The BPD New Management Concepts: New Management Concepts (for Primary Care Physicians) - BPD New Management Concepts (for Primary Care Physicians)

Written by Dr. Leland Heller

Retraining the Brain: Borderlines must learn to think differently. Cassette tapes, books, and affirmations can teach them how. I strongly encourage borderlines to purchase and listen to the "How to Stay Motivated" tape series (or at least "Success and the Self-Image") by Zig Ziglar. (1-800-527-0306).

Borderlines need to listen to positive/motivational tapes frequently and persistently. Brian Tracy's "The Psychology of Achievement," and others (Earl Nightingale, Denis Waitley, Robert Schuller) from Nightingale /Conant (1-800-323-5552) are excellent subsequent tapes.

Borderlines must be convinced to read positive/inspirational books. I recommend How to Win Friends and Influence People by Dale Carnegie, The Power of Positive Thinking by Norman Vincent Peale, Seeds of Greatness by Denis Waitley, Unlimited Power by Anthony Robbins, Your Erroneous Zones by Wayne Dyer, and books by Leo Buscalia and Norman Cousins.

Affirmations: Saying a meaningful phrase in a repetitive, broken record like manner - are very effective. The borderline needs to say these affirmations dozens of times daily, and within a few weeks they will subconsciously accept new and much needed positive concepts. I recommend phrases like "I like myself and feel terrific," "I am lovable," and "I'm a success." This technique is very powerful.

FINAL COMMENTS

The borderline personality disorder is common and now treatable with a combination of medications, psychological counseling, and self-help approaches. Untreated borderlines suffer painful, destructive lives. They are victims of an illness they don't want and didn't cause. They deserve to be helped, and the primary care physician is in the best position to initiate treatment.

TABLE 1 - DSM - III-R CRITERIA

"A pervasive pattern of instability of mood, interpersonal relationships, and self-image, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:

1. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of overidealization and devaluation.

2. impulsiveness in at least two areas that are potentially self-damaging, for example, spending, sex, substance abuse, shoplifting, reckless driving, binge eating, (do not include suicidal or self-mutilating behavior covered in No. 5)

3. affective instability: marked shifts from baseline mood to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days

4. inappropriate, intense anger or lack of control of anger, for example, frequent displays of temper, constant anger, recurrent physical fights

5. recurrent suicidal threats, gestures, or behavior, or self-mutilating behavior

6. marked and persistent identity disturbance manifested by uncertainty about at least two of the following: self-image, sexual orientation, long-term goals or career choice, type of friends desired, preferred values

7. chronic feelings of emptiness or boredom

8. frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behavior covered in No. 5)"

Those who suffer from the Borderline Personality Disorder have at least 5 of the 8 criteria.

TABLE 2 - BIOLOGICAL ABNORMALITIES

1. Abnormal neurological soft signs (such as awkward gait, left-right confusion, and difficulty with pronation/supination and finger-thumb opposition). [17]

2. Abnormal REM sleep. [18,19]

3. IV procaine, normally sedating, causes dysphoria in BPD. [20]

4. Abnormal auditory P300 on EEG - sharing a dysfunction of auditory neurointegration with schizophrenia. [21]

5. EEG abnormalities in 1/3 - ½, not usually correlating with symptoms. [22,23]

6. Altered platelet alpha 2-adrenergic receptor bind sites. [24]

7. Low platelet monoamine oxidase activity. [25]

8. Low circadian melatonin profile. [18]

9. Abnormal lithium transport. [26]

10. Normal head CT's. [22,27]

11. Cases of BPD have been described from CNS trauma and infection. [27]