Where we find a diagnosis for my daughter’s mental health condition: BPD.

*Trigger warning: discussion of suicide attempts.

This week has been a bit of a doozy. My trans daughter tried to kill herself again. This is the second deliberate attempt. I won’t mention the times she drowned, got run over by a car, spent days in hospital with chronic asthma attacks and broke her arm so many times in 18 months that she was awarded a prize by her school for the most accident prone child. No, those things occurred prior to deliberate thought.

After several weeks of not hearing from her, because mum horrible, I get a panicked phone call late at night from one of her partners (she calls them this – I think they’re hug-buddies more than anything), who tells me said daughter is threatening on FB to kill herself.

DH and I dash about the suburb where she was last seen not one hour prior, driving up and down darkened streets, hoping that my poorly dressed, barefooted adult child will be sitting at a bus stop without anywhere to go – she doesn’t drive. Finally, after not seeing her anywhere we call the police, report her vitals and go home to wait. Soon after the police arrive at our house and inform us she has been found, she is alive and well and being taken to hospital as we speak. Wonderful police. Discreet and empathetic. Thanks to Queensland Police for their great work. Well. DH and I dash to the hospital only to find she has not yet been admitted and so we hang about for a couple of hours until we are informed that yes, she is here, and no, she won’t speak to us. We go home and get some sleep, relieved by the knowledge that she is safe.

The following day she texts me. She wants to come home. But she cannot until she has been assessed by the mental health unit and admitted to a ward. So she stays there, unhappy but fed and watered and safe, until I go to pick her up the following afternoon.

We hug. While all is not forgiven, and there are things to talk about, but she is at least talking to me. We hug lots more and then I find out she has a condition called BPD – Borderline personality disorder. I looked the condition up on http://www.sane.org. You can find more information here. This condition is characterised by the following, which I have reproduced:

People with BPD have persistent difficulty relating to other people and to the world around them. This can be very distressing for the person and for those who care for them.

Symptoms may include one or more of the following:

Deep feelings of insecurity
Difficulty coping with fear of abandonment and loss; continually seeking reassurance, even for small things; expressing inappropriate anger towards others whom they consider responsible for how they feel; a fragile sense of self and one’s place in the world.

Impulsiveness
This impulsiveness is a response to feeling emotionally overwhelmed, and may include self-harm (for example, cutting, burning, or abuse of alcohol or drugs) or attempts at suicide. Self-harm may bring short-term relief from emotional distress, but can have a longer-term negative impact on the person.

Confused, contradictory feelings
Frequent questioning and changing of emotions or attitudes towards others, and towards aspects of life such as goals, career, living arrangements or sexual orientation.

Some people with BPD may also have symptoms of other mental illnessses. They may experience symptoms associated with anxiety or mood disorders, such as excessive worrying and having panic attacks, obsessive behaviour, hoarding or having unwanted thoughts, feeling persistently sad, moving or talking slowly, losing sexual interest or having difficulty concentrating on simple tasks. They may even experience psychotic symptoms such as delusions or false beliefs – believing, for example, they are being deceived, spied on or plotted against.

Do you know, about 2-5% of the population have symptoms of BPD at some stage in their lives? It’s a common condition, I suspect most usually experienced in late adolescence. Well, luckily it’s treatable, if not curable. We’ll begin a treatment plan for her next week some time, which involves something called DBT – Dialectical Behavioural Therapy. An offshoot of Cognitive Behavioural Therapy, it combines group and individual treatments. I’ve reproduced the information below from an Australian website.

What is Dialectical Behaviour Therapy (DBT)?

Dialectical Behaviour Therapy is a form of psychological therapy which was developed for the treatment of Borderline Personality Disorder (BPD), particularly those individuals with self harm and/or suicidal urges. DBT has been shown by research to be an effective psychological treatment for Borderline Personality Disorder. While the treatment of BPD remains probably the most common use of Dialectical Behaviour Therapy, the DBT treatment approach is increasingly being applied to a range of other psychological disorders and problems, particularly disorders that include issues of emotional dysregulation such as bulimia.

Dialectical Behaviour therapy was developed by psychologist Dr Marsha Linehan (1993). DBT developed out of the recognition that traditional Cognitive Behaviour Therapy (CBT) techniques, while of some assistance for symptoms of BPD, seemed to have limited impact on the core problems in BPD.

Dialectical Behaviour therapy combines traditional CBT with techniques such as mindfulness and acceptance, which are often associated with newer or “third wave” behavioural strategies. These extra techniques focus particularly on teaching people with DBT emotion regulation skills to assist them in dealing with the sometimes overwhelmingly intense negative emotions which occur periodically in BPD and hinder sufferers from being able to progress in therapy.

By acquiring effective DBT emotion regulation skills, BPD sufferers frequently feel empowered able to be able to tackle the wide range of other issues in their lives which otherwise hem them in and frequently prevent them from reaching their full potential.

As well as the inclusion of some novel therapy techniques, Dialectical Behaviour Therapy differs from traditional CBT in the typical time frame for therapy. CBT is generally considered ‘brief therapy’ because clients are typically seen for somewhere between 6 and 20 visits (although there is obviously substantial variation. By contrast, because Borderline Personality Disorder is a chronic condition which involves very significant emotion coping difficulties, Dialectical Behaviour Therapy can be conducted in weekly or twice weekly visits over a year or more. Nonetheless the skills building group programme is designed to be run over

There are two forms of Dialectical Behaviour Therapy, Individual DBT and Group DBT. While based on the same underlying principles, DBT Group Therapy tends to focus on teaching practical coping skills, while individual DBT focuses on addressing issues specific to the individual client and assisting the client to put DBT skills into practice in everyday life. Click here for more information on group verses individual DBT.

What is involved in Dialectical Behaviour Therapy (DBT)?

DBT Group programs which follow Linehan’s program closely involve training in 4 key areas:

(1) Mindfulness techniques – techniques designed to increase the ability of clients to stay ‘present focussed’ and to overcome the mental wrestle over unwanted intrusive thoughts, images & emotions.

(2) ‘Interpersonal Effectiveness Skills’ – skills at negotiating interpersonal challenges, especially confrontation and conflict.

(3) Emotion Regulation Skills – skills designed to replace unhelpful and/or destructive emotion coping approaches

(4) ‘Distress Tolerance’ Skills – skills to tackle the extreme emotional pain, often associated with crises.

In practice many therapist use DBT skills as part of their treatment approach, particularly in the early stages of treatment for BPD, but may use other treatment techniques such as Schema Therapy and traditional CBT, in their treatment programs.

In fact it is possible to attend DBT Group Skills Training while receiving individual treatment by a therapist using an entirely different treatment approach. This is not usually problematic provided the individual therapist does not use a contradictory treatment approach and the individual therapist is aware of what is occurring in then DBT skills training program.

I’m hoping this therapy will work for my daughter. It’s a chronic condition and requires long-term treatment, but the prognosis appears to be good, particularly for suicide reduction. Keeping my fingers crossed.

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