Border­line per­son­al­ity disor­der - The cure (Part two)

Costa Levante News - - HEALTH -

BPD is a learned con­di­tion (or a fail­ure to learn prop­erly) and there­fore it can be un­learned. The past only de­fines the per­son un­til they de­fine them­selves. This means that it is not the fault of the suf­ferer if they have BPD, but it is their re­spon­si­bil­ity to re­solve it.

A part of the process of re­cov­ery is to learn about them­selves. It is im­por­tant that they de­velop a re­al­is­tic self-im­age so that they can feel bet­ter about them­selves. It is of no use hav­ing a low or in­flated self-im­age; it must be based on proper prin­ci­ples and not just on ap­pear­ance, wealth or fame.

Along with other or­gan­i­sa­tions, the Na­tional Health Ser­vice rec­om­mends a va­ri­ety of treat­ments for BPD. The main ones be­ing:

Dialec­ti­cal be­hav­iour ther­apy (DBT). A be­havioural ther­apy in­cor­po­rat­ing mind­ful­ness (med­i­ta­tion train­ing) based on skills train­ing to in­crease coping skills. It in­volves the idea that a non-sup­port­ive en­vi­ron­ment has con­trib­uted to the de­vel­op­ment of BPD in early life, lead­ing to emo­tional dys­reg­u­la­tion.

Men­tal­i­sa­tion based ther­apy (MBT). Men­tal­i­sa­tion is a psy­cho­log­i­cal skill, and refers to the abil­ity to con­sider one’s own and other’s men­tal states (emo­tions, wishes, be­liefs and so on) in making judge­ments about sit­u­a­tions. Peo­ple with Border­line have more dif­fi­culty pro­cess­ing facts in some sit­u­a­tions.

Ther­a­peu­tic Com­mu­nity (TC). A treat­ment for per­sonal- ity disor­der in­volv­ing mu­tual sup­port, care and chal­lenge in a group based en­vi­ron­ment. TCs are also used in the treat­ment of ad­dic­tions. Lo­ca­tions of pos­si­ble NHS funded ther­a­peu­tic com­mu­ni­ties can be found at: www.bpdworld.org/ther­a­peu­tic­com­mu­ni­ties.html.

Art Ther­a­pies. These in­clude art ther­apy, dance move­ment ther­apy, drama ther­apy and mu­sic ther­apy.

Trans­fer­ence-Fo­cused Ther­apy. This is a psy­cho­anal­y­sis ther­apy based on the the­o­ries of Freud.

Border­line is treat­able but med­i­ca­tion may be needed at the out­set to en­able the pow­er­ful, raw emo­tions to be tamed. This en­ables the talk­ing ther­a­pies to be­gin. It must be stated that anger is a ma­jor prob­lem with suf­fer­ers and the anger trig­gers can only be dealt with when the per­son is calm.

In all cases, the re­la­tion­ship be­tween ther­a­pist and client is key. The ther­a­pist must be seen as an ally and not an ad­ver­sary. This prob­lem of­ten arises due to the para­noia of the Border­line char­ac­ter, be­liev­ing that the ther­a­pist must take sides, ei­ther with the client or against them.

A fur­ther prob­lem arises with ther­a­pists, and that is burnout. The suc­cess rate for BPD is rel­a­tively low, not much bet­ter than that for schizophre­nia and due to the na­ture and pre­sent­ing con­di­tion of the client progress is dif­fi­cult. Some ther­a­pists see the lack of im­prove­ment as frus­trat­ing and may even end the ther­apy due to lack of progress. The choice of ther­a­pist is there­fore vi­tal; the wrong or in­ex­pe­ri­enced ther­a­pist may in­ad­ver­tently make the con­di­tion of their client worse.

The key to suc­cess­ful ther­apy must be to let go of past griev­ances and fo­cus on the present. Old think­ing habits must there­fore be chal­lenged and ex­pe­ri­ence all present emo­tions with per­spec­tive and pro­por­tion. As a part of the process, facts must be dis­cussed ex­clud­ing judge­ments such as “good, bad, un­fair” etc.

Many Border­line suf­fer­ers grew up in an en­vi­ron­ment where their emo­tions were ei­ther dis­missed, told that they had no right to feel that way, or that they were be­ing silly. The re­sult was that they grew up feel­ing worth­less and guilty for hav­ing such feel­ings. Pow­er­ful emo­tions there­fore make the suf­ferer feel that they are bad. The over­all aim of psy­chother­apy is to break the cy­cle of re­jec­tion, worth­less­ness and fail­ure, but to ex­pe­ri­ence their emo­tions in a more mea­sured way. Re­cov­ery is of­ten dif­fi­cult and takes time; the main­stream ther­a­pies men­tioned above can go on for years, and in-pa­tient care can be for be­tween one and two years. Some of the is­sues of re­cov­ery in­clude:

1 Border­line peo­ple may feel un­com­fort­able in nor­mal com­pany, more like aliens.

2 The fa­mil­ial pat­tern must be bro­ken, or they may pass on BPD to their chil­dren.

3 A good idea dur­ing treat­ment may be to ad­mit to their fam­ily that, “I am feel­ing re­jected right now”. This will teach their fam­ily how to re­phrase and recog­nise trig­gers that will il­licit an an­gry re­sponse.

4 It is use­ful for par­ents to understand that they do not have to be right all the time. Some­times it is bet­ter not to con­tra­dict or cor­rect un­less re­ally nec­es­sary.

5 Re­cov­ery from BPD must be seen as a marathon and not a sprint.

6 Those with BPD are ex­tremely sen­si­tive in the same way that rub­bing a bad burn with sand­pa­per is sen­si­tive. Those in contact with BPD should not walk as if on eggshells, but be aware that highly sen­si­tive an­ten­nae are tuned into ev­ery word, look­ing for hid­den mean­ing.

7 Border­line peo­ple should look for ways to soothe them­selves such as playing mu­sic when aroused.

8 Re­lax­ation tech­niques must be in­ves­ti­gated and adopted in an at­tempt to slow down or min­imise the ex­plo­sions.

9 In ad­di­tion to psy­cho­log­i­cal sup­port, it is im­por­tant to look af­ter the body, so cor­rect eat­ing, avoid­ing drugs and al­co­hol; sleep and ex­er­cise are im­por­tant.

10 Border­line peo­ple should be en­cour­aged to be gen­tle with peo­ple. Many BPD suf­fer­ers have a fear­ful tem­per and can frighten their friends and fam­ily.

11 They should be will­ing to apol­o­gise (only once), remember to ad­here to their mo­ral code and be truth­ful.

12 Crit­i­cism must be given care­fully; their be­hav­iour can be crit­i­cised but not their char­ac­ter.

13 Ev­ery­one, in­clud­ing the BPD suf­ferer should remember that be­ing con­struc­tive is more im­por­tant than be­ing right.

14 Suc­cess rates are de­pen­dent on the on­go­ing com­mit­ment of the BPD suf­ferer. It would ap­pear that Border­line Per­son­al­ity Disor­der is cer­tainly some­thing to avoid, be­cause once ac­quired, it is hard to re­move. Once it is in a fam­ily, the like­li­hood is that it will be passed on. Though re­cov­ery rates are low, this must be seen in the light of very low sup­port lev­els. If sup­port lev­els were in­creased, the num­bers of re­cov­ered Border­line suf­fer­ers would im­prove. Where sup­port is avail­able, the re­sults are en­cour­ag­ing, once an ac­cu­rate di­ag­no­sis is made. For more in­for­ma­tion call Gra­hame on 96 540 5631 or visit the web­site www.san-luis-clinic.co.uk

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