Posted by: carolg1849 | December 13, 2009

Managing stress from Carers.org

About stress

Experts say that short periods of stress in our daily lives are actually good for us. Continual stress, however, can cause health problems, which may not always appear to be stress related and can not only affect you, but also those closest to you, not least the one you’re caring for.

As a carer you are in a situation that can be a constant cause of stress – there are many additional responsibilities and frustrations for you to cope with, so feelings of anger and hopelessness are not uncommon.

You should try to be aware of and identify any symptoms of stress you may experience. It may be unusual behaviour such as overreacting to situations, a short temper, shouting at people or a constant feeling of being unable to cope. Lack of appetite, poor sleeping patterns and headaches are other typical reactions to stress.

For carers in particular, stress is usually mental or emotional rather than physical and the effect is that the body is constantly ‘keyed up’, sometimes without any physical activity as a release (see our exercise section for help relieving stress).

Stress is not only harmful to your health and wellbeing – it can also harm relationships – so it is vital to identify the causes of stress and address them as soon as possible.

The problem is often that the cause of stress may not always be the most obvious, and there is often more than one. You could be worried about money, the future, the health of the person you care for or the activities of other members of the family, or you may feel guilty – another common source of stress.

Stress can strain relations, and it’s not just your relationship with the person you are caring for that can be affected. For example, caring for an elderly parent can place enormous strain on a marriage because of the continual stress experienced by the carer and the perceived lack of support from your partner.

For information on how you can resolve issues within your relationships click here.

Dealing with stress

No matter how well you deal with your caring role there will inevitably come a time when you experience higher than normal levels of stress.

To enable you to continue your caring role effectively – and to ensure your own health does not suffer – it is important to try and deal with your stress.

Possible ways of doing this are;

  • Using friends and family for discussion and support
  • Using the carers’ boards on this site in the community section to talk to other carers, or attending local support groups of carers
  • Taking through situation with appropriate professionals face-to-face or by telephone
  • Seeking help and advice from GPs, pharmacists and other health professionals you may know

Taking time out to do what you want to do is very difficult when you are a carer, but it is extremely important.

For further advice and information on coping with stress, anger, depression, and other common feelings associated with being a carer, the Northumberland, Tyne and Wear NHS Trust have produced a number of Self-Help Leaflets. These may be useful to you and the person you care for.

via Managing stress from Carers.org.

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Posted by: carolg1849 | November 23, 2009

Carers Assessment – its your right !

Some of us think mental illness does not count would you believe!, please remember Personality disorders are a MENTAL DISABILITY and as such your are entitled to an assessment.

This article has been copied from CARERS UK website, fur more information click HERE for a link to their site.

Do I qualify for a carer’s assessment?

The law says you have a right to an assessment if care for someone for ‘a substantial amount of time on a regular basis’.  The relevant legislation here is the Carers (Recognition & Services) Act 1995 and the Carers & Disabled Children Act 2000.  You  may be a carer living with or away from the person you care for, caring full time or combining care with paid work – you will still have a right to a carer’s assessment.

If you are aged over 16, your right to an assessment is not affected, even if the person you care for does not want to receive help from social services.

You also have a right to an assessment if you intend to look after someone. For example: if your friend or relative is in hospital and you expect to look after them when they come back home (see Coming out of hospital for more on this).  Or it may be very helpful to ask for an assessment if you intend giving up work.

If you look after a disabled child you also have a right to an assessment. You do not always have to be the child’s parent, but must have parental responsibility for the child.

Sadly, not all professionals are aware of carers’ right to an assessment and some carers are wrongly told that they are not entitled to one.  If this happens to you and you believe you are entitled to an assessment, you should put your request in writing and ask why they are refusing you an assessment.  You should seek advice from a local carer’s organisation or Citizen Advice Bureau. See our directory for contact details.

What is the purpose of a carer’s assessment?

The purpose of a carer’s assessment is to discuss with social services the help you need with caring, plus help to maintain your own health and balance caring with your life, work and family commitments.  Social services use the assessment to decide what help to provide. The range of help available is discussed in the section ‘What help is available’

The person carrying out the assessment shouldn’t assume you want to take on a caring role or continue caring.  They should ask if you are able and willing to carry out the tasks involved. For instance, you may be find it hard to move someone in a wheelchair due to your own health problems or you may suffer from stress in coping with the challenging behaviour of the person you care for. You still care about the person you look after, but you may no longer be able to care for them.

As well as looking at the help you need, the assessment can be useful in:

  • Exploring how you feel about caring with a professional
  • Giving you information on benefits and support such as carers groups.
  • Deciding if you want to stay or return to work and how to make this happen.
  • Looking at how caring may affect you in the future and what help you might need.

How do I get an assessment?

You may be offered a carer’s assessment by your social services department or, if not, can ask for one.  The telephone number and address of the social services department will be listed in the phone book under the name of your local authority.  You can also ask your GP or district nurse to contact social services for you.  We have provided a sample letter to ask social services for an assessment. This can be downloaded at the end of this page.

If the person you look after is in hospital, speak to a nurse and ask to be put in touch with a hospital social worker.

Is there anything I can do to help me prepare for my assessment?

You may find it hard to think what is involved in caring, as you just see it as part of everyday life. It is even harder to pinpoint what is involved in looking after someone with mental health needs.

If possible, talk to the person you care for before you call social services and agree what points you want to raise. You will both be involved in the assessment.  If there are aspects of your situation you would rather discuss in private with a social worker, you are entitled to ask for a separate assessment on your own.

If either you or the person you care for has difficulty communicating, let social services know and they will provide help.

You may find this checklist useful in preparing for your assessment:

Housing

  • Do you and the person you care for live together or apart?  Is this arrangement satisfactory? If not, what changes are needed?
  • Does the person you care for have difficulty moving about in the home? (e.g. can they climb the stairs or bathe on their own?
  • Aids or adaptations to your home may make it easier for you and the person you look after.

Health

  • Does the person you care for have any health problems you find hard to deal with?
  • Are you getting enough sleep?
  • Do you have any health problems? Are you stressed, anxious or depressed?

Work

  • Are you struggling to combine work and caring?
  • Have you had to reduce your hours of work?
  • Would you like to return to work?

Other interests

  • Do you want to do any training or adult education?
  • Do you want to pursue any leisure interests but can’t because of your caring role?

Time

  • How many hours a week do you care? Include all the time you spend with the person you care for, the taks you do for them and how long they take you.
  • Do you have to help with – Housework… shopping… extra laundry… bathing… toiletting… cooking… other personal care… ensuring they don’t come to any harm… dealing with money/pensions… administering medications… keeping them company… going to the shops with them…  taking them to hospital?
  • Do you have to help during the day or night – or both?
  • Does anyone else help?  Who and for how long?
  • Would you like some help with these jobs?
  • List the tasks you would most like help with, putting the most important first.
  • Are there things you enjoy which you can’t do any more due to caring responsibilities? E.g. cinema, hobbies, seeing friends
  • When was the last time you had a whole day to yourself to do as you pleased?

Feelings

  • Do you feel you don’t have a choice about providing care? You may feel that you can’t carry on at all, or only if you reduce the amount that you do. Tell the social worker about these feelings.
  • What would you most like to change about your situation?

Relationships

  • Is caring affecting your relationship with the person you look after, family and friends?
  • If you are a parent, is caring making this role harder?  Do you feel you have time for your children?

Dealing with emergencies and unplanned events

  • Do you need help in planning what happens if you suddenly become ill or have an emergency?
  • Do you know who to contact in an emergency?

The future

  • Are you concerned at all about the future for you and the person you care for?

What will happen at the assessment?

Usually a social worker or a member of social services will carry out the assessment. A meeting may also be needed with your GP or nurse if a lot of care is required. You can ask to talk confidentially to the person carrying out the assessment, without the person you care for being present.

The quality of carers’ assessments can vary, with some workers having a good understanding of how to help carers, but this is not always the case. It’ important the social worker is aware of your situation (see the Preparing for an assessment checklist above).  You are entitled to have a friend or advocate present at the assessment.

If you feel certain aspects of your caring role were not fully covered during your assessment, you may contact the social worker and arrange a follow up visit.  This is quite common – people’s lives are often complex and it can be tough to talk about difficult issues regarding close relationships.

The social worker should explore with you the support and services to help you to look after the person you care for.  Social services can give help and support directly to you, or give help directly to the person you care for.  This is covered in What help is available?

If your caring situation is likely to continue for at least the foreseeable future, the social worker should set a date to review your needs and see if the help provided is working out.  This is usually at least on an annual basis and more frequently if you are new to caring and your situation is complex.

What will happen after the assessment?

It is important that you are able to make an informed choice about how much you do or want to take on in the future as a carer. When social services decide what help and services to provide they have to take into account the results of both your carer’s assessment and the community care assessment of the person you care for.  They will summarise this in a care plan for the person you look after – a copy will be given to both of you.

Local authorities are required to set out how they make decisions about whether or not to provide services.  These are termed eligibility criteria.  The needs identified in the assessments are compared against their eligibility criteria.  If the needs of the person that you look after match these eligibility criteria, the local authority must provide services to meet their needs. You can obtain a copy of their eligibility criteria by phoning your local authority and asking for their Better Care, Higher Standards Charter.

Social services are only required to meet the needs that no-one else is willing to meet.  It is important  that if you are unable or unwilling to provide care or any aspect of caring, that this should be taken into account by the local authority when deciding what services to provide.  For example, you may be willing to provide the bulk of the care as long as you get a regular break or services to fit around your job. Try to be clear about what level of care you can manage.  If you feel under pressure to accept inadequate services, seek advice from Citizens Advice Bureau,  Carers Centreor ring CarersLine 0808 808 7777.

Social services cannot refuse to meet a need they have identified solely on the basis that they do not have the money or other resources.

The person that you look after can refuse help from social services.  This may leave you as a carer with very little or no support.  If this is the case, it is important that the local authority should consider other areas of support  which may ease some of the pressures of caring.  For instance, help with cleaning your own house or washing could benefit you.  Taxi fares may assist you to get to hospital appointments or help get you to work on time.  A mobile phone could help you keep in touch and give you peace of mind.  These services are examples of carers’ services which will be provided to you rather than the person you care for.

Social services must make it clear which services are for you and which are for the person you are looking after.

What happens if I am not satisfied with the outcome?

You may be unhappy with how your assessment was carried out.  You may be dissatisfied with the decision about what services will be provided to you and the person you look after.  Advice centres like the Citizens Advice Bureau or a disability organisation can help you make a complaint or give you details of lawyers able to advise on community care law.

Social services have a procedure for dealing with concerns and complaints.  Read our Guide to challenging decisions and making a complaint.

What happens if I am not satisfied with the outcome?

You may be unhappy with how your assessment was carried out.  You may be dissatisfied with the decision about what services will be provided to you and the person you look after.  Advice centres like the Citizens Advice Bureau or a disability organisation can help you make a complaint or give you details of lawyers able to advise on community care law.

Social services have a procedure for dealing with concerns and complaints.  Read our Guide to challenging decisions and making a complaint.

What happens if I am not satisfied with the outcome?

You may be unhappy with how your assessment was carried out.  You may be dissatisfied with the decision about what services will be provided to you and the person you look after.  Advice centres like the Citizens Advice Bureau or a disability organisation can help you make a complaint or give you details of lawyers able to advise on community care law.

Social services have a procedure for dealing with concerns and complaints.  Read our Guide to challenging decisions and making a complaint.

What happens if I am not satisfied with the outcome?

You may be unhappy with how your assessment was carried out.  You may be dissatisfied with the decision about what services will be provided to you and the person you look after.  Advice centres like the Citizens Advice Bureau or a disability organisation can help you make a complaint or give you details of lawyers able to advise on community care law.

Social services have a procedure for dealing with concerns and complaints.  Read our Guide to challenging decisions and making a complaint.

What happens if I am not satisfied with the outcome?

You may be unhappy with how your assessment was carried out.  You may be dissatisfied with the decision about what services will be provided to you and the person you look after.  Advice centres like the Citizens Advice Bureau or a disability organisation can help you make a complaint or give you details of lawyers able to advise on community care law.

Social services have a procedure for dealing with concerns and complaints.  Read our Guide to challenging decisions and making a complaint.

The following article I recieved this morning from Psychiatric News

Although its from across the pond it as much relevance for us here in the UK.

An Interesting read and arguments to make if you come  across “dont need to drag up the past” meaning we dont want to spend the money scenario, which I have had to deal with for my son.

 

Psychiatrist Helped Demonstrate Psychotherapy Is Cost-Effective

Mark Moran

Whether psychotherapy is cost-effective was an important question during President Clinton’s health care reform effort. Lessons from that era remain relevant during current health reform debates.

If psychotherapy has a place in the American health care system of tomorrow, give some credit to psychiatrist Susan Lazar, M.D., and other clinician-researchers who helped establish the evidence base for the cost-effectiveness of psychotherapy beginning more than 16 years ago.

That was when Hillary Rodham Clinton’s Health Care Task Force was at work. Though the exact content of health insurance benefit packages hasn’t yet been a focus of today’s health care debates, a decade and a half ago task force members were weighing the relative value of any health care service as a criterion for inclusion in mandated benefits.

And “value” meant cost-effectiveness—the cost of providing the service compared with the benefits derived from the service.

“My own work on establishing the cost-effectiveness of psychotherapy really began in 1992 during the presidential campaign when people were worried about what Clinton was thinking about for health system reform,” said Lazar, a clinical professor of psychiatry at Georgetown University School of Medicine, George Washington University School of Medicine, and Uniformed Services University of the Health Sciences and a supervising and training analyst at the Washington Psychoanalytic Institute. “I said, ‘Let’s study it to see if we can justify it.’ That led to the study group at the Washington Psychoanalytic Society to which I belonged beginning to read the mainstream medical, psychiatric, and psychological literature for cost-effectiveness studies.”

In fact, there was a fledgling literature on the subject going back to before the early 1980s. And in time Lazar’s work on the subject earned her a role as a consultant to Bernard Arons, M.D., who was named the chair of the Work Group for Mental Health of the Health Care Task Force. And so Lazar became a regular at the task force’s White House meetings.

“I soon realized that when you called researchers who had looked at cost-effectiveness of psychotherapy, they were eager to contribute what they had,” Lazar told Psychiatric News. “We created a network of interested researchers and clinicians.”

This included leading lights in research on all kinds of psychotherapy and psychiatric services such as Kenneth Wells, M.D., of Rand; Willard Manning, Ph.D., then of the University of Minnesota; Myrna Weissman, Ph.D., of Columbia University; Glen Gabbard, M.D., then with the Menninger Foundation; Lenore Terr, M.D., of the University of California, San Francisco; Jacob Lindy, M.D., of Cincinnati; Judith Herman, M.D., of Cambridge Hospital; and David Spiegel, M.D., of Stanford University, who had done research on psychotherapy and group therapy for women with breast cancer.

“They came on their own nickel to present data about cost-effectiveness,” Lazar said.

As they went along, they learned how to argue their case. “We learned that you had to talk about the effect of a specific service on a specific medical budget within a given period of time,” Lazar said, a feat that was difficult when discussing psychotherapy because the benefits might accrue many years out. “Most budget people can’t think in terms of five or 10 years, only the next budget year.”

Lazar said she and her colleagues were able to present data about “cost-offset”—that is, data showing that psychotherapy saves money elsewhere, such as medical costs for disorders exacerbated by untreated depression. It was ultimately more meaningful, however, to present data reflecting cost-effectiveness, a measure of the economic value of a service obtained per dollar spent, she said.

“Cost-offset is interesting, but it is not a moral standard,” Lazar said. “It holds psychotherapy to a more stringent standard if you need to demonstrate cost-offset before you will provide psychotherapy benefits. You would not ask a surgeon or internist to prove they will lower other medical costs before you would reimburse for their care, especially for urgent services.”

The group’s message began to be heard. “We found that in speaking with people and to staffers, when you make a cost-effectiveness argument with good data, you are really making two points at once,” she said. “So many people said, ‘Wait—you mean it works at all?’ ”

Since that time, the study of the cost-effectiveness of psychotherapy has matured. Today, Lazar is the editor and coauthor of Psychotherapy Is Worth It: A Comprehensive Review of Its Cost-Effectiveness with other members of the Committee on Psychotherapy of the Group for the Advancement of Psychiatry (GAP). The book is in press with American Psychiatric Publishing Inc.

(GAP’s Web site describes the organization as a “think tank” for psychiatry. “The goal of GAP is to continue to germinate new and exciting ideas which will impact on the thinking and practice of mental health clinicians,” according to the Web site.)

The book includes chapters reviewing the literature on the cost-effectiveness of all kinds of psychotherapy in the treatment of schizophrenia, borderline personality disorder, posttraumatic stress disorder, anxiety disorders, depression, substance abuse, and psychotherapy of patients with medical illness. The book also covers psychotherapy for children and adolescents and the place of long-term and intensive psychodynamic psychotherapy and psychoanalysis.

“While there are perhaps still too few large-scale studies addressing the cost-effectiveness of psychotherapy for specific diagnostic groups of patients, we can arrive at some important impressions from the studies that we do have,” Lazar and colleagues write in their book. “Those that exist do confirm that, for many conditions, psychotherapy works, is cost-effective, can at times provide a significant cost-offset in other medical and hospital expenses, and is not overused or ‘abused’ by those not truly in need. Also, it is important to understand that a treatment that is cost-effective is not ‘cheap’, may not save money in other treatment costs, but does provide effective medical help at a cost acceptable to society, both in comparison to other effective treatments for the same condition and to medical treatments for other classes of medical disorder.”

Following the collapse of the Clinton health reform effort, Lazar continued to publish on the subject of psychotherapy and cost. In one publication in 1997, she joined Gabbard, Spiegel, and Jeffrey Hornberger, M.D., M.S., in writing “The Economic Impact of Psychotherapy,” which was the cover article for the February 1997 American Journal of Psychiatry.

Lazar said she believes the new book represents an up-to-date compendium of what has been learned about costs, cost-effectiveness, and psychotherapy since the subject first began to be studied in a formal way.

“What you see in the past 10 years is a much more sophisticated measure of cost-effectiveness, including measures of work productivity, and such measures as quality-adjusted life years,” she pointed out.

(Quality-adjusted life years is a measure of disease burden, including both the quality and the quantity of life lived.)

And she believes the book presents a case that will be difficult to ignore. “I think it can be a very powerful tool if you are talking to those designing medical insurance benefits,” she said. “It presents an unassailable argument.”

via Psychiatrist Helped Demonstrate Psychotherapy Is Cost-Effective — Psychiatric News.

Posted by: carolg1849 | November 15, 2009

Family Guidelines

Family guidelines taken from “family groups” literature,  written by John G Gunderson MD and Cynthia Berkowitz MD

pdf version of this can be found in the “files” page of our yahoo groups website carers4pd.  If you are not a member please go to our support page for details.

These guidelines are invaluable

GOALS: GO SLOWLY

1. Remember that change is difficult to achieve and fraught with fears. Be cautious about suggesting that “great” progress has been made or giving “You can do it” reassurances. Progress evokes fears of abandonment.

The families of people with Borderline Personality Disorder can tell countless stories of instances in which their son or daughter went into crisis just as that person was beginning to function better or to take on more responsibility. The coupling of improvement with a relapse is confusing and frustrating but has a logic to it. When people make progress – by working, leaving day treatment, helping in the home, diminishing self-destructive behaviors, or living alone- they are becoming more independent. They run the risk that those around them who have been supportive, concerned, and protective will pull away, concluding that their work is done. The supplies of emotional and financial assistance may soon dry up, leaving the person to fend for herself in the world. Thus, they fear abandonment. Their response to the fear is a relapse. They may not make a conscious decision to relapse, but fear and anxiety can drive them to use old coping methods. Missed days at work, self-mutilation, a suicide attempt, or a bout of overeating, purging or drinking may be a sign that lets everyone around know that the individual remains in distress and needs their help. Such relapses may compel those around her to take responsibility for her through protective measures such as hospitalization. Once hospitalized, she has returned to her most regressed state in which she has no responsibilities while others take care of her.

When signs of progress appear, family members can reduce the risk of relapse by not showing too much excitement about the progress and by cautioning the individual to move slowly. This is why experienced members of a hospital staff tell borderline patients during discharge not that they feel confident about their prospects, but that they know the patient will confront many hard problems ahead. While it is important to acknowledge progress with a pat on the back, it is meanwhile necessary to convey understanding that progress is very difficult to achieve. It does not mean that the person has overcome her emotional struggles. You can do this by avoiding statements such as, “You’ve made great progress,” or, “I’m so impressed with the change in you.” Such messages imply that you think they are well or over their prior problems. Even statements of reassurance such as, “That wasn’t so hard,” or, “I knew you could do it,” suggest that you minimize their struggle. A message such as, “Your progress shows real effort. You’ve worked hard. I’m pleased that you were able to do it, but I’m worried that this is all too stressful for you,” can be more empathic and less risky.

2. Lower your expectations. Set realistic goals that are attainable. Solve big problems in small steps. Work on one thing at a time. “Big”, long-term goals lead to discouragement and failure.

Although the person with BPD may have many obvious strengths such as intelligence, ambition, good looks, and artistic talent, she nonetheless is handicapped by severe emotional vulnerabilities as she sets about making use of those talents. Usually the person with BPD and her family members have aspirations based upon these strengths. The patient or her family may push for return to college, graduate school, or a training program that will prepare her for financial independence. Family members may wish to have the patient move into her own apartment and care for herself more independently. Fueled by such high ambitions, a person with BPD will take a large step forward at a time. She may insist upon returning to college full time despite undergoing recent hospitalizations, for example. Of course, such grand plans do not consider the individual’s handicaps of affect dyscontrol, black and white thinking, and intolerance of aloneness. The first handicap may mean that, in the example given, the B received on the first exam could lead to an inappropriate display of anger if it was thought to be unfair, to a self-destructive act if it was felt to be a total failure, or severe anxiety if it was believed that success in school would lead to decreased parental concern. The overriding issue about success in the vocational arena is the threat of independence —much desired but fraught with fear of abandonment. The result of too large a step forward all at once is often a crashing swing in the opposite direction, like the swing of a pendulum. The person often relapses to a regressed state and may even require hospitalization.

A major task for families is to slow down the pace at which they or the patient seeks to achieve goals. By slowing down, they prevent the sharp swings of the pendulum as described and prevent experiences of failure that are blows to the individual’s self-confidence. By lowering expectations and setting small goals to be achieved step by step, patients and families have greater chances of success without relapse. Goals must be realistic. For example, the person who left college mid-semester after becoming depressed and suicidal under the pressure most likely could not return to college full time a few months later and expect success. A more realistic goal is for that person to try one course at a time while she is stabilizing. Goals must be achieved in small steps. The person with BPD who has always lived with her parents might not be able to move straight from her parents’ home. The plan can be broken down into smaller steps in which she first moves to a halfway house, and then into a supervised apartment. Only after she has achieved some stability in those settings should she take the major step of living alone.

Goals should not only be broken down into steps but they should be taken on one step at a time. For example, if the patient and the family have goals for both the completion of school and independent living, it may be wisest to work on only one of the two goals at a time.

FAMILY ENVIRONMENT

3. Keep things cool and calm. Appreciation is normal. Tone it down. Disagreement is normal. Tone it down, too.

This guideline is a reminder of the central message of our educational program: The person with BPD is handicapped in his ability to tolerate stress in relationships (i.e., rejection, criticism, disagreements) and can, therefore, benefit from a cool, calm home environment. It is vital to keep in mind the extent to which people with BPD struggle emotionally each day. While their internal experience can be difficult to convey, we explain it by summarizing into three handicaps: affect dyscontrol, intolerance of aloneness, and black and white thinking. To review:

Affect Dyscontrol:

A person with BPD has feelings that dramatically fluctuate in the course of each day and that are particularly intense. These emotions, or affects, often hit hard. We have all experienced such intense feelings at times. Take for example the sensation of pounding heart and dread that you may feel when you suddenly realize that you have made a mistake at work that might be very costly or embarrassing to your business. The person with BPD feels such intense emotion on a regular basis. Most people can soothe themselves through such emotional experiences by telling themselves that they will find a way to compensate for the mistake or reminding themselves that it is only human to make mistakes. The person with BPD lacks that ability to soothe herself. An example can also be drawn from family conflict. We have all had moments in which we feel rage towards the people we love. We typically calm ourselves in such situations by devising a plan for having a heart-to-heart talk with the family member or by deciding to let things blow over. The person with BPD again feels such rage in its full intensity and without being able to soothe himself through the use of coping strategies. It results in an inappropriate expression of hostility or by acting out of feelings (drinking or cutting).

Intolerance of Aloneness:

A person with BPD typically feels desperate at the prospect of any separation – a family member’s or therapist’s vacation, break up of a romance, or departure of a friend. While most of us would probably miss the absent family member, therapist or friend, the person with BPD typically feels intense panic. She is unable to conjure up images of the absent person to soothe herself. She cannot tell herself, “That person really cares about me and will be back again to help me.” Her memory fails her. She only feels soothed and cared for by the other person when that person is present. Thus, the other person’s absence is experienced as abandonment. She may even keep these painful thoughts and feelings out of mind by using a defense mechanism called dissociation. This consists of a bizarre and disturbing feeling of being unreal or separate from one’s body.

Black & White Thinking (Dichotomous Thinking):

Along with extremes of emotion come extremes in thinking. The person with BPD tends to have extreme opinions. Others are often experienced as being either all good or all bad. When the other person is caring and supportive, the person with BPD views him or her as a savior, someone endowed with special qualities. When the other person fails, disagrees, or disapproves in some way, the person with BPD views him or her as being evil and uncaring. The handicap is in the inability to view other people more realistically, as mixtures of good and bad qualities.

This review of the handicaps of people with BPD is a reminder that they have a significantly impaired ability to tolerate stress. Therefore, the family members can help them achieve stability by creating a cool, calm home environment. This means slowing down and taking a deep breath when crises arise rather than reacting with great emotion. It means setting smaller goals for the person with BPD so as to diminish the pressure she is experiencing. It means communicating when you are calm and in a manner that is calm. It does not mean sweeping disappointments and disagreements under the rug by avoiding discussion of them. It does mean that conflict needs to be addressed in a cool but direct manner without use of put-downs. Subsequent guidelines will provide methods for communicating in this fashion.

4. Maintain family routines as much as possible. Stay in touch with family and friends. There’s more to life than problems, so don’t give up the good times.

Often, when a member of the family has a severe mental illness, everyone in the family can become isolated as a result. The handling of the problems can absorb much time and energy. People often stay away from friends to hide a problem they feel as stigmatizing and shameful. The result of this isolation can be only anger and tension. Everyone needs friends, parties, and vacations to relax and unwind. By making a point of having good times, everyone can cool down and approach life’s problems with improved perspective. The home environment will naturally be cooler. So you should have good times not only for your own sake, but for the sake of the whole family.

5. Find time to talk. Chats about light or neutral matters are helpful. Schedule times for this if you need to.

Too often, when family members are in conflict with one another or are burdened by the management of severe emotional problems, they forget to take time out to talk about matters other than illness. Such discussions are valuable for many reasons. The person with BPD often devotes all her time and energy to her illness by going to multiple therapies each week, by attending day treatment, etc. The result is that she misses opportunities to explore and utilize the variety of talents and interests she has. Her sense of self is typically weak and may be weakened further by this total focus on problems and the attention devoted to her being ill. When the family members take time to talk about matters unrelated to illness, they encourage and acknowledge the healthier aspects of her identity and the development of new interests. Such discussions also lighten the tension between family members by introducing some humor and distraction. Thus, they help you to follow guideline #3.

Some families never talk in this way, and to do so may seem unnatural and uncomfortable at first. There may be a hundred reasons why there is no opportunity for such communication. Families need to make the time. The time can be scheduled in advance and posted on the refrigerator door. For example, everyone may agree to eat dinner together a few times a week with an agreement that there will be no discussions of problems and conflict at these times. Eventually, the discussions can become habit and scheduling will no longer be necessary.

MANAGING CRISES

PAY ATTENTION BUT STAY CALM

6. Don’t get defensive in the face of accusations and criticisms. However unfair, say little and don’t fight. Allow yourself to be hurt. Admit to whatever is true in the criticisms.

When people who love each other get angry at each other, they may hurl heavy insults in a fit of rage. This is especially true for people with BPD because they tend to feel a great deal of anger. The natural response to criticism that feels unfair is to defend oneself. But, as anyone who has ever tried to defend oneself in such a situation knows, defending yourself doesn’t work. A person who is enraged is not able to think through an alternative perspective in a cool, rational fashion. Attempts to defend oneself only fuel the fire. Essentially, defensiveness suggests that you believe the other person’s anger is unwarranted, a message that leads to greater rage. Given that a person who is expressing rage with words is not posing threat of physical danger to herself or others, it is wisest to simply listen without arguing.

What that individual wants most is to be heard. Of course, listening without arguing means getting hurt because it is very painful to recognize that someone you love could feel so wronged by you. Sometimes the accusations hurt because they seem to be so frankly false and unfair. Other times, they may hurt because they contain some kernel of truth. If you feel that there is some truth in what you’re hearing, admit it with a statement such as, “I think you’re on to something. I can see that I’ve hurt you and I’m sorry.”

Remember that such anger is part of the problem for people with BPD. It may be that she was born with a very aggressive nature. The anger may represent one side of her feelings which can rapidly reverse. (See discussion of black and white thinking.) Keeping these points in mind can help you to avoid taking the anger personally.

7. Self-destructive acts or threats require attention. Don’t ignore. Don’t panic. It’s good to know. Do not keep secrets about this. Talk about it openly with your family member and make sure professionals know.

There are many ways in which the person with BPD and her family members may see trouble approaching. Threats and hints of self-destructiveness may include a variety of provocative behaviors. The person may speak of wanting to kill herself. She may become isolative. She may superficially scratch herself. Some parents have noticed that their daughters shave their head and color their hair neon at times when they are in distress. More commonly, what will be evident is not eating or reckless behavior. Sometimes the evidence is blunt – a suicide gesture made in the parent’s presence. Trouble may be anticipated when separations or vacations occur.

When families see the signs of trouble they may be reluctant to address them. Sometimes the person with BPD will insist that her family “butt out.” She may appeal to her right to privacy. Other times, family members dread speaking directly about a problem because the discussion may be difficult. They may fear that they would cause a problem where there might not be one by “putting ideas into someone’s head”. In fact, families fear for their daughter’s safety in these situations because they know their daughters well and know the warning signs of trouble from experience. Problems are not created by asking questions. By addressing provocative behaviors and triggers in advance, family members can help to avert further trouble. People with BPD often have difficulty talking about their feelings and instead tend to act on them in destructive ways. Therefore, addressing a problem openly by inquiring with one’s daughter or speaking to her therapist helps her to deal with her feelings using words rather than actions.

Privacy is, of course, a great concern when one is dealing with an adult. However, the competing value in these situations of impending danger is safety. When making difficult decisions about whether to call your loved one’s therapist about a concern or call an ambulance, one must weight concern for safety against concern for privacy. Most people would agree that safety comes first. There may be a temptation to under-react in order to protect the individual’s privacy. At the same time, there may be a temptation to overreact in ways that give the person reinforcement for her behavior. One young woman with BPD told her mother excitedly during an ambulance ride to a psychiatric hospital, “I’ve never been in an ambulance before!” Families must apply judgment to their individual situation. Therapists can be helpful in anticipating crises and establishing plans that fit the individual family’s needs.

8. Listen. People need to have their negative feelings heard. Don’t say, “It isn’t so.” Don’t try to make the feelings go away. Using words to express fear, loneliness, inadequacy, anger, or needs is good. It’s better to use words than to act out on feelings.

When feelings are expressed openly, they can be painful to hear. A daughter may tell her parents that she feels abandoned or unloved by them. A parent may tell his child that he’s at the end of his rope with frustration. Listening is the best way to help an emotional person to cool off. People appreciate being heard and having their feelings acknowledged. This does not mean that you have to agree. Let’s look at the methods for listening. One method is to remain silent while looking interested and concerned. You may ask some questions to convey your interest. For example, one may ask, “How long have you felt this way?” or “What happened that triggered your feelings?” Notice that these gestures and questions imply interest but not agreement. Another method of listening is to make statements expressing what you believe you’ve heard. With these statements, you prove that you are actually hearing what the other person is saying. For example, if your daughter tells you she feels like you don’t love her, you can say, even as you are contemplating how ridiculous that belief is, “You feel like I don’t love you?!?” When a child is telling her parents that she feels as if she has been treated unfairly by them, parents may respond, “You feel cheated, huh?” Notice once again, these empathic statements do not imply agreement.

Do not rush to argue with your family member about her feelings or talk her out of her feelings. As we said above, such arguing can be fruitless and frustrating to the person who wants to be heard. Remember, even when it may feel difficult to acknowledge feelings that you believe have no basis in reality, it pays to reward such expression. It is good for people, especially individuals with BPD, to put their feelings into words, no matter how much those feelings are based on distortions. If people find the verbal expression of their feelings to be rewarding, they are less likely to act out on feelings in destructive ways.

Feelings of being lonely, different, and inadequate need to be heard. By hearing them and demonstrating that you have heard them using the methods described above, you help the individual to feel a little less lonely and isolated. Such feelings are a common, everyday experience for people with BPD. Parents usually do not know and often do not want to believe that their daughter feels these ways. The feelings become a bit less painful once they are shared.

Family members may be quick to try to talk someone out of such feelings by arguing and denying the feelings. Such arguments are quite frustrating and disappointing to the person expressing the feelings. If the feelings are denied when they are expressed verbally, the individual may need to act on them in order to get her message across.

ADDRESSING PROBLEMS

COLLABORATE AND BE CONSISTENT

9. When solving a family member’s problems, ALWAYS:

a) involve the family member in identifying what needs to be done

b) ask whether the person can “do” what’s needed in the solution

c) ask whether they want you to help them “do” what’s needed

Problems are best tackled through open discussion in the family. Everyone needs to be part of the discussion. People are most likely to do their part when they are asked for their participation and their views about the solution are respected. It is important to ask each family member whether he or she feels able to do the steps called for in the planned solution.

By asking, you show recognition of how difficult the task may be for the other person. This goes hand in hand with acknowledging the difficulty of changing.

You may feel a powerful urge to step in and help another family member. Your help may be appreciated or may be an unwanted intrusion. By asking if your help is wanted before you step in, your assistance is much less likely to be resented.

10. Family members need to act in concert with one another. Parental inconsistencies fuel severe family conflicts. Develop strategies that everyone can stick to.

Family members may have sharply contrasting views about how to handle any given problem behavior in their relative with BPD. When they each act on their different views, they undo the effect of each other’s efforts. The typical result is increasing tension and resentment between family members as well as lack of progress in overcoming the problem.

An example will illustrate the point. A daughter frequently calls home asking for financial bail outs. She has developed a large credit card debt. She wants new clothing. She has been unable to save enough money to pay her rent. Despite her constant desire for funds, she is unable to take financial responsibility by holding down a job or living by a budget. Her father expresses a stem attitude, refusing to provide the funds, and with each request and insisting that she take responsibility for working out the problem herself. The mother meanwhile softens easily with each request and gives her the funds she wants. She feels that providing the extra financial help is a way of easing the daughter’s emotional stress. The father then resents the mother’s undoing of his efforts at limit setting while the mother finds the father to be excessively harsh and blames him for the daughter’s worsening course. The daughter’s behavior persists, of course, because there is no cohesive plan for dealing with the financial issue that both parents can stick to. With some communication, they can develop a plan that provides an appropriate amount of financial support, one that would not be viewed as too harsh by the mother, but would not be considered excessively generous in the father’s eyes. The daughter will adhere to the plan only after both parents adhere to it.

Brothers and sisters can also become involved in these family conflicts and interfere with each other’s efforts in handling problems. In these situations, family members need to communicate more openly about their contrasting views on a problem, hear each other’s perspectives, and then develop a plan that everyone can stick to.

11. If you have concerns about medications or therapist interventions, make sure that both your family member and his or her therapist/doctor/treatment team know. If you have financial responsibility, you have the right to address your concerns to the therapist or doctor.

Families may have a variety of concerns about their loved one’s medication usage. They may wonder whether the psychiatrist is aware of the side effects the patient is experiencing. Can the psychiatrist see how sedated or obese the individual has become? Is he or she subjecting the patient to danger by prescribing too many medications? Families and friends may wonder if the doctor or therapist knows the extent of the patient’s non-compliance or history of substance abuse.

When family members have such concerns, they often feel that they should not interfere, or are told by the patient not to interfere. We feel that if family members play a major supportive role in the patient’s life, such as providing financial support, emotional support, or by sharing their home, they should make efforts to participate in treatment planning for that individual. They can play that role by contacting the doctor or therapist directly themselves to express their concerns. Therapists cannot release information about patients who are over the age of 18 without consent, but they can hear and learn from the reports of the patient’s close family and friends. Sometimes they will work with family members or fiends but obviously with their patient’s consent.

LIMIT SETTING

BE DIRECT BUT CAREFUL

12. Set limits by stating the limits of your tolerance. Let your expectations be known in clear, simple language. Everyone needs to know what is expected of them.

Expectations need to be set forth in a clear manner. Too often, people assume that the members of their family should know their expectations automatically. It is often useful to give up such assumptions.

The best way to express an expectation is to avoid attaching any threats. For example, one might say, “I want you to take a shower at least every other day.” When expressed in that fashion, the statement puts responsibility on the other person to fulfill the expectation. Often, in these situations, family members are tempted to enforce an expectation by attaching threats. When feeling so tempted, one might say, “If you don’t take a shower at least every other day, I will ask you to move out.” The first problem with that statement is that the person making the statement is taking on the responsibility. He is saying “I” will take action if “you” do not fulfill your responsibility as opposed to giving the message, “You need to take responsibility!” The second problem with that statement is that the person making it may not really intend to carry out the threat if pushed. The threat becomes an empty expression of hostility. Of course, there may come a point at which family members feel compelled to give an ultimatum with the true intention to act on it. We will discuss this situation later.

13. Do not protect family members from the natural consequences of their actions. Allow them to learn about reality. Bumping into a few walls is usually necessary.

People with BPD can engage in dangerous, harmful, and costly behaviors. The emotional and financial toll to the individual and the family can be tremendous. Nonetheless, family members may sometimes go to great lengths to give in to the individual’s wishes, undo the damage, or protect everyone from embarrassment. The results of these protective ways are complex. First and foremost, the troublesome behavior is likely to persist because it has cost no price or has brought the individual some kind of reward. Second, the family members are likely to become enraged because they resent having sacrificed integrity, money, and good will in their efforts to be protective. In this case, tensions in the home mount even though the hope of the protective measures was to prevent tension. Meanwhile, the anger may be rewarding on some level to the individual because it makes her the focus of attention, even if that attention is negative. Third, the individual may begin to show these behaviors outside of the family and face greater harm and loss in the real world than she would have faced in the family setting. Thus, the attempt to protect leaves the individual unprepared for the real world. Some examples will illustrate the point.

* A daughter stuffs a handful of pills in her mouth in her mother’s presence. The mother puts her hand into the daughter’s mouth to sweep out the pills. It is reasonable to prevent medical harm in this way. The mother then considers calling an ambulance because she can see that the daughter is suicidal and at risk of harming herself. However, this option would have some very negative consequences. The daughter and the family would face the embarrassment of having an ambulance in front of the house. The daughter does not wish to go to the hospital and would become enraged and out of control if the mother called the ambulance. A mother in this situation would be strongly tempted not to call the ambulance in order to avoid the daughter’s wrath and to preserve the family’s image in the neighborhood. She might rationalize the decision by convincing herself that the daughter is not in fact in immediate danger. The primary problem with that choice is that it keeps the daughter from attaining much needed help at a point when she has been and could still be suicidal. The mother would be aiding the daughter in denial of the problem. Medical expertise is needed to determine whether the daughter is at risk of harming herself. If the daughter’s dramatic gesture has not been given sufficient attention, she would be likely to escalate. As she escalates, she may make an even more dramatic gesture and face greater physical harm. Furthermore, if an ambulance were not called for fear of incurring her wrath, she would receive the message that she can control others by threatening to become enraged

* A 25-year old woman steals money from her family members while she is living with them. The family members express great anger at her and sometimes threaten to ask her to move out, but they never take any real action. When she asks to borrow money, they give the loan despite the fact that she never pays back such loans. They fear that if they do not lend the money, she may steal it from someone outside the family, thus leading to legal trouble for her and humiliation for everyone else involved. In this case, the family has taught the daughter that she can get away with stealing. She has essentially blackmailed them. They give her what she wants because they are living with fear. The daughter’s behavior is very likely to persist as long as no limits are set on it. The family could cease to protect her by insisting that she move out or by stopping the loans. If she does steal from someone outside the family and faces legal consequences, this may prove to be a valuable lesson about reality. Legal consequences may influence her to change and subsequently function better outside the family.

* A 20-year old woman who has had multiple psychiatric hospitalizations recently and has been unable to hold down any employment decides that she wants to return to college full time. She asks her parents to help pay tuition. The parents who watch their daughter spend most of her day in bed are skeptical that she will be able to remain in school for an entire semester and pass her courses. The tuition payments represent great financial hardship for them. Nonetheless, they agree to support the plan because they do not want to believe she is as dysfunctional as she behaves and they know their daughter will become enraged if they do not. They have given a dangerous “You can do it” message. Furthermore, they have demonstrated to her that displays of anger can control her parents’ choices. A more realistic plan would be for the daughter to take one course at a time to prove that she can do it, and then return to school full time only after she has demonstrated the ability to maintain such a commitment despite her emotional troubles. In this plan, she faces a natural consequence for her recent low functioning. The plan calls upon her to take responsibility in order to obtain a privilege she desires.

Each of the cases illustrates the hazards of being protective when a loved one is making unwise choices or engaging in frankly dangerous behavior. By setting limits on these choices and behaviors, family members can motivate individuals to take on greater responsibility and have appropriate limits within themselves. The decision to set limits is often the hardest decision for family members to make. It involves watching a loved one struggle with frustration and anger. It is important for parents to remember that their job is not to spare their children these feelings but to teach them to live with those feelings as all people need to do.

14. Do not tolerate abusive treatment such as tantrums, threats, hitting and spitting. Walk away and return to discuss the issue later.

Frank tantrums are not tolerable. There is a range of ways to set limits on them. A mild gesture would be to walk out of the room to avoid rewarding the tantrum with attention. A more aggressive gesture would be to call an ambulance. Many families fear taking the latter step because they do not want an ambulance in front of their home, or they do not want to incur the wrath of the person having the tantrum. When torn by such feelings, one must consider the opposing issues. Safety may be a concern when someone is violent and out of control. Most people would agree that safety takes priority over privacy. Furthermore, by neglecting to get proper medical attention for out-of-control behavior, one may turn a silent ear to it. This only leads to further escalation. The acting out is a cry for help. If a cry for help is not heard, it only becomes louder.

15. Be cautious about using threats and ultimatums. They are a last resort. Do not use threats and ultimatums as a means of convincing others to change. Give them only when you can and will carry through. Let others – including professionals – help you decide when to give them.

When one family member can no longer tolerate another member’s behavior, he or she may reach the point of giving an ultimatum. This means threatening to take action if the other person does not cooperate. For example, when a daughter will not take a shower or get out of bed much of the day, an exasperated parent may want to tell her that she will have to move out if she does not change her ways. The parent may hope that fear will push her to change. At the same time, the parent may not be serious about the threat. When the daughter continues to refuse to cooperate, the parent may back down, proving that the threat was an empty one. When ultimatums are used in this way, they become useless, except to produce some hostility. Thus, people should only give ultimatums when they seriously intend to act on them. In order to be serious about the ultimatum, the person giving it probably has to be at the point where he feels unable to live with the other person’s behavior.


 

 

This book is particulary helpful  THE OMEGA-3 CONNECTION and can be purchased from amason.co.uk – click here

 

I am not saying this is in anyway a cure for  BPD but it most definitely helps with depression and mood.  Omega-3 Connection: The Groundbreaking Omega-3 Antidepression Diet and Brain Program: Amazon.co.uk: Andrew L. Stoll: Books.

The following article is something I fully believe and encourage my son to follow, what we eat is important factor in our well  being.    He now takes supplements to correct any deficiency in his food intake and  is concentrating now on omitting his white sugar intake, more on this to follow in a future article.

 

 

 

iStock_000000637101XSmallOmega-3 fatty acids are polyunsaturated fatty acids that are considered essential because they cannot be synthesized by the human body. Dietary sources of omega-3 fatty acids include plants (particularly flax, canola, walnuts and hemp) and fish (particularly ocean fish such as sardines, anchovies, salmon and mackerel). Plants contain the parent omega- 3, alpha-linolenic acid (ALA), which can be converted into eicosapentanoic acid (EPA) and docosahexanoic acid (DHA).

 

Dietary fish and fish oil supplements are a direct source of EPA and DHA. The influence of ALA, EPA and DHA in human health has been the subject of intense research over the last three decades. Although best known for cardiovascular benefits, new findings indicate that the influence of omega-3 fatty acids in mental health, particularly EPA, may currently be underestimated.

 

Epidemiological, experimental and new clinical studies have all shown a strong connection between omega-3 fatty acids, or a lack thereof, and major depression.

 

These exciting new findings are not entirely surprising when one considers that the brain itself is 60 percent fat and that one-third of all fatty acids are of the polyunsaturated variety. As discussed below, the current research highlights the critical role of these fatty acids in the central nervous system (CNS).

 

Omega-3 Intake Declines, Depression Rates Climb

There has been a significant drop-off in omega-3 fatty acid intake within Western

countries over the last century. The opposite can be said of omega-6 intake. Although essential, omega-6-rich oils are found in abundance in the North American food supply.

 

Currently these omega-6 oils (corn, safflower, sunflower, cottonseed, sesame) are outnumbering omega-3 fatty acids by a ratio of up to 20:1.

 

This ratio is a long way off the close to 1:1 omega-6 to omega-3 ratio as recommended by the international panel of essential fatty acid experts in the Journal of the American College of Nutrition. The average daily intake of EPA/DHA combined is 130mg in North America, 520mg short of published recommendations and 870mg short of the 1000mg recommended by the American Heart Association in cases of heart disease.

 

In direct contrast to the depletion of omega-3 fatty acids from the Western food supply, the rates of depression have dramatically increased in Western countries. In addition, depression is now occurring more commonly in younger persons. The average age of onset of depression has continued to dip over the last 100 years. Scientists investigating the change in rates of depression have made it clear that these findings cannot be explained away by changes in attitudes of health professionals or society, diagnostic criteria, reporting bias, institutional or other artifacts. Perhaps the inadequate omega-3 intake, the major deviations in fatty acids ratios and the quarter-century-old message that all fat is unhealthy has had an untold influence on rates of depression.

 

Fish Consumption and Depression

There have been a number of studies that have examined national and international fish consumption data and compared them to rates of depression. Dr. Joseph Hibbeln of the National Institutes of Health is a pioneer in this area. He, and his group, have shown that higher national consumption of fish for a nation equals lower rates of depression versus countries consuming the least amount of fish. He has also shown that higher fish consumption is correlated with lower risk of postpartum depression and seasonal affective disorder.

 

Other researchers have shown that even within a nation, fish consumption is associated with lower risk of depression and higher mental health status. Finally, researchers are now observing increasing rates of depression in regions of the world that are moving away from traditional omega-3-rich diets to typical Western foods.

 

Laboratory Tests in Depression

The epidemiological studies clearly suggest that adequate omega-3 fatty acids may be an important protective factor in depression. Correlation, however, does not prove causation.

 

To add to the strength of the epidemiological studies, scientists have examined the levels of omega-3 fatty acids in the blood cells and fat storage cells of those with major depression.

 

Four studies have shown that those with depression do indeed have lower levels of omega-3 fatty acids in the blood. One of the studies showed that the lower the level of EPA, the more severe the clinical depression. In addition, a recent study showed that the patients with depression have 35 percent less DHA in fat storage cells versus healthy controls.

 

Experimental Studies

Over the last decade, neuroscientists have been examining the consequences of omega-3 deficiencies in the central nervous system. Alterations in serotonin and dopamine levels, as well as the functioning of these two important neurotransmitters is evident in an omega-3 deficiency. The changes observed in omega-3 deficiency in animals is strikingly similar to that found in autopsy studies of human depression.

 

In addition to changing serotonin and dopamine levels and functioning, omega-3 deficiencies are known to compromise the blood-brain barrierwhich normally protects the brain from unwanted matter gaining access.Omega-3 deficiency can also decrease normal blood flow to the brain, an interesting finding given the studies which show that patients with depression have compromised blood flow to a number of brain regions. Finally, omega-3 deficiency also causes a 35 percent reduction in brain phosphatidylserine (PS) levels.This is also of relevance when considering that PS has documented antidepressant activity in humans.

 

Mechanisms of EPA/DHA Regulation of Mood

DHA is found in high levels in the cells of the central nervous system (neurons); here it acts as a form of scaffolding for structural support. When omega-3 intake is inadequate, the nerve cell becomes stiff as cholesterol and omega-6 fatty acids are substituted for omega-3. When a nerve cell becomes rigid, proper neurotransmission from cell to cell and within cells will be compromised.

 

While DHA provides structure and helps to ensure normal neurotransmission, EPA may be more important in the signaling within nerve cells. Normalizing communications within nerve cells has been suggested to be an important factor in alleviating depressive symptoms. In addition, EPA can lower the levels of two important immune chemicals, tumour necrosis factor alpha (TNFa) and interleukin 1 beta (IL-1ß), as well as prostaglandin E2.

 

All three of these chemicals are elevated in depression. In fact, higher levels of

TNFa and IL-1ß are associated with severity of depression. Finally, EPA has been hypothesized to increase brain-derived neurotropic factor (BDNF), which is known to be lower in depressed patients. BDNF is neuroprotective, enhances neurotransmission, has antidepressant activity and supports normal brain structure. BDNF may prevent the death of nerve cells in depression.

 

Clinical Studies

There have been some published case reports indicating that flaxseed oil may be helpful in cases of bipolar depression and the anxiety disorder agoraphobia. The first controlled clinical trial indicating that omega-3 fatty acids may be of benefit in

depression was published in 1999. In this case, 9:6 g of EPA/DHA versus placebo led to longer periods of remission and improvement in depressive symptoms in those with bipolar depression.

 

Some researchers theorize that such high doses of EPA/DHA may not be necessary and that low levels of pure EPA may be of benefit. In a study published in the American Journal of Psychiatry, researchers showed thatjust 2g of pure EPA could improve the symptoms of treatment-resistant depression. The researchers found that the EPA (versus placebo), when added to an ineffective antidepressant for one month, significantly improved depressive symptoms.

 

A larger study published in Archives of General Psychiatry replicated these findings, however, this time various doses of EPA were examined. Those on ineffective antidepressants were given 1g, 2g or 4g of pure EPA or a placebo in addition to the medication. Interestingly, the 1g daily dose of EPA led to the most significant improvements over the three-month study; it appeared that less was more. There were significant improvements in depressive symptoms, sleep, anxiety, lassitude, libido and thoughts of suicide.

 

Researchers from Taiwan Medical University published a recent study in which they found that a 4.4g EPA and 2.2g DHA mix could alleviate depression versus placebo in those with treatment-resistant depression. This was a two-month study involving patients who were on antidepressants that were not working. As with the other omega-3 studies discussed, the fish oil was well tolerated and no adverse events were reported.

 

There is also evidence that omega-3 oils may be of benefit in treating depressive

symptoms outside of major depressive disorder. Canadian researchers showed that Antarctic krill oil (400mg EPA, 240mg DHA) could improve depressive symptoms associated with premenstrual syndrome. Harvard researchers have also shown that just 1g of pure EPA is beneficial in the treatment of borderline personality disorder. This personality disorder, which is particularly difficult to treat, is characterized by both depressive and aggressive symptoms. This was a two-month placebo-controlled study and the results showed that EPA has a mood-regulating effect, improving both depression and aggression versus placebo.

 

To date, with one exception, all studies conducted on omega-3 fatty acids and mood have had a positive outcome. The singular negative study examined pure DHA in patients with depression. The results in the case showed that DHA alone was no better than placebo in alleviating depressive symptoms.

 

Conclusion

Although an influence of EPA and DHA on brain physiology and structure is apparent, the precise mechanisms whereby omega-3 fatty acids may alleviate depression remain unknown. The results of the clinical trials reinforce the epidemiological and experimental studies, underscoring the importance of adequate omega-3 intake in those with depression.

 

The long-term studies of fish oil supplements in the area of cardiovascular health, some spanning three-plus years, have shown that they are safe and well tolerated. Patients with depression or depressive symptoms should discuss omega-3 fatty acids with their health care providers. While scientists continue to unravel the neuropsychological influences of omega-3 fatty acids, it should be recognized that they are not a substitute for appropriate mental health evaluation and care.

By Alan C. Logan, ND, FRSH 

 

Alan C. Logan is a naturopathic physician licensed in Connecticut. Valedictorian of the Canadian College of Naturopathic Medicine, class of 2001

Posted by: carolg1849 | September 17, 2009

Article LA times, optimistic and interesting

Hello everyone, this article arrived this morning, after reading through it, thought it held great optimism .  I know this is stateside talking, but PD is global, the bigger the ground swell for recognition, services and the like the better it will be for us all.  What they do have in the states which we do not have much of here is “family and friends” live group support.  This is what we need so badly, not just piece meal, one is thames valley and one new one in norther ireland.  Although admirable, what happens to the hundreds of thousands of PD suffererers, let alone carers who are ignored, “dumped” by CMHT’s as untreatable or diagnosed with Bi Polar and put on medication that is  no help to the PD whatsover.  What happens to the carers who have to live with emotional fall out on a daily basis, alone, told they are doing everything wrong, isolated with feelings of great shame that they were to blame.  Read on, its heart warming to know the light at the end of the tunnel is burning brighter!!

 

help on the horizonBy SHARI ROAN
LOS ANGELES TIMES
September 17, 2009 12:00 AM

They have the thinnest skin, the shortest fuses and take the hardest knocks. In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.

They are the kind of people who drive a friend away for interfering and subsequently berate that friend for abandonment.

But almost 20 years after the designation of borderline personality disorder as a recognized mental health condition, some understanding and hope have surfaced for people with the condition and their families.

Borderline personality disorder was center stage in May at the annual meeting of the American Psychiatric Association — with multiple sessions and speakers devoted to the topic. And the message from the meeting was clear: After years during which they threw up their hands, leaders in psychiatry now want to convey a more positive message about the condition and what can be done to help those who have it.

“Borderline personality disorder is considered a pejorative term,” says Dr. Richard G. Hersh, a psychiatrist at Columbia University’s College of Physicians and Surgeons. “But there are new treatments and new data that give reason for optimism.”

That is especially significant given results of a survey of more than 24,000 adults, conducted by the federal government and released last year, that found a lifetime prevalence of borderline personality disorder to be almost 6 percent — more than double previous estimates.

“The public and patients want to learn more about this condition, and more doctors want to treat it,” says Valerie Porr, founder of a national advocacy group called TARA, Association for Personality Disorders.

“You look back now and see things,” says Patricia Green, the mother of a 25-year-old woman diagnosed with borderline personality disorder.

As a child, Sooki (a pseudonym) was sensitive and easily rattled. In high school, she had such difficulty making friends that she opted for home schooling.

After high school, the real trouble began. She had a series of turbulent relationships; was fired from jobs and racked up serious credit card debt. She began cutting herself and was diagnosed with depression.

Patricia, a school nurse in San Diego, attended a workshop on borderline personality disorder six years ago and left suspecting her daughter had it. The description seemed to fit Sooki.

“Suddenly, all the things about Sooki that didn’t seem to be related were all under one umbrella,” Patricia says.

As in the case of Sooki, people with the disorder make a mess of their relationships — and no wonder, given the hallmark symptoms: mood instability, fear of abandonment, impulsive behavior, anger and suicidal or self-injurious acts. People with the disorder may misperceive the actions — even the facial expressions — of others.

“You can’t regulate your emotions despite your best efforts,” says Marsha Linehan, a University of Washington psychologist and leading expert on the disorder.

Borderline personality disorder occurs equally in men and women and sufferers often also have other mental illnesses or substance abuse problems. The composite of an angry, unstable, clingy, substance abuser is not a pretty one, and people with the disorder suffer greatly because they drive away even the people who love them most, experts say.

“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD. “But our message to families is to please stay the course with your relative because it’s crucial to their well being.”

One of the most significant developments for those affected by the disorder has been the emergence of a strong family and patient advocacy movement pressing for more research and establishing support networks and treatment referral services. Porr started TARA in 1995; Hoffman launched her organization in 2001. In 2007, the National Alliance on Mental Illness, a patient advocacy group, put borderline personality disorder on its list of “priority populations” for public policy efforts.

The National Institute of Mental Health, along with the nonprofit advocacy groups and major medical institutions such as the University of California, Los Angeles and the Mount Sinai School of Medicine in New York have convened national and regional conferences on the disorder.

The flurry of research on borderline personality disorder is casting the condition in a new light. Originally, the behavior was blamed on abuse, trauma or neglect in childhood. But newer research suggests that people with the disorder are born with the predisposition to be emotionally sensitive. Abuse puts a person at higher risk for borderline personality disorder but not everyone who develops it is abused or neglected.

“Parents commonly say, my kid has not been normal since he or she was born,” says Dr. Marianne Goodman, a psychiatrist at Mount Sinai School of Medicine in New York.

In a study presented at the American Psychiatric Association meeting, Goodman found signs of emotional sensitivity in young children who were later diagnosed with borderline personality disorder. Via a Web questionnaire, Goodman collected data from parents on 234 people with the disorder and 87 unaffected siblings.

She found that as infants, the children who were later diagnosed with borderline personality disorder tended to be self-soothing — they sucked their thumbs or had attachments to objects, such as a blanket — compared to unaffected siblings. They also were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as few friends and more conflicts with peers and authorities.

As teenagers they were more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide became common.

“Children are really starting to look so different at that point,” Goodman says.

Other research shows that, by their 20s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.

Research on the brains of people with the disorder suggest there is a biological predisposition to the core symptoms of emotional sensitivity and misperceiving the actions and feelings of others.

For example, a study published in 2008 in Science showed different patterns of brain activity in people with the disorder: The scans showed abnormal responses in a brain region called the bilateral anterior insula when borderline personality patients played a game with other people that tested their sense of fairness and social norms.

Through such studies, experts say, it is becoming clearer that the condition may simply be a type of personality that some people enter the world with. Some describe that mind state as a “pervasive emotional dysregulation” — a brain that is primed to overreact.

“I don’t think you can learn to be borderline,” Linehan says. “They are intensely emotional people. The sensitivity to emotion is probably there at the beginning.”

Future progress in helping people with borderline personality disorder may rest on the willingness of therapists to recognize it and apply therapies that are specific to the condition. One study of 70 patients presented at the American Psychiatric Association meeting found that 34 percent had been given a wrong diagnosis before finally being identified with borderline personality disorder.

The study also found that 74 percent of people who met the criteria for the disorder had never been diagnosed with the condition despite an average of more than 10 years since their first encounter with a psychiatrist.

The correct diagnosis is key because specific behavior-change therapies seem to work best.

There are several helpful therapies, experts say, notably dialectical behavioral therapy, and all share common elements. The bond between the patient and therapist is strong — important for a long-term, therapeutic relationship. And the therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

After Sooki’s diagnosis, her mother Patricia began to change the way she communicated with her daughter by remembering that Sooki is ultra-sensitive and easily misperceives others’ feelings.

Sooki began seeing a therapist who specialized in borderline personality disorder. She attended group support meetings, took medication for depression and began to exercise to battle her depression in a positive way. She is now in a healthy relationship with an understanding, supportive boyfriend, her mother says, and is taking college classes.

She doesn’t yet tell people she has borderline personality disorder because, she says, few people understand what it is.

But, recently, she has started telling the truth about the scars on her arms. “The scars from my cutting are a reminder of how bad things were,” she says.

“For so long I felt like an outsider looking in. I hated myself,” she adds. “I’ve really improved, and I think each year I get  better

Posted by: carolg1849 | September 6, 2009

Royal College of Psychiatrists leaflet on PD

Another inormative leaflet. Most of the information is up to date , however its widely know now that Drug therapy is not the therapy of choice now, medication is best used only as temporary measures to help a person over a particular period and not continously.  

Personality Disorders

About this leaflet

This leaflet is for anyone who has been given a diagnosis of personality disorder – and also for their family and friends.

Introductionpersonality disorders_web

It’s not easy to pin down exactly what we mean by the word ‘personality’.  It seems obvious, but it is hard to put into words.  Part of the reason is that many of the words we use to describe people have wide meanings – and these meanings often overlap.

These words can cover more than one area of experience. ‘Anxiety’ describes the feeling of worrying, ‘nervousness’ describes the behaviour that others might notice if you feel like this. ‘Shyness’ describes the feeling of awkwardness with other people, but also the behaviour of being rather quiet in company.

It is also difficult because the way we appear to other people can be very different in different situations.  If you only know someone from work, you may see quite a different side to them if you meet socially.

However, in mental health, the word ‘personality’ refers to the collection of characteristics or traits that makes each of us an individual. These include the ways that we:

  • think
  • feel
  • behave

By our late teens, or early 20s, most of us have developed our own personality with our own distinctive ways of thinking, feeling and behaving. It remains pretty much the same for the rest of our life. Usually, our personality allows us to get on reasonably well, if not perfectly, with other people.

Personality disorder

However, for some of us, this doesn’t happen. For whatever reason, parts of our personality develop in a way that makes it difficult for us to live with ourselves and/or other people. It can be difficult to learn from experience and to change those traits – the unhelpful ways of thinking, feeling and behaving – that cause the problems. Unlike the changes in personality that can be caused by traumatic events, or an injury to the brain, these traits will usually have been noticeable from childhood or early teens.

You may find it difficult to:

  • make or keep relationships
  • get on with people at work
  • get on with friends and family
  • keep out of trouble
  • control your feelings or behaviour

 

If, as a result, you:

  • are unhappy or distressed

and/or

  • find that you often upset or harm other people

then you may have a personality disorder (see below for descriptions of the different types). Having a personality disorder makes life difficult, so other mental health problems (such as depression, or drug and alcohol problems) are also common.

Talking about personality disorder

There are different ways to describe mental disorders, and to put them into categories. The difficulty in describing any personality clearly, makes this more controversial with personality problems than with mental illnesses, such as depression or schizophrenia. Indeed, many people feel that it is unhelpful to ‘label’ personality difficulties in this way. However, although we are all individuals, certain patterns of personality problems do seem to be shared by fairly large numbers of people. By identifying these patterns, we can then develop ways of helping, and treatments that can be of use to many people, not just an individual. 

Personality disorder – a suitable case for treatment?

There is good evidence that people with the diagnosis of personality disorder have not received the attention they should have from mental health services. These services have focused mainly on mental illnesses, such as schizophrenia, bipolar disorder and depression. There has been some uncertainty about whether they have anything useful to offer people with personality disorders. Research has made it clear that mental health services can, and should, help people with personality disorders.

Different kinds of personality disorders

Research has shown that personality disorders tend to fall into three groups, according to their emotional ‘flavour’:

Cluster A:  ‘Suspicious’

Cluster B:  ‘Emotional and impulsive’

Cluster C:  ‘Anxious’

As you read through the descriptions of each type, you may well recognise some aspects of your own personality. This doesn’t necessarily mean that you have a personality disorder. Some of these characteristics may even be helpful in some areas of your life. However, if you do have a personality disorder, these aspects of your personality will be quite extreme. They may spoil your life, and often the lives of those around you. 

People may display the signs of more than one personality disorder. 

Cluster A: ‘Suspicious’

Paranoid

  • suspicious
  • feel that other people are being nasty to you (even when evidence shows this isn’t true) 
  • sensitive to rejection
  • tend to hold grudges

Schizoid

  • emotionally ‘cold’
  • don’t like contact with other people, prefer your own company
  • have a rich fantasy world

 

Schizotypal

  • eccentric behaviour
  • odd ideas
  • difficulties with thinking
  • lack of emotion, or inappropriate emotional reactions
  • can see or hear strange things
  • related to schizophrenia, the mental illness

 

Cluster B:  ‘Emotional and impulsive’

Antisocial, or Dissocial

  • don’t care about the feelings of others
  • are easily frustrated
  • tend to be aggressive
  • commit crimes
  • find it difficult to make intimate relationships
  • impulsive – do things on the spur of the moment without thinking about them
  • don’t feel guilty
  • don’t learn from unpleasant experiences

Borderline, or Emotionally Unstable

  • impulsive
  • find it hard to control emotions
  • feel bad about yourself
  • often self-harm, e.g. cutting yourself or making suicide attempts
  • feel ’empty’
  • make relationships quickly, but easily lose them
  • can feel paranoid or depressed
  • when stressed, may hear noises or voices

Histrionic

  • over-dramatise events
  • self-centered
  • show strong emotions, but which change quickly and don’t last long
  • can be suggestible
  • worry a lot about your appearance
  • crave new things and excitement
  • can be seductive

Narcissistic

  • have a strong sense of your own self-importance
  • dream of unlimited success, power and intellectual brilliance
  • crave attention from other people, but show few warm feelings in return
  • exploit others
  • ask for favours that you do not then return

 

Cluster C:  ‘Anxious’

Obsessive-Compulsive (aka Anankastic)

  • worry and doubt a lot
  • perfectionist – always check things
  • rigid in what you do
  • cautious, preoccupied with detail
  • worry about doing the wrong thing
  • find it hard to adapt to new situations
  • often have high moral standards
  • judgemental
  • sensitive to criticism 
  • can have obsessional thoughts and images (although these are not as bad as those in obsessive-compulsive disorder)

 

Avoidant (aka Anxious/Avoidant)

  • very anxious and tense
  • worry a lot
  • feel insecure and inferior
  • have to be liked and accepted
  • extremely sensitive to criticism

 

Dependent

  • passive
  • rely on others to make their own decisions
  • do what other people want you to do
  • find it hard to cope with daily chores
  • feel hopeless and incompetent
  • easily feel abandoned by others

What causes personality disorder?

The answer is not clear, but it seems that like other mental disorders, genes, brain problems and upbringing can play a part. There is evidence for the importance of:

 

Upbringing

  • physical or sexual abuse in childhood
  • violence in the family
  • parents who drink too much

If children are taken out of this sort of difficult environment, they are less likely to develop a personality disorder.

 

Early problems

Behaviour problems in childhood, such as severe aggression, disobedience, and repeated temper tantrums. 

 

Brain problems

Some people with antisocial personality disorder have very slight differences in the structure of their brains, and in the way some chemicals work in their brains. However, there is no brain scan or blood test for a personality disorder.

 

Things that make it worse

  • using a lot of drugs or alcohol
  • problems getting on with your family or partner
  • money problems
  • anxiety, depression or other mental health problems

Help

Treatment for people with personality disorders can be psychological (talking therapies) and/or physical (medication).

 

1. Psychological: talking treatments or therapies

 

  • Counselling – talking and listening.  This depends on a trusting relationship between the counsellor and the person counselled.
  • Dynamic psychotherapy – looks at how past experiences affect present behaviour. 
  • Cognitive therapy – a way to change unhelpful patterns of thinking.
  • Cognitive analytical therapy – a way to recognise and change unhelpful patterns in relationships and behaviour.
  • Dialectical behaviour therapy – this uses a combination of cognitive and behavioural therapies, with some techniques from Zen Buddhism.  It involves individual therapy and group therapy. 
  • Treatment in a therapeutic community – this is a place where people with long-standing emotional problems can go to (or sometimes stay) for several weeks or months. Most of the work is done in groups. You learn from getting on – or not getting on – with other residents. It differs from ‘real life’ in that any disagreements or upsets happen in a safe place. The staff and other residents help you to get through such problems and learn from them. Users/residents often have a lot of say over how the place runs, but have to be prepared to stay and work through difficult periods.

 

2.  Physical

 

Medication can help in some personality disorders. 

 

Antipsychotic drugs (usually at a low dose)

  • Can reduce the suspiciousness of the three cluster A personality disorders (paranoid, schizoid and schizotypal).
  • Can help with borderline personality disorder if people feel paranoid, or are hearing noises or voices. 

 

Antidepressants

  • Can help with the mood and emotional difficulties that people with cluster B personality disorders (antisocial or dissocial, borderline or emotionally unstable, histrionic, and narcissistic) have.
  • Some of the selective serotonin reuptake inhibitor antidepressants (SSRIs) can help people to be less impulsive and aggressive in borderline and antisocial personality disorders.
  • Can reduce anxiety in cluster C personality disorders (obsessive-compulsive, avoidant and dependent).

 

Mood stabilisers

Medication such as lithium, carbamazepine, and sodium valproate can also reduce impulsiveness and aggression. 

 

These medications and treatments also help if someone with a personality disorder develops depression or schizophrenia.

 

The type of therapy offered depends on:

  • individual preference (of the patient/service user);
  • the type of personality disorder;
  • the availability of the treatment in that geographical area.

 

If you have a personality disorder, you may not need treatment at all – but you might find medication or talking treatments helpful, and sometimes both.  Admission to hospital usually happens only as a last resort (e.g. when a person with borderline personality disorder is harming themselves badly) and for a short time. A lot of the help that was once only offered in hospital wards is now available in day centres or clinics.

How common are personality disorders?

  • About 40-70% of people on a psychiatric ward will have a personality disorder.
  • 30-40% of psychiatric patients being treated in the community by a psychiatric service will have a personality disorder.
  • Around 10-30% of patients who see their general practitioner (GP) will have a personality disorder.

Do personality disorders change with time?

Yes. There is evidence that they tend to improve slowly with age. Antisocial behaviour and impulsiveness, in particular, seem to reduce in your 30s and 40s.

It can, however, sometimes work in the opposite direction. For example, schizotypal personality disorder can develop into the mental illness schizophrenia.

Do interventions/treatments work?

There is evidence for both psychotherapies and medication, but it is weak because:

  • the interventions are usually quite complicated, so it is difficult to know what part (or parts) of the intervention are actually having an effect;
  • the number of participants is usually small;
  • the ways of measuring improvement are poor;
  • the studies into interventions and treatments have mostly been quite short.

Living with personality disorder

People with a personality disorder, just like anyone who has mental health difficulties, can be stigmatised because of their diagnosis. They can attract fear, anger and disapproval rather than compassion, support and understanding. This is both unfair and unhelpful. Personality disorder is a real problem that demands real help. We can all help by extending our friendship, support and understanding, rather than our judgement and discrimination, to people with a personality disorder.

Self-help

  • Try to unwind when stressed – have a hot bath or go for a walk.  You may find yoga, massage or aromatherapy useful.
  • Make sure you get a good night’s sleep – but don’t get too upset if you can’t sleep.
  • Look after your physical health and what you eat.  You’ll feel better on a balanced diet, with lots of fruit and vegetables.
  • Avoid drinking too much alcohol or using street drugs.
  • Take some regular exercise.  This doesn’t have to be extreme.  Even getting off the bus one stop early, and walking the rest of the way can make a difference.
  • Give yourself a treat (although not drugs or alcohol!) when things are difficult or you have coped at a stressful time.
  • Take up an interest or hobby. This is a good way to meet others and take your mind off the day to day stresses that we all face.
  • Talk to someone about how you are feeling. This could be a friend or relative or, if preferred, a therapist or counsellor.  If you don’t have access to a counsellor or therapist, then try your general practitioner (GP). 
  • Looking for information on the internet is a good resource (see further information).
  • If things get really tough, try phoning the Samaritans (see further information).

Living with someone who has a personality disorder

You may worry about the effects the personality disorder is having on them, and maybe on your life too. How would they react if you talked to them about it?

 

If they take your worries seriously, find out some more information, perhaps from the sources at the end of this leaflet. Even if they don’t see a problem at the present time, they may do in the future. 

 

Day to day living with someone who has a personality disorder can be difficult – but it isn’t always difficult.  Giving people their own space, listening to and acknowledging their concerns, and involving others (friends, relatives and, at times, mental health professionals – nurses, therapists or doctors) can all be useful. It is also important to look after your own physical and mental health.

 

Further Information

Mind

Mind is a leading mental health charity in England and Wales and has extensive information on personality and personality disorder.

 

National Personality Disorder Website

This provides information, resources and learning opportunities for those with a personality disorder and their carers.

 

Borderline UK

This is a national user-led network of people within the United Kingdom who meet the criteria, or who have been diagnosed with borderline personality disorder.

 

Scottish Personality Disorder Network

Contains information about the network set up by the Mental Health Divison, and provides information about the services available for those with personality disorders in Scotland.

 

The BBC’s Health Website

Contains articles on personality, personality difficulties and personality disorder.

Samaritans

Helpline: 08457 90 90 90, R.O.I: 1850 60 90 90; email: jo@samaritans.org

Samaritans is available 24 hours a day to provide confidential emotional support for people who are experiencing feelings of distress or despair, including those which may lead to suicide. The website has helpful information about stress and self-harm.

 

Rethink

Rethink is a leading national mental health membership charity and works to help everyone affected by severe mental illness recover a better quality of life.  Has information on personality and personality disorder.

 

The ‘Mental Health Shop’

This is an online resource for mental health publications, leaflets, booklets, videos and DVDs.  Has information on personality and personality disorder.

 

Aware

Assists and supports those suffering from depression (which can occur in those diagnosed with a personality disorder) and their families in Ireland. A helpline is available as well as support groups, lectures, and current research on depression.

 

Personality disorder: No longer a diagnosis of exclusion” (published by the National Institute for Mental Health in England). Free to download at:www.personalitydisorder.org.uk/assets/Resources/56.pdf

This gives detailed information on personality disorder, current available treatments and services, and future plans. It also discusses the minority of those with a personality disorder who have committed a crime, and services available for them.

 

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn.) (DSM-IV). Washington, DC: APA.

Bateman, A. and Fonagy, P. (1999) The effectiveness of partial hospitalisation in the treatment of borderline personality disorder – a randomised controlled trial. American Journal of Psychiatry, 156, 1563-1569.

Bateman, A. and Tyrer, P. (2004) Psychological treatment for personality disorders. Advances in Psychiatric Treatment, 10 (5), 378-388.

Bateman, A. and Tyrer, P. (2004) Services for personality disorder: organisation for inclusion. Advances in Psychiatric Treatment, 10 (6): 425-433.

Coid, J. (2003) Epidemiology, public health and the problem of personality disorder. British Journal of Psychiatry, 182 (suppl. 44) s3-s10.

Coid, J. et al. (2006) Prevalence and correlates of personality disorder in Great Britain.  British Journal of Psychiatry, 188, 423-431.

Hill, J. (2003) Early identification of individuals at risk for antisocial personality disorder. British Journal of Psychiatry, 182 (suppl. 44) s11-s14.

Kendell, R. (2002) The distinction between personality disorder and mental illness. British Journal of Psychiatry, 180, 110-115.

 

Tyrer, P. (ed.) (2002) Personality Disorders, Psychiatry, Volume 1:1 March 2002, The Medicine Publishing Company Ltd.

 

Tyrer, P. and Bateman, A. (2004) Drug treatment for personality disorders. Advances in Psychiatric Treatment, 10 (5): 389-398.

 

Tyrer, P. et al. (2007) Critical developments in the assessment of personality disorder.  British Journal of Psychiatry, 190 (suppl. 49), s51-s59.

Posted by: carolg1849 | September 6, 2009

Borderline personality disorder grows as healthcare concern

This article dropped into my inbox today.

 Although I dont agree entirely with everything, especially only using DBT and not using talking therapies that bring up the past…….  (If there were childhoods that were damaged by abuse, neglect, etc then this will always be there in the unconcious acting out in all manner of ways if surpressed), it is still an informative article.  

Although DBT is excellent in dealing with the here and now it should not in my opinion be seen as the holy grail or elixir for BPD treatment alone.  

BPD is complex, has complex needs requiring a whole raft of  treatments to support and help the diagnosed person to gain insight and understanding into their suffering, support and help them to take responsibility for their lives, teach them to adopt coping strategies, challenge thought processes and help adopt ones that are based on reality, help to give structure to their days and above all GIVE THEM  SUPPORT , REAL UNDERSTANDING AND COMPASSION.  Something that here in the UK is very thin on the ground.

 

September 7, 2009 – Los Angeles Times

Sufferers display mood instability, fear of abandonment, impulsive behavior, anger and suicidal or self-injurious acts. People with the disorder also may misperceive the actions of others.

BPD shadows / masks

They have the thinnest skin, the shortest fuses and take the hardest knocks. In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat. They are the kind of people who drive a friend away for interfering and subsequently berate that friend for abandonment. 

 

But almost 20 years after the designation of borderline personality disorder as a recognized mental health condition, some understanding and hope have surfaced for people with the condition and their families.

Borderline personality disorder was center stage in May at the annual meeting of the American Psychiatric Assn. — with multiple sessions and speakers devoted to the topic. And the message from the meeting was clear: After years during which they threw up their hands, leaders in psychiatry now want to convey a more positive message about the condition and what can be done to help those who have it.

“Borderline personality disorder is considered a pejorative term,” says Dr. Richard G. Hersh, a psychiatrist at Columbia University’s College of Physicians and Surgeons. “But there are new treatments and new data that give reason for optimism.”

That is especially significant given results of a survey of more than 24,000 adults, conducted by the federal government and released last year, that found a lifetime prevalence of borderline personality disorder to be almost 6% — more than double previous estimates.

“The public and patients want to learn more about this condition, and more doctors want to treat it,” says Valerie Porr, founder of a national advocacy group called TARA, Association for Personality Disorders.

Messy relationships

“You look back now and see things,” says Patricia Green, the mother of a 25-year-old woman diagnosed with borderline personality disorder.

As a child, Sooki (a pseudonym) was sensitive and easily rattled. In high school, she had such difficulty making friends that she opted for home schooling. 

After high school, the real trouble began. She had a series of turbulent relationships; was fired from jobs and racked up serious credit card debt. She began cutting herself and was diagnosed with depression.

Patricia, a school nurse in San Diego, attended a workshop on borderline personality disorder six years ago and left suspecting her daughter had it. The description seemed to fit Sooki to a T.

“Suddenly, all the things about Sooki that didn’t seem to be related were all under one umbrella,” Patricia says.

As in the case of Sooki, people with the disorder make a mess of their relationships — and no wonder, given the hallmark symptoms: mood instability, fear of abandonment, impulsive behavior, anger and suicidal or self-injurious acts. People with the disorder may misperceive the actions — even the facial expressions — of others.

“You can’t regulate your emotions despite your best efforts,” says Marsha Linehan, a University of Washington psychologist and leading expert on the disorder.

Borderline personality disorder occurs equally as often in men and women and sufferers often also have other mental illnesses or substance abuse problems. The composite of an angry, unstable, clingy, substance abuser is not a pretty one, and people with the disorder suffer greatly because they drive away even the people who love them most, experts say.

“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD. “But our message to families is to please stay the course with your relative because it’s crucial to their well being.”

One of the most significant developments for those affected by the disorder has been the emergence of a strong family and patient advocacy movement pressing for more research and establishing support networks and treatment referral services. Porr started TARA in 1995; Hoffman launched her organization in 2001. In 2007, the National Alliance for the Mentally Ill, a patient advocacy group, put borderline personality disorder on its list of “priority populations” for public policy efforts. 

The National Institute of Mental Health, along with the nonprofit advocacy groups and major medical institutions such as UCLA and the Mount Sinai School of Medicine in New York have convened national and regional conferences on the disorder.

Roots in childhood

The flurry of research on borderline personality disorder is casting the condition in a new light. Originally, the behavior was blamed on abuse, trauma or neglect in childhood. But newer research suggests that people with the disorder are born with the predisposition to be emotionally sensitive. Abuse puts a person at higher risk for borderline personality disorder but not everyone who develops it is abused or neglected. 

“Parents commonly say, my kid has not been normal since he or she was born,” says Dr. Marianne Goodman, a psychiatrist at Mount Sinai School of Medicine in New York.

In a study presented at the American Psychiatric Assn. meeting, Goodman found signs of emotional sensitivity in young children who were later diagnosed with borderline personality disorder. Via a Web questionnaire, Goodman collected data from parents on 234 people with the disorder and 87 unaffected siblings.

She found that as infants, the children who were later diagnosed with borderline personality disorder tended to be self-soothing — they sucked their thumbs or had attachments to objects, such as a blanket — compared to unaffected siblings. They were also more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as few friends and more conflicts with peers and authorities. 

As teenagers they were more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide became common.

“Children are really starting to look so different at that point,” Goodman says.

Other research shows that, by their 20s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.

Research on the brains of people with the disorder suggest there is a biological predisposition to the core symptoms of emotional sensitivity and misperceiving the actions and feelings of others. 

For example, a study published in 2008 in Science showed different patterns of brain activity in people with the disorder: The scans showed abnormal responses in a brain region called the bilateral anterior insula when borderline personality patients played a game with other people that tested their sense of fairness and social norms.

Through such studies, experts say, it is becoming clearer that the condition may simply be a type of personality that some people enter the world with. Some describe that mind state as a “pervasive emotional dysregulation” — a brain that is primed to overreact.

“I don’t think you can learn to be borderline,” Linehan says. “They are intensely emotional people. The sensitivity to emotion is probably there at the beginning.”

By emphasizing a biological tendency to the behavior, therapists and family members say they hope to soften the perception of the borderline patient as willfully manipulative and argumentative.

“BPD is very popular in terms of literature, the media and movies,” says Dr. Josepha A. Cheong, the 2009 chairwoman of the American Psychiatric Assn.’s scientific program committee. But it often gets bad — and inaccurate — press in such media, she adds. 

One of the most prominent portrayals is the maniacal stalker played by actress Glenn Close in the movie “Fatal Attraction.” A more accurate portrayal, Cheong suggests, would be the character of Jenny in the movie “Forrest Gump,” who was a somewhat sympathetic but self-destructive, dysfunctional woman who wanted a normal life but couldn’t achieve it.

“It’s a far more compassionate portrait,” Cheong says. “It hints at the suffering of the patient.”

Toward treatment

Future progress in helping people with borderline personality disorder, however, may rest on the willingness of therapists to recognize it and apply therapies that are specific to the condition. One study of 70 patients presented at the American Psychiatric Assn. meeting found that 34% had been given a wrong diagnosis before finally being identified with borderline personality disorder. 

The study also found that 74% of people who met the criteria for the disorder had never been diagnosed with the condition despite an average of more than 10 years since their first encounter with a psychiatrist.

The correct diagnosis is key because specific behavior-change therapies seem to work best (see related story.)

There are several helpful therapies, experts say, notably dialectical behavioral therapy, and all share common elements. The bond between the patient and therapist is strong — important for a long-term, therapeutic relationship. And the therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims. 

After Sooki’s diagnosis, her mother Patricia began to change the way she communicated with her daughter by remembering that Sooki is ultra-sensitive and easily misperceives others’ feelings. 

Sooki began seeing a therapist who specialized in borderline personality disorder. She attended group support meetings, took medication for depression and began to exercise to battle her depression in a positive way. She is now in a healthy relationship with an understanding, supportive boyfriend, her mother says, and is taking college classes.

She doesn’t yet tell people she has borderline personality disorder because, she says, few people understand what it is. 

But, recently, she has started telling the truth about the scars on her arms. “The scars from my cutting are a reminder of how bad things were,” she says.

“For so long I felt like an outsider looking in. I hated myself, she adds. “I’ve really improved and I think each year will get better.”

BPDI recently read this article and found it very interesting indeed. It charts the years pre 1970’s to present date, although difficult to read about the way BPD had been sidelined, it does end on what would appear  to be  an optimistic future for a real understanding of BPD and  workable treatment plans for everyone.  

Really recommend  that you read it, it helps to give understanding to those caring for loved ones for a considerable length of time, one can see why it felt like we were banging our heads against a “brick wall”.   Its in PDF format and can be downloaded here

http://www.borderlinepersonalitydisorder.com/documents/Gunderson.pdf 

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