Welcome to BorderlineUK

Borderline UK has been a national user-led network of people within the United Kingdom who meet the criteria, or who have been diagnosed with Borderline Personality Disorder (BPD) or, as it is often known in the UK, Emotionally Unstable Personality Disorder (Borderline Type). It has now become a part of The Shack (Mjtacc).

Here we aim to provide information on all aspects of BPD – how it is defined, current theories of what may cause it, treatment options and details of the latest news, conferences and initiatives in the field. It also contains information from Borderline UK original website.

We believe that those of us diagnosed BPD are experts through our own experience and are able to articulate our views and opinions in a constructive manner. We believe that we have the ability to use our experiences and knowledge in partnership with other professionals and services to bring about real, sustainable change that will benefit us all. Members of Borderline UK Ltd were involved with a number of projects nationally and locally – the impact of which are beginning to be felt across the country.

We feel that those of us diagnosed with BPD have the ability to provide a vast amount of support for one another. To this end Borderline UK Ltd had run Yahoo Groups in the past that allowed people diagnosed with BPD to communicate regularly through e-mail. These boards not only enable the isolation that so many of us have experienced to be reduced but also provided members with access to a wealth of information and support. Some experts are also part of other online communities like BPD or BrainGains.

Borderline Personality Disorder Information

This section of the site is designed to give a brief overview of Borderline Personality Disorder, how it is diagnosed, suggested causes and some of the available treatments. If you’ve just been diagnosed BPD (or just found out!) or if you’ve just come across those three wonderful letters and want to discover more, this is the section to start with.

BPD is not only a controversial diagnosis, but the arguments as to what causes it, how it is best treated etc. provoke heated debate all over the world. The only thing one can say with any certainty is that there is no consensus amongst MH professionals, researchers, carers or even BPs themselves. It’s easy to be overwhelmed by the amount of information out there, so the information on this section is very basic and very brief.

Please feel free to distribute the leaflet. If you would like us to send a leaflet out through the post then please email us at admin@borderlineuk.co.uk. Single copies are free. Anyone requiring multiple copies will be asked for a small contribution towards the cost of production and postage.

Causes

There is still a great deal of debate concerning the causes of Borderline Personality Disorder. It is perhaps more meaningful to talk of the factors that shape Borderline Personality, about which there is increasing agreement and research. Broadly speaking there are two schools of thought on the processes that lead to the development of BPD.

Attachment Theories

These models of the development of BPD emphasis the psychobiological and neurophysiological processes that influence personality. During the first five years of life, and in particular during the first two, a child’s brain is still growing and developing at a substantial rate. All the experiences that child has are directly influencing how various parts of the brain develop. Of prime importance in this process is the child’s interaction with its mother or primary care giver. Separation from the mother, or poor or negative nurturing (eg abuse, violence), can have a dramatic effect on the development on areas of the brain, especially those which handle emotions and social functioning.

“traumatic experiences, especially if severe, sustained and repetitive, lead to cell damage and premature death in key centers [of the brain] and wiring patterns that evoke unmodulated and maladaptive responses to the ordinary events of life.”
Kernberg et al, “Borderline Patients: Extending the Limits of Treatability”

It is perhaps this ‘hard-wiring’ that makes BPD and other PDs resistant to treatment. Whilst the brain is in a state of constant flux throughout adult life, it is harder to change the wiring pattern in later life. However, it is possible to learn to manage the behavioural difficulties that a differently wired brain may produce.

Whilst more is becoming known about what processes influence the development of BPD, far less is known about why certain individuals seem more prone to develop BPD (and other psychiatric problems) than others. It increasingly appears that there may be a genetic predisposition, given an adverse environment, for certain individuals to develop BPD.

Poor nurturing and an adverse environment is not guaranteed to result in a child experiencing psychiatric problems in later life; equally, good nurturing in a positive environment is no guarantee that a child will be free from psychiatric difficulties as an adult. However, a genetic predisposition towards psychiatric problems coupled with poor nurturing is far more likely to result in problems later in life.

Physical Causes

As research expands, more and more theories regarding the cause of BPD are being developed. Some of these theories suggest that BPD is a “neurological” illness – having little or nothing to do with environmental factors. Other recent research has suggested an interaction between a person’s early environment and their neurological development which may precipitate the onset of BPD. Of course, there are also those people who refute any neurological involvement at all.

Diagnosis

A WORD OF CAUTION: The personality traits described below are usually experienced by most people from time to time, especially adolescents. For these traits to be indicative of a personality disorder they must be long-standing, intense and persistent. Personality disorders are a notoriously controversial diagnosis, and making a self-diagnosis based on information on a web-page or in a book is not to be recommended. If you are at all concerned about your mental health, then seek professional help urgently.

As there are no physical or biochemical tests that can be made to establish whether someone does or doesn’t have BPD, clinicians use the criteria given in one of two psychiatric manuals. In Europe and the UK, most clinicians will use the ICD-10 Classification of Mental and Behavioural Disorders (World Health Organisation, 1992), whereas in America clinicians use the Diagnostic and Statistical Manual of Mental Disorders -DSM IV (American Psychiatric Association, 2000). Just to add to the confusion, the official label for BPD within Europe is Emotionally Unstable Personality Disorder (Borderline Type).

Misdiagnosis does, unfortunately, happen. Within the NHS you are entitled to request a second opinion – though there is no compulsion for such a request to be granted.

ICD-10 Diagnostic Criteria for Emotionally Unstable Personality Disorder

Impulsive Type

At least three of the following must be present, one of which must be (2)

1. Marked tendency to act unexpectedly and without consideration of the consequences
2. Marked tendency to quarrelsome behaviour and to conflict with others, especially when impulsive acts are thwarted or criticised
3. Liability to outburst of anger or violence, with inability to control the resulting behavioural explosions
4. Difficulty in maintaining any course of action that offers no immediate reward
5. Unstable and capricious mood

Borderline Type

At least three of the “Impulsive Type” criteria must be present, accompanied by at least two of the following:

1. Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual)
2. Liability to become involved in intense and unstable relationships, often leading to emotional crises
3. Excessive efforts to avoid abandonment
4. Recurrent threats or acts of self-harm
5. Chronic feelings of emptiness

DSM-IV Diagnostic Criteria for Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Do not include suicidal or self-mutilating behaviour covered in (5)
2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (eg spending, sex, substance abuse, reckless driving, binge eating). Do not include suicidal or self-mutilating behaviour covered in (5)
5. Recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood (eg intense episodic dysphoria, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (eg frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Treatments

Unfortunately, there are still health professionals in the world who regard personality disorders as basically untreatable. This extreme position is, of course nonsense, but there is no doubt that Personality Disorders constitute one of the greatest challenges facing mental health professionals today. Borderline Personality Disorder attracts an ever increasing amount of investigation and research, particularly in the United States.

Treatment includes psychotherapy and other ‘talking therapies’, in a one-to-one or group setting, that allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgemental therapist. Therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in their usual self-defeating ways. Different therapists will adopt different treatment strategies depending upon their particular school of thought.

Medications such as anti-depressants or anti-psychotic drugs may be useful for certain patients or during certain times in the treatment of individual patients. For more information see Tyrer and Bateman: “Drug treatment for personality disorders”. Treatment of any drug or alcohol problem is usually necessary if therapy is to be able to continue. Brief hospitalisation may be necessary during extreme stressful episodes, and, in the UK at least, you are likely to be hospitalised without your consent (‘sectioned’) if your therapist, GP or an Approved Social Worker believes you are a danger to yourself or to others. There is some research to suggest that long term hospitalisation for borderlines can be counter-productive.

Out-patient treatment is usually difficult and can sometimes take a number of years. Research suggests that borderlines being treated in an out-patient environment have an exceedingly high drop-out rate. Although recent research shows that psychosocial out-patient care can be highly effective if it immediately follows a brief in-patient stay in a therapeutic environment. Chiesa, “Time limited psychosocial intervention with patients with severe personality disorder following shorter inpatient stay.”

Effectiveness of Treatment

As yet, there have been only a few studies conducted assessing the effectiveness of the various types of treatment. These would indicate that the short-term prognosis is usually poor. Chronic symptoms, high relapse rates, poor employment and poor psychosocial functioning are reported in the short-term following treatment. The long-term outlook for borderlines is more optimistic as research suggests that symptoms such as dysphoria, impulsiveness, disturbed relationships and micropsychotic symptoms decrease over time, and also indicates that 75% of cases no longer meet the criteria for BPD fifteen years after initial diagnosis. So, if we can keep ourselves alive then the chances are we’ll eventually get better!

Availability of Treatment

The availability of treatment, particularly therapies, within the US & UK is far from adequate. Waiting lists are often very long, and the type of therapy available can vary considerably depending on your geographical location. Age can also play a part in that many health authorities and clinicians are unwilling to treat older people on the grounds that they respond less well to therapy. Long term therapy is expensive and it is worth remembering that cost effectiveness is usually the over-riding concern for Local Health Authorities.

Key Concepts

There are quite a few concepts that you’ll come across in the literature on BPD that can be difficult to get your head around. This is our guide to some of them.

Depersonalisation

Depersonalisation is the state in which an individual feels ‘unreal’ or detached from himself. This can include:

• Feelings of watching oneself from a distance (akin to an ‘out of body experience’)
• Feelings as if one were in a dream
• Feeling that one’s voice or movements are not under one’s control
• Inability to experience feelings
• Inability to experience emotions ‘normally’ – which may lead to difficulties in daily living

Depersonalisation can be experienced by normies. For example, following sleep deprivation, during meditation or transiently under stress. Depersonalisation can also be induced by alcohol, cannabis and other mind-altering substances.

In the world of mental health, depersonalisation is seen both as a symptom of psychiatric disorder and as an illness in its own right. Depersonalisation has been seen to occur in most well-known psychiatric conditions (e.g. depression, panic attacks etc) but has also been seen to occur on its own. In the latter scenario, it is referred to as ‘Primary Depersonalisation Disorder.’

What causes depersonalisation?

There are many theories as to the cause of depersonalisation. It is most likely that a disruption or imbalance within the temporal lobe region of the brain is involved in the mechanism of depersonalisation.

MRI studies showed that while patients with depersonalisation were capable of recognising emotive stimuli (e.g. photos of unpleasant scenes and facial expressions), the brain regions involved in emotion perception (the amygdala and insula) showed less activity than in a control group.

The MRI studies also revealed that patients with depersonalisation also show increased activation in the frontal cortex when exposed to emotive stimuli. Basically, individuals with depersonalisation do not perceive emotion ‘normally’

It has also been noted that depersonalisation patients show decreased autonomic nervous system response to emotive stimuli; adding weight to the argument that depersonalisation is caused by abnormal neural networking.

What is the difference between depersonalisation and dissociation?

In layman’s terms, depersonalisation and dissociation are used interchangeably.

Depersonalisation is a symptom that occurs in dissociative disorders.

Can medication help?

The neurotransmitter, glutamate, has been implicated in depersonalisation. Consequently, anticonvulsants with glutamate antagonist properties (e.g. lamotrigine) may improve depersonalisation symptoms.

Where can I get help?

The Depersonalisation Research Unit (based at Maudsley Hospital, South London) offers an outpatient clinic.

Transference

Transference is when individuals transfer emotions to their therapist that were originally attached to someone else in their life, past or present. (This figure is often a parent.) Individuals will feel and act towards the therapist, as they would towards the other person. For example, if an individual believed that his parents disliked him, this individual might develop feelings that his therapist disliked him as well and act accordingly. Transference is almost always a subconscious process.

Transferred feelings can range between love to hate, but the key is that they are feelings that are not related to the patient-therapist relationship, they have arisen from elsewhere in the patient’s life

Some literature suggests that transference is a positive thing as it allows great insight into the patient’s subconscious including internal conflicts and past relationships. Also, as the therapist and patient work through the transference, it may enable the patient to accept past events (some of which may have been repressed) and to relate to the therapist (and consequently the person who had originally given rise to these emotions.)

The concept of transference can be seen throughout the psychotherapy spectrum; however, it is most commonly seen in psychodynamic psychotherapy. This is possibly because psychodynamic therapy tends to concentrate on attitudes and feelings developed early in life, whereas cognitive therapies tend to concentrate more on the present.

With regards to therapies for borderline personality disorder (BPD), the concept of transference is most often used to better understand childhood interpersonal relationships and internalisation’s which often emerge as repeating patterns during adult life.

Counter-transference

Counter-transference describes the feelings that the patient evokes in the therapist (e.g. excessive involvement, dislike, attachment.) Therapists are encouraged to examine these feelings, in order to understand them and prevent them from affecting the working relationship.

Although counter-transference is influenced by the therapist’s past experiences, it is also believed to give clues as to the subconscious of the patient.

Because borderlines have the tendency to “split” (switch between idealisation & hatred) with their therapists, it is not uncommon for counter-transference to arise in BPD therapy. Therapists may be reacting to “splitting” as well as contending with the BP’s transference.

Dr M Kraft Goin (Psychiatry Times, 1998) writes that:

“by engaging with patients in a consistent and constructive manner, despite splitting, therapists will help their patient develop more emotionally mature psychological processes. This, in time, should limit the problem of counter-transference”.

Psychosis

The term “psychosis” refers to a group of psychiatric symptoms describing someone who has an interpretation of reality that differs from others of the same culture.

Although many people assume that someone who experiencing psychotic symptoms is schizophrenic, psychosis can occur for a number of reasons. In fact, it is estimated that between ten and fifteen percent of the population will experience at least one psychotic symptom at some point in their lives.

Psychosis can be caused by infection, head injury, sleep deprivation, hormone changes (e.g. during PMT or following childbirth) or the effects of drugs/alcohol. It can also be caused by a number of mental health disorders, including schizophrenia, depression and manic depression. People with Borderline Personality Disorder tend to experience psychosis transiently when under extreme stress.

Psychosis manifests via the following symptoms:

1. Hallucinations – sensory perception without outside stimuli. Hallucinations can occur by any/all of the five senses, although the most common hallucinations are auditory (hearing voices.)
2. Paranoia – a type of persecutory delusion in which the individual believes that other people or groups are out to harm them. n.b. Some people confuse the terms “psychotic” and “psychopathic”. Psychotic means that someone’s interpretation of reality is distorted (as described above), whereas psychopathic describes someone who behaves in an antisocial manner, shows little or no guilt for their antisocial actions and has difficulties forming emotional relationships.
3. Delusions – false beliefs held with no basis and which are not based in reality.
   • delusions of grandeur – individuals believe they have special powers or characteristics (e.g. believing they are God)
   • delusions of reference – individuals believe that people are making secret references to them (e.g. in television programmes or newspapers)
   • delusions of persecution – individuals believe others are plotting against them
   • thought insertion – individuals believe that other people can put thoughts in their heads (thereby controlling their behaviour)
   • thought broadcasting – individuals believe their thoughts are being broadcast out loud n.b. thought insertion and thought broadcasting are more common of schizophrenia psychoses, as opposed to the psychoses associated with Borderline Personality Disorder.

Medications

1.0 INTRODUCTION

The use of medication to ‘treat’ borderline personality disorder is, to say the very least, controversial. This terminology would imply it is possible, and desirable, to treat personality itself.

There are a number of general concepts that should be borne in mind when considering medications:

1. Medication should ideally be used in the context of an overall care-plan which includes psychotherapy. It is recognised that only psychotherapy can produce the interpersonal changes that are needed for the eventual cure of borderline problems. However medication can reduce the severity of perceptual disturbances, emotional turmoil and impulsive behaviour and can allow the BP to engage more productively in psychotherapy.
2. Borderline personality disorder is a multidimensional syndrome and no one medication is effective across the full spectrum of symptoms. Individual symptoms need specific medications.
3. Borderline personality disorder is a chronic disorder and at best, medication can offer only modest symptom relief.
4. At the time of writing good, impartial evidence for the efficacy of medications is lacking. Any information included herein may be superseded relatively quickly. However, the situation that exists in Britain is that psychotherapy is often not readily available to patients with BPD. Consequently, the vast majority of patients are treated by their psychiatrist or general practitioner, who are hard-pressed for time and resources and frequently conceive medication to be the best, and sometimes only, option.

2.0 ANTIDEPRESSANTS

Some symptoms of BPD are common to those observed in depression e.g. emptiness, hopelessness, lack of energy etc. Of course, it is possible for depression to exist concurrently with BPD and many of these symptoms are improved with antidepressant treatment. They may also be used to treat such symptoms as impulsive aggression, self-mutilation, anger and labile mood. They may also be used to treat the symptoms of anxiety, reduce panic attacks and alleviate the painful feelings, dysphoria, described by many sufferers.

All antidepressant medications may take several weeks before they have any noticeable effect on mood. It is important to persevere with treatment, at a recognised therapeutic dose, and give them an opportunity to have an effect.

2.1 TRICYCLIC ANTIDEPRESSANTS (TCA)

These older generation antidepressants are very effective and exert their effect by increasing levels of the neurotransmitters serotonin and noradrenaline (norepinephrine) in the brain. However, they have a number of common, unpleasant side-effects (which may appear before mood improves) and are very toxic in overdose. Sometimes discontinuation effects are experienced if the medication is stopped suddenly. In order to avoid this problem, a gradual tapering of the dose is recommended.
eg amitryptyline (Tryptizol®), clomipramine (Anafranil®), dothiepin (Prothiaden®), lofepramine (Gamanil®) and many others.

SIDE EFFECTS: Drowsiness, constipation, dry mouth, blurred vision, weight gain.

2.2 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)

This newer group of antidepressants all act to increase the brain levels of the neurotransmitter serotonin. The side effect profile is generally more acceptable and they are safe in overdose. They can be associated with a paradoxical increase in anxiety for the first week or so, but this should pass. There have also been many reports of a withdrawal (discontinuation) syndrome, especially with paroxetine. This may be avoided by a very gradual reduction in dose. They are taken as a single daily dose.
eg fluoxetine (Prozac®), paroxetine (Seroxat®), citalopram (Cipramil®), sertraline (Lustral®), fluvoxamine (Faverin®).

SIDE EFFECTS: Nausea and vomiting, insomnia, sexual dysfunction, loss of appetite

PAROXETINE: please be aware of the recent developments in relation to this drug and seek advice if you are at all concerned. Further information is available here. The relevant details are in “paraxoetine and pediatric and adolescent clinical trial data.”

2.3 MONOAMINE OXIDASE INHIBITORS (MAOI)

This is an older group of drugs that are used much less routinely. They may still be used to treat atypical depression (ie excessive sleeping, increased appetite, weight gain) and depression associated with obsessional thoughts, panic attacks and anxiety. They are toxic in overdose and are subject to a number of dietary restrictions and interact with a number of commonly available medicines.
eg isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate)

SIDE EFFECTS: Dizziness/faintness on standing (postural hypotension), drowsiness, dry mouth, constipation.

2.4 OTHER ANTIDEPRESSANTS

As these medications are relatively new to the scene, controlled studies are few and far between. Individual case reports have shown that some of these drugs are effective in certain individuals, though these effects may not be reproducible. The usual processes of testing new drugs against existing ones have not yet been performed, but trials are underway; some of more dubious standards than others.

2.4.1 Venlafaxine (Efexor®) is described as a serotonin and noradrenaline re-uptake inhibitor (SNRI). It is essentially a “cleaned up” version of a tricyclic antidepressant that lacks the sedative properties and other common side effects of the TCAs. It is also safer in overdose. It needs to be taken twice daily as a tablet, but a long acting capsule is available that only needs to be taken daily. The capsule form may cause less nausea initially.

Some trials have suggested that it is superior to other antidepressants in treating resistant depression and also that it may be more effective than SSRIs, particularly in the in-patient setting.

It’s side effects are similar to those of the SSRIs ie nausea, headache etc. Excessive sweating has been reported and it has a strong withdrawal syndrome. Occasionally, high doses of venlafaxine (ie greater than 200mg a day) can cause an elevation in blood pressure; therefore, blood pressure monitoring is advised if higher doses are being taken.

2.4.2 Reboxetine (Edronax®) is a selective noradrenaline re-uptake inhibitor (NARI). It needs to be given twice daily. It may possibly be more effective in severe depression and it may improve social functioning. The most common side effects are dry mouth, constipation, sweating and insomnia. It is not sedative and does not potentiate the effects of alcohol.

2.4.3 Mirtazepine (Zispin®) is classified as a NaSSA, or noradrenaline and specific serotonin antidepressant. It’s most noticeable effect is drowsiness, which may help people who suffer from insomnia. For this reason, it is usually given as a single dose at bedtime. In addition, weight gain as a result of increased appetite is common. Again, this may be advantageous if loss of appetite is a predominant symptom. A serious, though very rare side effect of mirtazepine, is a lowered white blood cell count. Patients taking this medication should note than any sign of infection, eg sore throat etc should be reported to a doctor. On a more positive note, it is less likely than most other antidepressants to interfere with sexual functioning. It is sometimes added to treatment with an SSRI, to enhance their antidepressant effect.

2.4.4 Nefazodone (Dutonin®) is related to one of the older types of medications (trazodone) and may be described as a serotonin receptor modulator (SRM). It increases the transmission of both the neurotransmitters serotonin and noradrenaline. It is a sedative-type antidepressant and has a specific effect in improving sleep patterns. It needs to be taken twice daily, and the dose must be gradually increased to the required dosage. A “starter pack” is available to make this increasing dosage simpler to take. Sexual side effects are reported much less commonly with nefazodone than other antidepressants.

3.0 ANTIPSYCHOTICS (MAJOR TRANQUILISERS, NEUROLEPTICS)

These medications are probably the most studied in the treatment of BPD and have been used successfully, over a number of years, to alleviate some of the symptoms of BPD. Some examples of symptoms reported to be improved are anger, irritability, hostility, dissociative symptoms, self-destructive impulses, hallucinations, paranoid thoughts and also intense anxiety. Despite their alternative name (tranquilisers), these medications are not addictive.

They exert their main effect by altering the effect of another of the brains neurochemicals, dopamine.

3.1 OLDER GENERATION NEUROLEPTICS / TYPICAL ANTIPSYCHOTICS

These medications have been used successfully for many years to treat various psychotic illnesses. They have a number of very unpleasant side effects, which limit their use now, as more acceptable alternatives are available. However, they are still very widely used and effective treatments are available to relieve some of the side effects. The main advantage they offer over more recent developments is that some are available as a depot injection. This allows the medication to be administered as an intramuscular injection once every few weeks. This eliminates the need to remember to take tablets every day. They may also be used in hospital settings to achieve rapid control of a difficult situation.
eg chlorpromazine (Largactil®), flupenthixol (Depixol®), fluphenazine (Moditen®, Modecate®) haloperidol (Serenace®, Haldol®), trifluoperazine (Stelazine®) and others.

SIDE EFFECTS: As mentioned above, these treatments frequently cause uncomfortable side effects (technically termed extra-pyramidal side effects). These include a sensation of inner restlessness or agitation, involuntary movement disorders and rigidity. The most concerning problem is known as tardive dyskinesia – a writhing of the tongue and mouth, which if develops, may persist even after the medication is discontinued. The problem is more common with higher doses given over a long time. Most of these symptoms can be alleviated with another type of medication (eg procyclidine).Other, less serious side effects include drowsiness, constipation, dry mouth, weight gain, blurred vision and altered menstrual cycle.

3.2 NEWER GENERATION NEUROLEPTICS / ATYPICAL ANTIPSYCHOTICS

There has been a lot of coverage in the media recently that patients should receive these newer medications as first line treatment. As they do not have the extra-pyramidal side effects of the older drugs, they are much more acceptable to patients and more likely to be taken regularly. Although they vary markedly in their chemical make up, they all produce their effect by affecting both dopamine and serotonin in the brain.

There have been individual case reports that clozapine may reduce self-harming behaviours. However, it is not commonly used, as regular blood tests must be performed to prevent serious infections developing.
e.g. olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), amisulpiride (Solian®), clozapine (Clozaril®)

SIDE EFFECTS: weight gain, drowsiness, excessive salivation, constipation, low blood pressure are amongst just some of the wide ranging reported side effects of these drugs.

4.0 MOOD STABILISERS / ANTI MANIC DRUG

Medications that come under this heading have primarily been investigated for the treatment of manic-depression (bipolar affective disorder). However, one of the most commonly reported symptoms of BPD are intense mood swings, which have been alleged to improve with mood stabilising treatments. Explosive anger, aggression and self-mutilation may also be diminished with mood stabilisers. Symptoms such as anger may occur as part of the clinical depression picture. In such instances, mood stabilisers may have a better effect than antidepressants, which can cause an increase in aggression, particularly during the early stages of treatment. They are also combined with antidepressants to augment their efficacy.

4.1 LITHIUM (Priadel®, Camcolit®)

Lithium has been used as a medication since the 1960s and much is known about its effects, although it’s precise mechanism of action is still unclear. A number of reputable trials have indicated lithium as effectively minimising mood swings in BPD patients. It has been reported to induce “reflective delay”, i.e. reducing impulsivity and giving more consideration to ones actions. Despite it’s efficacy, it is a very toxic substance, which must be very closely monitored by regular blood tests to prevent blood levels becoming dangerously high. It can interact with other medications to produce concentrations above the acceptable range. It is not uncommon that problems of the thyroid gland develop which may require replacement thyroxine treatment. Routine testing of the thyroid gland, kidneys and bone chemistry are also performed.

SIDE EFFECTS: Tremor, nausea, diarrhoea, excessive thirst, frequent urination and weight gain are common, non-serious side effects that may improve with continued treatment. Signs of excessive amounts of lithium in the blood are unsteadiness, confusion and blurred vision.

4.2 CARBAMAZEPINE (Tegretol®)

This is the most commonly used alternative to lithium, as it is much safer and requires less blood sampling. A number of trials have been conducted which have cited that it reduces the frequency and severity of aggressive outbursts. The incidence of suicide attempts has been shown to be reduced, and the intensity of anxiety and anger was improved.

SIDE EFFECTS: Drowsiness, double vision, dizziness, nausea and vomiting are the most commonly reported side effects. There is a very slight risk of the white blood cell count being seriously reduced (agranulocytosis), preventing the ability to fight infections. Although this risk is slight, it is important to mention any sign of infection to your doctor.

4.2.1 OXCARBAZEPINE (Trileptal®)

As yet, oxcarbazepine has not been studied in the treatment of BPD. However, as it is related to carbamazepine and is thought to be of a similar efficacy, it is likely that it will be tried in patients who are unable to tolerate carbamazepine due to unpleasant side effects.

4.3 SODIUM VALPROATE (Epilim®)

Again, used as an alternative to lithium. A very small study suggested that valproate effectively treated impulsive aggressive behaviour in BPD, which had not responded previously to an SSRI antidepressant. It is a relatively safe drug, which is generally well tolerated among patients. There is a slow release version, which needs only to be taken once daily.

SIDE EFFECTS: Increased appetite, weight gain, nausea, stomach irritation and drowsiness are the most common side effects. Very rarely, the liver can be affected. Regular liver tests are performed at the beginning of treatment.

4.3.1 VALPROATE SEMISODIUM (Depakote®)

This is a newly launched drug which converts in the body to valproate (as above). At present, it is thought to have very little advantage, if any, over the original version. Obviously it is too early to comment as to whether it improves the functioning of BPD sufferers.

4.4 OTHERS

ie lamotrigine (Lamictal®), clonazepam (Rivotril®), gabapentin (Neurontin®), tiagabine (Gabitril®), topiramate (Topamax®) and vigabatrin (Sabril®)

There is growing interest in the use of these agents as mood stabilisers and the list of individual case reports is ever increasing. However, as larger, controlled trials have not been performed, there is no definitive decision as to whether they are effective or not.

5.0 ANXIOLYTICS AND HYPNOTICS (MINOR TRANQUILISERS, SLEEPING TABLETS)

Anxiety and insomnia can often be quite disabling and distressing features of BPD. In many cases, therapy of some description is the most ideal, long term solution. However, during periods of increased stress, BPs may find the crisis too difficult to cope with and medication may be used on a short term basis. As mentioned earlier, SSRIs are often used to control symptoms of anxiety and long term use, if necessary, is a safer and more desirable option

5.1 BENZODIAZEPINES

eg diazepam (Valium®), nitrazepam (Mogadon®), temazepam, lorazepam (Ativan®) and others.

Historically, these agents have been used to treat anxiety and insomnia as a first line treatment. However, their potential for dependence, withdrawal effects and abuse have led to them becoming a less favoured approach. All available benzodiazepines reduce anxiety at low doses and induce sleep at higher doses, and are thus essentially all the same. The differences are in their length of action. For the treatment of anxiety, a product with a long duration of action is preferable as they are less likely to cause withdrawal problems. Benzodiazepines with a shorter duration of action are preferred to treat sleeplessness as this is less likely to cause a “hang-over” effect the following day, which may impair daytime performance.

Their use is not encouraged in patients with BPD as they may cause a paradoxical increase in hostility and aggression. They are also known to be disinhibiting, which may exacerbate behavioural impulsiveness. They can trigger flashbacks and in the long term, may worsen depression.

Benzodiazepines are both physically and psychologically addictive. This leads to their most troublesome effect; an inability to stop taking them if they have been taken for a long time. Withdrawal effects of benzodiazepines are characterised by insomnia, anxiety, loss of appetite and body weight, tremor, perspiration and ringing in the ears. For this reason, if a benzodiazepine has been taken regularly for a long time (ie longer than the recommended maximum of three weeks), it should be withdrawn very slowly, with additional support from a doctor or therapist. These effects are unlikely to happen if taken only occasionally.

SIDE EFFECTS: In addition to those mentioned above, benzodiazepines can cause dizziness, confusion and unsteadiness on the feet.

5.2 BUSPIRONE (Buspar®)

This is a unique product for the treatment of anxiety states (with or without accompanying depression). It seems to increase levels of dopamine and noradrenaline, whilst decreasing the action of serotonin and acetylcholine. However, it’s full mode of action is not known. When used in addition to an SSRI, it may counteract the problematic side effects caused by these drugs. It may take up to two weeks for any effect to show, and whilst it is not addictive, it is only recommended for short term use. It is therefore not suitable for treating acute anxiety states. It does not produce dependence and there is no withdrawal reaction on discontinuation of therapy. Doses higher than those published may be required to produce a noticeable effect.

SIDE EFFECTS: Dizziness, headache, nausea, restlessness, “light headedness” and excitement are most likely to occur early on in treatment.

5.3 OTHER HYPNOTICS

ie zopiclone (Zimovane®), zolpidem (Stilnoct®), zaleplon (Sonata®).

These newer sleeping tablets have very differing chemistry, but they are grouped together as they are all rapid acting, non-benzodiazepine drugs. They are claimed to be non-addictive and dose increases are not supposed to be required, however in practice people do report difficulty coming off them and needing higher and higher doses. Zaleplon is an ultra short acting drug that can be taken in the middle of the night if early waking is a problem. There is likely to be no hangover effect as a consequence of its rapid action. If necessary, two doses can be taken in the same night. Zopiclone and zolpidem have been shown to increase overall sleep duration.

SIDE EFFECTS: Headache, memory disturbances, metallic taste (zopiclone), dizziness and light-headedness are most likely to be encountered.

5.4 BETA-BLOCKERS

Drugs such as propranolol (Inderal®) and oxprenolol (Trasicor®) are mainly used to treat heart and blood pressure problems. However, they can help control some of the more physical signs of anxiety such as tremor, shaking, racing heart beat, sweating. These symptoms can induce further anxiety and a vicious circle is set up. Beta-blockers are effective at breaking this cycle. They are also effective at relieving the sensation of restlessness caused by some of the older generation antipsychotics. As they are not addictive, they are suitable for long term use.

SIDE EFFECTS: Fatigue, cold fingers and toes, nightmares and sexual dysfunction are relatively common occurrences.

Therapy Guide

Aromatherapy

Aromatherapy is the use of essential oils (which have been extracted from various organic material) for therapeutic purposes.

How Aromatherapy Works

In order for aromatherapy to work, the essential oils need to enter the body. They can do this by two methods: inhalation and absorption.

Inhalation

The smell of the essential oil stimulates the olfactory nerves, which are located at the back of the nose. (Olfactory is the posh way of saying “something involved with the sense of smelling.”) From the olfactory nerves, messages are transmitted to the olfactory bulb which is located in the limbic system of the brain. The limbic system is very important in many body activities, especially the expression of mood and activities within the endocrine (hormone) and motor systems.

In the limbic system, the oils may affect the pituitary gland (which regulates hormone production and gland activity.) They may also affect the hypothalamus (which affects both the appetite and the autonomic nervous system; the part of the nervous system involved in involuntary activity, e.g. heart beating, breathing etc.) Basically, inhaling essential oils can have many different affects on the body.

Also, as well as travelling to the olfactory bulb in the limbic system, the inhaled oils also travel the lungs where they are absorbed into the bloodstream. (They can then affect the body via “absorption means” which are described below.)

Absorption

When essential oils are applied to the skin, they are absorbed into the bloodstream. Once in the bloodstream, they either increase the levels of vitamins, nutrients etc that are naturally produced in the body (different oils affect different nutrients) or they increase the activity of the immune system.

The Different Ways of Using Aromatherapy Oils

• Bath
  Run hot bath. Once the bath is run, add approximately 6 drops of essential oils to the bath and swish water around. Soak in bath for at least ten minutes.
  n.b. It is advisable to dilute the oils in a carrier oil base as this makes for easier mixing with the water. Otherwise, you are likely to end up with a layer of the oil on the top of the water (as oil & water do not mix well.) You are then likely to get into the bath and sit directly in non-diluted oils which will hurt a lot. (take it from someone who spent 2 days with very sore thighs and other bits!)
  You can use a “normal” carrier base, or you can get special bath carrier which will give you bubbles! n.b. Do not use bubble bath etc at the same time as the chemicals may interact with the oils.
• Burner (Room Burner / Oil Burner / Vaporiser / Diffuser)
  Fill the top of the oil burner with cold water and then add a few (between 3 and 5) drops of the oil to the water. Light a candle in the base of the burner. The candle will slowly heat the water and as it evaporates, it will carry molecules of the oil throughout the room.
• Compress
  Fill a basin with hot or cold water and add approximately five drops of the essential oil to the water. Swish it about to mix it up. Put flannel into water, squeeze out excess water and apply flannel to affected part of the body. Compresses are often used for headaches and muscular aches.
• Cream (Lotions)
  Add 1-2 drops of essential oil to every 5 ml of carrier lotion. You can then gently rub the lotion into the skin.
  n.b. It is a good idea to store extra lotion in a dark glass bottle to prevent the sun from reacting with the oils in the lotion.
• Footbath
  Add a few drops of oil to a bowl of warm water and soak feet for at least 20 minutes.
• Inhaling
  Inhaling can be done in various ways. Add a couple of drops to a tissue and sniff as & when. Place a few drops on your pillow prior to bedtime and you can inhale throughout the night. Add a few drops of oil into a bowl of steaming water and inhale the fumes (max of 10 minutes).
• Massage
  Mix essential oils into carrier oil (approximately one drop of oil to 2ml of carrier oil)
• Neat
  Apply a few drops of undiluted oils, using fingertips or cotton bud. (Only Lavender, Chamomile, Tea Tree and Lemon are safe to use neat.)

Further Information about Aromatherapy

https://draxe.com/health/borderline-personality-disorder/

https://paintedbrain.org/painted-brain-media/news/aromatherapy-and-mental-wellbeing

• Before you start using any essential oils, talk to a qualified aromatherapist.
• If you are taking any prescription medication or over-the-counter medication, discuss possible essential oil interactions with your chemist, doctor or a qualified aromatherapist.
• If you have high blood pressure, do not use cinnamon, clove, hyssop, rosemary, sage or thyme.
• If you are pregnant, best to consult with an aromatherapist before you use any essential oils. But definitely avoid aniseed, basil, camphor, cedarwood, chamomile, cinnamon, citronella, clary sage, clove, cypress, fennel, hyssop, juniper, marjoram, myrrh, nutmeg, oregano, parsley, peppermint, rosemary, sage and thyme.
• If you are epileptic, do not use basil, clary sage, eucalyptus, fennel, hyssop, rosemary or sage.
• If you are diabetic, avoid angelica, eucalyptus, geranium and lemon.
• The following oils are phototoxic (i.e. interact with sunlight and you are likely to end up with a fantastically painful sunburn) bergamot, lemon, grapefruit, lime, orange & other citrus oils.
• Many oils should NOT be combined with alcohol as they may induce hallucinogenic effects.
• If you have sensitive skin, it is best to test an aromatherapy blend on a small area of skin before using it on a larger area. The following oils may irritate sensitive skin: basil, bergamot, citronella, fennel, ginger, grapefruit, lemon, lemongrass, orange, peppermint, scots pine, tea tree and ylang ylang.
• NEVER USE ESSENTIAL OILS INTERNALLY.

Dialectical Behavioural Therapy

This form of treatment was devised by Marsha Linehan (1993) and is a systematic cognitive-behavioural approach to working with individuals who meet criteria for borderline personality disorder with the aim of reducing suicidal or other severe dysfunctional behaviours. The emphasis is on “dialectics” – the reconciliation of opposites in a continual process of making the individual whole. It addresses self harming behaviour, encourages acceptance and validation strategies with training in the acquisition of new skills. DBT tries to get the person to reflect on their own thoughts and feelings without the need to act upon them, and is delivered by trained therapists either one-to-one or in a group. People receiving DBT may also receive telephone support from the therapist. This is usually given for 1 to 4 hours per week and lasts for at least one year. The participants are expected to maintain a diary between sessions.

According to Linehan DBT consists of a combination of:

“concomitant weekly individual behavioural psychotherapy sessions and psycho-educational skills training groups in its treatment plan. Individual therapy focuses primarily on motivational issues, including the motivation to stay alive, and the specific session agenda is determined by the patient’s behaviour since the last session. Behaviours highest on the dialectical behaviour therapy target list that are still problematic receive the most attention. Group therapy teaches self-regulation and changes skills (interpersonal, emotional-regulation skills) and self and other acceptance skills (distress tolerance, mindfulness skills). As whole, dialectical behaviour therapy blends validation and acceptance treatment strategies (similar to client-centred, Eastern and Zen psychologies, and psychodynamic approaches) with comprehensive cognitive behaviour therapy (including problem solving, contingency management, cognitive modification, exposure-based procedures and skills training)” (Linehan, M.M et al, 1994)

Ref: LINEHAN MM, TUTEK DA, HEARD HL, ARMSTRONG HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry, 151:1771-6, 1994.

Early Development of DBT

“Pilot study of the efficacy of a psychosocial intervention for frequent parasuicide attempters with personality disturbance” (Prof Peter Tyrer at Imperial College, Academic Unit of Psychiatry, London. December 1998)

The goal of this study was to evaluate a new (at the time) form of psychological therapy, which was based on Dialectical Behaviour Therapy (DBT) which had been developed in the U.S. This therapy was referred to as “manual-assisted cognitive therapy” (MACT) and was delivered by one therapist for up to six sessions. This study compared MACT with treatment as usual (TAU.)

34 patients (criteria: at risk of self harm, at least 2 previous self harm episodes in the last year and diagnosed with “personality disturbance in the flamboyant cluster”) were chosen and assigned to either MACT or TAU groups. These patients and their progress were reviewed after six months.

The results were as follows:

• Rate of suicidal acts per month was lower with the MACT group
• Depressive symptoms (self rated) were significantly improved within the MACT group
• MACT cost of care was 46% less expensive than TAU

Following this study, it was decided that MACT was indeed a possible NHS treatment, but that research with a larger sample had to be carried out. Funding was obtained via the MRC (Medical Research Council) to perform studies at seven centres throughout the U.K.

EMDR: Eye movement desensitisation and reprocessing:

EMDR is a relatively new form of therapy. It is used to ‘dissipate’ traumatic memories so that they can be worked through in therapy. It has been suggested that a few sessions of EMDR can be equivalent to many months of other talking treatments.

Many mental health problems (including BPD) have arisen from some form of early trauma. The traumatic event becomes frozen in the individual’s mind and may be recalled long after the original event. These memories are usually vivid, detailed and evoke strong emotions. Often, the ‘flashbacks’ of trauma can be just as frightening as the original situation. Because such strong emotions are evoked by the traumatic event and its memories, the body reacts by moving into the ‘fight or flight’ response. With individuals that have been exposed to long-term or severe trauma, their bodies are often in a chronic ‘fight or flight’ state of arousal. This affects perception of self and the surrounding world and consequently affects self-esteem, relationships etc. (often resulting in mental health issues.)

The basis of EMDR suggests that moving the eyes in a particular fashion whilst thinking of unpleasant or traumatic memories (i.e. when the body would be in the ‘fight or flight response’) decreases the intensity of painful emotions that accompany these memories. This, in turn, allows the individual to move into a situation where they feel able to discuss these memories without being overwhelmed by painful and difficult emotions.

The scientific basis of EMDR is not yet understood. One theory suggests that the specific movement of the eyes during EMDR mimics that found during REM sleep. A related theory suggests that EMDR produces a calming effect on the body and promotes physiological relaxation – thereby lessening emotion intensity.

Yet another theory suggests that EMDR activates areas of the brain, which are separate from the traumatic emotional memories. By ‘training’ the brain to do this when traumatic memories emerge, it can bring about considerable changes in the way the individual deals with his or her memories.

Studies have shown that EMDR is effective in treating individuals with a history of trauma. Most of these studies have been carried out in relation to PTSD. However, it has been suggested that EMDR is effective for BPD (perhaps because BPD often has a component of PTSD.)

The nature of EMDR does involve dealing with intense feelings & memories and therefore has the potential to trigger & evoke many unpleasant emotions (perhaps more so than other therapies.) It is, therefore, important to work with someone who is skilled in both EMDR and the relevant mental health problem.

Music Therapy:

Music therapy provides a setting in which individuals can express themselves non-verbally and become more aware of their feelings. Difficult feelings can therefore be accessed in a ‘safe’ fashion.

Music therapy is usually done as group therapy (between six and eight people), although individual sessions can be arranged. The group meets weekly for approximately 90 minutes and is co-ordinated by a music therapist, and sometimes another mental health professional. The group members do not need to have any musical abilities or previous experience; and might play instruments or listen to music.

The co-ordinator may choose a theme for the session, or individuals may simply express their current thoughts and emotions. The music therapist might join the individual in playing music or may ask them to discuss the sounds and mood of the music they have just played.

The crux of music therapy is that it enables the client to express emotion that may not be able to be expressed verbally.

How to get help

If you have been diagnosed BPD and require further information or help:

• Your GP may know of local support groups, or may be able to refer you for specialised treatment, as well as being able to prescribe medication or sign you off work as necessary.
• Self-help – by learning more about Borderline Personality Disorder you will gain insight in to yourself that may help you to manage your feelings. There are an increasing number of publications and internet websites about BPD details of which can be found in the Resources section of the site.
• Mental Health Day Centres – you can find your local day centre in the Yellow Pages. You do not need to be referred to these by your doctor, and you will be able to talk to other people with mental health difficulties, speak to professionals, get help filling out benefit forms etc. You will also be able to find out what treatments and support networks are available in your immediate area. Local MIND offices can also provide advice and information and may operate a pop-in centre.
• Contact Borderline UK – the BUK network as a whole has access to a large amount of information on BPD, therapies, medication, local services etc most of which is not yet available through the site. Also, as the network is continually growing with members throughout the UK, if you are looking for information we don’t have, then we can use the network to try and find that information for you. We’ll certainly try.

Obviously the measures described above are very much an initial first step. Those of us who have been in the mental health service for many years know how difficult it is to get substantial help or access to treatments or crisis services. Until such time as there is a wide-ranging national service for PDs we’re very much in the position of having to help ourselves, help each other.

General Safety Points / Contra-indications

References

Books

This is a selection of some of the titles available on BPD and related issues. If you’d like us to include any books that you found particularly useful, or if you would like to add a review to any of the titles here, please email us with your comments.

Borderline Personality Disorder

“Borderline Patients: Extending the Limits of Treatability” by Harold Koenigsberg et al (ISBN 0-465-09560-7)

“Cognitive Analytic Therapy and Borderline Personality Disorder” by Anthony Ryle (ISBN 0-471-97618-0)

“Cognitive-Behavioral Treatment of Borderline Personality Disorder” by Marsha Lineham (ISBN 0-89862-183-6)

“Eclipses : Behind the Borderline Personality Disorder” by Melissa Ford Thornton (ISBN 0-9659392-2-7)
Written by a “recovered” BP, Eclipses focuses on the treatment (via hospitalisation & DBT) of BPD. Excellent clear accounts of DBT. As the book is set in the US, it is hard to relate to some aspects.

“I Hate You, Don’t Leave Me” by Jerold Kreisman & Hal Straus (ISBN 0-380-71305-5)
The “original book” on BPD, but is now quite outdated. Not terribly optimistic about BPs’ prospects for the future.

“Personalities: Master Clinicians Confront the Treatment of Borderline Personality Disorder” eds Hellinga, van Luyn, Dalewijk (ISBN 0-7657-0294-0)
Interviews with fourteen BPD specialists (including Adler, Linehan and Kernberg) about their personal approach to treating people with BPD.

“Psychotherapy for Borderline Personality” by Larkin, Yeomans and Kernberg (ISBN 0-471-17042-9)
Very new (and expensive) book aimed at therapists working with BPs. It describes a new approach (transference focused therapy) that aims to provide ‘sufficient clinical structure to contain the destructive forces that can undermine the therapeutic process’ whilst allowing the therapist flexibility to safely interact with the BP. Sounds like lion-taming doesn’t it?

“Skills Training Manual for Treating Borderline Personality Disorder” by Marsha Lineham (ISBN 0-89862-034-1)

“Stop Walking on Eggshells” by Randi Kreger & Paul Mason (ISBN 1-57224-108-X)
Written for those who have borderline loved ones. Makes BPs sound absolutely hellish, but may provide insight into borderline behaviour.

“The Angry Heart” by Joseph Santoro & Ronald Cohen (ISBN 1-57224-080-6)
A guide to moving from the “Borderline Zone” to the “Recovery Zone” to the “Free Zone.” Interactive self-help exercises combined with personal accounts & information re BPD. Raises valuable & important questions, but neglects to mention disordered eating as a borderline coping mechanism.

“Understanding Borderline Personality Disorder” by MIND (ISBN 1-903567-19-X)
Mind’s handy little intro to BPD is useful for giving to friends and family members. Available from MIND on 0208 221 9666 priced £1.

“Women and Borderline Personality Disorder : Symptoms and Stories” by Janet Wirth-Cauchon (ISBN 0-8135-2891-7)
Investigates the social, cultural and medical assumptions underlying the diagnosis of BPD from a feminist viewpoint.

Depression

“Cognitive Therapy of Depression” by Aaron Beck et al (ISBN 0-89862-919-5)
As the title suggests, a discussion of the treatment of depression using cognitive therapy. Rather complex and is aimed primarily towards professionals, as opposed to service users.

“Freedom from Depression Workbook” by Les Carter & Frank Minirth (ISBN 0-8407-6207-0)
Very simplistic guide to depression. Includes questions to answer as part of a self-help programme.

Eating Disorders

“Binge No More” by Joyce Nash (ISBN 1-57224-174-8)
Discusses the causes & possible triggers for binge-eating and considers its role in various eating & psychiatric disorders. Two-thirds of the book is devoted to self-help techniques for eliminating bingeing behaviour, improving coping skills and increasing interpersonal skills.

“Eating Disorders: The Facts” by Suzanne Abraham & Derek Llewellyn-Jones (ISBN 0-19-850937-5)
Concise & clear overview of eating disorders, including specific chapters on anorexia, bulimia, obesity and eating disorders during pregnancy. Does not discuss binge-eating disorder.

“Good Girls Do Swallow” by Rachael Oakes-Ash (ISBN 1-84018-480-9)
An autobiographical account of a journey through anorexia, bulimia, binge eating, body image problems and food obsession. Full of black humour & very easy to relate to.

“Making Peace with Food – Freeing Yourself from the Diet/Weight Obsession” by Susan Kano (ISBN 0-06-096328-X)
Self-help workbook. Offers suggestions & asks appropriate questions -but may need to be tackled with a professional at one’s side. Not as helpful as some other self-help programmes.

“On Eating” by Susie Orbach (ISBN 0-14-100751-6)
Small simple guide to overcoming emotional eating.

“Overcoming Binge Eating” by Christopher Fairburn (ISBN 0-89862-179-8)
Excellent book. Dr Fairburn understands!!!! Divided into two sections. Information about the role & background of binge-eating in anorexia, bulimia and binge-eating disorder. And a self-help guide to overcome binge eating & improve the quality of life.

“Stop Bingeing!” by Lee Janogly (ISBN 0-7160-2125-0)
Provides a light-hearted look at the diet-bingeing-guilt cycle and offers suggestions to break this cycle. Does offer helpful ideas, but vulnerable & sensitive types may take offence at the assertions made about those who binge-eat.

“You Can’t Quit ’til You Know What’s Eating You” by Donna Le Blanc (ISBN 1-55874-103-8)
A guide to overcoming compulsive eating.

Self Harm, Injury and Mutilation

“Cutting” by Steven Levenkron (ISBN 0-393-31938-5)
Primarily uses personal accounts to talk about self-mutilation & the reasons behind it. Unfortunately, casts the impression that all self harmers are teenage girls who cut (failing to mention men, other age groups & other means of self-harm.) Recovery section is limited.

“Self-Harm : Perspectives From Personal Experience” ed. Louise Pembrooke (ISBN 1 8980020 2 9)
Revealing first hand accounts from self-harmers. Very funny cartoons as well.

“The Hurt Yourself Less Workbook” by The National Self-Harm Network (ISBN 0 9534027 0 3)
Written by self-harmers for self-harmers, this is a work book for anyone wishing to understand their self-harming behaviour and to take control. Highly recommended (available at a discount price to service-users from the NSHN)

General Mental Health

“Emotional Health” by Bob Johnson (ISBN 1-904327-00-1)
Refreshing new approach to Personality Disorders and other MH health problems from the founder of the James Naylor Foundation. This is available at a discounted price direct from the James Naylor Foundation (see www.TruthTrustConsent.org)

“In Your Right Mind” by Thomas Stuttaford (ISBN 0-571-19348-X)
An overview of psychological disorders. Fairly comprehensive but neglects to mention Multiple Personality Disorder.

“Mad Pride: An Celebration of Mad Culture” eds Curtis, Dellar et al (ISBN 0-9525744-2-X)
Highly recommended. Accounts of madness and mayhem from the people who know best.

“Seeing Red & Feeling Blue” by Susan Aldridge (ISBN 0-7126-8073-X)
Explains emotion from a scientific perspective, concentrating on stress, depression, anger and respective treatments.

“The Emotional Brain” by Joseph LeDoux (ISBN 0-297-84108-4)
Discussing how emotions are evoked in the brain, and why they interfere with conscious thought. Very scientific, not written for a layperson.

“Toxic Psychiatry” by Peter Breggin (ISBN 0-00-637803-X)
Should be read by everyone who is about to put any form of psychiatric medication in to their bodies. Excellent forward by Dorothy Rowe.

“Users and Abusers of Psychiatry” by Lucy Johnstone (ISBN 0-415-21156-5)
A critical discussion of psychiatry, arguing that “traditional treatment” often exacerbate the patients’ original difficulties. Well written & thought provoking.

General Self Help

“How to Get What You Want and Want What You Have” by John Gray (ISBN 0-09-182650-0)
Discusses the concept that there are ten components of one’s soul which need to be full in order to achieve happiness.

“Reinventing Your Life” by Jeffrey Young and Janet Klosko (ISBN 0-452-27204-1)
Excellent program to help you identify your “lifetraps” and steps to escape ’em. Very practical & inspiring.

Articles

Personality Disorder Q&A; Society, Guardian.

National Institute for Mental Health in England

“Twist of Trait”; Society, Guardian

“A safe haven”; Society, Guardian

Google News (search engine for the world’s media giving access to the latest articles)

Research

The vast quantity of research being undertaken currently makes it nigh on impossible for us to keep this page up to date. So we’ve linked to some of the most comprehensive sites and search engines.

American Journal of Psychiatry

British Journal of Psychiatry

American National Library of Medicine – doesn’t always have the full paper but does usually link to sites that do.

Google Scholar – search engine for academic and research papers

Publications

Personality Disorder: No longer a diagnosis of exclusion.

Evaluation of Policy Implementation Guidelines

Personality Disorder Capabilities Framework

The National Service Framework for Mental Health

Currently, the network extends from the highlands of Scotland in the north, to Devon and Cornwall in the south; from Northern Ireland in the west to Holland in the east (okay, so it’s not strictly speaking the UK, but we’re told we have a problem with boundaries). Our members are drawn from all walks of life – some are professionals, some are careworkers, some are in hospital, some are in prison, some are drifting around the UK and some of us are tied to computers. Anyone, anywhere can find themselves diagnosed with BPD, and the network reflects this.

This web site aims to provide information on all aspects of BPD – how it is defined, current theories of what may cause it, treatment options and details of the latest news, conferences and initiatives in the field. It also contains information on Borderline UK, who we are and what we’re trying to achieve.