Augusta, Ga. (WJBF) – From depression to anxiety to bipolar disorder and beyond — there are so many things to understand about the mind and mental illness. During this Mental Health Awareness Month, we wanted to take a moment to look at one disorder that you may know little about – Borderline Personality Disorder. For help with that we turned to Dr. Amy house, a clinical psychologist with the Medical College of Georgia at Augusta University. She explains how what you may think of as mood swings could actually be a bigger problem.
Brad Means: So I’m on the internet last night and I just do a curse read BPD search and it says borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. At first I thought well we all have that. And so my question to you is, what separates a moody person or a person who may have up or down days from someone who perhaps has reached a problem area?
Dr. Amy House: Yeah, so you’re right I mean everybody experiences moods and changes in moods and sometimes we experience really intense emotions that are painful and that’s all part of normal life. Borderline personality disorder is a disorder … We call it a disorder of emotion regulations. So people who have this disorder are just exquisitely sensitive to things happening in their environment and experience a lot of intense emotions very frequently that last for a long time, and usually are very painful.
Brad Means: Is it because of an imbalance of some sort? Do we know yet? Does it vary from person to person like a chemical imbalance?
Dr. Amy House: Well there’s no evidence that there’s a chemical imbalance, but there is … a theory about how borderline personality disorder develops. It’s really a developmental model of something that starts in childhood and you begin to see evidence of it in adolescence and then into adulthood. And what we think happens is that there are some people who are just more biologically vulnerable for whatever reason. We know there’s certain percentage of the population that has kind of just a more emotionally sensitive temperaments, and that’s just a normal variation of temperament. But there are some kids who have this sort of emotionally vulnerable temperament who find themselves in environments that are a poor fit for that temperament. Some of those environments are abusive environments where they’re experiencing abuse and trauma. Other times it’s a family who is really trying to do the best they can, but are far less emotional than their child and they don’t really understand their emotional child, and they inadvertently really invalidate that child and give messages that the child shouldn’t be the way that they are or punish and criticize them for being so emotional. Kind of over time being a really emotionally sensitive person in an environment that’s punishing or invalidating creates this pervasive kind of dysregulation and emotions.
Brad Means: Are you talking a parent or caregiver who might say why are you so moody, I don’t get you, why aren’t you normal. Would it be that kinda thing that we’re witnessing as the parent.
Dr. Amy House: Yeah that kind of thing, but some of that is a normal part of childhood.
Brad Means: Sure.
Dr. Amy House: But we’re talking about environments where that’s kind of chronically and repeatedly and pervasively the message that people get about their emotions.
Brad Means: So who’s your typical patient? A child, a man/woman. Who do you see most often?
Dr. Amy House: Our DBT program has services both for adolescents and for adults. And typically the reason why people are coming into treatment is not just that they’re having intense emotions, but that they’re having extreme behaviors. And so what you see is people who are driven by their emotions to engage in extreme behaviors or they’re engaging in extreme behaviors to try to escape their emotions.
Brad Means: What’s an extreme behavior?
Dr. Amy House: Things like attempting suicide, harming themselves through cutting or burning, engaging in substance abuse behavior. Other kinds of risky and self-destructive behaviors that are often why people end up coming to treatment and coming to our program.
Brad Means: Can you inherit it?
Dr. Amy House: There’s really no clear research on that right now in terms of whether there’s something that’s inherited. Most likely what’s inherited is just this temperament style that I talked about that by itself isn’t a disorder, it isn’t problematic.
Brad Means: Alright I don’t want to stay on it too long because of our time that we have together, but I do wanna maybe get a clear understanding of how someone can determine that someone they know or love or themselves might have borderline personality disorder, and when they should seek help. In other words, do those extreme behaviors … And you’re talking about excessive spending. You’re talking about sex. I’m sure you’re talking about drug and alcohol abuse perhaps.
Dr. Amy House: Right.
Brad Means: Is it when those become an everyday occurrence that you realize I better call somebody?
Dr. Amy House: Well it’s not necessarily whether or not they’re an everyday occurrence, but it’s that if there are a number of extreme behaviors that are causing problems for the person or for their family. If the person is somebody who’s experiencing a lot of intense emotions, chronic feelings of emptiness, who has difficulty in relationships, difficulty maintaining relationships, maybe difficulty maintaining a job or doing well in school. Then those would be signs that somebody really needs to seek mental health treatment.
Brad Means: What can you do for them? What kind of treatment are we talking about, and is it life-long?
Dr. Amy House: So the good news is it’s not life-long.
Brad Means: Alright good.
Dr. Amy House: In the last probably about 30 years there’s been the development of a treatment called dialectical behavior therapy. And dialectical behavior therapy is a form of behavior therapy that’s considered really the primary treatment for borderline personality disorder. It’s a psychotherapy that involves weekly individual therapy meetings that are focused on targeting behaviors that are problematic and changing those behaviors. Along with that there’s a weekly skills training class. So the idea is that people really need to learn skills to manage themselves, their emotions and their behaviors and their relationships more effectively. So we have skills training classes to teach those skills. And then the therapists who are involved in this program meet regularly as well. Part of the treatment is therapists meet regularly for consultation to keep the treatment going well together. So we have a comprehensive DBT program here at MCG that includes those components.
Brad Means: How long best case scenario from the time you start DBT treatment and the time where you’re released back into the world with the coping skills you need?
Dr. Amy House: So it really depends on the individual and the severity of the problem and how long they’ve been dealing with it. For adolescents, our adolescent program can be as short as six months. For adults we ask for a one year commitment to the program for adults. And then often people will stay longer than a year, but we expect to see significant improvement in the space of six months to a year.
Brad Means: That’s not bad.
Dr. Amy House: No it’s not too bad, but people often do stay in the treatment program longer to continue to develop and work on their goals.
Brad Means: So while they’re going through DBT and they’re learning how to cope, they’re learning what the triggers are, you’re learning how to help them. Is there every a point especially during that time when you have to take steps to remove them from that invalidating environment that you described? Especially with a child, can you ever step in as a professional and say I need you out of this home ’cause you’ll never get better if you stay here.
Dr. Amy House: Well, it’s not our job as professionals to do that. Although if we suspect that there’s abuse happening, of course we report that to family and children services, and they make a determination about what to do in those cases. What we do have though is a family and friends support group for parents, spouses, children, friends of people with BPD. And that support group also offers families skills training so that families can learn how to be more validating. How to create an environment that’s more healthy for everybody in the family, and facilitates the recovery of their loved one with BPD.
Brad Means: Do you want to implement any prescription medication during DBT or before or after? Do you try to steer clear of that and just let the therapy try to address the issue?
Dr. Amy House: A number of people who have BPD in our treatment program are also getting medication from a psychiatrist.
Brad Means: Is it in the depression category? Borderline personality.
Dr. Amy House: No not necessarily. It’s really more pervasive in that. So it’s not just a mood disorder, but it’s also behavior and the ways that you think about things. So that’s why it’s called a personality disorder is because it’s just this sort of comprehensive set of problems and patterns. But medication itself doesn’t treat borderline personality disorder, but it can treat specific symptoms that people are struggling with. So many people who have BPD also have depression, also have anxiety disorders, also have post-traumatic stress disorder. So sometimes medication can be helpful in the treatment of some of those things.
Brad Means: What about any success stories that you’ve seen. My question is how does it make you feel? I’m certain that you’ve seen someone go from a pretty dark place to a place where they can get back into society. I just wanted to see how you feel about that. That’s gotta feel wonderful.
Dr. Amy House: Yeah it does feel really good. It’s one of the reason I do this work, is it’s really rewarding to see people who are really suffering and know that we’re offering them a treatment that’s really gonna help. And actually see them change their life and go on to live lives that are worth living. Lives that are full of joy and vitality.
Brad Means: Well I appreciate what you do and I appreciate you helping people out of those places. We’re grateful to you and certainly thanks for your time today.
Dr. Amy House: Thank you very much for having me I appreciate it.
Brad Means: Any time, Dr. Amy House, Medical College of Georgia at Augusta University. If you recognize any of the signs or symptoms that Dr. House talked about, give MCG a call. Help is there. She can get you back on the right track, she and her team at MCG at AU.
If you need more assistance you can call Mental Health America. There’s the number on your screen. You can text MHA to 741741. Do this for yourself for a loved one. Please we can all improve our mental health.