Borderline Personality Disorder Conference

Wednesday, August 26, 1998

Bob M is Bob McMillan, editor of our online magazine CCI Journal at the Concerned Counseling and Concerned Counseling Eating Disorders websites.
Melissa Ford Thornton: has Borderline Personality Disorder and is author of the book: Eclipses: Behind the Borderline Personality Disorder.
The people color-coded in green are audience members who had questions.

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BEGINNING

Bob M: I know that many of you are new visitors to our site. I'm Bob McMillan, the moderator of tonight's conference. I want to welcome you all to the Concerned Counseling website. Our topic tonight is Borderline Personality Disorder. As with many of the topics for the conferences, the suggestion for this one came from one of the visitors to our site. So I appreciate that. Our guest tonight is Melissa Ford Thornton, author of Eclipses: Behind the Borderline Personality Disorder. Some of you, I'm sure, recognize Melissa from the BPD list. For those of you who don't know her, Melissa has been a BPD patient for many years. We'll be talking about her experiences and also the various treatments she underwent, until she found one that really worked for her. Good evening Melissa and welcome to the Concerned Counseling website. Just so everyone can get a sense of who you are, can you tell us your age and a little about your background?

Melissa Ford Thornton: Good evening, everyone. I'm 36 years old. I've worked in public relations, media relations, and freelance for creative magazines.

Bob M: For those of you who aren't familiar with Borderline Personality Disorder (BPD), I put together an explanation.

Borderline Personality Disorder: A pervasive pattern of staability of interpersonal relationships, self-image, and affects,and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. frantic efforts to avoid real or imagined abandonment;
  2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation;
  3. identity disturbance: markedly and persistently unstable self-image or sense of self; or sense of long-term goals; or career choices, types of friends desired or values preferred;
  4. impulsivity in at least two areas that are potentially self-damaging: for example; spending, sex, substance abuse, and binge eating.
  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (self-injury);
  6. affective instability: marked shifts from baseline mood to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days;
  7. chronic feelings of emptiness;
  8. inappropriate, intense anger or difficulty controlling anger; frequent displays of temper;
  9. transient, stress-related paranoid ideation or severe dissociative symptoms.

I want to note here, that everyone has all these traits to a certain extent. Especially teenagers. These traits must be long-standing and persistent. And they must be intense.

From Dr. Richard Corelli's website: A person with a borderline personality disorder often experiences a repetitive pattern of disorganization and instability in self-image, mood, behavior and close personal relationships. This can cause significant distress impairment in friendships and work. A person with this disorder can often be bright and intelligent, and appear warm, friendly and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent.

Relationships with others are intense but stormy and unstable with marked shifts of feelings and difficulties in maintaining intimate, close connections. The person may manipulate others and often has difficulty with trusting others. There is also emotional instability with marked and frequent shifts to an empty lonely depression or to irritability and anxiety. There may be unpredictable and impulsive behavior which might include excessive spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating or physically self-damaging actions such as suicide gestures. The person may show inappropriate and intense anger or rage with temper tantrums, constant brooding and resentment, feelings of deprivation, and a loss of control or fear of loss of control over angry feelings. There are also identity disturbances with confusion and uncertainty about self-identity, sexuality, life goals and values, career choices, friendships. There is a deep-seated feeling that one is flawed, defective, damaged or bad in some way, with a tendency to go to extremes in thinking, feeling or behavior. Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms. Even in less severe instances, there is often significant disruption of relationships and work performance. The depression which accompanies this disorder can cause much suffering and can lead to serious suicide attempts.

Bob M: Melissa, at what age did you develop BPD and how did it come about?

Melissa Ford Thornton: I probably had it since childhood, but was diagnosed at 29.

Bob M: Can you tell us how you developed BPD and what kind of symptoms you've experienced?

Melissa Ford Thornton: I was under stress, working fast-paced, lost weight and patience. I was despondent and was self-mutilating.

Bob M: From the Secret Shame website: One theory about BPD is that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings. Other research shows that borderlines are distinguished by a set of "primitive defense" mechanisms that they set up. Chief among these is splitting, in which a person or thing is seen as all good or all bad. Note that something which is all good one day can be all bad the next, which is related to another symptom: borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they lasted interacted with the borderline.

Bob M: Had you experienced any other kind of psychiatric disorder before being diagnosed Borderline Personality Disorder?

Melissa Ford Thornton: I suffered from depression after my mother died from suicide in 1986.

Bob M: For those of you just coming in, our guest is Melissa Ford Thornton, author of the book "Eclipses: Behind the Borderline Personality Disorder". We are talking about her experiences with Borderline Personality Disorder and later her treatment. What has living with BPD been like for you?

Melissa Ford Thornton: Emotions raging wildly, I could not concentrate to read. I was depressed and I had lots of suicidal thoughts and plans.

Bob M: I also want to mention that Melissa is not a doctor or psychologist, so she won't be able to give advice on medications but she can certainly share her experiences and talk about the various treatments she's been through. Were you able to control your thoughts or emotions, or was it just something that was out of control?

Melissa Ford Thornton: Absolutely not. It was as if my mind was no longer my own.

Bob M: Here are a couple of audience questions:

Jase: Can you explain more about the self-multilation?

Melissa Ford Thornton: It's an attempt at emotional relief, usually cutting, burning, or hitting oneself. I cut my wrists...not enough to die.

Bob M: And just to clarify, many who are self-injurers, do not self-injure as a way to commit suicide. It's an emotional outlet/release. I have read that in some instances there is something that triggers a person to become Borderline, for instance, sexual abuse, a violent act, etc. Did you experience that prior to developing BPD?

Melissa Ford Thornton: 75% of BPDs have been sexually abused. I did not know I had been until I was in longterm care.

holmesg: What is your background regarding marital status, siblings, children, etc?

Melissa Ford Thornton: 4 brothers, all older. I've been happily married 15 years. No children.

Bob M: One of the characteristics of Borderline Personality Disorder is the person's emotional state can swing wildly from one end of the spectrum to the other - very quiet to raging. Was that part of your experience, and if so, could you talk a little about that?

Melissa Ford Thornton: Yes, one day I'd be on top of the world, the next day I couldn't get out of bed. This is by the way different from manic depression.

Ceejay: How did you deal with the angry rages to avoid hurting others?

Melissa Ford Thornton: At first I could not. I was violent, throwing things, hitting, tearing my hair out. Later, with medicine and treatment, I could redirect anger appropriately.

Bob M: How long did you experience these severe symptoms before you realized that something wasn't right?

Melissa Ford Thornton: A friend suggested I had depression and gave me a psychiatrist's number. I didn't call because I thought I was in control. Two months later, I was in the hospital ICU, after taking an intentional overdose of sleeping pills.

Mariealaina: Do you believe a person is born with borderline tendencies?

Melissa Ford Thornton: Yes. One definition of Borderline Personality Disorder is an overly emotional reaction to every hurt which gets worse with age. But you are also parasuicidal, which is any unsuccesful suicide attempt-considered very serious by BPD specialists.

Bob M: Here are a few audience comments:

Summers: Have you gotten a chance learn how you 'were' as a child - behavior that might substantiate your belief that it came in your childhood? I wonder about that because I've been told the same thing, but have no way to 'check it out'. I began being able to read again during this last winter. It's nice.

glmills007: I am finding it more helpful today to focus on myself rather than my wife who probably has some BPD. In this way I can better change the things I can, accept the things I cannot change (her), and focus on ways to cope - such as honoring her need for space sometimes. This may mean I leave the home for an evening or two, she calms down etc. I don't know, as I just found out about her BPD, and am in the initial stages of just learning about my anger at marrying her 5 years ago and only awakening to it recently.

Ma7738: I believe in my daughters case there was minor sexual abuse trigger that blew away her self-esteem.

Sonnie: I adopted my son at 5 days old. He started yelling at 5 days old and has not stopped since. He was never abused.

Summers: But HOW DO you avoid the acting out? What do you do/say to yourself?

Melissa Ford Thornton: Dialectical Behavior Treatment (DBT) skills help me with a set of skills for dealing with most, if not all, situations.

Bob M: I want to turn to your treatment of your borderline personality disorder. Before we get into DBT, what other kinds of treatment did you have and please detail how effective you found each to be.

Melissa Ford Thornton: I had a series of antidepressants, one after another, all ineffective. I also had one-on-one therapy.

Bob M: And the one-on-one therapy, was that effective at all and for how many years did this treatment go on?

Melissa Ford Thornton: In longterm hospitalization, I began therapy sessions. I didn't dig into my past,keeping me alive was the goal. It motivated me, however, to continue trying all avenues, eventually leading to Dialectical Behavior Treatment.

Bob M: Did you try any medications that you found have worked for you and are you taking any now?

Melissa Ford Thornton: Yes, I take anti-depressants (paxil and wellbutrin) plus a set of mood stabilizers and sleeping medication. It took my psychiatrist 5 years after long-term care to find this wonderful combination that has given me my life back.

Bob M: And then you found DBT, Dialectical Behavior Treatment. Can you explain what that is?

Melissa Ford Thornton: Dialectical Behavior Treatment was an intregal part of longterm hospitalization. Mandatory group sessions, homework and role-playing helped hone skills that worked for me. This was the foundation, in addition to therapy sessions and right combinations of medication. I now see how DBT was a life-saver too.

Bob M: How long were you hospitalized and specifically what skills have you learned that worked for you?

Melissa Ford Thornton: I was hospitalized a year. The list of skills is long, however, suicidal urges are gone. After I hold an ice cube in my hand until it completely melts, it causes pain without permanent damage. My urges to punish myself painfully (self-injury) and die painfully are fulfilled. Other skills, deep breathing, staying in the moment (mindfulness), change of physiology through intense exercise, cold shower or if appropriate something self-soothing, like a hot bath or calming happy music are also very helpful treatments for the symptoms of Borderline Personality Disorder.

Ma7738: How does DBT differ from regular therapy and medications?

Melissa Ford Thornton: It is a behavioral treatment, not unlike those designed for alcoholics, smokers, etc. only the stakes are higher. It was developed by Marsha Linehan, PhD, specifically to lower suicide rates so prevalent among borderlines. 10 % of borderlines eventually commit suicide. There are over a million borderlines in the US.

Eleanor: Do you feel that hospitalization for that long was helpful? What was it like?

Melissa Ford Thornton: At first it was terrifying, confining. I trusted no one. After a week or so, patients began to talk to me, to include me in scrabble and share. I was not alone. To be there that long felt equivalent to being abandoned by my family. Abandonment is one of the most common fears among borderlines. I missed 2 Christmases and 2 New Years at home. Of course, I was visited by family. My husband was especially supportive. Fear of abandonment is one of the symptoms listed as criteria for BPD. There are 9 symptoms listed. You need have only 5 to be diagnosed as a borderline.

Bob M: By the way, I'm getting some audience questions on where to get Melissa's book. It's easy to purchase Eclipses: Behind the Borderline Personality Disorder

Melissa Ford Thornton: This is true, at least for me and those I interviewed for my book. You are scheduled rigidly and expected to groom properly, etc. You aren't paying bills,taking care of children, etc. At home, no schedule, too much free time or too much expected, errands, work, bills, etc. can be overwhelming. You are no longer in an environment where having a mental illness is ok. You face stigmas and taboos.

Bob M: If you don't mind me asking, how were you able to afford 1 year of hospitalization? I'm sure that must have been VERY expensive.

Melissa Ford Thornton: I returned to a previous employer when I began cutting (self-injury) hoping for a slower work schedule. They very kindly combined all previous years of work to the present and kept me on payroll without pay until I was released from the hospital. This is very unusual. Today, most insurance will not pay for more than a certain number of hospital days and limit therapy. Mental illness is a brain disorder. The National Alliance for the Mentally Ill has so defined it. It is no different than high blood pressure where medication, frequent doctor visits, and a healthier lifestyle sustain health. This is covered by major medical insurance which pays much more. So it's upsetting to see that insurers won't properly cover mental illness.

Bob M: What hospital were you in and where is it located?

Melissa Ford Thornton: It no longer exists as a hospital, it was bought out after I left. It was Highland Hospital, in Asheville, North Carolina. It dated back to when Zelda Fitzgerald stayed there.

Bob M: So you were lucky/fortunate that your employer's insurance covered a good portion at least. Here are some more audience questions:

babareep: How much control does the person with BPD have over stopping the self-mutilation? Is there hope for someone who has been doing it for 10 years?

Melissa Ford Thornton: There's always hope. Sometimes the mind disconnects from the body. This is called dissociation. Those are times when the body being hurt does not look or feel to be your own. It is hard to stop. With treatment, dissociation can be relieved, especially with DBT skill of mindfulness--staying in the moment. If searching for self-punishment or pain, ice cubes held until completely melted sometimes greatly relieves these urges. Professional care is advised.

Kamala: How did it affect your relationship with your husband?

Melissa Ford Thornton: He hurt as much or more than I did, yet he stayed by my side all the way. Many divorces arise from such trauma. He was always caring, but expected me to try harder each day. A great partner to my other treatments.

Mariealaina: Do you consider yourself "cured"?

Melissa Ford Thornton: It is a lifetime disorder. However, recent research has shown that as a borderline grows older, 75% of them have a chance of not displaying any symptoms!

Bob M: Here are a few audience comments made throughout the evening:

MamidAel: I Have BPD. Canadian CPS has just used that in their final arguments to take My Child from me Permanently!

SoHandy2: I often feel suicidal, but I never feel like just hurting myself. Are there many Borderlines who don't self-injure?

willow bear: Bob, maybe you could mention Dr. Marsha Linehan's workbook "Skills Training Manual for Treating Borderline Personality Disorder". It costs $27.00.

hitchhiker: I've been a "problem" in my family since I was 4 because of the sexual abuse. I've tried to tell people I need help, but no one will believe me. And when doctors see my records, they always base their opinions off of them. What can I do differently to seek help? I don't have a job, or medical coverage yet. I'm only 18.

Bob M: As Melissa is answering that last question from hitchhiker, here are a few more audience comments:

Tee: Thank you for some valuable info, I will use the ice cube one right away

Summers: Thank you for the time you spent helping us out here tonight. You have given a gift appreciated by many.

Melissa Ford Thornton: I would contact my local Mental Health Association. They have lists of doctors and their specialties, such as abuse. Also the Association could put you in touch with resources to lower cost, no insurance required.

Sharyl: Can you be more specific on what DBT skills you have acquired to help you cope with emotional outbursts?

Melissa Ford Thornton: Staying in the present, deep breathing, changing physiology, journalling, distraction, call a friend, play with cat, whatever works for you.

Allison1: What did you find that helped you to keep from dissociating? My daughter does this as her means of coping.

Melissa Ford Thornton: Mindfulness is complete awareness of where you are and what you are doing at all times. Example, "I am washing dishes", "I put a plate in the suds, I feel cool water as I rinse the plate". Talk out loud if you want to. It helps. If distracted by something like thunder and become judgmental such as "I hate this storm", "I hate myself", immediately focus on each action you make or sensation you feel.

territ: Any recommendations as to how to find a therapist / Dr. that specializes and is current on Borderline Personality Disorder?

Melissa Ford Thornton: Local Mental Health Association (in phonebook). Some doctors are listed as references in the back of my book "Eclipses: Behind the Borderline Personality Disorder". It costs about $11. DBT is spreading. If you can't find a local doctor, perhaps you can contact one of the references asking for a conference via phone/fax or whatever. Ask for the conference between your doctor and the specialist and if that's not possible many doctors referenced have materials and worksheets to help you. Also Linehan's book is recommended.

Bob M: You have had many years of experience with Borderline Personality Disorder. Do you think most people with BPD could reach a point of "feeling good and in control" without professional help? In other words, by practicing "self-help"?

Melissa Ford Thornton: No, there is such a high suicidal element and life-threatening eating disorders, not just binge-eating. I had anorexia. The risk is too high. If you feel there's a problem or have been diagnosed, listen to the professionals.

Ashley1: I would really like to hear how her husband supported her so that we may get some ideas on Eclipses: Behind the Borderline Personality Disorder. Simply click on the link and you can buy the book. In it she describes her own personal experiences along with those of other borderlines that she interviewed. She also talks extensively about her Dialectical Behavior Treatment.

Ashley1: Some doctors feel that if someone is hospitalized for more than six months they become dependent on the institution. What are your feelings on that?

Melissa Ford Thornton: This is true, at least for me and those I interviewed for my book. You are scheduled rigidly and expected to groom properly, etc. You aren't paying bills, taking care of children, etc. At home, no schedule, too much free time or too much expected, errands, work, bills, etc. can be overwhelming. You are no longer in an environment where having a mental illness is ok. You face stigmas and taboos.

Bob M: If you don't mind me asking, how were you able to afford 1 year of hospitalization? I'm sure that must have been VERY expensive.

Melissa Ford Thornton: I returned to a previous employer when I began cutting (self-injury) hoping for a slower work schedule. They very kindly combined all previous years of work to the present and kept me on payroll without pay until I was released from the hospital. This is very unusual. Today, most insurance will not pay for more than a certain number of hospital days and limit therapy. Mental illness is a brain disorder. The National Alliance for the Mentally Ill has so defined it. It is no different than high blood pressure where medication, frequent doctor visits, and a healthier lifestyle sustain health. This is covered by major medical insurance which pays much more. So it's upsetting to see that insurers won't properly cover mental illness.

Bob M: What hospital were you in and where is it located?

Melissa Ford Thornton: It no longer exists as a hospital, it was bought out after I left. It was Highland Hospital, in Asheville, North Carolina. It dated back to when Zelda Fitzgerald stayed there.

discussion continues on page 2