Borderline Personality Disorder NEA-BPD Family Conference - 2/03

On February 22 and 23, 2003 I attended a two-day workshop sponsored by NEA-BPD (National Educational Alliance for Borderline Personality Disorder which was formed in August 2001). Dr. Alan Fruzzetti, Ph. D., was the workshop lecturer and also presented at the October 2002 meeting in NYC. He is a Professor of Psychology at the University of Nevada and is the Director of their DBT and Research Program. 

The aims of the workshop were directed to establishing better communication patterns among the members of the family and in fact, the workshop could have value to all families and help all families learn better ways to communicate with one another whether there is BPD in the family or not.

Dr. Fruzzetti first indicated that there is not much known about the family functioning when an individual in the family has borderline personality disorder. Family studies are non-existent. But he acknowledged that the ways the family functions in that situation is known to be difficult for all the members because any time there is someone who is functioning poorly all members suffer. Negative patterns are established by all the members. Negative patterns of communication, negative emotions are expressed, arguments escalate which all lead to family distress and breakdown. The goal of good communication is to mutually describe the situation, how you feel, what your aim is, what your thoughts are about a situation and to be non-blaming, non-judgmental. 

Dr. Fruzzetti defined BPD according to Marsha Linehan�s 1993 guidelines. The core problem is pervasive dysfunction of the emotional regulation system (limbic, amygdala etc.) and this dysfunction affects the self (identity), interpersonal relationships (chaotic relationships, abandonment fears), one�s behavior (impulsive destructive behavior) and one cognitive ability (dissociation/transient paranoia). The emotional temperament (inborn) of someone with borderline personality disorder is extremely sensitive. They notice more on an emotional level and they have greater emotional response and their emotional responses do not return to baseline as quickly as someone else. Their emotional self-soothing skills are faulty as well and because of all of the above their ability to communicate their emotional distress and the ability of the care-giver or family to soothe the individual is mis-matched. The communication between the individual and the environment does not work in being supportive because there is no understanding between the two, there is frustration, escalation and invalidation. That message is received continuously by the person with the disorder because they cannot be understood emotionally by those around them and nor can the family be understood by the person with the disorder. There is no one to blame for this mismatch, it just exists and does damage all around. 

DBT has become the standard of care and is the only treatment that has proven to be effective. Approximately 50% of the people who have this therapy get better because they learn skills on emotional regulation, mindfulness, distress intolerance and communication. Approximately 33% do not improve and another 16% show some benefit but do no report feeling better. However, a great percentage of people with BPD have some co-morbidity which requires medication and other treatment in addition to DBT. 

The un-learning of defective patterns by the family and learning of helpful communication seems to me to be family - DBT (learning validating communication, mindfulness, distress tolerance etc.) A few caveats were presented such as the time for effective communication is not when the emotional dysregulation is present but rather when the situation is calm and people are more receptive. Having a mediator (therapist) help with communication certainly is warranted at times. 

Dr. Fruzzetti also touched upon primary and secondary emotional reactions. Many times anger is not necessarily what we are really feeling but rather it may cover up fear, shame, jealousy and frustration. As part of mindfulness it is important to start to learn to be aware of what emotion you are feeling, learn how to manage one�s emotions better, learn how to express oneself in clear accurate ways. 

I think that the workshop helped to clarify for me what the core problem of the disorder is and how this core problem affects all of the other aspects of the person and that person�s family. I believe that anyone that has a person in their life with this disorder would benefit by attending this kind of workshop as a primary introduction to creating a better communication climate. I would assume that DBT for someone with the disorder and Family DBT would benefit both sides of the equation. However, this workshop is only an introduction. It is clear that an on-going course over a period of weeks to months is really needed by the family to learn how to put the elements into actual practice. I think any family would find this type of education very rewarding in both the short and long term. In addition, learning better communication will carry over to all other relationships in life...

Compliments of Jillian Samuels who attended that conference.