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Borderline Personality Disorder

Borderline Personality Disorder

Mental Illnesses on Movies

Movie attractions about mental illnesses

Recently I wrote about the premiere of a new movie, Mania Days, which stars Katie Holmes and is based on the life of the author who has Bipolar disorder.  One of our Facebook friends asked where it could be seen.

Well, the answer, in short, is “not yet”.  It is an independent film and caught my eye because it premiered in Austin TX, near where Old Fox MovietoneI live. Unfortunately, no matter how good it is, it won’t be released on the “big screen” until the writer/director/producer has an offer from a large movie production company – for a lot of money.

He may get one of those offers at upcoming independent film festivals, and the prospects look good as the film has received positive reviews.  It is likely that no matter how good the film is, we won’t see it in theaters for several months, if not longer. (It will probably be available on DVD though)

Sorry if it was a big tease.  In any case, it got me thinking that there are some well-known and available movies that you can see.  Maybe you have seen them, but you probably haven’t seen all or even most of them.

The good news is that since mental disorders tend to produce notable or even outrageous and shocking behaviors, they do make good subjects for movies.  This list is only a few of the movies that I have seen – and in many of them, there is no clear “diagnosis” for the characters but the symptoms are there.

Borderline Personality Disorder

Most of the films that feature characters that may have borderline personality disorder focus on murderous women.  Certainly BPD doesn’t only affect females but it does make good movie fodder.

•    Fatal Attraction
•    Single White Female
•    Casino
•    The Cable Guy
•    Margot at the Wedding
•    The Crush

Anxiety Disorders –

Anxiety disorders are harder to see in a movie as a single issue as they often occur with other disorders – as they do in real life.

•    Ordinary People
•    Parenthood

Social Anxiety Disorder

Can result in avoiding being in public, speech disorders and fears of other social situations.

•    The Kings Speech

Obsessive Compulsive Disorder

OCD is a real problem, but many people don’t realize how debilitating it can be.  In addition, it is also an anxiety disorder but doesn’t show as well on the screen.

•    The Aviator
•    As good as it gets

Post-Traumatic Stress Disorder

PTSD often follows a “war” event – but can follow other traumatic events. In most cases, these events are “acute” but in some cases they are chronic, occurring over a period of many years.

•    Prince of Tides
•    Forrest Gump
•    Born on the Fourth of July
•    First Blood
•    Sudden Impact
•    Reign Over Me
•    The Hunger Games: Catching Fire

Autism

There is really only one good example that I know of – and it is a classic.  That said, it is not an exact example as Autism is a “spectrum disorder” that ranges from high-functioning to non-functioning.

•    Rain Man
•    The Boy Who Could Fly

Bipolar Disorder

There are actually a lot of movies that can be seen showing bipolar disorder though. Rarely do they discuss the actual diagnosis but here are a few good ones.

•    Mad Love
•    Blind Date
•    Michael Clayton
•    Manic
•    Of Two Minds

Clinical depression

In most cases, clinical depression doesn’t look good on a screen.  Unless the character has some other event going on, watching someone not do anything doesn’t attract movie attention.  In these cases, there were other things going on in the movie that made them interesting.

•    The Fire Within
•    Leaving Las Vegas
•    Rushmore

Silver Linings PlaybookAnd the winner for “Most Psychiatric Disorders Featured in One Movie” goes to:

•    Silver Linings Playbook
•    Girl Interrupted

Both movies show a number of intertwining psychiatric disorders including anxiety, depression, borderline personality disorder, bipolar disorder, and eating disorder, are great films and two you really shouldn’t miss.

Most of these movies should be available on DVD.

Melissa Lind

List of films featuring mental disorders

Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind

Face of Borderline Personality Disorder

Pro Football Player Brandon Marshall Wants to be the “face” of Borderline Personality Disorder

Brandon Marshall - The Face of Borderline Personality DisorderIf you don’t follow professional sports in the U.S., you may not know who Brandon Marshall is. He is an NFL Wide Receiver, recently acquired by the New York Jets. His long history of violent outbursts, brushes with law enforcement and behavioral issues that have affected both his personal and professional life.

Marshall had played professional football since 2006 when the Denver Broncos drafted him. He has since played for the Miami Dolphins, the Chicago Bears and was recently acquired by the New York Jets. The Wide Receiver played in five Pro-Bowls, receiving an MVP award in 2011 and has set several receiving records during his NFL career.

Brandon Marshall - BPDThough he has played for four different teams in only nine years, most of the trades have come after a series of injuries. Not all of those injuries, however, have come from football and Marshall has a long history of legal trouble, and those issues have affected various team’s willingness to put up with his erratic behavior.

One notable injury was sustained in 2008 when he slipped on an empty bag in McDonalds. While this seems like a complete accident, the incident occurred during a physical scuffle with “family members”. Shortly after the event, he fell through a television set at his home, causing a severe arm injury.

Marshall has faced multiple fines with the NFL including two penalties for violating the team’s dress code by wearing brightly colored cleats during a game. The list of legal troubles he has had include drunk driving charges, domestic violence, assault, battery and disorderly conduct. Marshall was diagnosed with Borderline Personality Disorder in 2011.

Borderline Personality Disorder is not a well-known disorder and is highly stigmatized, with many people unwilling to disclose the condition. It is characterized by severe abandonment issues, risky behavior, personal identity issues, rapid changes in an Borderline Personality Disorder - Brandon Marshallemotional level, and high potential for self-harm. Treatment is largely comprised of behavioral therapy. However, some patients receive medication for other psychiatric disorders that may improve BPD symptoms. There is also some thought that medication treatment may be useful in Borderline Personality Disorder. However, no drugs are approved to treat the condition.

Marshall’s diagnosis of BPD likely comes as no surprise to those who understand the disorder. His willingness to come forward and publicly announce his condition may help others to understand BPD. He has been and is currently undergoing treatment and is in the process of filming a documentary about his battle with BPD. Marshall has stated that his goal is to be the “face” of Borderline Personality Disorder to bring public awareness for those who struggle with the condition.

Though he has been forthright, many in the sports world had stated that the New York Jets will have their hands full when he joins the team as his troubles have decreased only slightly since he began treatment.

Melissa Lind

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Borderline Personality Disorder in the News

In the news (and movies): Borderline Personality Disorder

Borderline Personality Disorder (BPD) doesn’t get a lot of “press” or screen time.

We have all seen movies and news stories about people with bipolar disorder. (Girl Interrupted, Mad Love, Borderline Personality Disorder Newsand the unforgettable Who’s Afraid of Virginia Wolf, drug addiction) (Chris Farley, Philip Seymore Hoffman, and Anna Nicole Smith), and major depression (Robin Williams, Owen Wilson, and Princess Diana).  Many of these movies or real-life examples also show how mental disorders are intertwined.

Depression comes with alcoholism, bipolar disorder comes with drug addiction, bipolar disorder comes with a lot of issues – but not much attention gets paid to Borderline Personality Disorder.

Borderline Personality Disorder has a few issues:

  1. It is a personality disorder and not a psychiatric disorder that can be treated with medication
  2. It is hard to diagnose and can often be confused with other disorders
  3. Borderline patients may misrepresent their behavior to medical professionals
  4. Borderline patients are often “difficult” to be around
  5. Borderline personality disorder is not well known – make it not well known… and, for this reason, there is no reason to write a news story or make a movie about it.

“Good news”;

I put that in parentheses because the diagnosis is not great – but it is good that BPD is getting a bit of attention.  Two notable examples – one not so great and one which may or may not be great.

Not So Great;

The trial of Jodi Arias.  In 2008, Travis Alexander was brutally murdered.  He was stabbed over 20 times, shot, and photographed after his death.  The alleged perpetrator: his girlfriend, Jodi Arias.

The case has been pending for many years – one of the reasons may be the development of a clear understanding of why Arias acted the way that she did after the murder.  Reportedly, Arias was witnessed immediately after Alexander’s memorial (including explicit text messages sent for “flirting”), and she has been pegged as a possible borderline patient.  This is in addition to Alexander’s former friends that reported her stalking behavior, and her statements that the boyfriend was a pedophile and a domestic abuser.

Arias’ own friends and a court psychologist have reported erratic behavior, similar to that of BPD.  No verdict has been issued as of yet, and we may never know, but it does bring BPD into the news (not in a nice way but into the light, however).

In fact, some mental health professionals have expressed the belief that BPD patients may be more dangerous – both emotionally and physically – than most other mental disorders, some likening it to a form of sociopathy.

Possibly good news;

Borderline Personality Disorder in the NewsOn the movie front, Kristen Wiig (of Bridesmaids –and the new, all-female Ghostbusters) has starred in a”dramedy”. Dramedy is  a combination of a comedy and drama that is centered around a woman with BPD.   In Welcome to Me, the character, portrayed by Wiig, wins the lottery and uses part of the money to start a talk show.

Along the way, she skips out on treatment, quits taking her meds and ends up living in a casino.  No word on reviews for the show, but it has some big names including Joan Cusack and Tim Robbins. It is produced in part by Will Farrell, and even though it premiered at the Toronto International Film Festival, theater showings have not been announced.

If you know a BPD patient – imagine what he or she might do after winning the lottery.  BPD is hard to diagnose, hard to predict and even tougher to be around.

Whether the movie is any good, whether the trial comes to a just end…

Melissa Lind

Borderline Personality Disorder has gotten some attention!

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