Family Therapy

Family Therapy: Parents, spouses and children bear a significant burden. Often, family members are grateful to be educated about the borderline diagnosis, the likely prognosis, reasonable expectations from treatment, and how they can contribute.

These interventions often improve communication, decrease alienation, and relieve family burdens. Some mental disorders, as in the treatment of schizophrenia, require close family involvement in the treatment process to be optimally effective.

There are now preliminary research data that suggest that family involvement is also very important in the effective treatment of borderline disorder.

Several organizations offer education programs and/or support to families challenged with mental health issues. The National Alliance on Mental Illness (NAMI), The National Education Alliance for Borderline Personality Disorder (NEA-BPD), The Depression and Bipolar Support Association (DBSA) and the Mental Health Association (MHA) offer programs across the nation.

Family training and support programs such as NAMI’s Family to Family and NEA- BPD’s Family Connections (www.neabpd.org) are in great demand. Nonetheless, too often many psychiatrists and other mental health clinicians continue to deny meaningful input from family members of a client with BPD.

This situation is especially frustrating for family members, who often provide the sole financial support for everyday living and treatment expenses, and much of the moral support, but who receive little or no response from the treating professionals.

Families are especially distressed when the treatment plan is not effective, and their loved one isolates them from their therapists.

Given the importance of the family in establishing functional relationships in the lives of people with borderline disorder, families should actively seek “family friendly” treatments and/or treatment providers and investigate family classes and support groups in their communities.

Suicidality and Self-harming Behavior

The most dangerous and fear-inducing features of BPD are the self-harm behaviors and potential for suicide. An estimated 10 percent kill themselves. Deliberate self-harming (cutting, burning, hitting, head banging, hair pulling) is a common feature of BPD. Individuals who self-harm report that causing themselves physical pain generates a sense of release and relief which temporarily alleviates excruciating emotional feelings.

Self-injurious acts can bring relief by stimulating production of endorphins, which are naturally occurring opiates produced by the brain in response to pain. Some individuals with BPD also exhibit self-destructive acts such as promiscuity, bingeing, purging and blackouts from substance abuse.

It is important for the client, family, and clinician to be able to draw a distinction between the intent behind suicide attempts and self-injurious behaviors (SIB).

Patients and researchers frequently describe self-injurious behavior as a means of reducing intense feelings of emotional pain. The release of the endogenous opiates provides a reward to the behavior.

Some data suggest that self-injurious behavior in BPD patients doubles the risk of suicide attempts. This dichotomy of intent between these two behaviors requires careful evaluation and relevant therapy to meet the needs of the patient.

Medications Studied and Used in the Treatment of Borderline Personality Disorder

There are two reasons why medications are used in the treatment of BPD. First, they have proven to be extremely helpful in stabilizing emotional reactions, reducing impulsivity, and enhancing thinking and reasoning abilities in people with the disorder.

Second, medications are also effective in treating the other emotional disorders that are frequently associated with borderline disorders like depression and anxiety.

The group of medications that have been studied most for the treatment of borderline disorders are neuroleptics and atypical antipsychotic agents. At their usual doses, these medications are very effective in improving the disordered thinking, emotional responses, and behavior of people with other mental disorders, such as bipolar disorder and schizophrenia.

However, at smaller doses they are helpful in decreasing the over-reactive emotional responses and impulsivity, and in improving the abilities to think and reason for people with BPD. Low doses of these medications often reduce depressed moods, anger, and anxiety, and decrease the severity and frequency of impulsive actions.

In addition, clients with borderline disorder report a considerable improvement in their ability to think rationally. There’s also the reduction, or elimination of, paranoid thinking, if this is a problem.

Medications Studied and Used in the Treatment of Borderline Disorder is adapted from the book, “Borderline Personality Disorder Demystified ” by Dr. Robert O. Friedel, Marlowe & Co., 2004.

Side Effects of Medications Used to Treat Borderline Personality Disorder

All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication or switching to a different medication.

Antidepressants may cause dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss. One class of antidepressants, the monoamine oxidase inhibitors (MAOIs) have strict food restrictions with the consequence of life-threatening elevation of blood pressure.

The SSRIs and newer antidepressants tend to have fewer and different side effects such as nausea, nervousness, insomnia, diarrhea, rash, agitation, sexual problems, or weight gain or loss. Mood stabilizers could cause side effects of nausea, drowsiness, dizziness and possibly tremors. Some require periodic blood tests to monitor liver function and blood cell count.

The group of medications that have been studied most for the treatment of borderline disorders are neuroleptics and atypical antipsychotic agents. Neuroleptics were the first generation of medications used to treat psychotic disorders.

The atypical antipsychotics are the second generation of medications developed to treat psychotic disorders. A specific side-effect the neuroleptics may produce is called tardive dyskinesia. This is an abnormal, involuntary movement disorder that typically occurs in those receiving average to large doses of neuroleptics.

The risk appears to be less with low doses of neuroleptics or the atypical antipsychotic agents. Atypical antipsychotics and/or traditional narcoleptics could have the ability to produce weight gain, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness.

Some of the side-effects are temporary and others are persistent. Before starting on a traditional neuroleptic or atypical antipsychotic, review the side-effect profile with the treating psychiatrist.

Reference

National Alliance on Mental Illness (2011), Borderline Personality Disorder, Treatment, Family Therapy/ Group Modalities/Suicidality and Self harming Behavior/Medications/Side effects of Meds http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=44780