New study on BPD or self mutilation

[BuzzKill]

http://www.psych.org/psych_pract/treatg ... 031505.pdf

[Paul]

The .pdf downloaded but wouldn't open up.

Are you referring to Borderline Personality
Disorder?

[BuzzKill]

Its working for me - try again, might have been a temp glitch.
And yeah, the article is specifically about treating Borderline Disorder - but the treatment modalities could be useful for someone cutting or hair pulling - or any number of other compulsions - weather or not a person meets the criteria for BPD.

[Paul]

Excellent document and link, thank you!

BTW - you where right, today the link
downloaded a-ok!

[Paul]

http://namisandiego.org/factsheets/borderline.html

Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is characterized by impulsivity and instability in mood, self-image, and personal relationships. It is fairly common and is diagnosed more often in females than males.
   
What are the symptoms of BPD?

Individuals with BPD have several of the following symptoms:

marked mood swings with periods of intense depression, irritability, and/or anxiety lasting a few hours to a few days;

inappropriate, intense, or uncontrolled anger;

impulsiveness in spending, sex, substance use, shoplifting, reckless driving, or binge eating;

recurring suicidal threats or self-injurious behavior;

unstable, intense personal relationships with extreme, black and white views of people and experiences, sometimes alternating between "all good" idealization and "all bad" devaluation;

marked, persistent uncertainty about self-image, long term goals, friendships, and values;

chronic boredom or feelings of emptiness;

frantic efforts to avoid abandonment, either real or imagined.

What causes BPD?

The causes of BPD are unclear, although psychological and biological factors may be involved. Originally thought to "border on" schizophrenia, BPD also appears to be related to serious depressive illness. In some cases, neurological disorders play a role. Biological problems may cause mood instability and lack of impulse control, which in turn may contribute to troubled relationships. Difficulties in psychological development during childhood, perhaps associated with neglect, abuse, or inconsistent parenting, may create identity and personality problems. More research is needed to clarify the psychological and/or biological factors causing BPD. The field is also actively looking at genetic vulnerabilities.


How is BPD treated?

A combination of psychotherapy and medication appears to provide the best results for treatment of BPD. Medications can be useful in reducing anxiety, depression, and disruptive impulses. Relief of such symptoms may help the individual
deal with harmful patterns of thinking and interacting that disrupt daily activities.
Long-term outpatient psychotherapy and group therapy (if the individual is carefully matched to the group) can be helpful.
   

Short-term hospitalization may be necessary during times of extreme stress, impulsive behavior, or substance abuse. More structured cognitive interventions like dialectical behavioral therapy (DBT) are now widely used.

Can other disorders co-occur with BPD?

Yes. Determining whether other psychiatric disorders may be involved is critical. BPD may be accompanied by serious depressive illness (including bipolar disorder), eating disorders, and alcohol or drug abuse.
   

About 50 percent of people with BPD experience episodes of serious depression. At these times, the "usual" depression becomes more intense and steady, and sleep and appetite disturbances may occur or worsen. These symptoms, and the other disorders mentioned above, may require specific treatment. A neurological evaluation may be necessary for some individuals.

What medications are prescribed for BPD?

Antidepressants, anticonvulsants, and the new atypical antipsychotics are common for BPD. Decisions about medication use should be made cooperatively between the individual and the therapist or psychiatrist. Issues to be considered include the person's willingness to take the medication as prescribed, and the possible benefits, risks, and side effects of the medication, particularly the risk of overdose.

NAMI San Diego

NAMI San Diego, a non-profit organization, provides education, support services, and advocacy to improve the quality of life of everyone affected by mental illnesses. It is an affiliate of the National Alliance for the Mentally Ill (NAMI) and NAMI California. Its membership includes persons with brain disorders, their families, friends, mental health professionals and supportive members of the community.
   

NAMI offers monthly informational meetings, a monthly newsletter, free educational programs, a lending library of books and video-tapes, and support meetings for consumers and families throughout the county.
   
Original information supplied by NAMI National. This information may be reproduced for non-commercial purposes only, and must include NAMI's name, logo, and contact information (September 2004)

[Paul]

http://bipolar.about.com/od/dbt/

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy (DBT) is a form of cognitive-behavioral therapy, which was developed by Dr. Marsha Linehan, a professor in the Department of Psychology at the University of Washington. This treatment was developed as tool for those who struggle with self-harm behaviors such as cutting and suicide attempts.

http://bipolar.about.com/gi/dynamic/off ... 2Fdbt.html

Dialectical Behavioral Therapy
Marsha Linehan (1991) pioneered this treatment, based on the idea that psychosocial treatment of those with Borderline Personality Disorder was as important in controlling the condition as traditional psycho- and pharmacotherapy were. Concomitant with this belief was a hierarchical structure of treatment goals. Paramount among these was reducing parasuicidal (self-injuring) and life-threatening behaviors. Next came reducing behaviors that interfered the the therapy/treatment process, and finally reducing behaviors that reduced the client's quality of life. In 1991, Linehan published results of a study that seems to do remarkably well at achieving these goals.

The Theory
Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
How it works
Dialectical Behavioral Therapy (DBT) consists of two parts:

   1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:

          Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
          (Linehan, 1991)

      DBT targets behaviors in a descending hierarchy:
          * decreasing high-risk suicidal behaviors
          * decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
          * decreasing behaviors that interfere with/reduce quality of life
          * decreasing and dealing with post-traumatic stress responses
          * enhancing respect for self
          * acquisition of the behavioral skills taught in group
          * additional goals set by patient
   2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

Followup studies
Since the 1991 paper, Linehan has been involved in several replication studies and has written a book and a skills training manual about DBT. Her results consistently show that DBT does seem to reduce the amount of self-injury and crisis among clients. (See references.

Linehan's group works out of the University of Washington in Seattle, but there are DBT-trained therapists in other parts of the U.S. For information, try contacting the University of Washington Department of Psychology or go to DBT Seattle.

There is also a DBT skills discussion list, also at UW. To subscribe, send mail to the listowner (Kieu) at [email protected] explaining your background and why you'd like to be on the list. It's intended to be a place to share experiences and get support while using dbt skills.

For a comprehensive, scientific review of DBT, see Dialectical Behavioral Therapy by Barry Kiehn and Michaela Swales of Gwynfa Adolescent Service in North Wales.