Understanding Borderline Personality Disorder

May usually represents springtime, flowers in bloom, and summer just around the corner. We honor our mothers and remember those who have given their lives in the service of our country to provide us with freedom and democracy. May is also Borderline Personality Awareness Month. BPD is a serious mental illness characterized by instability, emotional dysregulation, intense fears of abandonment, suicidal threats and behaviors, impulsivity, and identity disturbance.

In this May E-letter, we provide information about Borderline Personality Disorder, Our Ask the Doc question is about behavior changes in a college student, and our email of the month is about 7 Habits of Highly Ethical People. We hope you find the enclosed information helpful. As always, we appreciate your questions and feedback.

Research Study. We are pleased to announce that we will be participating in a four month research study with Life Extension Institute assessing the effects of cognitive therapy, nutritional supplements, and medications on weight management in overweight individuals. Dr. Kimmel and Denise Champagne will be conducting cognitive therapy groups for a sample of 40 subjects who will be followed by three physicians. For more information, contact our administrative assistant, Jillian, at 954 755-2885.

Parent Education and Family Stabilization Course. For several months now, we have been offering the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, it is required by the State of Florida for all parents divorcing or separating even if not legally married. We have provided this course many times and have designed it as a 4-hour, one-session presentation that focuses on ensuring that parents protect their children from the effects of divorce or separation by setting aside their differences and focusing on the children’s need for both parents in their lives. The course also provides information about divorce as loss, gives an overview of the Florida laws and statutes related to divorce and custody issues, and offers information on how children react to divorce based on their ages.  The course is offered live on a flexible schedule, based on the availability of those attending the course.  Please contact our Administrative Assistant, Jillian, at 954 755-2885 for additional information.

Low Cost Counseling. Denise Champagne, M.S., is offering low cost counseling as a mental health intern. She is currently seeing patients and is available to take on new patients. This allows those individuals who cannot afford treatment to obtain it and allows her to complete the required number of additional clinical hours for full licensure. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Testings. If you are concerned about your child’s school placement for the next school year, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Qualified Supervisor. Dr. Joel Kimmel has been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Our E-Letter this month focuses on Borderline Personality Disorder. This diagnosis has recently received attention in the media as it has been applied to convicted murderer Jodi Arias. People with BPD have been described as being emotionally unstable. They are characterized as having significant difficulty in regulating their moods and behaviors. Their moods can be quite extreme and intense and unusually variable. Symptoms of BPD include impulsive behavior, intense and unstable interpersonal relationships, unstable self-image, feelings of abandonment and an unstable sense of self. People with BPD often idealize and also devalue themselves as they have no stable sense of themselves. They can have high regard for themselves and quickly change to disliking themselves. Self injury including cutting and mutilation is not uncommon. Suicide threats and completed suicide attempts are also common. Relationships invariably contain intensity and drama with an underlying fear of rejection and abandonment. Frantic efforts are often made to avoid real or imagined abandonment. Manipulation and lying are quite common. People with BPD can dissociate or lose touch with reality and engage in intense behaviors. Because they do not have a stable sense of self, they often don’t care or think about the consequences of their behaviors.

BPD tends to be more prevalent in women as 75% of the diagnoses made are of women. It is also is believed to affect 2% of the general population. Co-occurring conditions are also quite common in people who have BPD. A study in 2008 found that 75% of people with BPD also had mood disorders including depression and bipolar disorder. Others met the criteria for an anxiety disorder, substance abuse or dependency, eating disorder, ADHD, and PTSD. The causes of BPD aren’t yet fully understood although researchers believe that genetics, early childhood trauma, and brain abnormalities are factors in the development of BPD. Treatment for BPD includes psychotherapy and medications. At times, hospitalization may be necessary. Dialectical Behavior Therapy (DBT) was developed specifically to treat BPD. It uses a skills based approach combined with exercises and meditation to teach self regulation, tolerance for distress, and how to improve relationships. Medications can be helpful in reducing symptoms of co-occurring disorders. Antidepressants, antipsychotics and anti-anxiety medications can reduce emotional distress. Hospitalizations can keep people with BPD safe and allow them to get intensive treatment.

We offer the following information on Borderline Personality Disorder:

• BPD is a mental illness characterized by unstable moods, behaviors and relationships
• It is more prevalent in females as 75% of diagnoses made are of women
• It affects 2 % of the general population
• BPD is estimated to occur in 20% of psychiatric hospitalizations and 10% of outpatients
• People with BPD have extreme reactions to real or perceived abandonment
• They have a pattern of intense and turbulent relationships that vary from extreme closeness and love to extreme anger and hate
• They have an unstable sense of self with frequent changes in self valuation
• People with BPD are impulsive and can be dangerous with unsafe sex, use of different substances, reckless driving, binge eating, gambling, and excessive spending
• They can be self harmful with recurrent self injury including suicidal threats, gestures, attempts, completions, cutting, and mutilation
• They experience intense and highly changeable moods with chronic feelings of emptiness and/or boredom
• They may have problems controlling intense and inappropriate anger
• They may dissociate where they feel cut off from themselves or lose touch with reality
• The symptoms of BPD, according to Marsha Linehan, fall into 5 areas of dysregulation:
  • Emotions: People feel emotions more easily, more deeply, and for longer times
  • Behavior: Impulsivity is common with substance abuse, promiscuity, recklessness
  • Interpersonal: Oversensitivity where feelings about others rapidly changes
  • Sense of Self: Self injury and suicidal behavior frequently occur
  • Cognition: Difficulty concentrating and dissociation where people “zone out”
• People with BPD also have a higher rate of depression, bipolar disorder, panic disorder, substance abuse and dependency, anorexia, bulimia, and ADHD
• Causes of BPD are diverse and include childhood trauma, brain abnormalities, a genetic predisposition, neurobiological factors, and environmental factors
• Long term psychotherapy is the treatment of choice for BPD and is focused on the needs of the person
• Dialectical Behavior Therapy (DBT) was specifically designed for BPD and teaches skills designed to regulate emotions, tolerate distress, and improve relationships

• If you have BPD, educate yourself and set realistic goals
• See a therapist to learn skills to regulate your emotions and reduce your symptoms
• Maintain a consistent schedule of eating, sleeping, and exercise
• Comply with treatment and attend every session
• Avoid drugs and alcohol but consistently take prescribed medications
• To help someone with BPD, offer support, understanding, patience, and encouragement while maintaining your own boundaries
• Educate yourself in depth about BPD
• Always take self-harm and suicidal statements seriously and notify the police
• Recognize that you will have varying emotional reactions to a person with BPD
• Seek professional help if you have difficulty relating with people who have BPD

BZ writes: My son returned home from college last week. He was an A student who barely passed the last semester. He is not interested in doing anything for the summer except hang out with friends. He sleeps until early afternoon and stays out late. He won’t tell my wife or me who his friends are or where he goes. He used to be very friendly and would do a lot with our family. But he has changed. We know he has been smoking pot as his room reeks of it. He used to smoke in high school but he was an A student and never got into trouble so it didn’t bother us. Now we don’t know what to do. Help.

Dr. Joel Kimmel replies: Very often we hear similar situations in our office. Without knowing more background information, it is difficult to identify what is going on. But there is a very high probability that his usage of marijuana has caused the changes that you see. Pot is a widely and frequently used drug that often doesn’t cause serious impairment in school or work functioning. However, some individuals do not only abuse pot but become dependent. Their friends change, they don’t meet their school or work requirements, and they tend not to take care of themselves. Rather, they focus only on hanging out, usually with other pot users, and staying high.

Even though it is legal in 2 states, marijuana is known to be an amotivational drug and can be dangerous in certain situations.  People who are frequent pot smokers tend not to be achievers and often remain stagnant in life. While this may not be true of everybody and I am sure that if you asked your son, he could tell you who is successful and smokes pot, it seems like this may be true of your son. From our experience, college students who become pot dependent tend to stop going to classes, don’t get their work and papers in or in on time, and stop caring about their grades. They rationalize to themselves but soon their life focuses on who else gets high, where they can buy pot, and going to events where other people get high. Invariably, they flunk out, drop out, or are asked to leave.
Because of the structure and expectations when your son lived at home, he may have been able to do well in school. However, at college with the complete freedom he has, it is likely that he lost his focus on achievement and responsibility. Even though he is home, it seems like he wants to maintain that same lifestyle of irresponsibility, secretiveness, and avoidance of responsibility.

I would recommend that you establish and maintain expectations within your home for your son. One of which is that you don’t condone his pot use and that there will be substantial consequences for him if he continues to use. I would also suggest that you expect him to get a job or take classes to show responsibility. You might have to consider taking him for a drug abuse evaluation and possible inpatient treatment. If you do nothing or enable him, he most likely will continue his current life style.

We would like to thank Robert C. for the following email:

Seven Habits of Highly Ethical People

People are ethical because of social norms, religious beliefs and laws. Ethical foundations in an individual define the way he lives his life by differentiating between right and wrong and by behaving in a way which improves the situation directly or indirectly. Below are top seven qualities of highly ethical people.

1. They are Empathic. Ethical people have a high degree of emotional intelligence. They understand things from multiple perspectives and seek first to understand than to be understood. They have strong observatory, listening and analytical skills to understand things deeply. This quality makes them unique which enables them to win the trust of others; consequently, people share their problems with them with open heart and seek their support.
2. They Forgive and Forget: It requires a brave heart to forgive and forget. Ethical people don’t keep grudges for long duration. They have the tendency to establish peace and not brawl. They stay away from such complications and move ahead with life by forgiving and forgetting the matters.
3. They are Always Willing to Help. Highly Ethical people always want to improve the situation regardless of their relationship with a person who is in trouble. They take either corrective, preventive or suggestive initiatives for resolving issues.
4. They are Implosive. Ethical people are not hyper sensitive or explosive personalities. They possess a cool mind and a soft heart. They avoid frequent mood swings in order to develop a consistent and stable personality. They handle indecencies with decency. They know how to ignore hard and harsh comments and still converse softly. They know how to handle idiotic situations. They have a high degree of anger management skills which further empowers their implosive personality trait.
5. They Mind Their Own Business. Ethical people do not interfere in others’ lives unnecessarily; they mind their own business. Ethical people understand the fact the character assassination is equally a great sin so they don’t give attention to rumors and focus on crystal clear matters and avoid peeping into others’ personal matters.
6. They are Flexible adaptable. The wise says: it is better to bend than to break. Ethical people possess a great deal of elasticity. They adapt themselves according to the situation. They don’t stick to one mind set. Their continuous thought process enables them to change their minds easily in order to improve a situation without making it a matter of ego. They are not stubborn at all; instead, they portray flexible behavior in all kind of tough situations.
7. They Do Not Criticize. Too much criticism is the root of several social and professional problems. Ethical people do not criticize at first place. In case they need to condemn or criticize something, they follow a positive methodology to approach the relevant person and advise in a way which doesn’t hurt anyone and conveys the message in an effective way.