April 2004
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Clinic offers help for people with borderline personality disorder
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John Burruss, MD |
Patients with one of the most misdiagnosed and misunderstood illnesses in the field of psychiatry are learning about their condition and how it is treated in an outpatient program led by Baylor College of Medicine psychiatrists.
Borderline personality disorder is characterized by a lifelong pattern of behaviors, including rapid mood fluctuations and unstable relationships, said John Burruss, MD, assistant professor of psychiatry and behavioral sciences at Baylor and chief of psychiatry at Ben Taub General Hospital.
“The predominant markers for this condition are chaotic attachments to loved ones and work,” said Burruss. “What we see often is a history of brief, fiery, intense relationships and tumultuous work or educational history that has been apparent in the person’s life since adolescence.”
While all people manipulate others to get what they want, most people use techniques such as humor or altruism.
“A significant problem for people with borderline personality disorder is that in trying to manipulate their environment to get what they need, they do it in very maladaptive and difficult ways,” said Burruss. “And it’s not just harmful to them, it’s annoying and frustrating and even enraging for those around them, leading to difficulties with relationships and work.”
Identifying the problem
Because of its similarity to other psychiatric illnesses, borderline personality disorder is frequently misdiagnosed or untreated, even though it affects around two percent of the population. It may seem like bipolar disorder, but the mood changes are quicker. It may seem similar to depression, but it isn’t quite the same. Once a patient’s condition is diagnosed, his or her situation can improve.
“People with borderline personality disorder can come to understand what they have been struggling with and it’s truly eye opening and enlightening,” said Burruss. “It can be very exciting for them to finally have some idea what has been wrong and what to do about it.”
Although borderline personality disorder is a lifelong condition, it impairs patients most during their 20s and 30s.
“It afflicts people during their most productive time,” said Burruss. “This is when people would ideally be making their way in the world.”
Help available
A variety of treatments can help patients manage the symptoms, which is where Ben Taub’s Intensive Outpatient Program comes in. It’s a two-month program, during which patients meet three times a week with psychologists, psychiatrists, social workers, pharmacists, and other professionals to receive interventions such as individual and group psychotherapy, substance abuse counseling, and job skills training. Patients have to be sober for 30 days prior to enrolling in the program.
“The name is appropriate – it’s intensive,” said Burruss. “The concept is to get a solid start in treating this difficult condition.”
Patients aren’t automatically ‘cured’ after the program, however, and they usually continue to see a therapist and take medication. There is even a treatment plan called the “step-up” program for patients who have graduated from the intensive program but still need more help and guidance than they would get with traditional outpatient care.
Burruss emphasizes that while borderline personality disorder is a lifelong challenge, the symptoms and behaviors can be addressed.
“The treatment can be very rewarding, and people can make substantial progress given that it’s often an extraordinarily debilitating condition to begin with,” said Burruss. He stressed, however, that an essential first step in the process is for people to recognize their condition and realize that help is available.
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