"Back From the Edge" - Borderline Personality Disorder

"Back From the Edge" offers guidance on treating Borderline Personality Disorder. The video was created by the Borderline Personality Disorder Resource Center at NewYork-Presbyterian. Learn more about the Center at http://bpdresourcecenter.org.

Also, learn about "Remnants of a Life on Paper," a book that tells the story of a young woman suffering with Borderline Personality Disorder (BPD) and watch a video featuring NewYork-Presbyterian psychiatrist, Frank E. Yeomans, M.D., by visiting http://remnantsofalife.com.

Lastly, you can watch this video with Spanish subtitles here: http://youtu.be/_34Yd6m50dk

>>My name is Andrew Jantz.
I'm a husband and father.

My background, as far as my career, was in publishing.
That career sort of imploded when I got sick.

>>My name is Kiera Van Gelder.
I am 36 years old.

I started cutting and burning myself
pretty regularly when I was 14.

>>Christina Knight and I'm 27. I sensed that
something was going on in my teenage years,

especially my senior year of high
school. I knew that something was up,

but I didn't know what it was and I kind
of tried to avoid it as much as possible.

>>Borderline Personality Disorder is really
a serious illness, that we do currently

now understand as a medical disorder, that
probably affects about 1% of the population.

>>The criteria for this disorder can be
grouped into 3 subsets: those that have to

do with emotional instability, those that
have to do with behavioral instability and

those that have to do
with interpersonal instability.

>>People with Borderline Personality
experience emotions more intensely.

>>Someone can say something to me and I can
have a severe reaction and then 2 minutes later

I can have another completely different
severe reaction.

And so its just constantly in the course
of a day. It's incredibly exhausting.

>>You also find a real pattern of
a lot of interpersonal problems.

>>They tend to be, on the one hand, very dependent and
clinging, and on the other, rapidly enraged and rejecting.

>>The hardest part for me was when she was acting
out in a behavioral way that was really angry.

>>You can't have interpersonal
relationships if you're not emotionally stable.

It's extremely difficult to deal
with someone who hates you one day,

likes you the next day, and could
love you the third day.

>>I grew up in a bunch of places. I started
out growing up in Europe until I was about 6.

My father was in the air force, so it was myself,
my mother and my brother in Holland and Italy.

I had a very active imagination. I loved
art and was athletic and played a lot.

>>When I graduated from college publishing
seemed a natural way for me to go since I

was bookworm and loved books. So, I got
into publishing and began to climb the ladder.

I had a good job, nice wife and two beautiful
children, bought a beautiful Victorian in a nice town.

I had it all. I remember one day I was raking leaves
in the front yard and here I was in my early 30's

and people walking by are thinking: "Look
at this guy. He's got everything." You know?

And I was conscious of that.
I felt fortunate.

>>A lot of people in my life or just people
that I would meet, I'm sure and I know this,

they thought that I had everything together.
They thought that everything was perfect

because that's how I appeared to the world.

I appeared as someone who had
everything going for them and that I was

under control of everything
and that I had all these goals.

>>Really until she was in her mid-teens,
everything seemed to be very normal.

She was a very involved child with a lot of
sports, very good at gymnastics and soccer,

and she was very motivated in school.

>>Outwardly I think people thought I was
very affable and outgoing and personable.

And I was a good manager.
I worked well with people.

What was happening inside of me was a different
story. And that began to get worse and worse.

>>One of the things that happened when I
was 6 was my parents had divorced and we

had moved from Holland to Massachusetts.
We were in this small community and there

was this street with a lot of people on it.
And one of the guys who was babysitting

for my brother and I regularly was
molesting me at that time.

And I remember starting to develop this sort
of aspect that I was always being watched

and it gave me a real sense of discomfort
and anxiety when I was around groups,

especially if I knew that
he was gonna be there.

I really didn't know how to handle the situation.
I just didn't say anything to anyone.

I think that was really the beginning of my sort of shift
into being more socially awkward and more fearful.

>>There was a sense of not
really knowing who you are.

I think there had always been like
a chameleon-like character in me.

I was sort of being who other people wanted
me to be or who they expected me to be.

And I felt that in the morning it was
almost like I had to "zip on" my suit and tie,

put on this persona of
a confident manager.

And I'd go into work and I'd sort of just
get through the day and then afterwards

walking to my car in the garage it
was just like a total deflation.

I felt totally depleted like I had given
everything I had just to get through the day.

And by the time I got home I had
nothing left for my wife and kids.

>>I feel like I don't really have a group I can identify
with. I don't really feel like I fit in with my family.

I don't feel like I fit in as a college
student. I don't feel like I fit in

whenever I work someplace and that's probably
because I don't have an idea of who I am.

>>My way of coping was to start journals
of how I should have a personality.

Writing down like this is the type of person
I should be so that people will like me

and I can therefore be a part of something.
You know, I would study people

and my writing was about observing other
people and how those observations

could be applied to how I should be
because I didn't know how to be.

>>You could actually define Borderline Personality
Disorder as the "I don't fit in" disorder.

They are, in my opinion,
the ultimate outsiders.

>>They oftentimes try to conform to what
they think other people want from them.

>>When we got married he pushed himself
down a path. Now he's gonna be a husband,

a father, a homeowner, he was gonna get on a track.
Maybe that was what he was supposed to do

and that would make him happy. We went down
that track and it didn't make him happy.

>>And I think that it engendered a lot of anger
inside of me that began to sort of fester.

And it began to feel like it was eating me up from
the inside like I was rusting through inside.

>>I remember one time when I was in 9th
grade and I had finally made a friend.

And this was a friendship where we were
spending time together and I was so happy.

My relationships with people tend to be so intense.
I didn't really know how to have casual friendships.

I was like, "You're my best
friend forever and ever."

And probably the 6-8 months of our friendship
this young woman lost a lot of weight

and went through this transformation. Her
sort of moving up the social ladder and

hanging out with the kids who were
cooler and prettier and whatever.

And when she did that I found that I
was unable to accept what she had done.

I ended up sending her a
letter written in my blood.

>>Writing a letter in your own blood is a
beautiful example of communication of a

desperate need which would be very
difficult for the other person to ignore.

>>This is a group of people who often
need other people to regulate them.

>>The relationships that they
form often breath life into them.

>>And therefore, if the people who
are regulating them in some way are

getting ready to leave them, it can
feel like a life and death proposition.

>>Absences or separations from those
relationships once they're established

are catastrophic in their significance.
Like, I don't exist myself.

>>I'm not sure that people with Borderline Personality
Disorder know that they're being manipulative.

But, it comes across that way often to the people
who are living with them or who are around them.

Sometimes for the family members it's
almost like walking on eggshells.

Sometimes living your life in what you
think is a normal way is upsetting to them,

so you stop doing that. And then you feel
like that was their purpose all along.

>>People see the emotional, I think there's
a phrase "I hate you, don't ever leave me."

People tend to see it not as a medical
condition, but as just somebody being

difficult, dramatic, self-absorbed.

These were all things that people should be
able to control because it's not an illness.

>>Manipulation assumes that a person has the
skills to think about and then execute a plan.

And manipulation in that sense I don't
think can be applied to BPD because it's

all about knee-jerk reactions and desperately trying to
get something to feel secure and safe and ok again.

And so, for me when I was sending letters
written in blood to people, one could say

that was a tad manipulative. On the other
hand, you could just as easily say I had

no clue about what I was doing.

I had no idea how to get people to pay
attention to me in ways that would work.

>>Manipulation is when you consciously
try to get someone to do something for

you without them knowing that
you actually got them to do it.

These individuals very rarely have the
interpersonal skills to figure out how to

get you to do things
in an unobtrusive way.

>>I began to lose a sense of
connection with my wife and kids.

I was becoming less and less engaged with
them, withdrawing from them, very irritable,

anger percolating, surfacing
at inappropriate times.

>>I can remember him having a
conversation with my sister on the phone.

For some reason something she said
just put him over the edge.

He slammed down the phone and broke the
glass coffee table because he slammed down

the phone that hard. And I
was like, "oh, my God."

>>Another time I remember I was trying to
get dressed for work and something minor

was getting me angry. Something like trying to
take my suit off a hanger and it got caught.

And I just began to sort of start ripping and
slamming the closet door, things like that.

Physical aggression that was coming out,
not against anybody, but just things.

>>This is a group of people who emotionally
respond much more sensitively to things.

In other words, they respond to some small thing,
when for you it might take something big.

So that's just an emotional vulnerability
factor. The second thing you have to know

about them is not only do they respond to a very
small event, they respond VERY rapidly.

>>You know they say that Borderlines can
feel like burn victims that their skin is

just raw like someone who's been burned.
And that if something is said to them or

done to them that they feel it with the
intensity that you would if you poked

somebody in the arm that
didn't have skin on their arm.

>>It's really easy for me to get out of control and it
takes a while for me to be able to calm myself down.

There was a specific instance, I went up to
this street vendor and he had these markers.

He had the markers spread out all over
the table and there was paper there.

I should be able to use the markers and
draw on the paper to see what the markers did,

but he didn't want me to touch the markers.
I lost my mind to the point where

my boyfriend at the time was
like, "we need to leave."

He had to drag me away from there because
I was so upset and could not understand

why you would have the markers and the paper out
on the table if he didn't want people to touch them.

And he just didn't want
me to touch them.

>>I think that it was embarrassing to the
person she was with and she doesn't seem

to understand at the time that it's over the top, and an
incident that didn't need to escalate to that degree.

>>I got so heated about it so quickly that I
felt like I didn't have any control over it.

And I obsessed about that for days afterwards
and I told the story to so many different people

just to justify that I was right in the fact that I
should have been able to use the markers.

>>Individuals who meet criteria for
Borderline Personality Disorder, ordinarily,

no matter how hard they try, despite all their best
intentions, simply cannot regulate themselves.

>>I would make relationships with people based
on these behaviors that were self-destructive.

There's was always the getting high or
doing something dangerous and then getting

crazy drunk and dancing with people and
going out to parties and having sex with

people who were very attractive and
ephemeral and I would never see them again.

>>Christina tends to have risky behavior whether it's
drug use or whether it's driving her car very fast.

>>I know that there's certain people
I've met that haven't been great for me.

Like, they have been doing drugs or
whatever and I will go to the extent that

I will actually do the drugs so that I fit in with them
and that's not necessarily the greatest thing.

>>She also has eating difficulties and
so she's been bulimic and I think that

that's a risky behavior that could
ultimately be life threatening.

>>That constant level of intense
distraction and chaos is a way to

distract from all the painful
things that are going on.

>>A lot of the dysfunctional, problematic behavior
that an individual who meets criteria

for Borderline engages in, if you look
at the behavior you will see that that

behavior is highly effective at regulating
their emotions. The only big problem with

that behavior is it regulates it short-term
instead of long-term. That is the problem.

>>I started cutting when I was 14. I had become
infatuated with another student and was rejected.

And the rejection, it was a romantic
infatuation, it was very public.

I was very upset and I went into the bathroom
in between classes and I had a tack

and I started dragging
the tack along my arm.

>>I remember once being...feeling very
hurt by a conversation I had with my father.

And there was a lot of anger and
emotion and I slammed down the phone.

I went and got a razor blade
and I started cutting my wrist.

>>Anytime that I've cut, it's been because
my emotions were so intense that I needed

a different outlet for them and to inflict
physical pain on myself was a relief

because then I could focus
on the physical pain.

And I didn't have to focus on the
emotional pain that I was feeling.

>>To me it was like a cigarette break, in
a sense, and a way of being able to manage

feelings that I hadn't
found a way to do yet.

>>There's no doubt about it at all,
cutting and physically damaging the self

regulates emotions in
this group of people.

No one is clear on exactly why it happens
and there's a lot of research on it.

>>The self-destructive behaviors of
Borderline patients can definitely serve

to help them alleviate feeling states that
they can't stand, oftentimes feeling states

that they can't even articulate.

>>There's a kind of gratification to it as you're
cutting and you're seeing the blood come out.

There's a satisfaction and after you do it, I'd make
4, 5, 6 cuts on my wrist and see the blood coming out,

there was a sense of relief afterwards.
I'd be sort of shaking with excitement,

but feeling calm. And the emotional
storm I was feeling had sort of subsided.

>>He would come down to me and go,
"Look." And he'd have blood down his arm,

but he'd have this look like,
[deep sigh] like he almost felt better now.

>>On the perfectly pragmatic side, the
reason it's a bad idea is it means that

you never solve the problem that
generated an emotion in the first place.

So, it becomes like taking drugs. It's a way
to avoid, distract, or get out of something,

but it isn't a way that makes you look
at it and figure out how to solve it.

Long term, you cannot be a parent, you can't be
a successful person, you can't be at work and

say "Ok, oh yeah right, I don't solve problems
like that. I'll cut." You'll have to leave meetings.

You'll have to leave your children
somewhere. I mean, how in the world are

you going to live your life if
this is how you solve your problems?

>>As I began to feel more worthless as a
person, I began to feel that people would

be better off without me because
I was just falling apart.

I was sort of a burning, wreck of a person.
So, the only way out as I say it was suicide.

>>The thing that started happening is I wasn't
able to live with what was inside of me

and what I was dealing with around me. I
felt very powerless. So, I started going

into my parents' liquor cabinet
and drinking from all the bottles.

>>I began to think about it more and more, and it
became almost like a little seed that started growing.

And suicide became more and more of an
infatuation. And all of a sudden I found

myself listening to Nine Inch Nails, Smashing
Pumpkins, Pink Floyd, a lot of really dark...

The Downward Spiral by Nine Inch Nails was
basically an album about somebody's self-destruction.

And I used to listen to that.
It really spoke to me.

>>I was pretty much walking around everyday
with a bottle of whiskey in my backpack

and razor blades and just drinking as much
as I could and then going into the woods

and cutting myself and hoping I could
actually make "the cut" that would do it.

>>I began to think about doing it more
realistically and I basically flirted with everything.

I would walk up on bridges, highway
overpasses and look down, think about jumping.

I put a loaded shotgun in my mouth.

I would stand up on a stool with a noose around
my neck. Overdosed massively a few times.

>>There was a math test & it was 7th grade & I remember
panicking because I couldn't find the math notes.

And that night before the test I went
into my mother's drawers in her bedroom and

I knew that she had pills there. So,
I ended up taking the bottle of pills

thinking, "Ok, this is it. I've failed." But,
they obviously weren't enough to do anything.

And I woke up in the
morning and felt disappointed.

>>I used to go to work and I'd look at the
subway trains pulling into the station and

think about jumping in front of them. I
actually did go for a walk in a subway

station in downtown Boston once. Wrote a
suicide note. I was dressed up in my suit.

Walked out of my office and walked into
a tunnel at Park Street Station. [scoffs]

I can still recall seeing the darkness
ahead of me as I was walking in the tunnel

and seeing my shadow in front of me growing longer
and longer as the subway train came up behind me.

I was totally detached. I didn't feel
afraid. I didn't feel depressed really.

I was just kind of shut down completely.
The train stopped and I turned around and

started walking next to the train to get
back out of the tunnel. When I got out,

went to a pay phone, called 911 and said,
"I just went for a walk in a subway tunnel.

I think I need to be put into the hospital."
[squealing wheels of subway train]

>>Thinking about suicide or wanting
to be dead is extraordinarily common.

Suicide attempts are very common and suicide
itself is very common. Between 8 and 10%

of people that meet criteria for Borderline Personality
Disorder ultimately end up dead by suicide.

>>Borderline patients are deeply
ambivalent about whether to live.

And if there isn't somebody who affirms their wish
to have them alive, they'd just as soon be dead.

>>I had to drop out my second semester.
The following year I tried to go back to school

and I got depressed again, I dropped out again, but
more severe to the point where I had suicidal ideation.

And I was just kind of sick of feeling the
way I had been feeling the past couple years

and I wanted more of an answer.

>>After getting a GED and going back to school,
dropping out of college, going back to college,

finishing college, going to graduate school
for creative writing, and at that point

I was starting to teach art and memoir
writing. But, what I was discovering was

my ability to function in life was really
compromised by these reactions I'd have to

situations, to relationships,
to responsibilities, to stress.

>>She went to McLean Hospital after
she had gotten her master's degree.

And she had climbed out, but she
had achieved a goal in her life and

then everything fell apart,
everything fell apart.

That was when I really saw what could happen to her.
>>I came in with a very serious list of complaints,

which was that I couldn't keep a job, I
couldn't tolerate being in relationships,

they were too painful. My emotional life
was out of control and I was crying and

reacting all over the place. Couldn't drive
a car because I couldn't think straight

and I thought people were chasing after
me. I was constantly feeling suicidal.

Just my perceptions were very skewed, I couldn't
see things clearly. I had no sense of who I was.

>>Well, the staff doctor that was treating
me came in and told me, "I think you have

Borderline Personality Disorder." And I
immediately thought that that meant that I

was on the borderline between sanity
and insanity or something. [laughs]

And he said no that's not what it is
and he explained to me the criteria.

>>"Do you find that you fear abandonment and
will desperately try to avoid it at all costs?"

I was like, "Yeah." He said, "Well, do you
find that you are really emotionally labile?

You know, up and down and change and sensitive
to the things around you and rejection?"

I said, "Oh my God, yeah." Just sort of
checked over the list...there's 9 criteria.

You know, stormy relationships, and when
people...do you idealize people and when

they disappoint you do you devalue them. By
the time he got to the ninth one he was like,

"Do you experience paranoia when you
are under extreme stress?" Yeah!

>>And everything he said to me was like,
"Oh, I have that. I have that. I have that."

So, that to me was like, oh there is
something out there that explains this.

>>People with the disorder more commonly than
not find it a great relief to be diagnosed.

"It's like looking in the mirror"
is a common phrase.

>>It's like, oh my God, I'm something.
And the something is understandable.

Somebody could actually understand me and if
they understand me maybe I can understand me.

Maybe other people are like me,
which means I'm not so alone.

I'm not different from everybody in the world.
I am not an outsider every single place I am.

And also, there's an enormous relief
that there might be a treatment.

>>Borderline Personality Disorder is an eminently
treatable disorder and patients can be helped.

And with good therapeutic resources
patients have a good chance to get better.

>>There are many therapies which are
appropriate and helpful for Borderline patients.

There are the individual psychotherapies, there
are psychosocial therapies which include

family interventions and group
therapies, and there are medications.

>>Psycho-pharmacological treatment is an
auxiliary treatment that is helpful in many cases.

>>We have very few evidence-based treatments for
Borderline Personality Disorder at this point.

DBT is probably the treatment for
which there is the greatest evidence.

>>Dialectical Behavior Therapy was designed
very specifically for people who self-harmed

and had strong suicidal impulses.

>>It basically is helping you to deal
with situations that are gonna come up

every day and your emotional
reaction is going to be a certain way

and it helps you deal with that emotional reaction.
It helps you find ways to stabilize yourself.

>>It is the synthesis or merging of trying
to change something while simultaneously,

radically accepting that it is what it is.

>>It encourages, first of all, the person
who's suffering to step out and look at

their own emotions as a third person might,
rather than to immediately act on them.

>>The reason it's called Dialectical
Behavior Therapy is because the treatment

itself is the synthesis of both the change
in behavior therapy and the acceptance,

which when the treatment was developed was drawn
primarily from my own practice and experience in Zen.

>>It used to feel literally like people's
eyes would have a physical effect on my body.

Like my neck would prickle and my heart
would constrict. And I interpret that they

are looking at my in a hostile way. The
fact is they are looking at me, but I

can't assume what they're feeling inside
and what they're thinking. DBT has helped

me tolerate that I feel this thing and I interpret it
this way, but it may not necessarily be the reality.

>>I like Dialectical Behavioral Therapy
because there were things I could work on

on a daily basis that would help me get
through the day. And there were certain

exercises that I could do and there
was concrete things that I could do.

>>The last time I desperately wanted to
cut myself, I did a type of technique I

learned through DBT, which is I held ice
cubes in my hand. And putting ice cubes in

your hand when you really want to
experience physical pain is a way to focus

on something without necessarily hurting yourself.
Instead of saying, "Oh, I just shouldn't feel this way,"

or "Oh, I need to change the way
I feel," you learn how to work with

what you're experiencing
in a more effective way.

>>It is so effective that we've had some
clients when they knew they were going to

have to discuss something extremely intense,
like sexual abuse or rape or something like that,

actually go to the store and buy those
little cubes that you can put in your freezer,

the ones that are wrapped up and you can
put in your freezer. And when they have to

have a session like that, take them to the therapist's
office & hold them in their hands during the session.

>>The other forms of treatment which
have been empirically validated include

Transference Focused Psychotherapy which is a
derivative of the early psychoanalytic treatments.

And it focused much more on the importance of
interpretation and understanding the ways in which

oneself, the Borderline patient, distorts their
views of other people and of themselves.

>>It tries to bring about an integration
of the patient's concept of self

and of the patient's
concept of significant others.

>>When I got into therapy I began to open
up and to talk about all kinds of things

that were bothering me. And one of the
things the therapist would try to do is

dissect a particular incident to see if
there were triggers that would set that off.

And I also participated in group therapy in the
hospitals because all the walls came down

and the pretenses and all these things that
you erect around yourself in the outside world.

And people are very open and honest and are willing
to talk about very intimate and upsetting things.

>>It's very important for patients or
their families who are troubled by

Borderline Personality Disorder to find
clinicians who are knowledgeable about this

and have experience with it and want to
treat them. To seek treatment from people

who don't have those qualifications
is likely to make the patient worse.

>>The right practitioner and the
right treatment are what's required.

You can find a really fabulous person who
doesn't know treatment or how to treat

this particular population. You can find
a person who knows an effective treatment

who the patient can't relate to. That's not going
to work either. You've really got to have both.

>>When I was first diagnosed I thought
that it was basically all my fault and

that it was an environmental thing
and I should be able to fix it myself.

And then later when I started going to these
conferences and learning more about the disease,

they came out with studies saying that there are
chemical and biological reasons for this disease.

So, that to me was a huge relief because, again
I felt like oh, there really is a reason for this.

It's not just because I'm not dealing well
with situations. It's not just because I'm

not working hard enough to feel better. It's because
I have chemical things wrong with my brain.

>>Borderline Personality Disorder, for
sure, has a predisposing biological base.

>>And whether somebody gets the
illness depends upon the environment.

In that respect it's not unlike Diabetes, or
high blood pressure within traditional medicine.

>>Take an interaction with another person,
for example. We're sitting here talking.

I see your face. Well, in the brain there's two
pathways. One directly to the visual cortex

that shows me the actual image of your
face so I have a mental picture of it, but

also a second pathway that goes to what's called
the Limbic System, particularly the Amygdala,

so that I can assess the emotional impact
of your face. And these two are integrated

in terms of my appraisal of you and of
course my behavioral response to you.

One of the most interesting findings is
the finding that the Amygdala, the area of

the brain that signals danger and fear, in Borderline
Personality Disorder seems to be overactive.

So that a face that a non-Borderline
person would react to in a neutral way,

a Borderline person may actually see as
fearful. And when you talk to patients

I think what you hear is they experience other
people as angry, critical, and hostile towards them.

When indeed, in many instances, that
may not be the other person's intent.

While the Amygdala, that part of the
brain that signals danger, is overactive in

Borderline Personality Disorder, the
Prefrontal Cortex, the part of the brain

that's responsible for higher
order thinking which can inhibit the

behavioral response to this alarming
signal, seems to be under-active.

>>It doesn't surprise me that people's
brains are actually wired differently,

that Andy might have an ultra-sensitivity
to things that create...to emotional things.

>>I think over the past 10 years that as we've
come to understand the physical component

of mental illness, people have begun more
and more to think of it as a real illness.

As opposed to somebody just having emotional
problems and unable to deal with things.

You know, "come on, snap out of it,"
that sort of thing.

>>Although, we're just beginning, in a
sense like Columbus leaving the port,

we're beginning to understand some of the neural circuits
involved in various aspects of this dis-regulation.

It would be fair to say that
BPD can be hell for families.

>>Having a person with Borderline Personality
Disorder in your family is devastating.

>>There's something in the nature of this
condition and in its symptoms that can draw,

not only from families but from trained
clinicians, unhelpful responses.

>>From my experience, the most common
response of other people who are around

people meeting criteria of Borderline Personality
Disorder is that their response is: "shape up."

>>If I had known about BPD at the time of
her adolescence, I think I would have been

much more attuned to the fact that she
reacted very quickly to things that were

things that she disagreed with. It was a
huge, what appeared to us, over-reaction

and then an inability to regroup. So, I
think that was a big sign that I missed

because I didn't understand what that
would have to do with mental illness.

>>They know the person is emotional, but
they don't know why and they really don't

have the fundamental understanding that
the person's actually doing the best they can.

>>It's important for me to get all the
emotions out that I'm feeling because if

I don't then I obsess about them. And I pick
myself apart and I think about every interaction

that I had with every person that I
interacted with and I can make myself

crazy thinking about, "Did I do this wrong?" or
"Did that person like me?" or "Did they not like me?"

>>The real tragedy for the individual is
they say, "I can't regulate it," and the

the other person says, "Yes, you can." So,
of course, then they start feeling worse

about themselves thinking they can,
but they just don't want to.

>>What really helped me was when I
realized that it wasn't about me,

that I wasn't necessarily what she
was angry at and the target of it.

But, that I was just there to be somebody
that she could vent all of this feeling

that was about something else. So, I don't know
if you remember the comedian, Gallagher?

Gallagher used to smash watermelons and
things. And the people in the front row

would have to put on rain coats or
something to cover them up because they'd

get splattered with all the watermelon juices.
And so, I kind of likened myself to being in

the front row with Gallagher when he was
about to smash the watermelons. [laughs]

>>She just understands that I need to get it
out and that there's nothing wrong with that.

And she doesn't have to help me qualify
anything, it's just that's how I feel and

I need to get it out. Once I
get it out I feel a lot better.

>>We have guidelines for families which
suggest that when their Borderline offspring

or family member has one of these excessively
angry reactions that they listen carefully,

look for whatever is true about it. And by
validating the part of it which makes sense

it'll calm the person down. To address the part
of it which is excessive and inappropriate

can and should only be done in a context
when the Borderline person is calm.

>>When you have a child with this disorder
it's not something you talk about at weddings.

That you go out socializing, you often
don't talk about these kinds of things,

so when family members go to a support group
it's an incredible process that happens for them.

Because they feel that someone else understands
them and understands what they've gone through.

>>You know, BPD is so much a disorder of relations
and the recovery really involves being able to get back

into communities and have relationships and tolerate
the distress. You know, build up a life for yourself again.

>>I found that insurance doesn't want to
cover Borderline as the initial diagnosis,

that oftentimes you need to be given a different
diagnosis, an Axis I diagnosis such as Bipolar,

and that will be
accepted for insurance.

>>Regrettably, families may have to strengthen
themselves to fight insurance companies,

when they do wrongfully deny coverage for
what is indisputably a medical disorder.

>>There's an effort to find brief treatments
that will get these patients going.

That's an illusion. These
patients need long-term treatment.

>>I think it's important for families to
recognize that the first 'no' from the

insurance company shouldn't be
the last word on the subject.

>>The key thing to recognize about
Borderline Personality Disorder is

you can't decide not to treat it. Insurance companies
have to come to grips with this particular reality.

Saying "we won't pay for the treatment" doesn't
mean they don't pay for the treatment.

They do pay for the treatment. Somebody
pays for it because when you don't give

them treatment they show up in the emergency
room and no one can kick them out of there.

When they get to the emergency room
they often get on an in-patient unit.

That's extraordinarily expensive care.

>>When family members call me for the first time,
the first think I want to give them is hope.

I want them to know that people
with this disorder get better.

>>For somebody whose family member's just
recently been diagnosed, I would say that

they want to participate in the therapy.
Get to understand what's going on and

what to expect, that they've probably got a long haul.
But, the more they understand it, the better off they are.

>>Borderline Personality Disorder is often
called "the good prognosis diagnosis," and

that's because people get better.
People recover from this disorder.

They manage their lives in effective ways.
They have children. They have careers.

>>People with this disorder have a remission,
meaning that their psychopathology is greatly reduced

within a couple years. And when that happens
it's sustained. Relapses are not common.

>>The emotionality that they have, the tendency
to react quickly, will probably always be there,

but you can build a corresponding
tendency to be able to regulate.

>>The payoff is that rather than having short series
of intense, volatile interactions with people,

you're probably going to go through a dry period
where it feels like there's no one around.

And then things start building. I
developed the vocabulary to say to people:

"I get triggered because of this," or
"I'm having a Borderline moment right now.

I think you're rejecting me." When you
get the diagnosis and a set of language to

bring awareness to the interpersonal
dynamics, things that used to destroy

relationships become opportunities
to build a new level of communication.

>>I think the thing that was really helpful
to me was to just know that I love my

daughter more than I need to be right all the time,
that the relationship is the most important thing to me.

If I can hang in there and learn to under-
stand the perspective of the other person,

that it's worth it to hang in there. We
really have a great relationship in spite

of a lot of ups and downs. It's also
learning that life with a Borderline can

be a roller coaster ride and I don't
always have to hop on the ride.

>>I think that families should remember that
most people with this illness will recover.

In some instances it will take time and that this
really is not a sprint, but a long distance race.

>>There's this crucial element that I
think is so important, which is the will

and desire to confront what's going on with
yourself. And believe that if you confront it

and get help for it, things will be so
much better. And I can look back now and

see that I'm much better off today than I was
when I was trying to do things on my own.

But, it takes an awful lot of trust and
faith in the people around you to admit to

having something that's so stigmatized. And then to
put yourself in their hands and say, "Please help me."