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Tanya,

Hey. There's a lot of info out there about BPD, some of it is helpful, and some of it is total bullshit. (for instance, stay as far away as you can from the book "stop walking on eggshells" and do not let anyone in your family read it. it's just horrid and harmful.)

ok. now on to other things.

there is always the DSM IV criteria for Borderline Personality Disorder, which is a good place to start in terms of gaining an understanding. There is also that little write up i did on marsha linehan's biosocial theory on borderline that AM mentioned that is my summary/interpretation of linehan's theory on how borderline develops. (i really need to revise it and add in some other things, but i think it has some food for thought in it.)

in terms of books that are good sources of info for understanding what's going on with yourself, I Hate You-- Don't Leave Me is a classic, so to speak, though it has its flaws. (but the title itself almost makes up for its shortcomings.) i really like Lost in the Mirror, though i've heard it can be hard to find.

medication wise, there is no one medication to treat borderline. there is a thread here where a few of us talk about meds we've been on and studies on medications for borderline. medication can help lessen some of the symptoms of borderline, but as it's a personality disorder and not a chemical imbalance like bipolar, there aren't any medications specifically approved for treating borderline. (not that anyone here ever said treatments should never be off-label, of course.) but medication can help.

the main treatment for borderline is therapy. dialectical behavioral therapy in particular was created as a treatment for borderline and many studies have shown it to be quite effective. (i personally could go on for days about how much dbt has changed my life, and i'm by no means the only one.... so on to the studies....)

for example, a study entitled Dialectical behaviour therapy for women with borderline personality disorder showed that:

Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation. CONCLUSIONS: Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.
and another, more long-term, study with an emphasis on suicidal behaviors called

Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. stated:

CONTEXT: Dialectical behavior therapy (DBT) is a treatment for suicidal behavior and borderline personality disorder with well-documented efficacy. OBJECTIVE: To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non-behavioral psychotherapy experts

...CONCLUSIONS: Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychotherapy. Dialectical behavior therapy appears to be uniquely effective in reducing suicide attempts.

DBT is usually done twice a week, with one session done in group where you learn skills (more like a class than group therapy,) and another one-on-one session with your personal therapist (who should be someone trained in DBT and in contact with the leader of the skills lesson sessions) where you talk about what is going on in your life, look for places where you could have used skills, your problems in general, etc. Ideally the relationship with your one-on-one therapist should be trusting and close, where the patient has a lot of access to the therapist for crisis management. This varies, of course, but the ideal is one where you have a relationship where there is someone there to help you work through times of extreme emotional stress. Usually a part of this relationship is that the patient signs a contract to not self-harm and to contact the therapist when in crisis. But, like i said, it varies. i have read the main textbook (and also the workbook and some other works) used by psychologists who do DBT, and there is the method in the book, and then there is reality, and it is often good to adapt a method to the specifics of your patient. for instance, i did my skills training on a one-on-one basis because that was what my doctor thought would help me the most, and he thought a group setting might not be good for me at that time. (if you want more info on my specific experience, please feel free to ask. DBT is probably the most important thing i've ever done for myself, and i'm always willing to talk about it.)

Skills training is done using a work-book by marsha linehan, phd (a psychologist who was a borderline herself, who created DBT) called Skills Training Manual for Treating Borderline Personality Disorder there are also a lot of great resources here

there is another form of therapy that is often used for borderline that has a more traditional psychotherapeutic approach (whereas DBT is a cognitive therapy tailored to borderline that utilizes a lot of buddhist ideas.) this therapy is called transference focused psychotherapy. i did DBT and transference focused psychotherapy at the same time. mixing the two therapies is not uncommon, and i've read of it being done at McLean at Harvard and also at Cornell, two institutions with very good borderline programs.

this study, Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder showed that:

Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF
RF is reflective functioning.

There is a description of transference focused therapy here, though honestly, it's a bit dense and while i understand it, i don't grasp it well enough to confidently explain it. basically it has to deal with helping you work through the parts of our pasts that lead borderlines to "split" (black and white thinking... things are all good or all bad....) and helps you to stop doing so. i had no idea that i was doing TFP when i was doing it, i thought i was only doing DBT. frankly, i think that (for me) it worked out better that i didn't know i was doing TFP as well, and that understanding the mechanisms of it doesn't really aid in helping the healing. (of course it may help others to understand.) which is very different than DBT. in DBT it is all about understanding the concrete whys of things and the hows to make things better.

DBT is very concrete and helpful in a day-to-day as well as life-long manner. frankly, it just rocks.

ok.

i know that i just said too much, and i'm pretty sure my side-trip into TFP was a bad idea as i don't know how to explain it.

but, if none of what i said made any sense, just remember this DBT is amazing it is a LOT of work, but it is worth every second of it.

you may read some things about borderline that cast it in a very negative light, but always remember that DBT is there, that it works, that it is proven to work even, and that you can get to a place where you are able to regulate your emotions. you can get better.

ok. now ask me to clarify all the things that didn't make any damn sense. ;)

and, really, always remember that you can PM me if you need to.

all my best,

penny

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