Borderline Personailty Disorder--Facts versus Myths

      Borderline Personality Disorder (BPD) is a serious condition that affects 3xs the number of women verses men. Women diagnosed with BPD have stormy and unstable relationships, problems regulating strong feelings, an unclear sense of self, chronic feelings of emptiness, and some may engage in impulsive and self-damaging behaviors such as suicidal thoughts and behaviors and self injurious behaviors like cutting one’s self.  Women suffering with BPD also struggle with trusting other people and tend to be suspicious of other’s motives and behaviors. This type of thinking usually stems from their processing reality in a “black” and “white” manner. And acknowledging the nuances in their relationships with other people and themselves is difficult for them to appreciate. “Black” and “white” thinking results in people with BPD idealizing themselves, other people, and/or situations which can then quickly change into devaluing themselves, other people, and/or situations all of which causes stormy unstable relationships and an inconsistent self-image. 

     All too often I have seen women receive a diagnosis of BPD in error or based on a clinician’s impressions after a brief meeting. Although this disorder may appear easy to self-diagnosis, a valid diagnosis of BPD involves an extensive evaluation. BPD is a complex condition and a full discussion is beyond the scope of this post. I have listed a few of the important facts and myths regarding the symptoms and treatment of BPD that I hope will be helpful to you for understanding this disorder.  

FACT: BPD is a common disorder with estimates of 10% to 15% of the general population. Many women diagnosed with BPD also suffer from depression, anxiety disorders, substance abuse, and eating disorders. It is not uncommon for women diagnosed with BPD to have been sexually, physically, and /or emotionally abused during childhood.

FACT: To have a diagnosis of BPD a person has to have five out of nine total criteria, according to the Diagnostic and Statistical Manual of Mental Disorders. These criteria include the following:

-problems with relationships (fears of abandonment; unstable relationships)

-unstable emotions (frequent emotional ups and down; high emotional sensitivity)

-unstable identity (clear sense of self; chronic feelings of emptiness)

-impulsive and self-damaging behaviors

-unstable thinking/cognition (suspiciousness; tendency to dissociate when under stress)

 

  

FACT: BPD usually develops during adolescence or early adulthood. In addition to sexual trauma being a factor in the development of the disorder, parental neglect and unstable family relationships has been shown to contribute to an individual’s risk for developing this disorder. Other studies suggest BPD may also have a genetic component; it is thought that individuals may inherit his or her temperament along with specific personality traits, particularly impulsiveness and aggression.

   

MYTH: Women diagnosed with BPD are always difficult to deal with, likely to be physically aggressive, untreatable, depressed, and/ or unable to live fulfilling and productive lives. These symptoms usually vary in their intensity. The majority of women and others diagnosed with BPD are genuinely very passionate, courageous, loyal, sensitive, thoughtful and intelligent individuals. 

MYTH: BPD is not treatable. This is one of the most harmful misconceptions about BPD. In fact, the opposite is true. Current studies indicate that rates of recovery from BPD are much higher than previously thought. Psychodynamic-psychotherapy 1 -2xs per week aimed at helping women regulate their intense emotions, reduce self destructive behaviors, create stable relationships, and develop a cohesive sense of identity has been shown to be an effective treatment. Group therapy that teaches mindfulness (paying attention to the present), interpersonal effectiveness, distress tolerance, and emotion regulation has also been shown to be helpful in treating BPD.

Developing a strong therapeutic relationship with a therapist that one trusts and feels safe and secure with in addition to being available by phone, e-mails, or other means of communication in between sessions is a crucial component for effective treatment. Other treatment options include cognitive-behavioral therapy, dialectical behavioral therapy, and schema-focused therapy. Additionally, family members of individuals diagnosed with BPD may also benefit from some kind of therapy.  Family therapy can educate family members and loved ones about BPD and it can educate them about ways in which they can reduce their loved one’s symptoms.

Below are a few tips for coping with BPD:

1. Seek professional help and try to stick with treatment even when you feel discouraged.
2. Exercise Regularly. Exercise has been shown to improve one’s mood, decrease anxiety, and reduce stress.
3. Get at minimum of 7-8 hours of sleep per night. Getting proper rest helps with mood regulation and decreases mood swings.
4. Educate yourself about the disorder. Consider joining a support group.
5. Set realistic goals for yourself.  Be patient and compassionate with yourself as you work on achieving your goals.
6. Identify and seek out comforting situations, places, and people.

  

How to Make It Through the Holiday Season Happier and Healthier

For many women the holiday season represents an opportunity to reconnect with loved ones, a time to create pleasant, loving memories, and to make-up for the other part of the year that we may have felt we were not being a good enough mother, wife, daughter, sister, or even friend. We send holiday cards to people we may not have been in contact with for months if not years, buy expensive gifts to show our loved ones how much we care, bake cookies for our children’s teachers and our co-workers, adorn our homes in holiday regalia and spend a lot of our time entertaining family and friends. We may feel completely responsible for all the planning and execution of our families’ holiday traditions, such as making dinners, gift buying, gift wrapping, and decorating our homes. We feel responsible for our families’ happy, particularly around the holiday season when we try so hard to make our families’ experience of the holidays perfect. And asking for help, even when not during the holiday season, is difficult for many of us to do.   

     With the kind of expectations we pile upon ourselves, it is no surprise that many women experience an increase in depression, anxiety, irritability, sleeplessness, exhaustion, and changes in weight and appetite during the holiday season. Several psychological studies indicate that women struggle with stress-induced depression more than their men counterparts and women are more likely to experience depression resulting from seasonal affective disorders caused by a decrease in daylight. Furthermore, the holiday season can stir up profound feelings of grief and mourning due to sadness associated with loved ones who have died or family members who can not be with us because of divorce, family strife, or distance; for example an adult child who may have moved across the country.   

     It is important not to ignore holiday season induced depression and stress. Taking positive steps towards minimizing unnecessary holiday stress can increase your chances of having a happier and healthier holiday season.  In most cases, holiday season depression and/or holiday induced stress can be lessened by finding a healthy balance between our expectations and our realities. Below are a few tips that I hope you will find helpful for reducing holiday season induced depression and stress:

1. Evaluate your holiday expectations.  It may be helpful to figure out which expectations are achievable and which are not. If you are working full-time and caring for young children, volunteering to cook a large holiday dinner may not be achievable, especially if you also want to enjoy it.

2. Be present when you are with your loved ones. Put away cell phones, computers, and other distractions so that you can focus on the people that mean the most to you.

3. Be sure to get enough sleep. Research suggests that 7-9 hours of sleep a night significantly improves our ability to regulate our mood and improves our thinking and cognitive capacities.

4. Delegate responsibility. Try to anticipate when and what you will need help with. Ask for help in advance, so you will not be setting yourself up for being and feeling frantic and overwhelmed. For example, ask your family to help you with cooking and clean-up; these are great opportunities for connecting and spending quality time together too.

5. Make time for exercise. Exercising for 30 minutes a day, a minimum of three days per week, has consistently been shown to improve mood, sleep, and to reduce anxiety.

How do you cope with holiday season induced depression or anxiety? Do you find you feel more “down in the dumps” or “blue” around the holidays? What do you do to help yourself feel better that may also help other women? I want to hear from you.

Wishing you all a less stressful and more enjoyable holiday season!

-Dr. Paula Durlofsky-

Striking a Healthy Balance between Aging and Our Changing Looks

      I recently had the opportunity to speak with Villian Diller, Ph.D.  the author of  “Face it: What Women Really Feel as Their Looks Change” a book about helping women   strike a healthy balance between letting their looks matter and accepting the inevitable fact that their looks will change as they age. As a psychologist myself and as, a middle-aged woman, I was particularly interested in learning how to help today’s women navigate the “ups” and “downs” associated with aging in a youth-obsessed culture that reinforces the notion that our looks are our currency, power, and what makes us ultimately female.

     Although most of us have been taught that beauty is really only skin deep, we may still find ourselves frantically attempting to put “the pause” button on our own aging as soon as our first wrinkle or gray hair appears.  Our own conflicting feelings and the conflicting messages we receive from the media and sometimes from our own family and friends can leave us feeling confused and with a lack of clarity regarding how we should “address” our aging and changing looks. Aging is a difficult process that involves mourning multiple losses-one of which is our youthful appearance and physical vitality.  

     After speaking with Dr. Diller about helping women achieve a healthy perspective about their own aging and changing looks here’s some of what she had to say that I found particularly helpful. I hope you will too:

-HAVE A FLEXIBLE DEFINITION OF BEAUTY. Try not to have only one vision of what you consider to be “the right look” in mind.  When we achieve a flexible image of beauty we develop a kinder inner dialogue as well as a more realistic concept of what “beauty” truly is and means.

-ADMIT TO YOURSELF THAT LOOKS MATTER: Working through feelings of loss and grieving associated with our changing looks and aging helps us achieve a healthy balance between “holding on” and “moving on” and an ability to enjoy our looks at any age.

-MOTHERS CAN MAKE A DIFFERENCE. It is important for mothers to educate their daughters about the myth of beauty created by the media. It is also important for mothers to have conversations with their daughters about the impact the media can have on self-image. Young girls also need to be made aware of the fact that most, if not all, of the images they see in magazines have been photo-shopped or altered.  

-IT IS IMPOSSIBLE TO ANTI-AGE. This is my personal favorite “take-away” from my conversation with Dr. Diller. She suggests focusing on caring for your skin and health with the goal of promoting health and vitality for your whole-being and a realistic improvement of appearance.  

-NUTURE YOUR INTELLECT: Although we have been taught that beauty isn’t everything many women still feel that their looks are their currency, power, and what’s makes them truly female.  Letting go of this priority gives us the chance to nurture and develop other aspects of ourselves. 

How do you feel about aging? Are you concerned about looking older? What are your feelings about how the media portrays women and beauty? Do you have other suggestions for how women can better cope with their changing looks and aging?  I would like to hear from you.