Q. I've been reading more of the questions and answers. I can see that your main concern is with immediate treatment and diminution of suffering, and I respect that very much. Since suicide is such an immediate risk alleviating the distress is the primary focus. I seem to be past the worst part of this syndrome, and I'm beginning to look forward to living another forty years. Can you recommend some researchers that are looking at long-term and/or causal research?

A. It is a great question you pose with no really good answer. To oversimplify just a bit, borderline research comes in two varieties. In variety one, you look at the symptoms that are present, and try to account for them from either a neurochemical or learned diathesis. Learning can obviously cause chemical changes in your brain, too. If you have a severe trauma, it can cause neurochemical changes in your brain. Likewise, having bad neurochemistry can effect learning. If you are depressed or anxious, you process information differently. This is the model I use. Someday it may lead to eradication of the illness via learning a cause, but for now, it minimizes suffering, which is the best we can do.

In research variety two, you assume that some force leads to borderline behavior, such as trauma, and that by getting to the root cause and eradicating its psychological conflict, you will make the individual better. Nice theory, but no data to support it.

All of the cause and effect mechanisms are theories. Actually, even the idea of having a positive therapeutic impact on BPD is really a new concept, as therapy was largely ineffectual until cognitive methods came along. Medications were poor until Prozac and its progeny. Long-winded answer. We do not know what to do after we get through the initial phases of treatment, and are still feeling our ways along. Hopefully, an insightful therapist and pharmacotherapist will get together in the near future, and actually come up with a research program to see how to move folks forward after the "standard" things are done.