Borderline Personality Disorder or Traumatic Stress Disorder

Borderline Personality Disorder – What if it is a traumatic stress disorder?

When most people think of Borderline Personality Disorder – they think of bad behavior.  It is someone that is very difficult to deal with, someone that you have to be on guard against, Borderline Disordersomeone who will try their best to manipulate you.
But, while that may be the outcome, just like most psychiatric disorders, it isn’t exactly their fault.

One of the problems with BPD is that since it is a “personality disorder“, there is often no recognized medical treatment.

We simply expect that the patient should self-monitor and control their behavior.  Therapy may help this, but how many of us (psychiatric patients, in general) really want to go to therapy.

Many of us have already spent hundreds of hours with a therapist – who may or may not help.  In addition, the best therapists are likely people who can “see through the bullshit” and refuse to be manipulated.  This obviously goes against the nature of someone with Borderline Personality Disorder.

In fact, the stigma is so bad that some therapists won’t even work with Borderline patients.

Co Morbid DisordersOne theory may help.  Some therapists have developed an automatic assumption that a Borderline patient is also a trauma victim.  While this co-morbid condition may not always be true, it can help some therapists feel more comfortable treating the patient.

Due to many soldiers returning from impossible battlefields in the Middle East, Post Traumatic Stress Disorder is fairly well recognized.  Remember; I am not saying that it is easily treatable, but to some extent, the stigma is less.

When therapists look at Borderline patients as truly a PTSD patient, they may be more willing to treat the disorder. And they will attempt to get to the underlying causes of abandonment, impulsive and destructive issues, loss of control and poor self-image.

While PTSD is well defined by the professional psychiatric community, a longer-term disorder currently known as complex traumatic disorder is not.  Most examples of CTSD still involve soldiers, or they may involve women who had difficult pregnancies or who were violently sexually abused, repeatedly.

However, what if you don’t fit any of those recognized categories?

There are more ways to treat traumatic stress disorders such as Cognitive Behavioral Therapy or a newer one, Dialectical Behavior TherapyDBT focuses on four major areas:

•    Regulation of emotionsPost-Traumatic Stress Disorder
•    Tolerance for distress
•    Interpersonal effectiveness
•    Mindfulness

Unlike CBT, there is no “processing” component – making it work well as an initial treatment, starting before the patient has developed coping skills.  It builds up the feeling of emotional safety so that coping skills may develop.

Differentiating between “plain” Borderline patients – and those whose behavior is brought on by traumatic experience may help to eliminate some of the stigma still associated with BPD.  It may also offer actual, more effective treatment than CBT or other approaches.

Melissa Lind

Mental Health Professionals and Suicide

Suicide – Threat of Liability for Mental Health Professionals

Suicide is the third most common cause of death for young adults – and the ninth highest for the general adult population.  This means that a large percentage of mental health professionals will have a patient that commits suicide. It may be as high as 80 percent of psychiatrists, psychologists, social workers, and other therapists, that eventually have a patient who commits suicide.

Serious Mental Health ProfessionalYou might think that professionals are insulated against emotions that come with the death of a friend or acquaintance – but they aren’t.  Many health professionals report that even when death is expected (natural causes), they spend a great deal of time going over their treatment of the patient. They try to find out if they could have done anything different, (given another treatment) in order to help.

But, what may be surprising is the number of liability lawsuits filed against mental health professionals, when a patient commits suicide.  In fact, it is the number-one cause of responsibility lawsuits brought against mental health providers.
The threat of lawsuits, and also the stigma against people working it in the mental-health profession, has led to many psychiatrists refusals to treat the chronically suicidal. The profession sees it as a failure of the doctorMental health professionals are also less likely to see additional suicidal patients after they have had a patient succeed at suicide.

When a therapist or physician is unable, or unwilling, to treat a suicidal patient – it leaves the patient in the lurch.  It produces feelings of failure and hopelessness, without a doubt, compounding the fact that they are suicidal.  It may also be difficult for an extremely suicidal patient to find a new therapist or doctor.  Many patients report that the mental health professionals suddenly “don’t have time”.

We don’t think much about the way suicide will affect those around us – and certainly the professionals are way down the list of people whose feelings are important.

Mental health professionals also report that there is a lack of training on how to deal with suicidal patients, and processing the death of a patient.  More than half of professionals surveyed also Knocking on Heavens Doorstated that they really don’t believe they can prevent a patient from committing suicide.

Oddly, the complaint process against physicians has been shown to increase the risk of the physician becoming depressed. One of the consequences of this will be a worsening of the situation for mentally ill people. (Chronically suicidal patients)

This is a complicated process with no easy answers, but you should know that it is likely that all psychiatrists, therapists, social workers and other counselors probably need to be in counseling themselves.  When you find a new doctor or therapist – you might want to ask.

Even if you aren’t suicidal, you need to know that your counselor is as mentally healthy as possible, certainly healthier than you.

Melissa Lind

Mental Health Professionals Report a Lack of Training on How to Deal With Suicidal Patients

Bipolar Disorder and Exercise

Does Exercise Help with Bipolar Disorder?

Everyone knows that exercise is good for your health.  It is a no-brainer, and it is repeated so often that you have probably gotten tired of it.  I know I should do some physical activity. It is good for my heart, my bones… blah, blah, blah.

Bipolar DepressionOn the other hand, aside from needing to exercise because I am getting old and tired – the idea, that exercise might be good for my Bipolar Disorder, might just motivate me to do it.
Nothing else has.

A research study conducted in 2012 showed that exercise may have positive benefits for people with Bipolar Disorder.  I should have thought of that – but I didn’t (probably because I am bipolar and tend to ignore obvious things that might help me).

When asked – I have given advice to those who have depression (major depressive disorder, clinical depression, situational depression – or even bipolar depression).  What I tell those people is in addition to taking their meds, they should get up.  Get out of bed, get outside, and get some exercise – even if it is just around the kitchen.  Exercise increases the blood supply to your brain and helps to rise your energy levels – even if you don’t want to, it will do you some good.

Bipolar Disorder ShadowI give that advice to people when they are depressed, but I am not usually depressed.  My disorder tends toward mania or at least a mixed mood state.  So I don’t think about the need to increase my energy level.

Evidence has shown that exercise has some positive effects for people with Bipolar Disorder – even those that are not depressed.  In addition to the obvious health benefits, it can help to regulate your mood levels and “bring structure to chaos”.

As “bipolar“, we are often subject to disorderDisordered mind, disordered days, disordered environment.  One of the biggest tools for a bipolar patient to get and keep their body and mind regulated is the establishment of a schedule.

Go to bed at bedtime (and not at 2 am when you fall asleep in front of the TV). Get up in the morning, go to work on time, eat on a schedule – and take your meds when you should.
Establishing a routine does, in fact, help to keep from extreme ups and downs.

Exercise can be a big part of this – and physically reinforce a schedule on your body – that then affects your brain.  Just like getting up at the same time and going to sleep at the same time helps to establish a normal circadian rhythmexercise can reinforce that in a big way.

There are other benefits to exercise as well.  Physical activity naturally increases blood flow to the brain, which gives it the best chance of functioning at optimum level. It also helps to “clear out the cobwebs” that can be especially important if you are teetering on the edge.
Bipolar ExerciseExercise can increase your self-esteem that may have taken many blows in the past.  It can also increase social activity – that is apparently good for you, even if you don’t like people.  I don’t.

In my opinion, the biggest benefit may be “getting in touch” with your body.  When you exercise, you are more likely to stay within yourself.  One of the greatest problems in people with any mental disorder, and one of the reasons why people abuse drugs or perform any other risky behavior is the inability to be comfortable within your skin.  If you are exercising, you don’t really have a choice; you have to stay there.  Over time, you feel better about yourself, you feel more comfortable there, and you learn what is and isn’t “normal” within your body.

Perhaps this can lead you to better response when something is going amiss – when you may be slipping into disorder.

I tend to disregard the advice given by those who are not bipolar experts… either those with Bipolar Disorder or those who know the disease intimately, but this advice looks pretty solid to me.

Exercise and take your medicines!

Melissa Lind

Bipolar Disorder and Exercise as text to speech article

(Mental health video for blind and partially sighted people)

Depression and Women

Does women suffer from depression more often than men?

Depressed ManBoth men and women suffer from depression, but studies have shown that women suffer from depression twice as much as men do. Over the decades, many things have been blamed on a woman’s biological function, and a great deal of research has been put into this.

While a woman’s biological function does play a role in depression, other factors come into play as well. Several decades ago, women had very little control over their lives. It was standard that the man of the house — whether that was a woman’s father, husband or a grown son — made the decisions and had all of the control.

This lack of control can lead to depression, both in men and women. But since it was women who were the ones without any control, it was more often they that had to deal with the depression that this causes. Today, however, women are more in control. But there are still factors that affect them, as much as men, that lead to depression, such as relationship problems, the loss of a loved one, and financial changes.Depression, sadness and lonelyness

Furthermore, society shows us images of what women are “expected” to be, and these are things that few women in the world can live up to. This in turn affects the self-esteem, which in turn can lead to depression. Women see men’s reactions to those unrealistic images, and think that this is what they are supposed to be.

Women, who were children in the sixties, are in a real quandary today. Then, the world was changing for women. Depressed Woman - All AloneThose women were raised in homes where the old standards still applied, and then tossed into the world where all of the rules, standards, and social expectations had changed. This has contributed to even more self-esteem issues. The question “Who am I, and who am I supposed to be?” becomes very hard to answer.

So, yes, women do suffer from depression more often than men, and while hormones do play a role, there are many other aspects of life that also contribute to depression for women.

Never assume that a female is just suffering from PMS and that everything will be better in a few days!

Differences between male and female depression:
Women tend to: Men tend to:
Blame themselves Blame others
Feel sad, apathetic, and worthless Feel angry, irritable, and ego inflated
Feel anxious and scared Feel suspicious and guarded
Avoid conflicts at all costs Create conflicts
Feel slowed down and nervous Feel restless and agitated
Have trouble setting boundaries Need to feel in control at all costs
Find it easy to talk about self-doubt and despair Find it “weak” to admit self-doubt or despair
Use food, friends, and “love” to self-medicate Use alcohol, TV, sports, and sex to self-medicate
Adapted from: Male Menopause by Jed Diamond

Bipolar Disorder and Suicide Risk

Physical Proof and a Big Shocker – Bipolar Disorder and Suicide Risk

Bipolar HeadI read a lot of news about bipolar disorder and other psychiatric disorders (OCD, ADHD, chronic depression, borderline personality disorder, etc.).  In my reading, I came across an article that describes brain scan abnormalities in teens and young adults who have attempted suicide but I found a lot more.

A study conducted at Yale School of Medicine examined brain scans of 26 young adults and teenagers with bipolar disorder who had attempted suicide.  These were compared with scans of 42 bipolar patients who had not attempted suicide and with 45 non-bipolar subjects.  The results were not really surprising – as many research studies are not.

The bipolar patients, who had attempted suicide, showed abnormalities when compared to the other two groups, specifically in the  which showed “less integrity”.

Frontal lobe animationThis means that the frontal lobe (which controls impulses) is not as “connected” to areas that control emotion, motivation and memory.  Researchers indicate that the brain abnormalities may disrupt the ability of the impulse control mechanism to filter emotion and motivational messages appropriately.

In short this means that those patients can’t stop negative emotions and impulses to do something drastic… like attempt suicide and not surprisingly, less integrity or more abnormality – likely means more suicide attempts.

While it is good that they are discovering some physical proof of actual defect, eventually to move bipolar disorder into a category that can be scientifically documented, it doesn’t offer a lot of real-life solutions.  Most of us who are bipolar or know someone who is bipolar, know that there is something wrong or at least different about our brain…and it only makes sense that a person, who is trying to kill himself, is probably a little worse off.

As usual, I found myself thinking “…and… the point is…” which I often do when I read a synopsis of a largely inconsequential research study but then something caught my eye.  It was something that was a lot worse than I thought – statistics.

About 4 percent of Americans are afflicted with bipolar disorder, though sometimes we feel like it is others who are afflicted.  That is not surprising either.  Some groups show a slightly lower percentage at about 2.6 percent of the population.

Bipolar SuicideWhat surprised me was the statistic regarding suicide.  The article – that is from a reputable source – indicates that 25 to 50 percent of people with bipolar disorder are likely to attempt suicide and that 15 to 20 percent are likely to succeed.  Wow.  I didn’t know that.  Funny thing that I didn’t know since of the 20 or so bipolar people I have been close friends with at one time or another – at least four of them are dead.

When searching for confirmation (which I found from the NIH that about 1 in 5 bipolar patients complete suicide), I also found a number of additional shocking statistics:

  • Bipolar disorder results in a 9.2 year reduction in lifespan
  • Bipolar disorder is the 6th leading cause of disability, worldwide
  • Bipolar disorder is found in all races, ethnicities, ages, genders and socioeconomic groups
  • A child with one bipolar parent has a 15-30% chance of having the disorder
  • A child with two bipolar parents has a 50-75% chance of having the disorder
  • There are 3.4 million CHILDREN with depression in the US but up to one-third of those kids may actually have bipolar disorder
  • Bipolar disorder criteria have likely been met for at least 1 percent of all adolescents

Maybe these aren’t shocking for you.  Maybe you already knew all this – but maybe you didn’t.

I have known I had bipolar disorder for a long time – and have known a lot more people with bipolar disorder and I didn’t know all this stuff or maybe like everything else, I chose not to remember.

Food for thought; Take your medicines!

Melissa Lind

Psychologically and Physiologically Addictive Medications

Are antidepressants psychologically or physiologically addictive? – Kind of – but not in the way that you think!

For many years, most of the medical community have held steadfast to the idea that antidepressants were not “addictive.” But many Prescription Pain Medicationof those, not in the medical community or those with no personal experience of drug abuse or psychiatric illness, were convinced that those happypills were subject to abuse.  In fact, both were wrong.  Antidepressants are not “abusable“, but they are sort of “addiciting“.

To be clear – antidepressants are not subject to abuse.  They do not produce a “high” or anything like intoxication.  There is no immediate reward for taking antidepressants; in fact, one of the most troublesome things about antidepressants is that they take several weeks to actually work.

However, there is a difference between “abusabledrugs and “addictivedrugs.  Addiction is generally thought of as a psychological illness – in the way that marijuana and cocaine are psychologically addictive.  There is little evidence that either drug is physiologically addictive.  The body does not become dependent on the drug… the brain may – but not the body.

On the other hand, some medications are physiologically addictive – without being psychologically addictiveHormones are an example of this.  Once you start taking hormones (such as estrogen replacement), your body will adjust to the presence of the Psychologically Drug Addicted Dreammedication – and if suddenly discontinued, will not function normally.  There are many other examples of this, but you get the point.

Drugs like heroin, alcohol, and tobacco are psychologically addictive – but they are also physiologically addictive.  In addition to the brain “wanting” them, the body “needs” them to function normally.  If you suddenly take away the heroin, a severe withdrawal syndrome will begin.  If you suddenly take away alcohol – you may have seizures and a number of life-threatening conditions.

Prescription pain medications and anti-anxiety agents, when taken inappropriately can also be both psychologically and physiologically addictive – like heroin and alcohol.  When taken as prescribed, they are often still physiologically addictive.

Back to the antidepressants.

Certainly, years ago, sudden withdrawal of prescription antidepressants was known to be dangerous. But, with the development of selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and many others, most people have believed that there was no chance of physical addiction, and there would be no withdrawal.

Over the years, I would hear about people who complained of “withdrawal” symptoms which I dismissed – like most people in the medical community.  Many of these patients also had a myriad of complaints – generalized pain, foggy thinking, and other things that were considered to be indicative of a hypochondriac or chronic complainer.  Turns out maybe I was wrong.

SSRIs and other “next generation” antidepressants CAN cause withdrawal symptoms.  Some (not all but some) patients may experience symptoms of withdrawal such as Anxiety.

  • Anxiety
  • Anxiety and irritability
  • Depression and mood swings
  • Light-headedness and dizziness
  • Fatigue, headache and flu-like symptoms
  • Electric shock sensations
  • Loss of coordination, tremors and muscle spasms
  • Nausea and vomiting
  • Nightmares and difficulty sleeping

Most people don’t experience these – or have only a mild reaction.  Unfortunately, even “tapering” down won’t make that much difference as the symptoms may take a long time to go away – but the withdrawal is real and shouldn’t be dismissed!

Melissa Lind