<PattySanc> Paul Mason, M.S., C.P.C, is the co-author of "Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About has Borderline Personality Disorder." He is currently the program manager of Child and Adolescent Behavioral Health Services at St. Luke's Hospital in Racine, Wis. In addition, as a psychotherapist, he specializes in treating people with borderline personality disorder and their families. 

<Lauranator> What do you think of the work of Marsha Linehan and DBT..do you think it's a valid treatment for BPD?

<paulm1> I think that Marsha Linehan's work is currently the premier treatment method available. It is the first treatment of its kind to be validated by research. overall I've seen pretty good results.

<EGGSHELL> do you think bpd can recover WITHOUT support from their families?

 <paulm1> I think it is possible and it happens however, family support can make recovery easier.

<isropen> Can BPD intensify with age? I never really noticed my mom's BPD traits until she hit middle age.

<paulm1> The answer to your question is yes. it usually intensifies in the late 20s and early 30s. By about 40 you usually see a "mellowing" of symptoms and the risk for suicide decreases significantly.

<Kellster> In your book there are a lot of pages telling dads how to get custody of their kids, why is this? it seems like it is saying no BPD moms can raise their kids-and it looks like an attack on us-done.
<paulm1> I think your referring to the later part of the book that goes into special issues. We certainly didn't intend to attack moms with bpd however I can see how that might be interpreted that way. We tended to use the "she" as the spouse with bpd when describing that section even though there are many dads who also can carry the diagnosis. Actually, I have only been involved with a handful of moms who I had significant childcare concerns about. 

<seanchai> Do you agree that bpd should be an axis I diagnosis? Do you think it will be an axis I diagnosis in the DSM V?

<paulm1> I would like to see bpd get the same recognition as a "primary" mental health diagnosis. The Axis system was designed by the American Psychiatric Association as a way of describing a person's problems. Unfortunately, insurance companies have chosen to interpret the Axis I diagnosis as the primary problem and therefore limits their funding to it. If we could do away with the Axis system altogether in the next DSM revision, I would be much happy.

<Julia> Do you think that hypnosis has any place in the treatment of bpd or any other Dissociative disorder?

<paulm1> Yes, hypnosis can be very helpful in assisting a person in achieving a therapeutic state of relaxation. This can help a great deal in decreasing anxiety and allowing one to talk about their experiences. I think this is especially true of people with Dissociative disorder given the high prevalence of abuse in their background.

<rootie_> Are you aware that non-bpd's use your book, SWOE, as a sort of "bible" so to speak, on how to divorce their BPD spouse and gain custody of the children? (for reference, see www.bpdcentral.com). Was it your intention to write this type of "guide book" or are non-bpd's using it as an easy out?  

<paulm1> I actually have become aware of that. I've been pretty upset about this since this has turned out to be an "unintended effect" of the book. The information was suppose to be helpful to spouses in understanding when a relationship may be in jeopardy. I've actually been asked to testify in many custody cases and I have turned them all down because that was never what I intended for the material to be used for. It really has been unfortunate.

<Perse> According to you, what are the criteria to consider that a BPD patient has recovered?

<paulm1> Significant reduction in self harm or suicidal behaviors.
Significant improvement in mood that is reported to be "manageable" by the client.
Reduced conflicts with self and others. Please notice I am not using the phrase "absence of" because some of these symptoms persist but are more "manageable' over time.

<digex> I have a suspicion that my wife may have BPD--she exhibits at least 7 of the 9 characteristics, and is in denial of this--however her symptoms are quite mild compared to what I have read about. My question is this: how do you get someone treatment that doesn't believe they have a problem? Is this a long-term problem, or can milder cases be treated quicker?

<paulm1> Milder cases are actually more common then the more severe cases that are usually the subject of books and case studies. If she exhibits milder symptoms then she may be able to do some reading and some self-exploration. If you can gently and, in a supportive manner, help her understand the benefits of treatment for herself and your relationship then maybe she would consider it. My experience has been (in the milder cases) that a supportive partner who encourages treatment "together" is more successful than compared to suggesting treatment on her own.

<Lonely_Star> I was wondering how early you think bpd can be diagnosed b/c I have had a lot of controversy over my diagnosis.

<paulm1> That's a very controversial subject altogether, according to the criteria bpd develops often develops in early adolescence, However, many practitioners and researchers are beginning to demonstrate evidence that it can be detected in childhood. I certainly have been involved in cases where a child as young as seven has shown symptoms of the disorder.

<non_loved> Hi, my girlfriend is BPD and the can't stop lying, is it typical from BPD?

<paulm1>Lying is common among many personality disorders, it often isn't a hallmark symptom of any one disorder though, lying actually is fairly common among people without any diagnosable disorder unfortunately so it is difficult to say what her lying might mean or signify.

<EGGSHELL> Abuse is mainly associated with dx of BPD.. are there many cases you have come across that have not been abused?

<paulm1> you're correct, abuse is fairly common in the histories of people with bpd, about 3 out of 4 people with bpd report a history of abuse. This is about the same frequency that I've seen in my experiences.

<Amaranthine> Yale school of Medicine & Medical University of South Carolina under a Dr. George are doing studies assessing the psychophysiology of BPD and using a new treatment called TMS (Trancranial Magnetic Stimulation) 1. are you familiar with this? 2. if so should we be hopeful in that this might be a breakthrough treatment?

<paulm1> No, I am not familiar with TMS. A great deal of research is pointing to the role of the limbic system as being responsible for the dysregulation of moods. I'm wondering if TMS is targeting the functioning of the limbic system. but no, I'm not familiar with TMS.

<emmespalace> as a person with bpd and clinical depression I feel as though I am in recovery, however do you consider a person in recovery that has not be able to rejoin the work force?

<paulm1> Yes, I think recovery doesn't always include work. Work is an important indicator of functioning but it is only one indicator. Social functioning, physical health, and emotional well-being all other indicators of functioning that are equally important.

<Chamia> Do you feel that it is better for a person to tell their co-workers or not to that they are bpd? I work in a small office of only 4 woman....and I am unsure what to do.

<paulm1> I think there is too much room for misinformation and misinterpretation, Unfortunately, mental health concerns still carry with them a great deal of stigma. It would seem to me that you would want to really weigh the pros and cons of doing so only because of the uncertainty in how people respond to that type of information. That being said, I hope one day people can talk with their coworkers and friends about their mental health concerns the same way that they talk about physical concerns.

<sleepy> [1]Do you consider therapy and/or meds essential in the recovery of BPD? Or is it ever simply "outgrown"? (as someone with moderate to, at times, severe symptoms not necessarily interested in therapy, meds, or recovery for that matter) Also, do you believe that BPD can be purely biological?

<paulm1> I believe there is a biological component to bpd but it is not well understood. Whether it is genetic or is a "physiological" reaction is unclear. Because of the strong evidence of biology having some play in the diagnosis, it would seem to me that medications would be an integral part of symptom management. I understand your wish to remain free of treatment but you may want to consider the benefits of treatment.

<raineygirl271> as a person of bpd I jump from relationship to relationship, is there anyway to break that cycle? It feel tortuous to be alone!

<paulm1> Good question...not an easy answer, however, the "alone" part of your question is probably the key. There are many ways to avoid being alone i.e. groups, clubs, activities. Intense and quick relationships rarely provide a relief from feeling alone. Its probably helpful to explore what "needs" you are looking to have met in the relationship and whether they are reasonable expectations of that person.

<wabbit> Why is it that we Bpds or at least I always want to superwoman, not being able to match up my demands and expectations?. My T called me superwoman!

<paulm1> being a superman or superwoman usually is a way to avoid feeling somewhat inadequate. However, many of us do this. We place unrealistic expectations on ourselves and then feel bad when we don't meet them. this isn't just a trait common to bpd...but good question.

<Moe43b> I hear that ODD in children will later become BPD as they become adults is this true cause my son will be so angry and what do you think about ECT for the borderline w/severe depression.

<paulm1> First re: ODD...I'm not aware of that research nor have I experienced that. That certainly doesn't mean that a child with a significant behavioral disorder can't develop a disorder like bpd.
Re: ECT I've actually seen some pretty good results with improving mood through the use of ECT. However, the ECT was directly targeting the neuro-vegetative signs of depression (can't sleep, can't eat, can't do anything). I have heard of ECT being used for the direct treatment of bpd.

<Chamia> My number one fear is being alone....how do you ever get rid of the totally EMPTY feeling that I feel all the time?

<paulm1> Feeling alone and feeling empty are very connected as you know, however, they are different. I think of the fear of being alone as being an indicator of how one experiences oneself and the relationship s/he has with him/herself. Emptiness, in my opinion, has to do with a sense of purpose and meaning. Working on bringing meaning to your life, a sense of purpose and course, is vitally important to filling the emptiness.  Unfortunately, many people try to combat the emptiness with relationships and mood altering chemicals...I often ask clients to look at what they could bring to life rather than waiting for something to fill the void.

<Perse> Why do we BPD have this tendency to drive others angry-mad and make them act irrationally? I can see the results but can't understand how it happens and why. done

<paulm1> In my opinion, people with bpd typically have a well-developed developed understanding of what makes others tick. That is, they are very perceptive and "in tune" with others. I certainly can't speak for your situation, but my experience has been that people with bpd can "pick the scab" of someone when they are feeling threatened. In addition, the unrealistic expectations that people with bpd typically have for others can often make others frustrated and upset.

<jadenshell> What major thing can parents of a BPD young adult do to help besides financially and trying to understand?

<paulm1> In my opinion, parents can really help by maintaining a consistent and supportive posture which can be difficult to do in the face of much turmoil. It sounds cliché or simplistic but it really is important. Providing a constant, secure environment and response to some of the internal chaos that people with bpd experience can be very therapeutic and supportive in the long run. My concern has always been when parents and loved ones "jump into the fire" in an effort to show support when what is often needed is to remain clear of the fire and available to them when the flames dim.

<Lauranator> In your experience, what is the best way to combat this all or nothing black and white thinking....this continues to be my biggest problem??

<paulm1> Practice, practice, practice, practice at looking at all of the subtleties and "in betweens' in the world. Some of my clients have practiced with looking at different shades of color or shades of gray. Others have practiced (retraining themselves if you will) by listing all the possibilities of what an ad on TV might mean. Looking for and "investigating" all the different possibilities and meanings about the things or events around them helps them to "take a minute and think through" what an event might mean before just reacting.

<Kellster> have there been any studies on the effects of pregnancy and the BPD woman? as in the traits becoming more pronounced during pregnancy? I exp. Several violent outbursts while pregnant, and it had been over 12 yrs since I had been so violent as to not care what physical harm I was causing myself and others.

<paulm1> I am not aware of any studies. The extreme changes in a woman's body chemistry during that period make that type of study very difficult to conduct.

<PattySanc> Is love addiction/relationship addiction related in any way to the BPD? I remember in the old days feeling "invisible" if I didn't have a man in my life. If he left, I was in fact "invisible" and it was intolerable to exist. I was unable to do daily living skills. Is this attachment disorder? Is this related to BPD?

<paulm1> It would seem less likely related to attachment disorder than bpd. The use of relationships or "someone in my life" to feel alive and important is a commonly reported experience by many people with bpd. In terms of an addiction, it is similar in that it often is a "void" or need that is going unmet, and many times, that need is a more internally-based need than an externally-based need (i.e.. self-acceptance, purpose, meaning, self-relationship issues).

<PattySanc> Thank you very much for being with us tonight Paul. We appreciate it very much. I think all of us have learned a great deal more about this disorder. I know I did.

<paulm1> Thank you for having me on as a guest, Excellent questions

<PattySanc> Excellent answers. That was a long two hours with a lot of challenging questions.