Hadley Finch Intro: Some dating singles are serenity seekers while others are hurricane hunters. If you or someone you’re dating often experience intense stormy relationships filled with conflicts, hurtful behavior and painful rejections, this may be the antidote that brings happy relief.
You get the help you need to manage fears, anger and self-destructive habits of this “untreatable” mental illness in this guest post edited by Tamara Eberlein, courtesy of Healthy Woman – Bottom Line Books.
In college, I worked as an aide on the psychiatric ward of a major university hospital. I recall a patient who spoke of intense, stormy relationships with family members, conflicts with coworkers, painful rejections by friends and frequent suicidal thoughts. He often acted impulsively and was prone to mood swings. The diagnosis: Borderline personality disorder (BPD), a mental illness marked by difficulty managing emotions, extreme fears of abandonment and self-destructive behaviors. I remember one of the psych nurses telling me, “There isn’t much we can do for a patient like that. Therapy and drugs just don’t help much.”
That was more than three decades ago, but the disorder has continued to be notoriously difficult to treat—until now. BPD patients finally can get the help they need, thanks to a novel form of psychotherapy called schema therapy. (Unhealthy or early maladaptive “schemas” are self-defeating, core themes or patterns that we keep repeating throughout our lives.)
The research is encouraging. In one study, for instance, one group of BPD patients received the typical treatment consisting of weekly individual psychotherapy sessions—but after eight months, 84% of these patients still met the diagnostic criteria for the disorder. However, a second group received the typical treatment plus weekly sessions of schema therapy—and after eight months, only 6% still had BPD! I contacted study coauthor Joan Farrell, PhD, director of the Schema Therapy Institute Midwest–Indianapolis Center and coauthor of the new book Group Schema Therapy for Borderline Personality Disorder, to learn more.
Who develops BPD? Though not as well-known as bipolar disorder or schizophrenia, BPD is actually more common, affecting from 2% to 6% of US adults. People who develop BDP tend to have sensitive, reactive temperaments. Dr. Farrell told me that often their core emotional needs were not met during childhood. Perhaps they had an unstable home environment…did not form a secure attachment with a caregiver…and/or were physically, sexually or emotionally abused. Genetics also may play a role, as the disorder appears to run in families.
Although more US women than men are treated for BPD, Dr. Farrell noted that this could be due to a gender bias in diagnosis. For instance, men with certain BPD symptoms, such as intense anger and aggressiveness, often are diagnosed instead with antisocial personality disorder (a long-term pattern of manipulating and exploiting others). In many cases, for both women and men, BPD goes unrecognized.
Signs of the disorder: BPD symptoms often first appear in adolescence. The diagnosis generally is made if a person exhibits five or more of the typical symptoms. For instance, he or she may…
• Make frantic efforts to avoid real or imagined abandonment.
• Have tumultuous, intense relationships in which he or she alternates between idealizing and disliking the other person.
• Have an unstable self-image (signs include difficulty choosing friends or sticking to a career path).
• Act impulsively and self-destructively (overspending, binge eating, excessive drinking, risky sex).
• Experience intense mood swings and excessive emotional reactions.
• Have chronic feelings of emptiness.
• Feel intense rage or have difficulty controlling anger.
• Experience brief episodes of being out of touch with reality.
• Engage in self-injury (such as cutting) or make repeated suicide attempts.
The treatment that can help: Schema therapy combines cognitive behavioral and emotion-focused techniques. It centers on helping patients change longstanding, negative self-images and self-defeating behaviors, incorporating methods such as role-playing, letter writing, assertiveness training, anger management, guided imagery, relaxation, gradual exposure to anxiety-producing situations and challenges to negative thoughts and beliefs.
A unique key element of schema therapy is limited reparenting in which, within the bounds of a professional relationship, the patient establishes a secure attachment to the therapist. “Many patients with BPD missed some critical emotional learning as children. They were not adequately validated and encouraged to express their emotions and needs. In schema therapy, the therapist meets some of those core childhood needs—for example, by setting limits, expressing compassion and providing nurturance,” Dr. Farrell said. The goal is for patients to become emotionally healthy and autonomous enough that eventually they no longer need the therapist to meet these core needs—because they learn to do so themselves.
Do you think that you or someone you love might benefit from schema therapy for BPD? Dr. Farrell recommended working with a therapist certified by the International Society of Schema Therapy. Referrals: www.isst-online.com/node/183.
Schema therapy usually is done in one-on-one sessions. However, research from Dr. Farrell and colleagues demonstrates a high level of effectiveness from a group-therapy version, and a large international trial is underway to further test this model. A combination of group and individual schema therapy may prove to be the optimal way, Dr. Farrell said, to go beyond the symptom control of other behavioral approaches to improve the quality of BPD patients’ lives—and even lead to remission of the disorder. For more information, visit http://BPD-home-base.org.
Source: Joan Farrell, PhD, is director of the Schema Therapy Institute Midwest−Indianapolis Center, an adjunct professor of clinical psychology at Indiana University−Purdue University Indianapolis, and research and training director of the Center for BPD Treatment and Research at Indiana University School of Medicine/Midtown Community Mental Health Center. Dr. Farrell also is a licensed psychologist, certified schema therapist supervisor, executive board member of the International Society for Schema Therapy and coauthor, with Ida Shaw, of Group Schema Therapy for Borderline Personality Disorder (Wiley-Blackwell).
I hope this helps you get the great love, health and happiness you deserve,
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