Book impression: Borderline Personality Disorder - New Reasons for Hope

As readers here know, in 2007 our family finally was provided with information that explained years of illness, sadness, and failed treatment.  Two psychiatrists at two different institutions diagnosed Borderline Personality Disorder (BPD) and gradually, since that diagnosis, so much has fallen into place.
  

Like many parents, I began to read and digest as much as I could about BPD and you'll find several books on this topic in the list of books I've provided here on my blog.  I've also written several posts on the topic.   Early on I came up against the same themes as many parents have when the myths about causes of autism and schizophrenia and now eating disorders were discussed.  As time has gone on, the term "biologically based" has been added to the framework.  Environment, I believe, is an important factor, too, if for no other reason than to support the concept of family education to assist the person with a diagnosis of BPD to get on the road to recovery.  I've written quite a bit about this concept as it relates to eating disorders and BPD on my blog, particularly under the topic of communication.

Randi Kreger's book, The Essential Family Guide to Borderline Personality Disorder:  New Tools and Techniques to Stop Walking on Eggshells (Hazeldon Press, 2008) was the first book to help me understand the ramifications of this diagnosis as well as what positive things I could do as a parent to help.

About a month ago, I came across a reference to a book published just last year (2011) by the Johns Hopkins University Press as part of the Johns Hopkins Press Health Book Series.  It's available in paperback, which is a wonderful decision on their part because the book is affordable for parents keen on learning more.  For that matter, it's also a valuable book for the person diagnosed with BPD, as an entire chapter is directed towards that person - "If You've Been Diagnosed" (pp. 215-228).

The book is Borderline Personality Disorder - New Reasons for Hope by Francis Mark Mondimore, M.D. and Patrick Kelly, M.D.

This extensive and grounded work incorporates the latest research about and treatment of this diagnosis (dx). The book is directed not only to the therapist but also to the person diagnosed with BPD as well as to those who are family members, friends and even employers and co-workers. 

The book is divided into four sections: Understanding the Problem including clinical discussion as well as "personality"; Causes - encompassing an enormous array of information from genetics to environment; Treatment, particularly with emphasis on the difficulties when a person has co-morbidities and the sometimes ineffectiveness of medication (some believe that medications are inappropriately administered and in fact, some like the benzodiazepines compound the problems inherent in addiction) under these circumstances while looking harder at the necessary therapeutic relationships and need for truly understanding this disorder; and finally How to Cope, How to Help - written for the person with the dx and for parents, partners, friends and co-workers. 

The chapter for the person with the dx is especially frank but also supportive with solutions, an approach that I liked very much, particularly the attitude that the person needs to engage, take responsibility, accept and commit.  The section titled, "Looking for Happiness in All the Wrong Places" offers (p. 226) "...a psychiatrist or psychotherapist cannot reveal to you the meaning of life, or tellyou why your life is worth living.....Treatment for borderline personality disorder can help you learn how to cope with setbacks and disappointments better, negotiate relationships more successfully, rein in impulsiveness, make peace with a traumatic past and put it behind you, and many other important skills and lessons.....But your happiness is your responsibility, just as it is for everyone else."

The authors emphasize that the tide is turning about the dx for the dx is now being called "the good prognosis diagnosis."  They promote the idea that the nomenclature is incorrect. Not only that, but they believe the nomenclature fosters the person with the dx to think something is inherently _wrong_ with them since the word "personality" conveys such a strong definition of self.

The authors include a section titled, "International and Cross-Cultural Considerations" that trounces what some have proposed as a dx only found in the United States.  Clearly there is more at work than just environment. 

The book, to me as a layperson, is very dense in the initial sections (meaning one needs to "chew" on what one is reading)  but well-written and includes a terrific definition with examples of "splitting", something I had a hard time understanding from previous books that I've read. 

The epilogue as well as the text emphasizes, given the complexity of this diagnosis -- meaning the many aspects of emotions and behaviors, that a team of professionals skilled in differing areas must be assembled to treat the person.  It's unlikely that one professional can because, as I've been told by several people now, one who treats this illness must receive ongoing support and counseling themselves to avoid being drawn into the whirlwind created. 

The authors "distill" the disorder by writing (p. 251),

"Borderline personality disorder develops when a child born with extremes of temperament and a biologically rooted difficulty managing emotions encounters a mismatched childhood environment. This mismatch may be quite subtle or quite pathological but is experienced by the child as inconsistent and unpredictable, leading her to develop a damaged sense of self and the expectation that others will continue to be inconsistent, unpredictable, and ultimately unreliable and abandoning. This in turn causes profound emptiness and hopelessness to dominate her emotional life. To cope with her emotional extremes, and her desperate and painful unhappiness, she develops self-destructive coping behaviors like addictions, eating disorders, and self-mutilation. Frequently, these individuals also suffer from biologically based mental illnesses that exacerbate all their other problems and prevent behavioral and psychological treatments from helping them.
....Borderline personality disorder results from an interaction of genetic and other biological factors, inborn temperament, and childhood experiences and is usually complicated by the development of abnormal behaviors and psychiatric illnesses. All these factors require therapeutic attention, often by different professionals using different approaches."
 

As I wrote above, I am encouraged by this new approach to this illness and enlightened by how important it is to bring therapists up to date on the treatment of this disorder (sounds familiar, I am sure, to those promoting a change in the way eating disorders are treated).  Valuable techniques are included for therapists.

I also was pleased to just come across (May 2013) this book review by the esteemed researcher in the field of BPD, Joel Paris, M.D., Professor of Psychiatry at McGill University in Montreal.  The review appears in Psychiatric Times, Volume 29 #4.

Finally, thanks to the Epilogue, I learned that this month (May) was established by the United States House of Representatives - unanimously - in 2008 as "Borderline Personality Disorder Awareness Month."  How fitting that I discovered and read this book this month.  How important it is to promote what the authors have assembled for our increased ability, as parents, to advocate for our loved one(s).