The Essential Family Guide to Borderline Personality Disorder
The Essential Family Guide to Borderline Personality Disorder
“This indispensable book is compassionate to all involved and avoids blame, jargon, and oversimplification.”
Freda B. Friedman, PhD
Dialectical Behavior Specialist
“With exquisite understanding of the disorder and empathy for both those who have it and their family members, Randi Kreger offers valuable ‘Power Tools’ to help readers endure the ravages of BPD.”
Jerold J. Kreisman, MD, coauthor of I Hate You—Don’t Leave Me: Understanding the Borderline Personality and Sometimes I Act
Crazy: Living with Borderline Personality Disorder
“Randi Kreger uncovers the marvelous symmetry of the borderline relationship, in which both participants experience similar self-doubts, irrational guilt and shame, wavering identity, helplessness, anger, and fear of abandonment. Those with BPD and their loved ones will, together, benefit from the tools she provides.”
Richard A. Moskovitz, MD, author of Lost in the Mirror:
An Inside Look at Borderline Personality Disorder
“Randi Kreger masterfully breaks down BPD to help people more easily understand this complex subject.”
Barbara Oakley, PhD, author of Evil Genes: Why Rome Fell,
Hitler Rose, Enron Failed, and My Sister Stole My Mother’s Boyfriend
THE ESSENTIAL FAMILY GUIDE TO
Borderline Personality Disorder
New Tools and Techniques
to Stop Walking on Eggshells
• Randi Kreger •
Hazelden
Center City, Minnesota 55012
hazelden.org
© 2008 by Randi Kreger
All rights reserved. Published 2008
Printed in the United States of America
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, scanning, or otherwise—without the express written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement.
Library of Congress Cataloging-in-Publication Data
Kreger, Randi.
The essential family guide to borderline personality disorder: new tools and techniques to stop walking on eggshells / Randi Kreger.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-59285-363-2 (softcover)
1. Borderline personality disorder—Treatment. 2. Borderline personality
disorder—Patients—Family relationships. 3. Antisocial personality disorders—
Treatment. I. Title.
RC569.5.B67K73838 2008
616.85'852—dc22
2008036456
Ebook ISBN: 978-1-59285-783-8
Editor’s note
The BPD stories quoted in this book are either composites or used with permission. In some instances, names, details, and circumstances have been changed to protect anonymity.
This publication is not intended as a substitute for the advice of health care professionals.
12 11 10 09 08 1 2 3 4 5 6
Cover design by Theresa Jaeger Gedig
Interior design by Ann Sudmeier
Typesetting by BookMobile Design and Publishing Services
Dedication
This book is for those who walked with me hand in hand—and sometimes carried me—in my own journey along the yellow brick road. It is also dedicated to the libraries in and around Saint Louis Park, Minnesota. The children’s novels there, more precious than any ruby-red slippers, made both me and this book possible.
When we are no longer able
to change a situation . . .
we are challenged to change ourselves.
• Viktor E. Frankl •
Contents
Foreword by Robert O. Friedel, MD
Acknowledgments
About This Book
Part 1: The ABCs of BPD
Chapter 1: Welcome to Oz
Chapter 2: Understanding Borderline Personality Disorder
Chapter 3: Making Sense of Your Relationship
Chapter 4: Risk Factors of BPD
Chapter 5: Treating BPD
Chapter 6: Finding Professional Help
Part 2: Power Tools: About Power Tools
Chapter 7: Power Tool 1: Take Good Care of Yourself
Chapter 8: Power Tool 2: Uncover What Keeps You Feeling Stuck
Chapter 9: Power Tool 3: Communicate to Be Heard
Chapter 10: Power Tool 4: Set Limits with Love
Chapter 11: Power Tool 5: Reinforce the Right Behavior
Conclusion: Start Today
Resources
Notes
About the Author
Foreword
The Essential Family Guide to Borderline Personality Disorder is a very useful addition to the growing literature on borderline disorder (the term most acceptable to my patients and readers). The author’s first book, Stop Walking on Eggshells (with Paul T. Mason), has been an international best seller in this field since its publication in 1998. A brief overview of the history and current status of borderline disorder will provide context for this guide.
Borderline disorder has been surrounded by many myths that leave people with the disorder and their family members feeling very hopeless. This should not be so because there are many actions that can be taken to markedly reduce the effects of borderline disorder on those who have it and on their families.
For almost a century, borderline disorder has been referred to as a “wastebasket diagnosis,” reserved for those patients whose presenting symptoms are often so complex that they do not fall cleanly into a single diagnosis, thereby frustrating the clinician, the patient, and the family. Borderline disorder is resistant to treatment with conventional uses of traditional treatment approaches, and it was not listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders until 1980. According to the latest research, this devastating disorder has an estimated prevalence of almost 6 percent in the general population.
The many years of neglect of borderline disorder have resulted in a high prevalence of underdiagnosis, disability, continued suffering, premature death by suicide, and a deep sense of hopelessness. These overwhelming emotions pervade not only those with the disorder, but also their family members, whose lives are terribly affected. In short, borderline disorder is an overlooked, devastating disorder of tragic proportions.
Today, however, there is new hope as a convergence of factors are causing dramatic strides forward. The first factor is represented, in part, by the reports of neuroimaging studies that demonstrate clear differences in the brains of people with borderline disorder compared with those of control subjects. Other studies have demonstrated a high degree of heritability of borderline disorder, further underscoring the fact that the disorder has a significant biological basis. These studies provide clear and visible evidence that borderline disorder is associated with anatomical and functional abnormalities of the brain, and that the disorder should be viewed no differently than medical disorders affecting other organs.
The second factor is the emergence of research on the effective use of a new generation of antipsychotic agents, antidepressants, mood stabilizers, and psychotherapeutic and psychosocial interventions specifically developed for borderline disorder. Treatment programs have also been significantly effective for patients with the disorder, and they have provided highly useful information and new skills to patients�
�� families.
The third factor has been the development of two national advocacy organizations focused solely on borderline disorder: the Treatment and Research Advancements National Association for Personality Disorder (TARA APD) and the National Education Alliance for Borderline Personality Disorder (NEA-BPD). These organizations are dedicated to educating patients and their families about the disorder and how to cope more effectively with it.
The other mission of these organizations is to increase awareness of the disorder on a national and even international level and stimulate public and private funding for research and education. As a result of the efforts of the leadership of NEA-BPD, people with borderline disorder, their families, and professional experts in the field, the U.S. House of Representatives passed a resolution (H. Res. 1005) on April 1, 2008, designating the month of May as Borderline Personality Disorder Awareness Month.
In addition, other organizations have added significantly to the increase in activity in the field. For example, the National Alliance on Mental Illness (NAMI) has recently named those with borderline disorder as one of their “priority populations.” The Borderline Personality Disorder Resource Center has been recently established to help those affected by borderline disorder “find the most current and accurate information on the nature of BPD, and on sources of available treatment.”
Two new important private resources for research funding of borderline disorder have begun to have a positive effect on the field. Founded in 1999, the Borderline Personality Disorder Research Foundation (BPDRF) “has mobilized research centers in the United States and Europe to investigate whether BPD is a recognizable distinct entity, and, if so, what the defining characteristics of the disorder are.” Initially, it selected and funded four centers to investigate borderline disorder from varying scientific and clinical perspectives. In addition, it has awarded research grants to twenty-two investigators.
During the past decade, the National Alliance for Research on Schizophrenia and Depression (NARSAD) has expanded its original focus from schizophrenia and affective disorders to other prevalent mental disorders such as anxiety disorders. Since 1987, this donor-funded organization has awarded more than $180 million in grants to senior and new meritorious researchers involved in brain research focused on psychiatric disorders. Recently, it has included borderline disorder in its areas of interest.
A final critical factor has been the marked increase in the amount of information readily available about borderline disorder. During the past decade there has been an increasing number of books written for the nonprofessional about borderline disorder, and there has also been a comparable number of Web sites launched. One of the most successful of these books has been Stop Walking on Eggshells, coauthored by Randi Kreger, the author of this guide.
In Stop Walking on Eggshells, Kreger focused her attention on the families of those who do not acknowledge their borderline disorder, do not seek treatment, and blame their difficulties on others. The success of this book attests to the large number of people who fall into this group—whom Kreger calls “higher-functioning invisible BPs” in this book—and the devastating effect their behavior has on their families and others close to them.
In The Essential Family Guide to Borderline Personality Disorder, Kreger significantly expands the scope of Stop Walking on Eggshells and her accompanying workbook by providing a current and understandable description of the symptoms, nature, and treatment of the disorder by using numerous helpful examples. She also provides much useful advice to families on how to effectively help and how to cope with a family member with borderline disorder.
To do so, Kreger has read broadly in the area and has consulted with a number of leading experts to ensure, to the highest degree possible, the accuracy of her content. This represents no small amount of investigative work, as scientific knowledge in the field is expanding rapidly.
In The Essential Family Guide to Borderline Personality Disorder, Kreger utilizes a markedly different approach to educate her readers. Using novel concepts and approaches, she integrates a comprehensive amount of information about the disorder and its treatment.
Kreger does so in a writing style that neither “talks down” to the reader nor expects a high level of knowledge of psychology and neuroscience. Kreger achieves her formidable task in a very impressive fashion. In The Essential Family Guide to Borderline Personality Disorder, there is much to be learned by family members who are affected by loved ones with borderline disorder, and also by professionals who strive to help them.
Robert O. Friedel, MD
Distinguished Clinical Professor of Psychiatry
Director, Borderline Personality Disorder Program
Department of Psychiatry, Virginia Commonwealth University
Richmond, Virginia
Author, Borderline Personality Disorder Demystified
www.bpddemystified.com
Acknowledgments
When someone asked a songwriter I know how long it took her to compose a song, she said, “my whole life.” In the same way, this book took my whole life—the years I spent in my own BP/non-BP relationship, the dozen years I spent managing my online community for family members, and the three years of intensive research and writing that went into this particular book, the third of my trio of books for those who are struggling to love someone who keeps painfully pushing them away.
On the publishing side, the heavy lifting was done by my good friend and literary agent Scott Edelstein and former Hazelden editor Rebecca Post. Few agents provide the hand-holding and “rah-rahing” that Scott does, and no one else could have been such an excellent sounding board. He has been with me from that day in the early 1990s when he said, “So, do you think you’re ever going to do that book on borderline personality disorder?”
Rebecca Post actually initiated this book when she asked me whether I was interested in writing something for Hazelden—a memoir, perhaps. That seed of an idea grew into the book you now hold in your hands. She nurtured this book in a way that few editors do today. Sid Farrar and the staff at Hazelden stepped in after Rebecca left and have been positive forces in shaping the manuscript, ensuring accuracy, and promoting the book to a wide audience.
Because of the success of my previous books, Stop Walking on Eggshells and The Stop Walking on Eggshells Workbook, I had access to some of the top BPD clinicians, researchers, advocates, and other professionals when writing this book. They all share my passion for helping those with this insidious disorder and for helping their friends and family.
At the topmost level is Robert O. Friedel, MD, Distinguished Clinical Professor of Psychiatry at Virginia Commonwealth University and the author of Borderline Personality Disorder Demystified. He kindly wrote the foreword and spent hours teaching me how impairments of the physical and chemical brain can lead to BPD behaviors. He also lent his insights to the chapters on treatment and finding a clinician. Thank you.
Another important contributor is Blaise Aguirre, MD, the medical director of the Adolescent Dialectical Behavioral Therapy Center at McLean Hospital in Belmont, Massachusetts. He is a child-and-adolescent psychiatrist recognized for his work in the treatment of BPD and is the author of Borderline Personality Disorder in Adolescents. Dr. Aguirre managed to do interviews with me despite his hectic schedule, sometimes fitting me in by cell phone as he walked through the hospital corridors. If you are the parent of a borderline child, you need his book.
Jim Breiling, PhD, from the National Institute of Mental Health, is the clinical cornerstone of all things BPD—a kind of real-life “BPDCentral.” He has been supportive of my work for many years and answered a multitude
of questions during the time we’ve worked together. He is the greatest.
Other clinicians and professionals who gave me in-depth interviews or significant content include the following (in no particular order):
• Beverly Engel, MFCT, a psychotherapist and the author of eighteen self-help books.
• B
arbara Oakley, author of Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed, and My Sister Stole My Mother’s Boyfriend. At the last minute, I asked Barbara to apply first aid to the brain chemistry section in chapter 4. She assisted me in writing it and came up with the analogy of tree pollen.
• John Gunderson, MD, Professor of Psychiatry at Harvard Medical School and Director of Psychosocial and Personality Research at McLean Hospital in Belmont, Massachusetts, and Cynthia Berkowitz, MD.
• Sharon, founder of the online community NUTS (parents Needing Understanding, Tenderness, and Support to help their child with borderline personality disorder).
• Perry D. Hoffman, President of the National Education Alliance for Borderline Personality Disorder and cofounder of the Family Connections Program.
• Floyd Koenig, who served as an impromptu research assistant, gathering information on topics at my request.
• A. J. Mahari, a recovered individual with BPD who has authored several electronic books and maintains the Web site Borderline Personality Disorder from the Inside Out
(www.borderlinepersonality.ca).
• Debra Resnick, PsyD, President of Psychological Services and Human Development Center, Inc., in Fort Washington, Pennsylvania. Debra, a psychotherapist who specializes in dialectical behavior therapy (DBT), uses my workbook in a great deal of her work with families.
Furthermore, I am honored that these leading clinicians known for their work with individuals with BPD reviewed chapters of this book for accuracy (although I take all responsibility for the content). These notable people are
• Robert O. Friedel, MD: chapters 1–6
• Marlene Schwartz, RN, MSN, PhD, ANCC, APNP: chapter 8 (Power Tool 2: Uncover What Keeps You Feeling Stuck)
• Debra Resnick, PsyD: chapter 9 (Power Tool 3: Communicate to Be Heard)
• Freda Friedman, PhD (DBT psychotherapist and coauthor of Surviving a Borderline Parent): chapter 10 (Power Tool 4: Set Limits with Love)