Had the island stranding plane crash in the film Castaway triggered a genetic predisposition to Borderline Personality Disorder in Tom Hanks' character, the possibility of symptoms manifesting would be about
as likely as his one way conversations with "Wilson" the soccer ball turning interactive. "It plays out within close relationships," says Dr. Perry Hoffman. Leaving the patient in a consistent state of
fearing abandonment - rage, distorted perceptions and self mutilating and suicidal behavior are prevalent. But what of family members trying to navigate their loved ones and themselves through a disorder that tears lives apart.
That's the question that promptedthe Rye based psychiatrist to found Family Connections. "There was nothing out there for families so we designed a twelve week program which provides the most
current information, teaches coping skills and creates a network of people who otherwise would be isolated because of the disorder," says the President of the National Education Alliance for BPD.
Matt and Ann Costello of Katonah can attest from both sides of the classroom. Haven taken the course at New York Presbyterian in White Plains as parents of a child with Borderline, says Mr. Costello, "My wife and I are class leaders and we've been through everything these parents have been through."
Their journey reached a crossroad in 2007. With a son who had long exhibited anger issues, instability in relationships, while developing a substance abuse problem, he said, "We hit our limit in that we could no longer live that way."
In real terms, the Costello's informed their then 18 year old son that he would no longer be welcome at home if he did not agree to medical intervention to address the substance abuse and the underlying Borderline issue. That said, ultimatum does not define the scenario.
"It's your choice," Mr. Costello told his son, and by acknowledging the breaking point, families begin to feel liberated.
"You automatically start feeling better," he says. At the same time, since the child will or won't acquiesce, observation of this limit really isn't directed at them.
"A lot of nuance and language," he admits is the general strategy of a treatment known as Dialectic Behavior Therapy, and families are clued in through Family Connections.
As anger is the prevalent emotion, staying calm is the best defense against a state of disregulation. "Borderlines take a very long time to come back down from anger," he says, and meeting an outburst
with equal force only makes it worse.
In turn, acquiring DBT skills allows the child to understand where their anger comes from and pause gives the family the chance to talk about the rage once things have calmed down.
On the parents end, a similar recognition allows parents to face confrontation calmly. "What I'm really feeling is sadness because you are afraid your child will not grow up into a normal life," he says. "Once you get to those types of primary emotions it's hard to become angry."
Dealing with perceptions - distorted or not - is also an important skill parents learn. "Validation is such a key and core skill," he says.
So if your adolescent or young adultchild claims that no one in school likes him, what needs to be validated is that the emotion exists. Not hearing the concern or attempting to disprove the data is invalidating, while
trying to understand where the emotion comes from should be the approach. Then it becomes a matter of, he says," validating what can be validated."
In the process, though, the conversation can put the parent on the defensive and staying targeted without fighting back is hopefully learned. "Ask questions, get more information on what triggered the feeling and then say I understand or maybe you are right," he says. This - without necessarily agreeing - again provides validation and a framework for ongoing conversation.
That said, money often becomes as issue and an immediate one. Gently validate and hear their reasoning, he said, "but step back and tell them you need time to think it over."
Hopefully, the disregulation passes and eventually parents won't sound like a script. "It's a bit of an art form," he says, and rehearsing scenarios ahead of time gives parents the advantage.
On the other hand, the ends of friendships and relationships may not be avoidable. In the Costello's case, their son reacted horribly to one breakup but luckily DBT skills gave him a fall back. "The pain didn't go away," said Mr. Costello, "but he spent 70 days learning stress tolerance skills and those skills helped him."
For parents, overcoming guilt is a key component needed to get by. With tremendous guilt, parents often think they triggered the onset of BPD. Teaching there's no shame or guilt, he says, "If the world and girlfriends, friends and parents were perfect it would never happen but they have a predisposition and the world can be an invalidating place."
As it stands, about 3% of the population is diagnosed with BPD, while many others are misdiagnosed or go undiagnosed. The Seriousness of the condition show that 10% will commit suicide, but treatment has 34% of patients recovering after two years and 90% after that, according to Dr. Hoffman. For the most part, she says, "You get better and you stay better."
The choice seems clear and hopefully more families recognize it.
For more info : www.borderlinepersonalitydisorder.com
NYC #ADHD Coach for Moms http://expertscolumn.com/content/coaching-moms-attention-deficit-disorder-new-york-city
My article originally appeared at
The Westchester Guardian - May 10 - Typepad