Borderline Personality Disorder Chat Conference at BPD Today

Neil Bockian, Ph.D. on March, 2003

Dr. Bockian is the author of "New Hope for People With Borderline Personality Disorder"

Terri:   

I would now like to introduce Dr. Bockian to everyone. Dr. Bockian is the author of "New Hope for People with Borderline Personality Disorder. "Neil Bockian, Ph.D., associate professor of clinical psychology and behavioral medicine at the Illinois School of Professional Psychology, Chicago campus, is co-author of "The Personality Disorders Treatment Planner." 

Dr. Bockian:   

Good evening. I'm here to answer any questions I can about BPD and about the book I wrote with Valerie Porr, "New Hope."

Patty:  

As I understand it, Ms. Porr wrote the chapter on families.

Dr. Bockian: 

Yes, she did. Valerie has been an advocate for people with BPD and their families for years. I got to Valerie via Ken Silk, M.D., a leading psychiatrist in the borderline PD area. Valerie and I had a lot to say right away, and I'm glad she became a part of this project.

Are there any questions people have?

emollie: ?

Terri:  

emollie your question please end

emollie:  

Can you give us a brief overview of the books contents and what the "new hope" is>? end

Dr. Bockian"

 Sure. How much time do you have :). I'm collecting my thoughts..

Terri: 

we have two hours lol

emollie:

I'm set up to wait...lol

Dr. Bockian:

At one time, BPD was considered almost untreatable. When it was first discovered (it is credited to Stern in 1938), one of the defining characteristics was a disorder that looked like an average disorder, but which did not respond to the main treatment available then--psychoanalysis. In "New Hope," I review many treatments: Dialectical Behavior Therapy, Cognitive Therapy, Psychodynamic Therapy, and client centered therapy... (continued)
Those are the psychological treatments. I also review medications. All of those are scientifically shown to help. I then review treatments that are well known, but which do not have specific scientific investigation of people with BPD (such as dance/movement therapy and music therapy). Finally, I cover treatments that are considered unconventional in the U.S. (cont'd)
Such as homeopathy, Traditional Chinese Medicine, and Vedic medicine. Science has also shown that these treatments are worthwhile, but not specifically with BPD. I spoke to leading practitioners in the field, who shared their clinical wisdom with me.
throw in a chapter on upcoming research, and that's the new hope.
(I mean everything combined!)

emollie:  ty

shuggie:  ?

Terri:

shuggie your question please

shuggie: 

have you heard of therapy for bpd called schema therapy ....and what do you think of that end

Dr. Bockian: 

Yes. I interviewed Jeffrey Young, Ph.D., the founder of schematherapy. cont'd

Patty: ?

Dr. Bockian:

Young was a student of Aaron Beck, the leader of the Cognitive Therapy movement. Young is currently conducting studies to show that schematherapy works with BPD. I believe it will work very well.

Terri:

pattytoday your question please

shuggie:

thank you Dr. Bockian very interesting end

Dr. Bockian:

I assign the book "schematherapy" to my students at ISPP.

Patty:

What do we know today about the etiology of BPD? Is it primarily psychological or a medical disorder of the brain? Where does this painful disorder come from? Thanks for being here tonight Dr. Bockian. End.

Dr. Bockian:

The answer is "both." I think it was surprising to most of us--I guess I should speak for myself--it surprised me to learn that BPD is 50% biological, and 50% environmental. cont'd
Convincing studies have shown that, on average, people with BPD have brain differences, especially generating and utilizing serotonin. cont'd
Serotonin is related to both depression and to controlling one's impulses. cont'd
What is the role of the environment? The best-known theory is Marsha Linehan's "invalidating environment" theory. Linehan believes that people with BPD experienced invalidation--such as not being believed--growing up. cont'd
As best I can tell, a reasonable synthesis of Linehan's theory and the brain studies is that people with BPD often process information differently--for example, they are extremely hypersensitive. Advice that might be ok for other children, such as "c'mon, pull yourself together," is difficult or impossible for the child, who then feels invalidated. Of course, specifically harmful behavior such as teasing or abuse are invalidating to anyone

Terri: ?

emollie: ?

Dr. Bockian:

Does that answer your q., Patty?

Patty:

Yes very much. Thank you.

Terri:  

Dr Bockian do you think there could be a relation between autism and bpd? end

Dr. Bockian: 

Wow--great question! Yes, I do. The extreme hypersensitivity connects them. In my book, I discuss Stanley Greenspan, M.D.'s theory. cont'd
I have called Dr. Greenspan. Some day, I dream of doing a study that will show if BPD can be prevented, using methods currently used to treat hypersensitivity in autistic children. cont'd
The nice thing is that Greenspan's work has been with children 0-3 years old. If we can identify problems that early, imagine what we could do!

Terri:   

wow you are the first person I have talked to that I've connected with on this, this is just been my own personal theory for about 3 years now thanks 
emollie your question please

emollie:

Okay, there's the biological aspect...what about genetic?... I have 2 sisters diagnosed bpd..(cont)
my father was almost certainly bpd, and I have a child who seems to me to show many of the characteristics...especially the hypersensitivity...I have often thought of him as "borderline autistic".
I am also bpd...end

Dr. Bockian:

The biological factors in the studies that were done were mostly genetic. I'm not aware of other biological risk factors that are not genetic. cont'd
The best example of a disorder that is biological but not genetic is cerebral palsy, which is caused by trauma to the brain (such as lack of oxygen). BPD seems to be transmitted genetically. The exact genes and mechanisms have not been identified. Certainly, it runs in families. cont'd

Jilsam: ?

Dr. Bockian:

The genetics will probably relate to the brain issues identified above. end

Terri:

Jilsam your question please

Jilsam: 

Late blooming BPD, marriages that after 10, 15 years go awry when one spouse starts to exhibit BPD symptoms?

Terri:

is that your question Jilsam? end

Jilsam:

Is there such research on this?

Dr. Bockian:

In theory, the proclivity was always there. However, there is another important theory that may shed light on your question. cont'd

emollie: ?

Dr. Bockian:

Millon discusses "vicious circles"--patterns of behavior that reinforce themselves over time, leading to a downward spiral. One pattern that may fit someone whose behavior that changes over time is that he has an unmet need that he perceives (e.g. he wants more closeness--or more distance) or he is ambivalent (he wants closeness, but gets nervous when it happens). cont'd
If he tries inappropriate ways to get his needs met, and persists inflexibly, things get worse over time. With people with bpd a common pattern is to rush to closeness (fearing abandonment) then feeling overwhelmed, and backing away. This provokes anxiety in the partner, who creates distance to stay safe. The person with bpd pursues even harder, creating more anxiety in the partner. You could see how this would make things harder.
It is important to find ways to break vicious circles--usually through therapy, communication work, and so on.

blanche: ?

Terri:

emollie your question please

Dr. Bockian:

I'm not aware of specific studies on this pattern. As Patty mentioned, Valerie Porr did the family chapter. You can see her website at www.TARA4bpd.org. end

emollie:

biological again....I'm wondering if the same type birth traumas might also start bpd in motion
i.e. oxygen deprivation?
and part 2, how old is too old
to treat for desensitization
? end

Dr. Bockian: 

Part 1: Could be, but I'm not aware of any studies that have been done in that area. cont'd

Tasumi: ?

Dr. Bockian: 

Part 2: Unfortunately, brain plasticity--the ability of the brain to re-wire itself--declines rapidly. I don't know of a specific cutoff, but I would say early childhood. However, other treatments remain effective throughout the lifespan. end

Terri:

blanche your question please

blanche: 

I'm starting treatment for bpd but know so little. All this info is fascinating. Can you suggest somewhere to do basic reading on background, medications, treatments, etc? end

Dr. Bockian:

Well, hard for me to be objective on that one. I'd say "New Hope for People with Borderline Personality Disorder," by myself, Valerie Porr, and a gifted writing specialist named Nora Villegran. In "New Hope" I give info on the other popular press books on bpd cont'd
such as "Lost in the Mirror" and "I hate you--don't leave me." end.

Patty:

Sorry to interrupt but I've read "all" the bpd books and "New Hope" is the first book I recommend.

Terri:

anyone else have a question for Dr. Bockian?

Tasumi:

i do

Dr. Bockian:

Thank you, Patty. Go ahead, Terri.

Aim: ?

Terri:

Aim your question please

Aim: 

Are there a definite treatments for bpd end

Dr. Bockian:

Yes. The best known is Linehan's "Dialectical Behavior Therapy." Cont'd
DBT combines cognitive behavior therapy and "mindfulness"--awareness in the present moment. cont'd
The DBT approach has more scientific studies than most. In my book, the best thing about DBT is that you know you will see a specialist in borderline PD. cont'd
I know that many people with BPD have had unsuccessful treatment. It's nice to go to a program where that is exactly what they treat, and there are groups of people who can relate to you, since they have BPD as well. cont'd
To find a DBT program, contact the cont'd
I think it's the technology transfer group--I'm looking it up...

Terri:

it's the behavioral tech transfer group
we have that information on our website

Dr. Bockian:

Yes--thanks Terri. Do you have their web address?

Terri:

yes i do it's on the website but i'll go and look it up as well

Dr. Bockian:

Great. Look up the behavioral technology transfer group on the website.

Aim: 

ok thank you Dr Bockian

Dr. Bockian: 

end

Terri:

tasumi your question please

Tasumi:

do you think its possible for a child to have and or be diagnosed with BPD?

Dr. Bockian:

Yes. There is a new book out by Paulina Kernberg on that topic. I have not had a chance to read it yet. cont'd

Patty (after the conference)

[Personality Disorders in Children and Adolescents] by Paulina Kernerg

Dr. Bockian:

Prior to 1994, all personality disorders had an age criterion (at least 18 years old), but that requirement has been dropped.

Terri:

end

Dr. Bockian:

end

Tasumi: ?

emollie: ?

Terri: 

tasumi your question please

Tasumi:

how would i go about finding out if my son has BPD he is 11 yrs old
end

Andre: ?

Dr. Bockian: 

You would need to have him evaluated. I would look for a psychologist who specializes in borderline PD. Psychologists can give batteries of tests that can help clarify the distinction between normal pre-adolescent behavior and BPD.
end

Terri:

emollie your question please

emollie: 

mine is similar
I have an 11 yr old son who is my 4th child, i know it's not normal

Patty: ?

emollie:

are there dialectical behavior groups to treat children? end

Dr. Bockian:

Again, a thorough evaluation is the best way to know. With regards to DBT groups for 11 y.o. kids, the Beh. Tech. Transfer group would be the best source. I report on the work of a U. of Miami psychologist doing a cont'd
combination therapy, including elements of DBT, with adolescent substance abusers. I would guess that there are others doing similar work. end.

Terri:

Andre your question please

Andre: 

yes
Hi Dr Bockian
It is my understanding that you are interested, among other approaches, in how creativity can be a canvas for people to process their inner dynamics. Have you yourself developed any specific outlines for therapist, or do you know of any who are specialized with BPD clients? 
As an artist, I'd be interested to know how I could trace within my works, the expression of my inner systems and understand their interactions and functions better. Or would that be helpful in any way?
end

Dr. Bockian:

I interviewed a few wonderful dance-movement therapists--e.g. Danielle Fraenkel (kinections.com) & Susan Kierr. I tried to interview Natalie Rogers, an art therapist, but we could not hook up. Natalie, Carl Rogers' (the famous client-centered therapist) daughter, wrote a book that would be a good place to start. I'll bet Natalie has a website, and that would be where I would start networking.
Artwork is a great way for self-exploration and healing, whether done on your own, or in conjunction with a therapist.
end.

Terri:

Patty your question please

Patty:

Is there a theory as to why many people with BPD tend to burn out as they age and meet less criteria of the BPD? End.

Dr. Bockian: 

I'm not aware of any theoretical work on that (though there may be some). My own theory is that cont'd people are 

emollie: ?

Andre: ?

Dr. Bockian:

people are creative problem solvers. They don't stay stuck forever. People learn from their errors. They try new things, and some of them work. Many people break vicious cycles on their own.
Also, things that feel good when you're young (e.g. substance abuse) sometimes don't feel so good as you age.
end.

Dr. Bockian:

Makes sense. Thanks.

Terri:

emollie your question please

emollie: 

mine is a comment
I asked my t the same q and his theory was that the pathology just changed
but the person didn't necessarily become "well" without help of some sort
end

Dr. Bockian:

Thanks emollie.

Wooly:  Wooly?

Terri:

wooly your question please

Dr. Bockian:

That appears to be the "symptom substitution" theory, which is important in psychodynamic circles. We cognitive behaviorists tend to put less stock in symptom substitution. I believe it is important to continue to have faith in the human spirit, and, cont'd
as Jon Kabat Zinn notes, "anyone who is breathing has more right with them than wrong with them." It is important for all of us to focus on our strengths. end.

Terri:

andre your question please

Terri:

Is there an effective method for dealing with the day to day turmoil associated with bpd so that you can control the symptoms and not the other way around? 

Andre:

thanks! :O)

Wooly: 

end

Terri:

Wooly is there an effective method for dealing with the day to day turmoil associated with bpd so that you can control the symptoms and not the other way around? 
end

Terri:

Great question. There are several ways. cont'd
First step is "mindfulness," mentioned before. Linehan discusses mindfulness in her skills training manual. Jon Kabat Zinn has some great books--I'd recommend "Wherever you go, there you are" as the place to start. cont'd
I would then work on all the skills in Linehan's skills manual. I also have a chapter in "New Hope" --chp. 8: Self-Help.
end

Terri:

mguitarman your question please

emollie: ?

Terri:

emollie your question please

emollie: 

re: DBT
I've been in psychodynamic treatment for years.. and am relatively happy...would I find a DBT workbook helpful with out the accompanying therapy group?

Patty: ?

Dr. Bockian:

It would probably be best to talk to your therapist. My impression is that it would be helpful. Mindfulness tends to dovetail with psychodynamic therapy. Mindfulness meditation (Vipassana) means "insight meditation." The practice bears some resemblance cont'd
to free association, and, I believe, would tend to complement psychodynamic work. Nice to hear of someone doing well in their therapy, and validating that many treatment approaches can work. Again--double check with your therapist first.
end

Terri:

patty your question please

Patty: 

In regards to the bpd rages, are we really having a seizure? Someone said if they hooked us up to an EEG it would register seizure during a rage. What is happening to cause these rages? What's going on in the body? End.

Dr. Bockian:

I don't think anyone has hooked up an eeg to someone during a rage--how would you keep the electrodes on? So, we don't have a scientific answer. The theory has practical support, however, in that we know that anti-seizure medications are used with people with BPD, with good effect. One of the main effects of the medicine is better emotional control. end.

Terri:

are there anymore questions for Dr. Bockian?

emollie: ?

Terri:

your question emollie

Andre: ?

emollie:

back to the child thing....is there any focus at all being put on prevention or early intervention?
I noticed behaviour quite early
end

Dr. Bockian:

I would say that the best bet is to go to Dr. Greenspan's website--www.icdl.com. They have a network of therapists who can do evaluations on children of ANY age (down to infants). cont'd 
Whether we call it BPD in these young children is secondary to noting that the child has a problem with hypersensitivity or is prone to rages. The intervention--"Floor time"--is fun. It is great therapy, but it is good for kids who don't have disabilities. It helps the brain grow. cont'd
Parents can learn to do it with their kids to supplement the therapy. BTW, I found Marsha Linehan's website--http://brtc.psych.washington.edu. I'm still looking for the behavioral tech transfer group site.
end

emollie: ?

Terry 

http://www.behavioraltech.com/resources/crd/clinresdir.cfm

emollie: 

ok, thx

Andre: 

This is more a comment I guess, but I have experienced blinding rages only a couple of times in my life. Under extreme emotional abuse. 
But I carry a latent rage against social injustice, and have found that the more I isolate myself, the worst it becomes. It seems that changes have occurred best when I engaged in real life, with the motivation to be changed by the situation. And it seems that most times, there are people involved in those situations who kind of walk alongside and inspire me to act with more maturity, look beyond the offense, forgive, take time before

Patty:

www.behavioraltech.com/ is the main page. You found it before I did. LOL

Andre:

I find fascinating the fact that most changes occur as if I was "growing up," becoming an adult (I'm 46...). Something about character and self-control. And beside my past with illegal drugs, although I've just been diagnosed with BPD a few months ago, I've not been on medication at all. 
Love seems to work really well... :O)
end
oh and not keeping a record of harms done to me

Dr. Bockian:

Here here (to all of it)! Anger can be productive, when appropriately channeled. Most civil rights gains--including those for people with mental illnesses--start when someone says, "hey, that's not fair, and I demand fair treatment."
end.

Terri:

emollie did you ask your question or do you still have one?

emollie: got it answered

Terri: 

does anyone else have a last question for Dr. Bockian?

Andre: ?

Terri:

Andre your question please

Andre:

just to finish this 
the challenge can be to see if this unfair treatment is real in comparison to being "perceived"

Dr. Bockian:

indeed.

emollie: ?

Andre: 

for me it's been a journey to discover that I perceived them very deeply as if they were occurring, 
and most times, I DID find injustice
seems there's a radar inside that finds them quickly
it's helpful to help bring change for those who don't have a voice

Terri: 

I want to take a couple of minutes right now to just tell everyone a few things, first of all the chat will be edited and made available on MHT's main website at www.mental-health-today.com

Andre: 

regards and blessings to all... :
:O)
end

Dr. Bockian:

These 2 hours have really flown. I enjoyed your excellent and at times challenging questions. cont'd

emollie:

After I read your book, if I have questions then will there be a forum for asking them? i.e. will you come back again some time for a follow-up discussion?

Terri:

great question emollie

Tasumi:

yes do come back

Dr. Bockian:

I'd be happy to. Patty, you have my contact info.

Patty:

I sure do. 

Andre:

thanks

Terri 

I would like to thank everyone for their attendance 

Dr. Bockian:

Thanks to all.

tasumi:  yw

Patty:

This has been extremely informative. Thanks so much Dr. Bockian for doing this conference.

Andre:

Are you coming to Canada any time soon?

emollie: 

Thank you Dr.B

Dr. Bockian:  yw.

Terri:

Dr. Bockian is there anything else you would like to comment on at this time?

Dr. Bockian:

I'll be at the American Psychological Assn. convention in Toronto, Andre.

Patty: 

Goodnight everyone!!!!

Dr. Bockian: 

No, just to say I've enjoyed this meeting.
Goodnight!