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To help patients, clinicians should not fear BPD diagnosis

In a room packed beyond capacity, the National Education Alliance for Borderline Personality Disorder (NEABPD) held a conference on November 4th at the Carter Center in Atlanta, GA. The audience was mixed with sufferers of Borderline Personality Disorder, loved ones/family members of BP sufferers, mental health specialists, and others.

Attendees listened to experts in the field discuss early detection of BPD in adolescents; family dynamics; how to set limits for yourself when dealing with a borderline, legal aspects of mental illness, and medical management--what works, what doesn't, what needs to be explored.

The mother of a young adult borderline (with periodic suicidal ideation) gave an excellent, heartfelt presentation of the challenges their family face in trying to support and protect their BP daughter, while setting needed boundaries for themselves.

Also present was a representative of Brandon Marshall--the NFL's Miami Dolphin who revealed in late July that he has BPD. As I've stated before, I am so proud of Mr. Marshall for coming forth because the disorder needs someone in the public eye to increase awareness of this painful disorder. (I also feel that the incidence of BPD is unnoticed in the Black community, and in men; it needs more awareness. For a while, I want to focus my community efforts in those two arenas.)

As you may know, people with BPD have a difficult time regulating their emotions, regulating their reactions to things, and have repeated chaotic relationships. People with BPD have a lot of emotional pain, and they cause pain in those who love them. BPD is felt to be more prevalent in women, but I think this is untrue; I think the diagnosis has just been overlooked in men, or an erroneous diagnosis was given instead. BPs can come from normal, or dysfunctional, families.

It is said that BPD affects 1% to 6% of the population; I tend to lean toward the latter (at least 6%); and 10% of these patients succeed at committing suicide; even more have suicidal attempts.

I attended the conference because I know someone who has BPD and he refuses to get evaluated and treated; meanwhile he is escalating in all his behaviors. It is so sad. With his refusal to get help, I've had to set limits for myself. Here are some points that stood out to me during the conference:

The diagnosis of BPD is often missed during adolescent years. Mental health specialists have been reluctant to assign a personality disorder to young people just as their personality is developing. But if someone's behavior meets the criteria, evaluation for BPD should begin sooner rather than later. I think this is a key point. Re: "my" borderline, no one picked up on all of his "acting out" and being "rebellious," and as a result, he was undiagnosed and is now a senior citizen. He's had decades of emotional pain, and ruined relationships in his church, work, and especially close personal relationships.

Most BPs are relieved to actually get a diagnosis--a name--for what is wrong with them; for why they do what they do. Brandon Marshall expressed this very thing in his previous press conference. He'd sought answers before, but when someone--Dr. John Gunderson and his team at McLean Hospital in Massachusetts--put the pieces together that identified Marshall's problem as BPD, everything came into clear view.

Mental health specialists seem to still have a hesitancy to identify a patient as borderline. I feel this is a tragedy. Related to this...

With all due respect to my medical colleagues, it seems the "stigma" of the disease seems to be in the mindset of the mental health specialists (MHS) more than the patients themselves. Admittedly I was kind of stunned to hear how so many MHS either didn't want to tell the patient they have BPD [how can you not tell a patient what their diagnosis is!?], and/or they don't want to deal with BPD patients. They also face the issue of insurance possibly not paying for BPD care. BPD is a real disorder. I say it definitely needs a new name, and it should be treated as all other mental disorders.

In that the disorder is not as well known as other mental disorders--think ADHD, PTSD, bipolar disorder and schizophrenia--I feel that the "stigma" doesn't initiate with the patient and their families (many haven't even heard of the disorder); instead, it begins with the mindset of the clinician. In a Time magazine (Jan. 19, 2009) the article "BP: The Disorder Doctors Fear the Most" speaks to this problem. The mindset of many clinicians must be changed in order to treat millions of people in deep emotional pain.

I created a color flowchart about BPD that I want to get in the hands of mental health specialists everywhere. (I shared the chart with many of the speakers and they felt it was quite good.) I want to get it in a psych journal or other publications. It can be something to simply stick on a board to simply remind clinicians about the disorder, and to not overlook BPD as a possible diagnosis.

Medications may/can help, but counseling is key. I think that a definite evaluation protocol should be standard across the board. It should include personality testing, blood tests and brain imaging (MRIs, PET scans, etc.) to check brain anatomy and neurochemical transmitter levels in all evaluated patients. In listening to the experts there, I do feel there is another component that should be included in their workup. I'm trying to make the needed connection to share my point re: certain neurotransmitters I feel are currently being overlooked.

BPs and their families have less emotional burden and less disruption to their lives when the borderline is in treatment and the family is supportive. Also, with help, the borderline is better able to master their emotions


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