Parenting is challenging. Every parent (hopefully) wishes to raise their child into a successful adult. Someone who can be self-reliant and live life to their full potential. Someone who can find happiness and growth in a solid relationship, and then effectively parent their children in the future.
Borderline personality disorder traits can be traced back to early childhood. The disorder has a strong genetic component. There are brain abnormalities detected on neuroimaging. All of this is evidence that borderline personality disorder is a disorder of the brain, not just a psychological disorder. Salient features of this disorder are:
Emotional dysregulation (extremely unstable moods). Flipping between joy and suicidal desperation before breakfast is not uncommon.
Fear of rejection (even if this “rejection” is an age appropriate push towards encouraging autonomy). I remember one mom telling me that she told her 14 year old to remember to pack her tennis bag. This was met with “you always do it for me. Don’t you love me anymore?” and an episode of her daughter cutting herself.
Rage. This rage can be directed inwards, in the form of self-harming and suicide attempts, or outwards towards anything or anyone in her line of fire.
When this is what you are dealing with, then the aims of parenting are radically modified to just getting through the day.
Matters are made worse by the constant allusion that as the parent, this is all your fault. Your friends and parents say that you must set limits and keep your boundaries. Your daughter regularly tells you that you are a terrible parent. The psychiatrists say that borderline personality disorder is highly heritable. The psychologist says that there was some kind of trauma. Maybe a major trauma, maybe the continuous trauma of you being misattuned to your child’s needs. It is possible that they are all a little bit right. But actually, they know nothing of the challenges that this kind of parenting presents.
Your self-esteem gets eroded, you get depressed. Your resources are greatly diminished by the cost of all the therapy, psychiatric care and special schooling needs. You are constantly called away from work to deal with some crisis. You and your spouse are at loggerheads; sometimes it feels as if your daughter is deliberately pitting you against each other. (She is). The other children complain that there is no time or energy for them and they are probably right.
If this not only has a familiar tone to it but a blasting crescendo, then you and your family are being held hostage by borderline dynamics. There is hope. The first step would be to know what you are dealing with and be realistic in trying to manage it. A child with borderline personality disorder needs specialised parenting. It is less important wondering who is to blame and more important to identify who can help.
Fortunately, when realistically dealt with, there is a lot of help available. There will always be emotional instability and chaotic relationships, but there can be a reduction in the constant abuse and high-risk behaviours. When the noise of borderline personality disorder is contained, then those glimpses of a warm, passionate child can be given a chance to grow.
Borderline personality disorder often coexists with depression and other mood disorders, eating disorders and substance abuse. Psychiatrically treating these mental illnesses with medication can go a long way to stabilise things. A therapist well versed in borderline personality disorder can help both you and your child. One therapeutic method that has had considerable success is DBT (Dialectic Behaviour Therapy). DBT tries to teach a person how to logically look at thoughts and behaviours, instead of becoming flooded and overwhelmed with emotions. It has the added component of trying to teach the practice of mindfulness, the ability to be fully present. Tall challenges, to be sure, but when worked hard at can be of enormous benefit to both the patient and their family.
Fortunately, where I practice in Cape Town, I can make referrals to very effective DBT practitioners:
Robert and Janine Boulle (www.rjboulle.com)
The Glenbrooke Practice (www.glenbrookpractice.co.za)
If you want to get started right away, download “Stop walking on eggshells: Taking your life back when someone you care about has borderline personality disorder” by Mason and Kreger (available on Amazon or Takealot).
Growing a child with borderline personality disorder is an intense, wild journey. When the noise of borderline personality disorder is contained, then those glimpses of a warm, passionate child can be given a chance to grow.
A couple came to see me as the last stop before initiating divorce proceedings. Since the birth of their son 18 months before, their home had deteriorated into a war zone. Their baby had colic and was a particularly bad sleeper. Typically, the baby would squawk, and mom would jump up to try to settle him before he woke properly. Inevitably, he did wake and then stayed awake for hours. Mom would become tearful and desperate. Knowing this, dad would also jump up when baby stirred because he wanted to support mom.
Both parents were exhausted. Mom was in a constant state of emotional disarray, weepy and angry. Dad was cynical and sarcastic. Both felt that the other was doing less than their fair share. They constantly argued, mainly about sleep training strategies. Also, mom had flu which she couldn’t shake. Dad was making silly mistakes at work, and his anxiety was mounting as he constantly had to put out fires.
Another one of my patients was passionate about an online game called Overwatch. He felt that it was his only joy after a day of work in a frustrating job. His typical pattern was to grab a takeaway on the way home and start playing as soon as he could. He often played until the early hours of the morning. Even when he did try to unplug earlier, he would be plagued by insomnia.
Three patients, all struggling with chronic sleep deprivation. They all recognised their sleep debt and realised that it caused exhaustion. But sleep deprivation affects much more than fatigue. It can make you physically and mentally sick. It is a social problem too. A report released by the AAA Foundation for Traffic Safety suggests that drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more.
During sleep, the brain makes use of microglial cells to vacuum up waste products so that the brain can function efficiently, just as the body has a lymphatic system to mop up waste. The brain needs sleep periods to enable the microglia to do their work. We need four to six sleep cycles for this to happen effectively (each cycle lasting about 90 minutes). If this does not happen, waste builds up, and the brain ceases to function adequately. The ability to concentrate, remember and learn is impaired, hence the dad’s struggles at his work.
Judgement gets impaired, including judgement about sleep. Sleep deprived people often say “I have adjusted to less sleep”. They have not.
Sleep deprivation wreaks havoc with emotions, a fact well abused in military interrogation techniques. It can leave one feeling tearful, overwhelmed and irrational, like the mom. It can trigger a full-blown depression, like the gamer.
With the couple, we reframed lack of sleep as the problem, not the marriage. We worked out a plan which divided the night up into shifts and a night nurse twice a week. Initially, the mom could not sleep during her time off; she was too attuned to baby’s every grunt. So we needed to use sleeping tablets for a short time. As soon as she got a bit of sleep, her mood greatly improved and she was able to acknowledge how hard her husband was trying. She recovered from her flu. Lack of sleep impairs immunity and can increase the risk of certain cancers. So much so, the WHO has listed shift work as “possibly carcinogenic”.
We simply gave the dad permission to sleep, and he could not keep his eyes open. His ability to concentrate was restored, as was his humour. He became worried about his cumulative lost sleep and increased risk of dementia (insomnia is often one of the first symptoms of dementia, and lack of sleep accelerates memory problems). I was able to reassure him that restoring sleep rapidly restores brain function.
The gamer was trickier to help. His mood was persistently low. I was worried about his isolation and addiction (gaming). His sleep hygiene was terrible. It was not a surprise that he suffered from insomnia. We are supposed to wind down before bed, not engage in activating activities. Furthermore, the blue light emitted from screens inhibits melatonin production. Melatonin is an important hormone in sleep regulation. My patient was becoming increasingly isolated, steadily more obese, and his mood was depressed. For these reasons, he needed a hospitalisation to stabilise his mood and set up healthier structures and routines in his life. He still struggles with his addiction at times, but he is careful to prioritise sleep. His mood has improved. His weight has stabilised, partially because of a better lifestyle, partially because his brain is producing leptin and ghrelin again (the “feel full” hormones which aren’t produced with poor sleep).
The reasons for sleep deprivation are varied. The consequences are serious. This is one of those places where patients can heal themselves.
Summer holidays are starting. I have learnt to close my practice doors in the middle of December. Partially because of increased family commitments, but also because everybody is so out of their routines that they miss their appointments or get the times wrong. During the December holidays, routine psychiatric work falls apart and emergency work picks up.
We cannot compare holiday blues and stress to clinical depression and anxiety. It’s like comparing a cold to incapacitating flu. The emergency work I handle seems to be triggered by increased alcohol and substance abuse, less sleep than usual and financial stress. There is nothing that says “holidays” better than partying and spending with abandon. Unfortunately, these are also stressors for relapse of underlying mood disorders.
Many of the moms I know need a holiday after the Christmas holidays. Very often, they work until late in December, but their usual support systems of family, aftercare or nannies are not in place. There is a pressure to keep bored kids at least moderately entertained. There are more social commitments, with visiting family and friends. Wise moms have carefully crafted self-care slots; times when they can exercise or get their hair done. This time of year steals all those personal minutes. Many moms are left in a reactive space of service to others, grumpy and worn out.
Moms are the emotional carriers of most families. They do the family work of making sure everybody is happy and that things run smoothly. Nowhere is this magnified as much as with religious holidays. Add to this a touch of personal perfectionism and the pressure can become relentless.
Some of my patients are genuinely sad and lonely and become even more so over the holidays when they ruminate over their losses. Even when happy, some of us also have a deep melancholy for lost loved ones or broken ideals, such as with divorce. The relentless tinsel pressure to have fun when we are sad is exhausting.
In trying to find advice for my blog, my usual approach of turning towards neuroscience research for guidance failed miserably. But some of my saddest patients have offered deep wisdom for dealing with this period.
One patient who is profoundly bereaved does not try to escape her melancholy; it is not possible anyway. She uses the spirit of Christmas to help her grieve and has made new family rituals to help her and her family remember and connect. Another of my patients accepted things as they came as a result of a complicated divorce and used Christmas to forgive; striving for harmony rather than a perfect family picture that didn’t exist.
Many of my patients tell me that connecting with a place of worship, or going carolling is an antidote to all the parties and shopping.
For myself, I try to slow things down. Giving one family member my full attention is better for my soul than trying to connect with everyone. I refuse to do a shop dash for less than five items. I try to balance binge days by eating a bit less and moving a bit more. And I get out of town, even if only for a few days.
The holidays magnify expectations. We must have fun, we must party, we must host perfect dinners, our kids must get all that they desire, everyone must be happy, and we must love family members we would rather avoid. Or we can consciously choose not to and just take things as they come.
Cape Town is a city that’s blessed to have its heart as a nature reserve. And Cape Town residents relish opportunities to appreciate it. When it’s hot we are on Cape Town’s beaches. When its very hot we hike in her forests. And when the wind blows, we go fly a kite.
Every year the Annual Kite Festival is hosted by Cape Mental Health (27-28 October) Its message is simple- “we all have a right to fly.”
The right to explore our abilities and live our best life.
When I make a diagnosis and start treatment, many patients want to know “are there any vitamins I can take to support my getting better?” I love this question because it tells me that the patient wants to be an active participant in their recovery. They don’t just believe that medication will make it all right.
Multivitamins and other supplements are multimillion-rand industries. Just walk into any major pharmacy and view the confusing array of vitamins. Time magazine in 1992:
I have fallen for the hype too. My son can be a bit of a picky eater, I feel like a good mother by giving him a multivitamin to address the shortfalls. I have patients taking various vitamins in the hope of staying younger and stronger for longer. Sometimes people use vitamins as a sort of bargaining point for an unhealthy lifestyle: “I smoke, but it’s ok because I take antioxidants.” Patients are excited because they have a way to cure all ills.
This way of thinking is encouraged by doctors. We want our patients to have better odds in the health lottery. Think of the vitamin D deficiency “epidemic” of the last decade. I too have been supplementing my Vit D levels, because my blood test reported low levels. Vit D deficiency has been linked to everything from cancer to dementia. While no-one is arguing that a serious deficiency causes serious illnesses like rickets, it now seems that the lab cut off values are arbitrary and not linked to clinical evidence. Further, supplementation has not been shown to be that much of a useful intervention. So, for now, I’m just making sure that I get outside more during the “safe sun” periods of early morning and evening.
The pendulum has swung. A recent meta-analysis suggests that there is not much evidence for the benefits of multivitamin supplementation. It seems as if regular multivitamin use might be associated with a shorter lifespan!
If doctors and scientists can’t get it right, what’s the average Joe supposed to make of this? A few guidelines I use when I think of multivitamin supplementation nowadays:
Is there a clinical deficiency that needs treatment?
If someone has symptoms of scurvy, rickets or any of the other deficiency illnesses, then restoring the deficiency is the treatment.
Sometimes it’s less obvious. There might not be an overt illness, but the patient is still not functioning at optimal health. All, literally all, my vegetarian patients have proven to have a Vit B12 deficiency. Patients who have been on the contraceptive pill or anticonvulsants might be folate deficient.
Is there a vulnerability in how the body absorbs and uses the vitamin?
We are living in the time of personalised medicine. Genetic tests can now comment on “low penetrance” genes. These are genes we can influence by diet and behaviour. (In the past, we focussed on “high penetrance” genes, those genes which influence the risk for cancers and serious diseases). Maybe Banting diet is good for you but bad for me. Maybe salt intake will make you sick and have little effect on me. Knowing how your body deals with food and the environment means that you are in control of intelligent health choices.
When I advise patients on how to get vitamins, I focus on how to do so naturally. Feel a cold coming on?- up your naartjie consumption. Taking 4000mg of Vit C as is promoted in some flu remedies is equal to 60-70 oranges! At this dose Vit C is not a nutritional supplement, it’s a drug with potential side effects.
More and more I have come to realise that Granny was right. If it’s too good to be true, it’s probably too good to be true. You can’t take a vitamin to “neutralise” unhealthy choices.
In my work, I come across a lot of pathos and suffering. People endure incredible pain, surviving only because of love from families and friends. My experience is that most people are flawed human beings, just trying their best.
After being in this business for a while, I have come to realise that there is a small minority of people who repeatedly make it very hard for the rest of us. There is much pain in the world, and most of it is perpetrated by the same 10% of humanity. If you come into the crosshairs of one of that 10 %, if they peg you as a “Target of Blame”, they set about to destroy you. They will lie, maliciously gossip, undermine you and even physically attack you.
Bill Eddy, a lawyer, therapist and mediator, describes these people as High Conflict Personality Disorders (HCPD). Not everybody who is high conflict is personality disordered; they might just be prickly or a good litigation lawyer. Not everybody who has a personality disorder is high conflict. In fact, many people suffering from personality disorders struggle greatly in conflictual situations. But when personality disorder and high conflict overlap, you have a problem.
I mostly see the fallout from these wars. The broken ex-wife who left an abusive narcissist, only to discover that the amount of malicious rage, the insults and abuse, in the years following the divorce, was neverending and extreme. The boyfriend who was confused and hurt by the vengeful and violent behaviour from the love of his life, who has borderline personality disorder. The mother who is afraid of what her psychopathic son is capable of doing. The sister who finds herself completely depleted by her histrionic sibling who is capable of creating drama out of nothing. The neighbour involved in a baffling and expensive litigious feud with his paranoid neighbour, the original grievance long forgotten.
The personality disorders most likely to be high in conflict are Narcissistic Personality Disorder (PD), Borderline PD, Antisocial PD, Histrionic PD and Paranoid PD.
Whilst they have key differing features and slightly different ways of best managing them, it is possible to spot people who will ruin your life and avoid getting caught in their sights. I actually think that this knowledge should be taught as a matric subject, for all the pain and suffering it could avoid!
One of the key features of personality disorders is that once you understand what the dynamic at play is, then they are very predictable. A healthy personality style would tend to hit his head against a brick wall once, twice, maybe three times but then start to learn and adjust. He would start to look for other ways around or over the wall. As such, healthy personalities are not too predictable, their reactions would very often depend on the situation.
Personality disorders have a certain way of engaging which is possible to spot. High conflict personality disorders have these features which set off alarm bells:
They have a preoccupation with blaming others
Nothing is ever their fault or responsibility. Everything that is wrong in the world or their life is someone else’s fault. Because they tend to narrow in on one person, that person becomes the “Target of Blame”, and they will stop at nothing to humiliate, control and destroy their target.
If you are in conversation with someone who rants on and on about the evils of their ex, or the incompetence of a specific subordinate – take note.
They have all or nothing thinking
Everything is black or white; there is no space for greys. It’s not a situation where they don’t like somebody but can acknowledge their strengths. Any negotiation is “my way or the highway”; you are either with them or against them. You can imagine how polarising this would be in the workplace. A team can get split into good vs bad in no time. If you are “bad” for a superior with all or nothing thinking, you will never be able to do anything right, no matter how hard you try. I have seen so many victims of this dynamic: burnt out by working 16 hour days for months, with no self-confidence because they were constantly berated.
They exhibit unmanaged emotions
Yelling, storming out, fits of tears. We have all been vulnerable and end up being overwhelmed by our emotions. But mostly, by the time we finish grade school, we have strategies in place to manage emotions on a day to day basis.
They have extremes of behaviour
We might see someone who is shockingly rude to the waiter, or who kicks the dog. These behaviours are usually not isolated events. They are the tip of the iceberg.
Your psyche-senses tingling, you now realise that someone in your orbit is a high conflict personality disordered individual. We all have to deal with them from time to time; we can’t always avoid it. But we can certainly do our darndest not to become their target. Because if you go to war with such an individual, you will lose. It does not matter what is fair, or what is right. You will suffer. Simply put, if you are just a normal kind of person, then you don’t stand a chance.
Two big rules of engagement
Don’t get too close.
The people closest to them are the ones most at risk for becoming the target. Don’t strive to become the powerful but narcissistic CEO’s favourite protege. Don’t marry the charming but psychopathic businessman. Keep it friendly, professional, distant.
Don’t engage in conflict
It takes a bit of maturity. When we are young, we tend to get caught up in what is right or fair. Sometimes these personalities take such an outrageous position that you might feel compelled to take them on about it. Carefully examine your motivations for doing this. It’s not as if you are going to change their minds, or make them see reason. It might be far more prudent to de-escalate the situation by going “oh, ok. I suppose you could view it that way” and then leave.
For heaven’s sake, don’t tell them that they are personality disordered! That would be escalating, not de-escalating. It is possible to keep your (and their) dignity and not to engage in conflict. You just have to be aware with what you are dealing.
“Does Fortnite cause ADHD?” was one of the questions a parent in my practice recently asked me. She was wrestling with whether to put her son on Concerta for ADD (Attention Deficit Disorder). He is a very bright boy and has always done well academically. His first year of high school has been challenging, with a drop in marks and an increase in anxiety and moodiness. His teacher had mentioned ADD, saying that there was a huge discrepancy between his IQ and his marks and that he seemed to “zone out” in class.
These are typical symptoms of ADD. ADD, or ADHD when there is hyperactivity involved, usually presents in younger kids. But sometimes bright kids can cruise through for longer, and their diagnosis can be missed until the work starts becoming more demanding. My patient’s question stemmed from the fact that her son was able to focus for hours on Fortnite (a popular action-adventure video game), but seemed unfocused after ten minutes of homework. She was wondering how he could he have ADD when he could focus on a game for so long? Could the game be causing it?
She was also concerned because it seemed as if all the boys in her son’s class were on Concerta or Ritalin. These were the same boys with whom her son was gaming all day. Surely not all of them needed to be on medication to function in a class?
Her observations are very astute. These are the very questions with which researchers and doctors are grappling. Between 2003 and 2011 the diagnosis of ADD/ADHD has increased by 43%, and it keeps rising. We need to ask why.
Any parent will tell you that they always regret letting their kids have a screentime binge because they are left with irritable, oppositional kids afterwards. We know that screen time affects our kids, but does it make them sick? A study published this year in the Journal of American Medical Association found a clear link between symptoms of ADHD and heavy screen use. They could not say if it caused ADHD, or if kids with ADHD use screens more, but they could show a clear link.
Let me be clear. When we look at all the studies on causes of ADD/ADHD, genetics comes out tops. It’s just how the brain is wired. Environmental factors (including screentime) and childhood development seem to influence the presentation, that is, how severe it is. But if a child has it or not, is just a roll of the genetic dice.
When there is ADHD/ADD, then treatment with appropriate medication can be nothing short of miraculous. I have seen kids go from failing, feeling stupid, constantly irritating their friends and always being in trouble to thriving academically and socially. I have a patient that stands out. He barely passed matric and hated school. When his son was diagnosed with ADHD, he realised that he too suffered from it. He started Concerta and discovered a passion for learning. He now has degrees in history, philosophy and is currently doing business science. I can’t help wondering how different his life would have been had he been treated properly from a young age.
But back to my patient’s son. He is one of those “borderline ADD” kids who present later in life. It is sometimes seen with bright kids; they cruise until the workload gets too much and then symptoms present. Does he need medication for his symptoms? Well, I’m not sure yet. He may well fulfil the diagnostic criteria on rating scales, but he also games three to four hours a day.
The neuroscience behind these games, particularly first-person shooter action-adventure games, is multipronged in how it affects the brain. Especially the young, developing brain. Adrenalin and stress hormones are released, putting the body into fight or flight mode. This state of arousal can make a child seem jumpy and irritable, conversations with mom or a math’s class seem mundane by comparison. These games have intermittent rewards which cause spikes in dopamine. Dopamine release feels good, increases focus and sets up craving for these “hits” (and results in incessant nagging in parents’ ears) It is also the same pathways involved with addiction. Lastly, but very importantly, light emissions from screens disturb melatonin’s action which in turn disturbs sleep.
Considering this, I advised my patient first to try to greatly reduce non-work screen time for a term, and then to revisit the ADD question.
Easier said than done because you can’t just remove what a child has been doing for several hours a day, without replacing it with other activities. But what I told her of the neuroscience echoed her own intuition. Already marks have greatly improved. We will see in time if the other ADD symptoms settle a bit.
To get diagnosed with a psychiatric illness is a big deal. Mental illnesses are often chronic and may require heavy medications, each with their own problems and side-effects, to stabilise. Labels such as schizophrenia or bipolar mood disorder carry with them the weight of stigma and poor prognosis. Further, when you are fragile and vulnerable, it’s very painful to be misunderstood; especially if it’s by the very people you turn to for help. It is very, very important to get the right diagnosis when you visit a psychiatrist. But psychiatrists, myself included, can get it wrong.
Mostly, we have gotten very good at getting to the nub of a mental illness. We have learnt tricks like following genetic links in a family tree, watching for psychiatric presentations of physical problems and having the time to take full histories so that we can flesh out lifelong patterns. But there are many reasons why the diagnosis can go completely wrong:
most symptoms are self-reported.
Of course, it is up to the psychiatrist to help tease out symptoms and to help give the patient words to describe their illness. The problem is a human quirk called “state specific memory”. I remember a patient early on in my career. She was very depressed. Her history showed periods of high activity and productivity, so I suspected that there might be an element of bipolar mood disorder. However, she insisted that she had felt this low for most of her life. She denied ever feeling elevated, or of having patches of more energy. Her bipolar mood disorder came into focus when I increased her antidepressant dose, triggering a hypomania. Then she was able to give me a long history of excitable, reckless, energetic periods, which spanned throughout her life. She was not lying. It’s just that when she was depressed, she could only remember being depressed. It took being hypomanic to remember the times when she was hypomanic.
Psychiatric diagnoses are made in symptom clusters and categories
The DSM (Diagnostic and Statistic Manual) is the Bible in which psychiatrists find their diagnosis. It’s a reliable, well researched and well-tested document, which is being constantly reviewed and revised. It is a good starting point for any good psychiatrist.
The problem is that human beings are stubbornly non-categorical. We are individuals, and our mental illnesses are as rich and varied as we are. I know a patient who presented with extreme mood lability. She was always up and down. She did not respond well to mood stabilisers. It was after she got to know and trust me, that she eventually was able to disclose the extent of the abuse she had suffered growing up. And of how she sometimes drank to keep her tortured memories at bay. Only when I made the diagnosis of post-traumatic stress disorder and alcohol abuse and treated her accordingly, did she start to improve. It took several years to get it right.
Psychiatrists are human
And as such, prone to human error. It is especially true if there is a cultural or language difference. Sometimes the psychiatrist might genuinely not get it.
In an ideal world, psychiatrists wouldn’t need to make a definitive diagnosis within the first few sessions. Psychologists have this luxury; they can let the story unfold. But if the diagnosis isn’t made, then patients can’t access the benefits from medical aid funders due to them for their diagnosis. This includes benefits such as expensive medications or prescribed minimum benefits (PMB’s).
A clue that you have been misdiagnosed is that you are not stabilising. Keep in mind that the neurological system heals very slowly, so it might take a few months. Be honest with yourself: if you are still drinking a lot or in a toxic relationship, then there are many factors as to why you are not getting better.
But if all things are taken into account and if there is no improvement, it’s worth going back to the drawing board. Talk to your psychiatrist, challenge your diagnosis and your meds. Make sure you know what you can expect from every pill. A good psychiatrist should be a “co-manager” of your condition, and might even recommend a second opinion.
If your psychiatrist gets irritated and defensive, then it might be worthwhile reviewing your relationship. If you have a difficult to manage illness, then a good relationship with your psychiatrist is essential to your prognosis.
Historically, the border of Borderline Personality Disorder (BPD) refers to the edge of neurosis and psychosis. That unstable area which is always hysterical or mad. It is classified as a personality disorder. Personality disorders are considered fixed throughout life and not amenable to treatment. Unlike psychiatric illnesses such as schizophrenia or bipolar mood disorders, which are considered chronic but responsive to treatment.
It is a very bleak view of BPD. Because of this, when I was doing my specialist degree, many psychiatrists felt that it was pointless telling a patient of their BPD diagnosis, that it would just add to distress.
In the last two decades, we have learnt much about the disorder. We have realised that the borderline patient’s brain is wired differently; they are not just “badly behaved”. We have discovered that BPD responds well to correct treatment and management. Our perceptions were challenged by a study which showed that six years after being hospitalised for serious borderline problems, 70% of the patients in the study no longer met the diagnostic criteria for BPD. In all, BPD is looking more like a mental illness which can be managed, than a pervasive personality defect.
With this in mind, I do tell my patients when I suspect that they are suffering from BPD. Their most typical response has been one of relief. Through the BPD-patient’s psychiatric career they often pick up many diagnoses: PTSD, depression, anxiety, dissociative disorder, eating disorders, bipolar mood disorder, substance abuse, maybe even a psychotic label or two. While these disorders often occur in addition to BPD, the patients typically feel that the core problem remains. With the BPD diagnosis, they feel that it “fits” and that they finally had something with which they could work.
I spend a lot of time in my practice containing the fall-out of a borderline patient’s behaviour. Loved ones burn-out by capriciously being loved and hated, often in the same day. Bosses have enough of promises not being met and drama constantly being stirred up in the office. Emergency rooms get tired of sewing up the same person, who keeps harming themselves. It’s very hard having a BPD person in your life.
It is hard being a BPD sufferer. Somebody suffering from BPD truly suffers.
They are excruciatingly sensitive. This sensitivity, when properly harnessed, often makes for a very effective therapist or inspires great creativity. Which often makes things worse, because when we see a gifted, intelligent person, we expect a lot from them. The nature of a severe personality disorder is that the sufferer never lives up to their gifts. They constantly undermine mine themselves and destroy whats good in their lives. And they know it, which adds to the despair.
Of all the things Borderline sufferers are sensitive to, rejection can make them completely crazy. (In psychiatry we even have a term for it: a micropsychotic episode.) We are all rejection sensitive, but a BPD person takes it to a new height. To be so rejection sensitive makes for tricky relationships. They often spend too much time in unhealthy relationships because they fear to be alone. Or they get into pathological cycles of rejecting good relationships because they anticipate rejection, so they get in first and reject before they get rejected.
Thus BPD sufferers have a chaotic relationship history and often end up alone. Loneliness is not just a normal, albeit unpleasant, experience for them. It is devastating. Loneliness is this endless pit of emptiness where they can feel like they don’t exist. One of my Borderline patients described to me that if she posts an experience on Facebook, and no-one “likes” it, then she doubts it ever existed. The internal core of a BPD patient is very fragmented and fragile; they feel that they exist only as a reflection from others.
It’s not a wonder that with this poor sense of self and with career disappointments and unstable love lives, that the sufferer often ends up seeking solace in pathological behaviours. Like harming themselves or substance abuse.
Breaking these pathological cycles of living and relating takes hard work and commitment. I think that even with the correct therapy the deeper feelings of emptiness still haunts. But I have seen how patients can get to a place having loving relationships and satisfying careers.
Unfortunately, not all patients have the financial resources to get the help they need. Sometimes, they do not have the will or the commitment to get better. Borderline Personality Disorder still does a lot of damage to its sufferers and in those around them.
Meditation is the practice of using various techniques to train the mind to focus and be clear. The modern world is becoming more and more plugged-in, frenetic and multi-tasking. Meditation may well need to be the next step in our evolution.
Eastern religions and philosophies have always extolled the benefits of meditation. In the West, we have been more sceptical of the benefits of sitting still and doing “nothing”. Over the last few decades, science has been applying tools like functional MRI’s and EEG’s and rigorous research techniques, like longitudinal studies, to challenge meditation’s benefit claims.
The evidence has been consistent and impressive:
Meditation keeps the brain young
Springer’s Journal of Cognitive Enhancement recently published one of the most extensive longitudinal studies on meditation to date. It’s data spans seven years and shows how meditating holds off age-related decline, that is, it keeps our brains young.
The study began in 2011 from a population of 22 to 69-year-olds attended a three-month meditation retreat.
The immediate findings, published after the retreat, revealed that the training enhanced the participants’ emotional well-being and led them to perform better on tasks related to focus and sustaining attention.
Seven years later, researchers checked back in with the group. All of the participants reported that they continued to meditate in some capacity. Evaluations showed that their mental improvements had withstood the test of time. These benefits were especially true for the older participants.
Meditation keeps the brain fit and strong
It was thought that after a certain age, somewhere in the twenties, the brain stops growing and starts declining. This simplistic approach has been disproven and replaced with the concept of neuroplasticity. Neuroplasticity is the ability of the brain to mould and form. Pathways we use a lot get stronger and bigger. Parts of the brain we don’t use, get smaller and weaker.
You can teach an old dog new tricks.
Meditation seems to harness the neuroplastic power of the brain. In a meta-analysis of 21 neuroimaging studies, no less than eight brain regions were found to be consistently altered in individuals who meditate regularly. The areas mentioned are mainly in the fronto-limbic areas of the brain. Areas which correlate with claims of improved self-awareness, clarity of thought, empathy, compassion and improved mood.
The studies included in the meta-analysis and the conclusions it makes, do have problems. For one, the sample sizes are small. For another, it’s not so easy to directly plot vague structural changes to complex behaviours like compassion.
That said, the results of therapies using meditation as a cornerstone (like mindfulness-based cognitive therapy) in treating psychiatric illnesses, like chronic depression and anxiety, are very exciting.
The reported benefits of meditation are so appealing that the world’s early adopters, companies like Google and Nike, have initiated programmes to get all their employees meditating. Early studies have raised the hope for a rational thinking workforce with high job satisfaction and emotional resilience. Certainly, whenever a company tries initiatives to address their employees needs, the employees are happier for it.
Meditation won’t help you levitate, nor is it a highway to bliss. Like learning any new skill, it takes at least some level of application to reap the full benefits. In the striving to become healthier and happier, meditation really is all that.