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June 27, 2008 8:44 PM

Borderline Personality Disorder: What's next?

I just went through my first real, in depth, psychiatric assessment, and it looks like I have a diagnosis. I've never read about BPD, believing all this time that I was just depressed. I'm in the process of being referred for DBT, but I'd like suggestions on what to do in the meantime. It's going to be at least a couple weeks until I get into therapy, and I'm just starting new prescriptions of Wellbutrin and a low dose of Seroquel for my depression/anxiety.

What can I expect in the days, weeks, months and years to come? How can I help my boyfriend, and others around me, to cope? In the past you mefites haven't sounded so hopfeul, so share some more positive experiences, please! By all means, total horror shows will be just as helpful.

I feel like it's a big step just knowing what the hell it is that's been wrong with me all this time. I knew I wasn't 'just depressed'.

Anecdotes, resources, tips, anything!

data: 23, female, and I've had symptoms for upwards of 14 years. No, YANMD.

posted by sunshinesky to health (16 comments total)

First, good on you for getting help. I can only imagine what an emotional roller coaster you've been on all these years.

I don't know how helpful this is, but when I was studying psych in undergrad (about 10 years ago, yikes), there seemed to be a growing critical chorus about the treatment of bpd, mostly stemming from the fact that it is diagnosed far more in women than men. Some doubt it even exists. My professor was of the opinion that it exists, but that the dire predictions about the possibility of successful treatment stemmed more from sexism and lack of compassion than reality. Ie, "women are crazy, needy, irrational creatures, what can you do?" Her perspective was that it was certainly treatable *with the appropriate treatment*.

Again, this may not be very helpful, but it may give some perspective to the idea that there's no helping a person with bpd.
posted by lunasol at 9:03 PM on June 27

The Last Psychiatrist has a thing or two to say about BPD.
posted by rhizome at 9:34 PM on June 27

First, I very highly recommend that you read BPD Demystified. (Right now!!) It is the best I have seen for giving you a good picture of what it is, the history (and prejudices) that go with diagnosis, the symptoms, and the current thinking about why it happens. I liked it because it seemed to leave room for people having many different degrees or styles of borderline. For example, many people with BPD are prone to angry rages, it is part of the stereotype. But the one in my family avoids confrontation as much as possible.

Which brings me to my second point - when you read that people with Borderline PD are this way or that, please question whether it applies to you - don't assume the experts are right. Also, since the development of DBT and some later therapies, it has become clear that it is treatable - you may still have certain tendencies that you associate with your former BPD behavior but they will be just be your personal style, no longer that something that interferes with your life. So, it's not a really a personality disorder because it is something you can change, not a fixed part of your personality. The Demystified book has information about success rates and which symptoms seem to be easier to get free from.

In terms of what to expect, the first step in therapy is usually learning to control your emotions and especially any self-destructive behavior. Usually there is a combination of learning the DBT skills as part of a group and working one-on-one on your own issues.

If your boyfriend has been able to put up with you so far, he should find that things mostly get better. There may be times when the therapy is bringing up difficult memories and your depression or desire to self-harm gets stronger but your therapist should be able to help you handle that and it will pass. One thing you will probably be encouraged to do as part of your therapy is to figure out what your boyfriend can do that will helpful to you in different situations and then make a plan together for how you can help. There is a book on living with someone with borderline that is often recommended called "Stop Walking on Eggshells". It really depends how much the boderline stuff affects your relationship whether this book will be of any use to him.

You have one very big advantage - you want to change. If you work honestly and only with your therapist and take your meds, you will find things will be better a year from now. (Maybe still a long way to go but better than they are now.)
posted by metahawk at 9:42 PM on June 27

oops - the last paragraph should read "If you work honestly and openly with your therapist"
And by the way, if you don't trust therapist or you don't feel like therapy is working after you've given it a fair try (maybe 6-8 sessions), don't give up on therapy, just find a new therapist. There is a chemistry involved in this work - someone may be very competent but if the chemistry doesn't work, you should try someone else.
posted by metahawk at 9:49 PM on June 27

BPD is one of my primary professional interests. Here are a few books and resources you might want to check out:

I Hate You, Don't Leave Me by Jerold Kreisman
Twenty years ago, Jerold Kreisman wrote this, the seminal work about BPD. He is a psychiatrist who became renown throughout the mental health profession, and he just so happens to be My psychiatrist (although I do not have BPD-- I have a different set of diagnoses).

Books by Marsha Linehan
Marsha Linehan is the widely regarded creator of Dialectical Behavior Therapy (DBT). Basically, DBT integrates techniques of Cognitive Behavior Therapy with the added influence from the Zen principle of Mindfulness. She lives in Seattle and is director of the Behavioral Research and Therapy Clinics (BRTC) at the University of Washington


Books by Thich Nhat Hanh
Thich (Thay) Nhat Hanh is a Buddhist monk of Vietnamese origin who lives at the Plum Village Practice Center in France. He has written many books about mindfulness. Unlike many books on Eastern religious concepts, which Americans or people from western civilizations find esoteric, Thich Nhat Hanh's work explains the concept of mindfulness in ways that are very simple for the American mind to grasp.

Good luck in your journey...
mynameismandab
posted by mynameismandab at 11:37 PM on June 27

Positive experience: I'll be 28 in a few days, was diagnosed at 23, and am doing mostly fine, only fighting minor depression and anxiety.
posted by IndigoRain at 11:49 PM on June 27

I have 10 years experience as the partner of a BPD sufferer. I can only back up all of metahawks answer. I personally have found the book Stop Walking On Eggshells a great help in developing strategies for coping. I have also been seeing a therapist about my co-dependent behaviour, which he tells me is quite common in partners of BPD sufferers.
All in all, it's been a tough road, progress is slow but steady as long as all involved can work together honestly.
Best wishes to you all.
posted by Duke999R at 11:53 PM on June 27

Thanks to everyone so far- it looks like I have quite a few books to check out. Time to check out the library!
posted by sunshinesky at 6:23 AM on June 28

Don't let a diagnose you define you. It's worth repeating: don't let a diagnosis define you.

You can still have your dreams, continue to set goals, keep on keepin' on. After all, many professionals believe we've even had a President of the United States who was/is a BP.

I always worry that a diagnosis like this can sink a receiver of the news and make them feel like a member of the emotional infirmed who "can't" because, well, they've been told they're a fill-in-the-blank. A person can just as easily take the information, for what it's worth, and say, "Ah, okay, that explains why I do some of the things I do," - and move forward with tools and resources to deal. The worst thing is to take the diagnosis as news that life is over and that you now must prepare for the worst. It's gets back to my first line in this post. Especially with a diagnosis like BPD - it's critical.
posted by Gerard Sorme at 2:10 PM on June 28

(I don't have diagnosed BPD but I do have bipolar I)

This post has a lot of helpful stuff.

Oh man, Seroquel. Prepare to sleep. If it's too much, demand a lower dose. I sleep very well at 100mg but my shrink is constantly trying to up my dose. No, no, no.

Here is some basic meds info. That whole site is awesome. Read as much as you can. It'll make you feel a whole lot less alone.

Get a psychiatrist and a therapist. Having two people working with you keeps them both honest. I complain about them to each other.

Good luck.
posted by sondrialiac at 2:26 PM on June 28

A person can just as easily take the information, for what it's worth, and say, "Ah, okay, that explains why I do some of the things I do," - and move forward with tools and resources to deal

That is exactly how I feel about this diagnosis, but I understand the importance of not defining myself as BPD.

Don't worry, the doctor who spoke to me about it was very clear about how treatable this is. I'm not feeling limited by this diagnosis at all. It feels like the doors have been swung open!
posted by sunshinesky at 2:59 PM on June 28

That's great to hear sunshinesky. (I'm glad my first line was worth repeating - I have no idea how I garbled that so badly.) It sounds like you are handling this very well and I wish you nothing but the best!
posted by Gerard Sorme at 3:31 PM on June 28

I wholeheartedly agree with Gerard, please do not let this one therapist's diagnosis define you. As a psychotherapist, I do believe borderline personality disorder exists, but there is no blood test or MRI that makes this diagnosis, it is subjective from a "snapshot" seen by one therapist during one moment in time of your life. You may or may not have this disorder. Medications can help you with depression, anxiety, and sleep issues (which could be symptomatic with personality disorders), but meds can not treat the actual personality issues. Borderline or not borderline, the issue is to work on mood regulation, self soothing, autonomy, boundaries, healthy relationships with others and with yourself, self acceptance, and learning how to identify, test, and challenge the thoughts that are resulting in unpleasant feelings. Your doctor is right about this being treatable, especially at your age and with your obvious motivation. All the books reccomended by others responding to this post are excellent resources, but try not to get TOO immersed in self help books, read some, then live your life and try to apply what works for you before reading more, find balance. I would further reccomend (no matter what your diagnosis) cardio exercise on a regular basis, yoga or a meditative practice, and limiting alcohol intake. Best of luck to you.
posted by Lylo at 11:17 PM on June 28 [2 favorites]

Wow. It's not often that I feel like there was a question on the green that I was meant to answer! But you've presented one.

I do not (to my knowledge) have BPD but I do work with an individual therapist and a group that meets once a week when in session. I started this work last fall. Ask your therapist about Marsha M. Linehan's Skills Training manual for Treating Borderline Personality Disorder. There are lots of great handouts that cover mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.

These things have all been immensely helpful in dealing with some severe childhood trauma, particularly in helping me get through some basic daily stuff.

I hope things continue to improve for you. Many people will tell you that the hardest part is deciding that you want to change. I agree, but I also want to add that sometimes it may be hard to remember why you wanted to change. A lot of the problem behaviors are habits, and it takes time and practice to change your habits, no matter what methods you're using to get to those skills.

Good luck!
posted by bilabial at 11:48 PM on June 28

You have one very big advantage - you want to change.

Yes yes yes yes.

I think a lot of the hopelessness that is felt about BPD (specifically by the "nons" as coined by Randi Kreger, I think) is because many (most?) people who have BPD (really, those who are suspected of having it) won't ever seek treatment/admit it. So I think you are way ahead of the game if you have recognized it and have a therapist who believes it can be treated (some won't even work with patients with BPD).

Good luck.
posted by Pax at 7:36 AM on June 30

(I don't know why I'm so parenthetical today)
posted by Pax at 7:36 AM on June 30