Personality Disorder « Peter H Brown Clinical Psychologist

There IS Hope: Effective Treatment For Borderline Personality Disorder

Source Credit: Mental Health Grace Alliance

The Good News about Borderline Personality Disorder
Date: 06 Feb 2012
Guest Blog:
Amanda Smith, Founder of Hope For BPD
After being diagnosed with Borderline Personality Disorder in 2004, she started her path of recovery. As she oversees the programs of Hope for BPD, she has also served as Executive Director of a NAMI affiliate in Florida and currently serves on a local NAMI board of directors in Texas.

Harvard-based researcher Mary Zanarini, PhD has called borderline personality disorder (BPD) the “good prognosis diagnosis” and there are many reasons to be hopeful about the long-term outlook.

Borderline personality disorder—most frequently characterized by rapidly-changing mood swings, unstable relationships, identity disturbance, and chronic feelings of emptiness—is a mental illness with a lifetime prevalence rate of almost 6% among the general population.

Time and again, research has shown that individuals who have been diagnosed with borderline personality disorder can feel better about themselves and their world, are able to work towards academic and vocational goals, sustain healthy relationships, and experience a sense of purpose or meaning in their lives. We also know more now about the neuroplasticity of the brain and understand that our brains continue to change and adapt so that we can learn new behaviors and process information in healthier ways.

But there are many things that increase the likelihood of recovery. These include:

• taking part in an evidence-based treatment that was created specifically to treat BPD such as dialectical behavior therapy (DBT) and mentalization-based treatment (MBT)
• reading books and articles that actively promote recovery
• getting steady support and encouragement from family, friends, church leaders, and other people who have been diagnosed with BPD
• making a commitment to self-care that includes getting enough sleep, eating balanced meals, exercising, and treating physical illnesses
• being brave and asking for help before things become a crisis or an emergency

Family members who are in need of education and support can connect with organizations such as NEA-BPD and take part in their free Family Connections classes or NAMI’s Family-to-Family program.

Remember, the vast majority of people with BPD get better and go on to create lives worth living. If you’re someone who has been diagnosed with the disorder, that means you!

For more information about BPD, please visit Hope for BPD.

Amanda L. Smith
Treatment Consultation for Borderline Personality Disorder and Self-Injury
http://www.hopeforbpd.com

February 11, 2012 Posted by peterhbrown | Cognition, Dialectical Behavior Therapy, Identity, Personality Disorder, research, Resilience, Spirituality | borderline personality disorder, bpd, dbt, personality, Personality Disorder, treatment | 6 Comments

The Type A B C’s Of How Your Personality Effects Your Health

Could your personality kill you—or might it make you live longer? Could it give you heart disease, or protect you from illness? Could it push you toward or away from doctor appointments?

Credit: Angela Haupt , health.usnews.com

Personality traits play a distinct role in determining how healthy we are, psychologists say. “Everything is related to everything else. How stressed or angry you are, and how you interact with the world, is contingent in large part on your personality style,” says Michael Miller, editor in chief of the Harvard Mental Health Letter. “And that is going to have an enormous impact on your health.”

Here’s a look at common personality types and traits and how each can help or hurt your health (sometimes both):

Hostile
One of the aspects of the impatient, hard-charging Type A personality that is known to increase heart disease risk is hostility. Hostile people eat and smoke more and exercise less than other personality types, says Redford Williams, head of behavioral medicine at Duke University Medical Center and author of Anger Kills. They’re likelier to be overweight in middle age and have higher cholesterol and blood pressure. Williams’s past research suggests hostile people are also more likely to develop irregular heart rhythms, and to die before reaching their 50s. Most of these problems can be traced back to elevated levels of the stress hormone cortisol, as well as increased inflammation in the walls of the coronary arteries, which leads to a greater risk of heart attack.

No personality is set in stone, however, and Type A’s can be taught how to take the edge off their hostility. Hostile heart patients who attend workshops that teach coping skills, for instance, have a lower incidence of depression and healthier blood pressure than Type A’s who don’t go. The key, Williams says, is learning how to communicate more clearly and how to control anger and other negative emotions. He suggests asking yourself four questions when you get angry: Is this issue truly important? Is what I’m feeling appropriate to the facts? Can I modify the situation in a positive way? Is taking such action worth it? Meditation, deep breathing, and yoga can damp hostility with a layer of calm.

Impulsive
Because Type A personalities are defined by competitiveness, a drive to succeed, and a sense of urgency, they are prone to take risks and act without thinking, neither of which is likely to improve health. Non-Type A’s can be impulsive, too. Such people are often not as well-grounded as others, says Robin Belamaric, a clinical psychologist in Bethesda, Md.: “They’ll look at an opportunity that comes along and say, ‘Hmm, that sounds like fun,’ whereas another, more thoughtful person, will say, ‘I’m going to pass, because I’m not sure it’s the best idea.’ ”

Relaxed
If you’re a Type B, you roll with the punches. You’re relaxed, take life a day a time, and handle stress without cracking. That translates to a higher quality of life and lower likelihood of heart disease—less anxiety strengthens the immune system. The more we chill, the better off we are, says Miller: “You don’t want to get locked into a stressful, tense state of mind.” Over the long term, he adds, relaxing and managing stress effectively will lengthen your life, help your heart and gastrointestinal system, and just make you feel better overall.

Extrovert
People who are outgoing, involved in their communities, and have strong social connections reap health benefits. An analysis of 148 studies published in the online journal PLoS medicine in July found that on average, adults enrolled in a study with many close friendships were 50 percent likelier to survive until their study ended than were those with few friendships. And a 2009 study published in Perspectives in Psychological Science suggests that social support leads to improved coping skills, healthy behavior, and adherence to medical regimens. Bonding with others also reduces stress and improves the immune system—so making friends and getting involved becomes, in effect, a well-being tonic.

What drives at least some of the health benefits goes beyond biology, Miller says. “It may have to do with the fact that when you’re around people, you think, ‘Oh, Martha has gone for her mammogram—that reminds me, I should, too.’ ”

Eager to please
People-pleasers—Type C’s—are conforming, passive, and want to accommodate. That can be a good thing when it comes to patient compliance: They’re more likely to take the right medicines in the right doses at the right times, for instance—once they see a doctor, that is. Making and following through on appointments can be challenging for Type C’s, who tend to accept their fate as inevitable and fall readily into hopelessness and helplessness. That means others must push them to take care of themselves. “They may be less likely to maintain their health on their own,” Belamaric says. “If they develop a problem, they may just complain about it, hoping somebody says, ‘I have a good doctor, I’ll make you an appointment.’ ”

Some Type C’s may be so mired that they don’t seek medical attention—even when it’s clearly necessary—and slough off preventive behaviors, like watching what they eat. “If they get a serious diagnosis, they may be passive, throw their hands up, and say, ‘Well, there’s nothing I can do about it, anyway. If it’s my time, it’s my time,’ ” Belamaric says.

Click image to read reviews

Stressed and distressed
Type D’s—D is for distressed—dwell on negative emotions and are afraid to express themselves in social situations. Compared to more optimistic sorts, a Type D may face three times the risk for future heart problems, according to a recent study in the journal Circulation: Cardiovascular Quality and Outcomes. Type D’s also face a higher likelihood of compulsive overeating and substance abuse. “If you’re a person who is prone to depression or anxiety, or if you’re overly self-critical, there’s more of a chance of turning to gratifying behavior to feel better,” Miller says.

Optimistic versus pessimistic
Optimism “heavily influences physical and mental health,” concluded a study published in May in the journal Clinical Practice & Epidemiology in Mental Health after researchers followed more than 500 males for 15 years. The rate of heart-related deaths was 50 percent lower among optimists than among pessimists. “Optimists have a higher quality of life, and they may be more resilient in the way they deal with stress,” Miller says. “So if a problem comes along, they’re able to handle it better, and they become less symptomatic.” Glass-half-empty types harbor little hope for the future and tend more toward depression and anxiety disorders.

But there’s a catch for those at the extreme end of the optimism spectrum: They think of themselves as impervious to risks. Extreme optimists who smoke are the best examples. They believe they won’t develop lung cancer. Why give up smoking to prevent a nonexistent risk?

The “self-healing personality”
That is the name Howard Friedman, a professor of psychology at the University of California-Riverside, attaches to people who are curious, secure, constructive, responsive, and conscientious. These traits translate to enthusiasm for life, emotional balance, and strong social relationships. “Positive emotions buffer hormonal responses to stress,” says Friedman, who studies the relationship between personality and longevity. Self-healers, he says, “have healthier behavior patterns: more physical activity, a better diet, and less smoking and substance abuse.”

Be Active, Sleep Better! Aerobic Exercise Helps Beat Insomnia (peterhbrown.wordpress.com)
What Were You Thinking? The Causes Of Online Disinhibition (peterhbrown.wordpress.com)

September 24, 2010 Posted by peterhbrown | Acceptance and Commitment Thaerapy, brain, Cognition, Health Psychology, Identity, Personality Disorder, stress | Conditions and Diseases, facebook, Health, Heart disease, Mental health, personality, psychology, research, Social Sciences | 3 Comments

Narcissism, Self-Esteem & Facebook

Following on from yesterday’s post on disinhibition and social networking, I came across this post from Dr Shock MD’s blog commenting on THIS RESEARCH PAPER (pdf) Credit to Dr Shock (excerpted). Interesting?

In normal every day life with face to face contact the physical characteristics and knowledge about social background form the identity of your contact. It’s stable and three dimensional. You know that person, it’s therefor very difficult for the other to claim another identity or create impressions inconsistent with how you know him or her. Online identity is a different topic. You can create ideal identities not necessarily overlapping your real identity. It’s a controlled setting in which you can create different identities from the person you really are. Moreover, from research it has been shown that people act differently in social networking environments when compared to those interacting in anonymous settings. Online self representation can vary according to the nature of the setting.

What is the relationship between offline personality and online self representation on facebook?

A recent study looked at the effects of narcissism and self esteem on online social activity and self promotion. The researchers included 50 male and 50 female facebook owners, they were randomly recruited at York university, their age ranged from 18 to 25 years. The facebook pages were rated and the participants took 4 questionnaires about demographic information, facebook activity, self esteem (the Rosenberg Self-Esteem Scale) and narcissism (the Narcissism Personality Inventory).

Five features of the Facebook page were coded for the extent to which they were self-promoting: (a) the About Me section, (b) the Main Photo, (c) the first 20 pictures on the View Photos of Me section, (d) the Notes section, and (e) the Status Updates section.

Click image to read reviews

Self promotion was distinguished as any descriptive or visual information that appeared to attempt to persuade others about one’s own positive qualities. For instance posting ‘‘My Celebrity Look-alikes”. Use of picture enhancement etc.

They found a strong relationship between narcissism and lower self esteem with greater facebook activity as well as more promotional self content. Gender did not influence these relationships.

This is another study implying that narcissism can be detected in facebook, the previous study is also discussed on this blog: The Dangers of Facebook. Gender differences were found in another study but on risk taking attitudes. Men with profiles on social networking sites are higher in risk taking behavior and less worried about privacy issues compared to women.

In research looking at other personality factors, the Big Five was used amongst facebook users. As discussed in a previous post on this blog: personality factors are not as influential as expected on using Facebook. The Big Five is probably not a very good instrument to investigate personality traits and facebook use.

Mehdizadeh, S. (2010). Self-Presentation 2.0: Narcissism and Self-Esteem on Facebook Cyberpsychology, Behavior, and Social Networking, 13 (4), 357–364

What Were You Thinking? The Causes Of Online Disinhibition (peterhbrown.wordpress.com)
Twitter: 10 Psychological Insights (spring.org.uk)

August 25, 2010 Posted by peterhbrown | Education, Identity, Internet, Personality Disorder, Social Psychology, Technology | narcissism, social networking | 7 Comments

Borderline Personality Disorder: What’s with the Name & Just What Is It?

I have continued to receive a number of requests by email and on Twitter about Borderline Personality Disorder, its name, its presentation, its treatment and its psycho-genesis. Below is a brief post which I think covers most of these questions in outline form. I am open to suggestions as to which, if any areas readers would like to discuss in more detail. A small collection of books on BPD which I recommend to patients, carers, significant others and counsellors can be found here, most with reader reviews. I would be happy to hear of others.

What’s with the name?

The term “borderline” was first used by early psychiatrists to describe people who were thought to be on the “border” between diagnoses. At the time, the system for diagnosing mental illness was far less sophisticated than it is today, and “borderline” referred to individuals who did not fit neatly into the two broad categories of mental disorder: psychosis or neurosis.

Today, far more is known about BPD, and it is no longer thought of as being related to psychotic disorders (and the term “neurosis” is no longer used in our diagnostic system). Instead, BPD is recognized as a disorder characterized by intense emotional experiences and instability in relationships and behavior.

Many experts are now calling for BPD to be renamed, because the term “borderline” is outdated and because, unfortunately, the name has been used in a stigmatizing way in the past. Suggestions for the new name have included: “Emotion Dysregulation Disorder,” Unstable Personality Disorder,” and “Complex Posttraumatic Stress Disorder.”

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. Originally thought to be at the “borderline” of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.¹ There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.²^,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.⁴ Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.⁵ These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.⁶ Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.⁷

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children.⁸ Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver.⁹ Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.

NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.¹⁰ The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.¹¹

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.⁷

Future Progress

Studies that translate basic findings about the neural basis of temperament, mood regulation, and cognition into clinically relevant insights which bear directly on BPD represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.

References

¹Swartz M, Blazer D, George L, Winfield I. Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 1990; 4(3): 257-72.

²Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 1994; 8(4): 257-67.

³Gardner DL, Cowdry RW. Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatric Clinics of North America, 1985; 8(2): 389-403.

⁴Zanarini MC, Frankenburg FR. Treatment histories of borderline inpatients. Comprehensive Psychiatry, in press.

⁵Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harvard Review of Psychiatry, 1998; 6(4): 201-7.

⁶Koerner K, Linehan MM. Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 151-67.

⁷Siever LJ, Koenigsberg HW. The frustrating no-mans-land of borderline personality disorder. Cerebrum, The Dana Forum on Brain Science, 2000; 2(4).

⁸Zanarini MC, Frankenburg. Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 1997; 11(1): 93-104.

⁹Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 89-101.

¹⁰Davidson RJ, Jackson DC, Kalin NH. Emotion, plasticity, context and regulation: perspectives from affective neuroscience. Psychological Bulletin, 2000; 126(6): 873-89.

¹¹Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation – a possible prelude to violence. Science, 2000; 289(5479): 591-4.

Bernstein, PhD, David P., Iscan, MD, Cuneyt, Maser, PhD, Jack, Board of Directors, Association for Research in Personality Disorder, & Board of Directors, International Society for the Study of Personality Disorders. “Opinions of personality disorder experts regarding the DSM-IV Personality Disorders classification system.” Journal of Personality Disorders, 21: 536-551, October 2007.

Sources: about.com and nimh.gov.org

March 15, 2010 Posted by peterhbrown | Cognitive Behavior Therapy, diagnosis, Dialectical Behavior Therapy, Education, Personality Disorder, Resources, self harm, therapy | borderline personality, bpd, diagnosis, dsm iv, Personality Disorder, therapy | 1 Comment

Borderline Personality Disorder: What’s with the Name & Just What Is It?

I have had a number of requests by email and on Twitter about Borderline Personality Disorder, its name, its presentation, its treatment and its psycho-genesis. Below is a brief post which I think covers most of these questions in outline form. I am open to suggestions as to which, if any areas readers would like to discuss in more detail. A small collection of books on BPD which I recommend to patients, carers, significant others and counsellors can be found here, most with reader reviews. I would be happy to hear of others, and I will also add a few more over the next few days.