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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Phillipa on April 16, 2010, at 21:48:27
Seems they found in this study that borlerline personality recovery long term out of reach of high percentage of patiens. No mention of meds??? Phillipa
Long-Term Recovery From Borderline Personality Disorder Out of Reach for Many
Megan BrooksApril 15, 2010 Recovery from borderline personality disorder, which includes symptom remission and good psychosocial functioning, seems difficult for most patients to attain, conclude study investigators in the April 15 online issue of the American Journal of Psychiatry.
However, "once attained, such a recovery is relatively stable over time," first study author Mary C. Zanarini, EdD, of McLean Hospital, Belmont, Massachusetts, and colleagues report.
These findings stem from a 10-year, prospective, follow-up study of 290 patients who met diagnostic criteria for borderline personality disorder. At baseline, the mean Global Assessment of Functioning scale score was 38.9, indicating major impairment in several areas, such as work or school, family relations, judgment, thinking, and mood, the researchers note.
The patients who were 80.3% female and 87.2% white, with a mean age of 26.9 years, were evaluated at baseline and every 2 years for 10 years via semistructured interviews and self-report measures. Attrition was relatively low, with 275 patients reinterviewed at 2 years, 269 at 4 years, 264 at 6 years, 255 at 8 years, and 249 at 10 years.
At 10 years, 93% of patients had attained a symptomatic remission lasting at least 2 years, and 86% had sustained remission lasting at least 4 years, the report states. However, only 50% of patients experienced a recovery from the disorder, which the researchers defined as a 2-year symptomatic remission and the attainment of good social and vocational functioning during the previous 2 years, as well as a Global Assessment of Functioning score of 61 or higher.
"It is sobering that only half of our study sample achieved a fully functioning adult adaptation with only mild symptoms of borderline personality disorder," the investigators note.
In addition, 34% of patients who recovered from borderline personality disorder lost their recovery. About 30% of those who achieved a 2-year remission of symptoms experienced a recurrence of symptoms, as did 15% of those who had achieved a 4-year sustained remission.
"This set of results is consistent with clinical experience," Dr. Zanarini and colleagues note in their report. The current study, they point out, is an extension of the National Institute of Mental Health (NIMH)funded McLean Study of Adult Development, which found "steady, if modest, overall improvement over 6 years of prospective follow-up." Another NIHM-funded study the Collaborative Longitudinal Personality Disorders Study found that borderline patients continued to function in the fair range of global functioning during 2 years of prospective follow-up.
Joel Paris, MD, professor of psychiatry at McGill University, Montreal, Quebec, Canada, who was not involved in the study, told Medscape Psychiatry that the latest findings from the McLean study "are not unexpected; they do confirm what is already out there in the literature. On the other hand, this is a well-described sample, and it's the first time we've gotten this much detail."
Taken together, Dr. Paris said, the research suggests that patients with borderline personality disorder "do get better with time, but they don't get all better."
The long-term observations in the McLean study, Dr. Zanarini's team notes, also suggest that remissions are "far more common than the good psychosocial functioning needed to achieve a good global outcome."
"It would thus seem wise for those treating borderline patients to consider a rehabilitation model of treatment for these psychosocial deficits. Such a model would focus on helping patients become employed, make friends, take care of their physical health, and develop interests that would help fill their leisure time productively," the researchers suggest.
Dr. Zanarini and Dr. Paris have disclosed no relevant financial relationships.
Am J Psychiatry. Published online April 15, 2010.
Posted by rnny on April 16, 2010, at 22:04:03
In reply to Borderline Personality Recovery Out of Reach For M, posted by Phillipa on April 16, 2010, at 21:48:27
They did a 10 year study on subjects and came up with the statistics that 93% of patients had attained a symptomatic remission lasting at least 2 years, and 86% had sustained remission lasting at least 4 years, the report states. However, only 50% of patients experienced a recovery from the disorder. To me those are not bad statistics for any mental illness since I am not aware of any by which one recovers "fully". However, one very important thing is missing from this article is what were the subjects doing in the 10 year period. Were they all in treatment or "winging it" on their own? I think a very relevant piece of information is missing. What the article says is that they found people who met the criteria for this diagnosis and interviewed them over a 10 year period. That tells me nothing in terms of therapeutic effectiveness of people with BPD who are actively engaged in treatment. I think the most telling statement in the entire article is: "However, "once attained, such a recovery is relatively stable over time," first study author Mary C. Zanarini, EdD, of McLean Hospital, Belmont, Massachusetts, and colleagues report." That's hopeful! Were the subjects provided with ongoing care to help them attain recovery in the 10 year period? How was cooperation with the treatment monitored if the subjects were only interviewed over 2 year intervals. I have alot of questions.
Posted by deerock on April 17, 2010, at 8:37:11
In reply to Re: Borderline Personality Recovery Out of Reach For M, posted by rnny on April 16, 2010, at 22:04:03
when i read this i feel like borderline's have no shot at a normal life.
Posted by Dinah on April 17, 2010, at 9:30:32
In reply to Borderline Personality Recovery Out of Reach For M, posted by Phillipa on April 16, 2010, at 21:48:27
I can see other, far more positive ways to summarize the article in one sentence. There were more positive than negative statistics in that article, I think.
I also rather wonder what group of patients they are talking about. Those who have been diagnosed with borderline personality disorder on this board already have decent or even very good vocational functioning, and the GAF score may already be over 61.
The research I've seen on DBT outcomes suggests that behavior changes enough that the patient minimizes the sort of additional pain that acting in certain ways might bring. But that the subjective scores of how a patient *feels* don't improve nearly as much.
To me, that makes perfect sense. I've always felt there were underlying biological disorders. Perhaps not the same ones for all patients. But ones that cause a lot of what Linehan talks about. Dysphoric feelings, easy arousal, slow return to baseline. Learning new ways of dealing with those feelings would minimize life disruptions. But they wouldn't actually make people feel entirely better. How could they if there are underlying biological issues?
Posted by deerock on April 17, 2010, at 10:41:37
In reply to Unusual choice for a headline » Phillipa, posted by Dinah on April 17, 2010, at 9:30:32
hi dinah, i agree with you regarding the underlying biological issues. i happen to function quite well. i work full time. i am in graduate school full time. most normal people would have trouble with that.
i also have the easy arousal, dysphoria, etc. but i must say, even though i function way better than i once did, having the biological problem and whatever goes along with it makes life extremely difficult.
i can see why philipa chose that headline. you can better. heck. you can get much better. but youll never ever ever be normal.
i think those biological aspects are enough to ruin many things, even if you do get what seems like a normal life.
but im in a particularly bad spot right now so maybe another day i would say someting different.
Posted by Dinah on April 17, 2010, at 12:41:37
In reply to Re: Unusual choice for a headline » Dinah, posted by deerock on April 17, 2010, at 10:41:37
Just to be clear, I wasn't speaking of Phillipa. I assumed that was the title of the article?
I don't think you need to accept that the biological stuff can't be changed. If you use therapy to help you cope with the life issues, and to help you make different choices so that your responses lead to the best possible outcomes, it may be time to turn to medications for the underlying issues.
I've found medications that help me. I guess I see it as any other chronic condition. I would be pretty p*ssed if, as a diabetic myself, I read a headline saying that recovery for diabetics was unlikely. Sure, it's unlikely my pancreas will ever start to secrete insulin like a nondiabetic's. But with medications and healthy choices, my future as a diabetic doesn't need to be all that grim. And I'd find that way of looking at my issues to be... non-headlineworthy.
Posted by deerock on April 17, 2010, at 13:06:11
In reply to Re: Unusual choice for a headline » deerock, posted by Dinah on April 17, 2010, at 12:41:37
you're right, it wasnt philipa's title. i thought it was but its the actual title of the article.
thanks for your additional comments. i understand what you mean.
medications have never helped me. and most of them cause diabetes especially if you are susceptible to it. im afraid to take them. maybe ill be forced into it someday. i hope not though.
Posted by floatingbridge on April 18, 2010, at 1:36:34
In reply to Borderline Personality Recovery Out of Reach For M, posted by Phillipa on April 16, 2010, at 21:48:27
Upon seeing the title, my first assumption was that it dealt with finances (affording therapy) and finding qualified therapists. So, I do think it is a poor title.
Second, the idea of 'recovery' is inaccurate, ill-defined, and not always helpful as others have noted. I expect, for myself that is--I'm using "I" statements here--to improve and continue to improve. In my case, do I recover from childhood abuse, years (o.k. a life) of mostly untreated or mistreated depression? Guess this is where radical acceptance comes in--I'm still trying to comprehend the concept.
Posted by floatingbridge on April 18, 2010, at 1:39:14
In reply to Re: Borderline Personality Recovery Out of Reach F, posted by floatingbridge on April 18, 2010, at 1:36:34
Oh, then there's that pesky notion of normal....
Now diminisment of pain or surcease of pain: I can understand that.
Posted by Phillipa on April 18, 2010, at 11:16:24
In reply to Re: Borderline Personality Recovery Out of Reach F, posted by floatingbridge on April 18, 2010, at 1:39:14
To all was just browsing the boards and found the link I'd posted on meds. Sorry to say I never got notification that it had been moved. I sure wish I had as I was also very much surprised by this study. These all come from my nursing newsletter. I'd always thought the Borderline was also a personality disorder that lots of children and teens had and many grew out of this. And also was under the impression that some meds could help and lots of theraphy also. I wish I'd been here to engage in the conversation and hoping it continues as I've read many articles but it still alludes me as to actually what it means. Cutting? Temper tantrums? I honestly don't know. Do know splitting? And the all good or all bad. Phillipa apologizing for not even following her own thread. Inexcusible.
Posted by hrguru on April 21, 2010, at 6:31:02
In reply to Re: Wow, posted by Phillipa on April 18, 2010, at 11:16:24
I don't have Borderline Personality Disorder myself, but I do have Bipolar Disorder (type II). Occasionally these disorders overlap, therefore a person can have both disorders. These cases are truly chaotic and tragic (my boyfriend's sister has both disorders). If you have a chemical imbalance, meds will work- as in the case of Bipolar Disorder. Since Borderline is a personality disorder, the main course of treatment is psychotherapy, and not medication- unless you have a comorbid mental illness (i.e. generalized anxiety disorder, depression). Personality disorders are behavioral in nature (not chemical), and are rarely treated with pharmacotherapy. So if you take meds for the Borderline, and you do not have a comorbid mental illness, this is why the meds have no effect.
Please don't get me wrong. Borderline Personality Disorder and Bipolar Disorder share a lot of the same characteristics and are painful for those who have to suffer with these life-long illnesses. One is often misdiagnosed as the other, and vice-versa. Both of our illnesses cause us to experience terrible mood swings; but, unless you have been diagnosed with Bipolar Disorder, you need to educate yourself on risks associated with mood-stabilizers- as they are usually prescribed for people with Bipolar Disorder. And there is a valid reason for this. Before you ask your p-doc or therapist for anti-convulsants or anti-psychotics, please understand that these drugs will probably just leave you with mortifying side-effects, and nothing else if you have a personality disorder and not an actual chemical imbalance.
I'm telling you this, because I don't want you to experience these side effects, as I have with some of these drugs. I don't want you to experience all of this in vain. That would piss anyone off. To go through the side effects, with no end results? Trying to find the right "drug cocktail" is horrifying, but I hate to think that people might be thinking about taking these drugs without fully understanding what the drugs are used for, and the risks involved. Someone in the thread mentioned anti-psychotics can cause diabetes. This is true and not only that, but they can cause permanent tardive dyskinesia. These might be side-effects that some people have to deal with, in order to feel mental wellness, but it's quite a hefty bargain. I'm just asking you to weigh the pros and cons and to look at all the options. That's what I'm doing now. I'm on meds, sure (not anti-psychotics though). But, I have been trying out DBT with my doctor, and I think it's amazing. It's opened my eyes to the fact that my perception/judgment is sometimes way off, and it's helping me to learn how to sort of "train" my judgment. I'm sure that some of you have tried it, but if you haven't you should! It's amazing :) I'm not trying to upset anyone, and I really hope that I haven't. I just understand where you are coming from. I hate reading articles that say there is "no hope" and that it's a "lifelong" illness. Sure there are meds, but sometimes they are horrible! They have terrible side effects, and sometimes they don't work very well. In certain cases, why even take a drug if you don't have to? Making sure you have a great support system, a good doctor, a correct course of treatment for the illness- these are all things that I have found to be most helpful :)
Posted by hrguru on April 21, 2010, at 6:52:20
In reply to Re: Wow, posted by hrguru on April 21, 2010, at 6:31:02
Just wanted to add something. To be clear, anti-psychotics are primarily the drug treatment of choice for people who have mental illnesses that are so severe (Bipolar type 1, Schizophrenia) that they must rely upon this type of drug- or it is a last resort because nothing else has worked. Therefore, many times people will deal with the dangerous side effects to get relief from the disorder. And they are dangerous side effects.
Just trying to look out for others who I know are searching like I am- Do you know what I mean when I say "searching"? It feels like I'm always searching for a balance in life, searching for the cure for this awful illness, searching for the reason as to why it had to happen to me...
Posted by Dinah on April 21, 2010, at 8:19:53
In reply to Re: Wow, posted by hrguru on April 21, 2010, at 6:31:02
Hello and welcome.
I'm glad you're getting good results with DBT. It sounds like such an intriguing therapy, although I haven't found anyone to offer it in our area outside inpatient hospital stays. My therapist does help me with my perceptions, and over time I've grown to often if not always approach things from the angles he's taught me.
I loved what my former psychiatrist told me once when I was talking about side effects. He said that yes, medications do have side effects. And not taking medications has side effects. It was up to me which side effects I prefer.
I've always kept his words in mind and tried to look at medication from a common sense point of view. Whenever possible, I use medications as needed. Antipsychotics have been a life saver for me, used in tiny doses as needed for anxiety. They work in a different way than Klonopin or Valium or Xanax, and for me it is a far more helpful way. My mood stabilizers have actually been prescribed by a neurologist for migraine prophylaxis, but I know they also help keep me on even keel.
I always believe in taking all types of medication seriously. It only takes a look at the class action lawsuits and medications being taken from the marketplace to realize that no medication should be taken lightly. I always try to take no more than is needed. And no less, because that has a negative impact on my life as well.
I *really* wish I could find another biofeedback provider. Of all the treatment modalities, that seemed to be the one that had the most promise to help with the biological issues.
Posted by hrguru on April 21, 2010, at 11:56:29
In reply to Re: Wow » hrguru, posted by Dinah on April 21, 2010, at 8:19:53
Hi Dinah!
Thanks for making me feel welcome :)
I have not done too much with DBT. My P-doc incorporates it into my therapy from time to time, and I think it works best when I'm not "catching onto him." It allows for more candid responses from me as the patient, I think.
The first tactic he used was when he asked me to write down 1. my expectations of myself, 2. what I thought others expected of me, and 3. what I expect from others (something like that). It was a homework assignment. Then we assessed how realistic these expectations were during my next visit. It was mind-boggling, and intriguing. This is my biggest problem area, so we have focused mostly on expectations; but, since DBT helps a person to explore their whole "inner world," I could really see how this technique could change someone's life. It would take some time, though (like many other effective therapy methods do). My psychiatrist has never called it DBT- I figured it out when I googled the style of therapy he was using :) I thought, "This is a strange technique he's using on me. It's random and he's asking me questions that are totally out of the blue!" I think he was suspecting Borderline at the time, as I had not yet been diagnosed Bipolar, but I'm glad I figured it out. Because he doesn't like to give away his methods. To his credit he's been practicing for over 50 years, and he's a genius when it comes to reading people. It's amazing.
I have heard of Biofeedback, but I don't know very much about it. Is that the method where they use an EEG? Am I way off or thinking of something else?
I am so glad that you've found meds that work. To be honest, after I posted what I did, I thought- "Who am I to be doling out medical advice? I'm no doctor!" I just worry about people who have never even touched these meds before, that's all. However, if a doctor prescribes a medication for their patient, then I should keep my mouth shut, because the doctor is the expert. Grandiosity tends to rear its ugly head when I get hypomanic. I don't want to use that as an excuse though, so I am sorry if I offended you or anyone else with my post. I really am glad that anti-psychotics have been working, as well as mood-stabilizers. I take a mood-stabilizer, and it is fantastic for migraines, and better than any tranquilizer I've found for anxiety! But every person is different. Xanax, in small doses, is my life saver for dysphoric mania, and klonopin is my last resort to bring me out of a hypomanic cycle. Ah...the drug cocktail.
Posted by Dinah on April 21, 2010, at 12:10:03
In reply to Re: Wow, posted by hrguru on April 21, 2010, at 11:56:29
I wasn't at all offended! I agree that medications shouldn't be taken lightly. I had one psychiatrist who answered every problem with more drugs, and it left me pretty screwed up in chemistry. The one I found after him was the one with such a sensible point of view, and now I evaluate med changes with his guidelines in mind.
I think DBT and CBT both have a lot to offer. I think I prefer the more accepting tone of DBT, and I like the mindfulness aspect. But I definitely prefer a therapist who slips those things in rather than follows the manual. I tend to be too stubborn for that.
That sounds like a good homework assignment. It could definitely make you think.
I did biofeedback briefly. They didn't get into neurofeedback with the eeg's. That was left for a later stage. He used thermometers and galvanic skin conductors that they taped all over. But I found I couldn't work with him. He was very direct, he'd say. I'd say abrasive. He'd get angry with me when all my anxiety indicators would skyrocket when he came in the room. I apparently hadn't learned to moderate my responses well enough to cope with a stressor of that magnitude. I haven't found anyone else in the area that does it, unfortunately.
Posted by hrguru on April 24, 2010, at 4:18:05
In reply to Re: Wow » hrguru, posted by Dinah on April 21, 2010, at 12:10:03
Dinah,
Biofeedback sounds interesting. I will have to do some research on this method. Is it neurologists who do it? It sounds somewhat expensive? I'm sure that those who specialize in Biofeedback have to undergo extensive training/certification in order to do these procedures. Perhaps this is why they are so hard to find :( I know kind of how you feel. Two years ago, I was battling mood swings with substance abuse (vicodin and alcohol). I knew that the two were separate issues. In other words, the substance abuse was not causing the mood swings (though I'm sure it did not help!). I needed a psychiatrist for the mood swings, but so often psychiatrist's prescribe addictive substances (sometimes in excess)- many just don't seem to "get" addiction. I searched and searched for a psychiatrist who was also an addiction specialist (special certification) - for months. There was only one in the state of Missouri, and he was only 20 miles from me! But I would have traveled further to that clinic. He saved my life. I am clean and sober for over a year, and now that I'm properly diagnosed and on mood stabilizers, I never crave alchohol or opiates. I can take benzo's only when necessary. So don't give up! It takes awhile, but you will find that specialist :) You should never settle for someone who not only makes your anxiety indicators skyrocket when he comes into the room, but someone who also becomes angry with you because of that! Something he caused, and something you cannot control. He does sound abrasive. You deserve much more than that. There's a specialist out there waiting to treat you with much more respect in the therapy process. After all, it is therapy we are seeking- not additional trauma. That's the last thing we all need!
Which avenues have you been using to search for Biofeedback specialists? I'm not sure how often the process requires you to receive treatments. If it's something that you could do once or twice a month(?) could you travel to a nearby city to get treatments, if you found a good specialist- say, an hour away? I think it would be worth it, if the treatments were very effective, and as long as your schedule, funds, work & family obligations, etc. permitted. Since you've found a therapy method that you like (which is hard in it's own right), maybe there's someone just a little outside of the area who's the right fit :) Just keep looking and you will find your specialist.
Lindsey :)
Posted by Dinah on April 24, 2010, at 10:14:02
In reply to Re: Wow, posted by hrguru on April 24, 2010, at 4:18:05
Congratulations! Your perseverance paid off.
I actually looked into it after I posted to you. It appears that there is one clinic that does biofeedback, apart from the one I went to. My therapist wants me to try EMDR right now, but maybe after that I can look into the biofeedback therapy. I really liked the way it directly targeted the physical symptoms. I think that would be helpful for me.
Posted by hrguru on April 28, 2010, at 0:00:58
In reply to Re: Wow » hrguru, posted by Dinah on April 24, 2010, at 10:14:02
Thank you!
That's good news, that there's another clinic that does biofeedback. I'm glad you found another one in your area!
I have heard of EMDR, and that it's used for the treatment of PTSD, but that is all I really know about it. I looked it up after I read your post. The website I found said it is also used for borderline, depression, and anxiety disorders. Are you going to try it?
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