Topic Tuesday **Closed ** Debunking the myths of BPD

The Clinical Guidelines for people with BPD states that medication is not the first choice of treatment. There is no drug that is labelled for BPD, all medications are off label. Sometimes medication is needed for emotional regulation. Psychotherapy and the transformative relationship within the therapeutic dyad is the most important aspect. Finding the right therapist who can contain high emotion without getting dysregulated her/himself is teh best person for the job. the fit of therapist/client is more important than the therapy mode and that includes DBT. DBT is great but not the be all and end all of treatment. There is Schema Therapy, Mentalisation based therapy and transference focussed therapy or just supportive psychotherapy. The main focus is on trust, rapport, safety, stability and containment. DBT has a good success rate for people who COMPLETE the entire 12 month therapy. Only 10% of clients go from initial assessment to completion.

My daughter is 16 and clearly BPD but psychiatrists are reluctant to put that label on her condition. Does it matter? Are there real disadvantages to being diagnosed with a BPD? Does non diagnosis delay effective treatment ?

Under the diagnostic criteria for impulsivity.

Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving,

Eating disorder and spending are part of lack of impulse control. Eating and spending in huge amounts is how people regulate their high toxic emotions. Other methods such as mindfulness and non harmful distractions, reading a book, riding a bike, exercising, gardening etc are better for you. It gives more a sense of purpose and does not damage any part of you or your finances.

I'm interested in the question about combination diagnosis of bipolar & BPD - if bipolar is physiological/genetic and BPD a combination of environment and/or childhood 'nuture' - the nuture va nature conundrum.Are there definitive answers from clinicians and researchers as to whether the two can exist together?

Psychiatrists will be reluctant to diagnose because of the HUGE stigma within mental health services. Mental helth professionals who do not keep up with latest research do not understand it is treatable and recoverable. The advantage of diagnosis is the relief of finding out there is a name to these feelings, emotions and behaviours. For some that is life saving and others are dismissive of it. I found it a huge relief because then I knew what I was facing. Diagnosis is good for DBT and other treatment referal otherwise you are just wandering around in the dark.