Laura Paxton: The most frequently recommended treatment for Borderline Personality Disorder is dialectical behavior therapy (DBT). Some patients have had positive results with Self Psychology. My program, Borderline and Beyond, integrates both approaches as well as some innovations that arose from my own recovery experiences.

David: So everyone knows what you're referring to, can you briefly describe what Dialectical Behavior Therapy (DBT) and Self Psychology are?

Laura Paxton: DBT is a program that focuses very heavily on the development of coping skills and practicing them in and out of a group setting. Self-Psychology deals with healing deficits in psychological development through forming a bond between therapist and patient. That is just a brief synopsis of two very broad approaches.

David: Considering that many who have BPD are suffering from abuse, coping with depression, self-injury, and other disorders, I imagine therapy is very complex and takes some time to reach a point where you notice real improvement.

Laura Paxton: Yes. Recovery is a long and complex process for most people. Generally, great improvement is not seen in the first year. However, there are exceptions. I think the most important factor is the willingness for the individual to take responsibility for her own recovery, to stay committed to that goal and to stick with recovery even when it feels too hard to continue.

David: Here are some more audience questions:

Sweetgirl01: Since biochemical changes occur in people who have experienced severe trauma, does it mean that it will take a lifetime of medication in order to correct that imbalance?

Laura Paxton: I used to believe this was true, and I took medications for a total of six years, thinking I would never be free of them. In my case, I don't need the medications anymore. I counsel everyone to talk to a medical doctor before making a decision to go off medications. They are essential for some people at some critical periods of recovery.

Baziust: Hello, I'm a "Major Object"/Victim. (Mother of a 26 year old 200 lb. BPD son). My husband and I were the victims of BPD rage and dysphoria from our son. When the patient's denial is working against us, are we supposed to just take it and remain victims ?

Laura Paxton: No. Absolutely not. Your role is to set firm, consistent limits but not to react with anger to his anger. People with Borderline Personality Disorder need structure and limit-setting and you should not live in fear of your son. Part of the acting out in dysphoria motivation is to see if you will still love and support him through the rage, but that doesn't mean you should tolerate abusive behavior.

Baziust: Then we handled it well yesterday. When he began to rage at us and abuse us with foul language, both dad and I were firm and said, time out!!! Go take a walk around the block. We insisted and he went. When he came back, he was a different person. I went down and gave him a hug. He seemed to appreciate that.

Laura Paxton: People suffering from BPD can be very dramatic and hurtful toward those closest to them. Baziust, it does sound like you handled the situation well with loving limit setting.

gracee124: The professionals have not been able to convince my daughter that medications will help, along with therapy for Borderline Personality Disorder. Can you suggest a way that will help to convince her? She is 17.

Laura Paxton: You may not be able to convince her they will help, but you might be able to help her to open up to giving them a try, if she is in enough pain to take the risk. You might also try letting her talk to someone else who is successfully taking medications.

David: I have a few audience comments on what's been said so far tonight that I'd like to post, then we'll continue with the questions:

TS: I can relate to being a victim to a son. We had to hold him accountable in court and finally the court could not help as they were afraid to send him anywhere. He continued to manipulate and threaten suicide every time the court ordered him into a juvenile setting. This was even with a psychiatrist's opinion to make him accountable after three visits to the hospital for treatment. We were all victims and now he went to his Dad's and then to a girlfriend's at age 16.

SuzieQ: In this JEALOUS insecure frame of mind, I become a hermit and antisocial to PROTECT myself from these feelings of jealousy and fear of being hurt.

Emma18: I was diagnosed with Borderline Personality Disorder about 3 years ago, when I was 15 and in the hospital for an eating disorder, suicide attempt, and self mutilation. I have read many things about borderline personalities to try to understand the disease but I still am so confused about what it actually is and what causes it and how I can help myself.

deeny: I think the chances of overcoming BPD problems depend on the relationship the sufferer is in or if they're in one. One of my main coping skills to counteract self cutting is to write, write, write!

Laura Paxton: Emma18 and deeny, yes, writing is an excellent coping skill. So is artwork. One of the key ways to work with this disorder is to channel the destructive urges into a creative direction. Also, deeny, a supportive social network goes a long way in the healing process.

Emma18, also the most important thing to remember is to learn to develop self-love and compassion for yourself to use as medicine in healing your wounds.