Jets WR Brandon Marshall and his battle with Borderline Personality Disorder

10:13:00 AM

Brandon Marshall's problems on and off the field could be a result of his borderline personality disorder.

Jonathan Daniel/Getty Images

When the Jets acquired Brandon Marshall from the Chicago Bears, they got a big, physical wide receiver who will immediately upgrade what was the NFL’s worst passing offense in 2014. The Jets also got a volatile athlete with a troubling past that includes domestic violence incidents, run-ins with police and conflicts with teammates.

Marshall’s problems may stem from borderline personality disorder, a disease linked to severe depression, mood swings, substance abuse and reckless behavior. The good news for the Jets is that Marshall has not only received treatment for the condition, but he has become an advocate for the mentally ill.

Football is still Marshall’s career, but battling the stigma that comes with mental illness has been his passion since he was diagnosed with BPD in 2011 at McLean Hospital in Belmont, Mass. Marshall has said he wants to raise awareness of mental health issues like Magic Johnson raised awareness of AIDS after he was diagnosed with HIV.

“Today I am making myself vulnerable to help others who suffer from borderline personality disorder,” Marshall said during a 2011 news conference he called to discuss his diagnosis and mental health struggles. “I have seen my life with BPD and how it played out. My goal is to walk the halls of Congress to fight for the insurance coverage for this, and walk the halls of the National Institute of Mental Health to raise awareness of this disorder. That is my mission moving forward. I love the game, but it’s not my priority anymore. Today my journey begins." “I want to be the face of BPD,” he added.

Marshall spent three months at McLean in 2011 undergoing intensive evaluation and treatment. Dr. Lois Choi-Kain, the medical and program director at McLean’s borderline personality disorder unit, said Marshall should be applauded for going public with his mental health struggles.

“He has been very public about his diagnosis, and I think that is very positive,” said Choi-Kain, who has not met Marshall and was not involved in his evaluation and treatment. “It shows a lot of courage and it shows what he has learned from his own treatment.”

Borderline personality disorder may explain why Marshall may be the most intense player on the field one minute and the most lackadaisical the next. It explains why he could catch a league-record 21 passes in one game with the Denver Broncos in 2009 — and why he was suspended that same year for bumbling through practices.

BPD might also explain — but not excuse — Marshall’s ugly run-ins with the law and clashes with his wife, Michi Nogami, and other loved ones, most of which occurred before he received his diagnosis.

“Right now, today, I am vulnerable, I am making myself vulnerable,” Marshall said in 2011. “And I want to be clear that this is the opposite of damage control. The only reason I’m standing here today is to use my story to help others who may suffer from what I suffer from.”

People with BPD such as Marshall, Choi-Kain said, react to events with intense anger and rage. Relationships with spouses and other loved ones swing between intense emotions.

“They are either in a very good place or a very bad place,” Choi-Kain said. “There is no middle ground.”

BPD patients often engage in reckless and impulsive behavior. They frequently abuse drugs and alcohol, Choi-Kain said. They express suicidal thoughts, and sometimes act on them. BPD patients, especially when stressed, struggle with self-understanding, Choi-Kain added. They can become paranoid and distrustful.

“They feel everyone is their enemy,” she said.

Regardless of Marshall’s history of troubles, Choi-Kain believes he can serve as an effective advocate for the mentally ill.

“Having someone who is so successful and skilled, having a person of strength publicly show that kind of vulnerability, shows that he has a lot of compassion,” she said. “It shows he has learned a lot from his treatment.”

BY Michael O'keeffe

NEW YORK DAILY NEWS

Saturday, March 7, 2015, 11:39 PM

Borderline Personality Disorder

Mental Health :: Borderline Personality Disorder

1:06:00 PM

What is Borderline Personality Disorder?

Source: National Institute of Mental Health

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

Problems with regulating emotions and thoughts
Impulsive and reckless behavior
Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
Intense and highly changeable moods, with each episode lasting from a few hours to a few days
Chronic feelings of emptiness and/or boredom
Inappropriate, intense anger or problems controlling anger
Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year. BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

Psychotherapy

Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following:Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.

Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person's treatment.

Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section onpsychotherapy.

Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.

Medications

No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

Other Treatments

Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

Living With

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.

How can I help a friend or relative who has BPD?

If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

To help a friend or relative you can:

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.

Never ignore comments about someone's intent or plan to harm himself or herself or someone else. Report such comments to the person's therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

Talk to your doctor about treatment options and stick with treatment
Try to maintain a stable schedule of meals and sleep times
Engage in mild activity or exercise to help reduce stress
Set realistic goals for yourself
Break up large tasks into small ones, set some priorities, and do what you can, as you can
Try to spend time with other people and confide in a trusted friend or family member
Tell others about events or situations that may trigger symptoms
Expect your symptoms to improve gradually, not immediately
Identify and seek out comforting situations, places, and people
Continue to educate yourself about this disorder.

Borderline Personality Disorder

Conoce Tu Salud Mental :: Trastorno Límite de la Personalidad

12:59:00 PM

Articulo Original: MentalHealth.gov

El trastorno límite de la personalidad (BPD, Borderline Personality Disorder en inglés) constituye una afección de la salud mental en la cual una persona exhibe patrones emocionales violentos o inestables a largo plazo. Estas experiencias interiores a menudo son la causa de acciones impulsivas y relaciones caóticas con otras personas.

Causas

Se desconoce la causa del trastorno límite de la personalidad. Se cree que los factores genéticos, familiares y sociales pueden incidir en las causas.

Entre los factores de riesgo del BPD encontramos:

Abandono durante la infancia o la adolescencia
Vida familiar inestable
Poca comunicación en la familia
Abuso sexual, físico o emocional

Este trastorno de la personalidad tiende a aparecer con más frecuencia en mujeres y entre pacientes psiquiátricos hospitalizados.

Síntomas

Las personas con BPD a menudo no se definen con respecto a su identidad. Como resultado, sus intereses y valores pueden cambiar rápidamente. También suelen ver las cosas en términos de extremos, es decir, todo está muy bien o todo está muy mal. Su opinión de otras personas puede cambiar rápidamente. Es posible que la persona a quien hoy admiran sea menospreciada mañana. Estos sentimientos que cambian repentinamente a menudo crean relaciones intensas e inestables.

Otros síntomas del BPD son:

Miedo intenso al abandono
Intolerancia a estar solo
Sentimientos frecuentes de vacío y aburrimiento
Arranques frecuentes de ira inadecuada
Impulsividad, como con el abuso de sustancias o las relaciones sexuales
Crisis repetidas y autolesión, como cortes en las muñecas o sobredosis

Exámenes y pruebas

El BPD se diagnostica según una evaluación psicológica que analiza la historia y la gravedad de los síntomas.

Tratamiento

La terapia de conversación individual puede tratar exitosamente el BPD. Asimismo, la terapia grupal también puede ser de utilidad en ocasiones.

Los medicamentos desempeñan un papel menor en el tratamiento del BPD. No obstante, en algunos casos, pueden mejorar los cambios en el estado de ánimo y tratar la depresión u otros trastornos que pudieran producirse junto a esta afección.

Expectativas (pronóstico)

Las expectativas del tratamiento dependen de la gravedad de la afección y si la persona está dispuesta a aceptar ayuda. Con una terapia de conversación de largo plazo, la persona a menudo mejora gradualmente.

Posibles complicaciones

Depresión
Abuso de drogas
Problemas laborales, familiares y sociales
Intentos de suicidio y suicidio efectivo

Cuándo se debe contactar con un profesional médico

Consulte con su proveedor de atención médica si usted o una persona que conoce exhibe los síntomas del trastorno límite de la personalidad. Es muy importante buscar ayuda de inmediato si usted o alguien a quien conoce está pensando en cometer suicidio.

Nombres alternativos

Trastorno de la personalidad - límite

Referencias

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds.Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 39.

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