my ex's Family Tree. Ideally in a positive way, "For every action in life, there may be an equal and opposite reaction."

As I continually say and write quite often, we have but two core emotions in life - Love and Fear. All other feelings are just aspects of these two core emotions. Yet, Love is much more powerful than FEAR ("False Evidence Appearing Real".

Fear weakens us and zaps our energy while Love, in turn, energizes us to NEVER give up. Since we are primarily "Energy Beings" at our true core, then bet on the people motivated by the more energizing Love to prevail one way or another.

[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).

[IfOnlyIKnew]

Hi all,

Sorry I'm quite new here and I didn't have time to read many boards yet, but I just read this on another website :

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."

This is VERY optimistic compared to what I read here. Could you tell me what you think about that cuz I'm a little bit lost now.

Thanks in advance.

[MammaMia]

I completed NAMI's Family to Family program several months ago.  This is an excellent program in which to learn about the more common "mental illnesses", i.e. bi-polar, schizophrenia, schizo-affective disorder, depression, anxiety, paranoia, etc.  However, I was the only person in a group of 20 with a BPD family member. When we had mental health professionals as guest speakers, and I would ask questions about BPD, they would just say something along the lines of... .  "Oh that is really difficult.  Personality disorders deal with that part of a person that actually MAKES them WHO they are, although BPD is usually accompanied by associated disorders like anxiety, depression, schizo-affective traits, etc. which are more readily treatable.  Behavior modification MIGHT be the only treatment available."   ?

That was it.  They had little else to recommend and seemed uncomfortable discussing BPD. Perhaps they did not feel qualified to do so, I am not sure.  I got the message loud and clear that BPD IS unique... .  it is very difficult to diagnose, very difficult to live with, and even more difficult to treat.   It is separate from other mental illnesses but is often combined WITH them, and the boundaries between them constantly blur.

NAMI helped me to understand the associated illnesses that often accompany BPD, but finding your website has been a Godsend.  These two resources have helped me so much.  I have read extensively, and sharing the real-life experiences of other BPD family members is very reassuring.  We are not crazy! We are dealing with a very serious, extremely frustrating illness in a loved one.  It affects not only the BPD sufferer but anyone who shares their life, regardless of whether the relationship is as an intimate soulmate or casual acquaintance.   

Thanks for being here.

[MammaMia]

PS   I just learned about another program through NAMI called Family Connections that deals SPECIFICALLY with BPD.  I will have to check that out.  I hope it is available in my town.

[IamDevastated]

Can therapy really change people with BPD?

I realize my experience is probably a little rare even on these boards, since my exBPD was diagnosed as well as attending therapy on a long term basis... . but still she showed ALL the BPD traits without any sign of getting better... .

[babyducks]

IamDevastated,

My Ex was in therapy, was religious about meds,  committed to getting better and I personally saw her working her butt off trying to do things a different way.  She had and will always have my complete respect for the bravery she displayed in doing battle with her demons.

That being said, she didn't always win her battles.  And of course part of the disorder is the extinction burst.  As she was trying to subdue a behavior it often became dramatically and visibly worse.

I am convinced that with time my Ex will get there.  I also know that I am not the person to accompany her on the journey.

babyducks

[MaybeSo]

There is a thread called success stories on the Staying Board with feedback from posters; it's starts off with Steph's story of her husbands recovery from BPD.

It's common for things to get worse before they get better.

Relationship is a major trigger for this illness. It would require a lot of detachment, self care, and work on codependent traits for a partner to survive or stay through a long healing journey. There are success stories and people do get better; that's why there is evidence based treatments today. But it's not easy, it takes a long time and a huge commitment. If addiction or other mental health issues exist, that also complicates treatment outcome.

So, no, it would not be accurate to conclude an individual failure means there is no successful treatment for anyone w/BPD. Even with BPD, people are still unique individuals, with their own unique strengths and weaknesses; the disorder is also on a spectrum in terms of severity.

I'm sure many relationships do not not survive the journey, as it's an incredibly difficult one with no guarantees that even a successful outcome means a great relationship. if a person did successfully make it through treatment, they may not even want to be in a relationship for a while. Someone recovered from BPD may not do the idealization or intense mirroring that tends to draw romantic partners to them like bees to honey.  Things would be quite different.

One year of therapy is really not very much. I would expect 2-3 years at least of a therapy targeted to symptoms of BPD. With additional maintenance as follow up.

My ex has been in T for about 8 years. He has improved a ton with anger management and interpersonal skills in general. But intimacy... . that's where things are still dicey.

[Reg]

I've recently seen very good reports on Schema therapy, even a report somewhere from last year, while DTB seems more effective for those borderlines harming themselves often or with suicidal ideas.

I think motivation and empathic support are very important for the person in therapy.  I think some borderlines may just lie about their 'big' motivation as they lie about anything else due to the borderline.

The stories referred to by MaybeSo is found here : https://bpdfamily.com/message_board/index.php?topic=113820.0

Someone posted somewhere earlier that therapy is actually emotionally growing up to an adult.  And I think it is, but think at the difference when someone goes in therapy at age 18 or age 40.  I think there's a lot more work to do in the last case !

Also medication seems to be able to play an important role to ease down some of the symptoms and better the results of the therapy according to MD Robert O Friedel :

www.BPDdemystified.com/treatments/medication

Still therapy seems to take at least 2 - 3 years to be successful... .

Reg

[TheDude]

Maybe 'triggers' isn't the right term for the title, or is it?

With Alcoholism, there's "rock bottom". With drug addiction, there's intervention. For so many illnesses and disorders, there's identifiable cause-and-effect catalysts that initiate the recovery process. In the course of swallowing a supertanker worth of information lately on cluster B disorders, including reading blogs of recovering sufferers, it seems there's little to no information regarding what the impetus is for recovery.

I would think that would be a prime area for research, no?

[Want2know]

I think the defining moment may be different for each person, as it is with anyone who feels their life is out of control and wants to change it.  Here is an interesting read with a video link about Marsha Linehan, an expert in the BPD 'world', and who had opened up about her own diagnosis as a pwBPD:

https://bpdfamily.com/message_board/index.php?topic=149362.0

Here is a link to the original article in the NY Times: www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all&_r=0

Perhaps this might give you some insight into your question.