Archive for October, 2009

Should You Stay With Someone Who Has Borderline Personality Disorder?

Thursday, October 22nd, 2009

People sometimes ask us if they should stay with a partner who has Borderline Personality Disorder. They tell us that their loved one can flip from wonderful to horrible in a split second. They wonder whether they should keep working on the relationship or abandon ship.

We tell those asking this question that people with Borderline Personality Disorder (BPD) indeed engage in a wide variety of behaviors and states of mind. Not surprisingly, people who care about those who have BPD often ask which of these various states represent the “real” person–the difficult states or the endearing ones? In order to answer that question, let’s first take a look at some of the disagreeable states as well as what may cause them. Then we’ll review the positive behaviors and the causes for those. We’ll conclude by filling you in on which ones reflect the “true” person at the core. And most importantly, we’ll give you a few issues that may help guide you in making this difficult relationship decision.

Negative Behaviors and States of Mind
People with BPD often inflict harm on those they love (sometimes quite intentionally; other times without conscious intent at all). They can say and do things that are perceived as astonishingly hurtful. Furthermore, people with BPD often fail to understand appropriate limits and boundaries of those they care about. Thus, a man with BPD might attempt to control his partner by demanding that she cut herself off from her family because they don’t “like him.”

In addition, those with BPD often criticize their partners for not “doing enough or earning enough” for them or their family. They may burst into rage, anger, or impulsive actions with seemingly little provocation. Often their partners who don’t have BPD find that their self-esteem suffers and they begin to question their own sanity, thinking that their partner is right–they really aren’t doing enough or they’re doing things the wrong way.

What causes such distressing, yet inappropriate behaviors in those with BPD? All too often, people with BPD completely fail to understand the nature of their behavior and how it affects those they care about. In addition, people …


PTSD and Evidence Based Practice

Sunday, October 18th, 2009
Like many professionals, clinical psychologists take advantage of continuing education to keep up with new advances in the profession, develop new skills, broaden their knowledge, and keep their license to practice. Frankly, after attending hundreds of hours of continuing education, I can tell you that some conferences are decidedly better than others. I can think of one conference that I sat in the back row and amused myself by counting the heads in front of me that dropped and bobbed.

Last week, I attended a well orchestrated day long conference on treating people with Post Traumatic Stress Disorder (PTSD). Organized by Dr. Rex Swanda from the New Mexico VA, the content of the conference primarily focused on therapeutic practices that have been studied and found to be effective in treating those who suffer from this disorder. Treatments that are considered evidence based have been subjected to at least several independent research studies, compared to other types of treatment, or to no treatment. Here is an abbreviated description of PTSD.

PTSD can occur when people suffer or witness a traumatic event in which they are threatened with death, injury, or physical violation. During the time of the trauma these people respond with horror, fear, or helplessness. The symptoms of PTSD include some of the following:

  • Re-experiencing the trauma: through dreams, flashbacks, unwanted thoughts, or distress when reminded of the trauma.
  • Numbing or avoiding: attempts to avoid situations, triggers, or thoughts about the trauma, feelings of detachment from others, loss of interest in activities, beliefs that their lives will be short, and restricted emotions.
  • Hyperarousal: problems with sleep, easily irritated or angry, problems concentrating, and jumpiness.

If you have concerns that you or someone you care about has PTSD, please consult with a mental health professional for a diagnosis and treatment plan.

Now, back to the conference. There were multiple sessions that mostly reviewed the effective treatments for PTSD. Not surprisingly the therapies that work are based on mixtures of cognitive and behavioral therapies. These approaches have stood the test of time and science. Cognitive Behavioral Therapy (CBT) has been used to successfully treat a wide range of emotional and behavioral problems.

It’s fun when …


Families do the best they can do

Friday, October 9th, 2009

We just returned from a trip to New York City. While there, we managed to do a little work and visit some family. Our family, like many families, stretches from the west coast to the east coast. We don’t see each other as often as we’d like. So, when we get together there are always changes. Change is the only predictable, dependable essence of our family (like most families).

For us, one significant change has been our assignment to the older generation. For many baby boomers, this new status is largely unanticipated and surprising. Where did all that time go? Our transfer to elder status comes with the gain of grandchildren, the joy and pain of watching our children love, learn, and leave. It also comes with the dissipation of dreams, the creation of new dreams, the loss of our own parents, new aches and pains, technological challenges, and the wonderful perspective of experience. Of course, that wonderful perspective derived from experience isn’t always sought out or appreciated. Sigh.

Family members change. Children are born, or adopted. Adults join families through new ties or partnerships. People leave families. Some die, others move on, some lose connections by choice, some by circumstance.

Getting together with family evokes lots of feelings. Okay family-Chuck and I are both clinical psychologists and it’s true, we really are analyzing everything you say or don’t say. And we know exactly what you’re really thinking (well, that’s not true-we still can’t read minds, but we’re working on that).

On the long (delayed) flight back to New Mexico, we had time to reflect on our family. And we both concluded that the people in our family–like those in most families–do the best they can do given the time and context of their births, childhoods, biology, learning, luck, and fate. We’re good people, for the most part, and we plod ahead, not always really sure of where we’re going.

So, does this hopelessly egocentric rambling have a point? Yes, one way to improve mental health and happiness is acceptance. So family, we have analyzed you completely by now and want you to know the outcome. You’re all okay. And it’s even …


Anxiety & OCD Exposed



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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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