Mood Disorder, Misunderstood

A few years ago, when I started perimenopause, I became clinically depressed, had wicked mood swings and my emotions were set on…well, on very shaky ground. I cried away boxes of tissues – I kept a box in every room - and I had a hard time relating to people, even those I loved. After a lot of rigmarole (that’s a story for another day), I ended up in a group therapy situation where I was trained in a discipline called “dialectical behavioral therapy.”

Pioneered by psychologist Marsha M. Linehan to treat patients diagnosed with borderline personality disorder, this therapy is a way of getting you think about all the thoughts, assumptions, and attitudes that go into your behaviors and how you can change them -- basically, learning how to acknowledge, understand and regulate your emotions. For instance, if you always find yourself getting waayyy out of control emotionally when trying to talk to your husband about parenting issues, you would learn when and how to back away, cool off, and try again. Or, if there’s something going on in your life that you hate but can’t change at the moment (long lines, visiting in-laws you can’t stand, bankruptcy, etc.), you’d learn ways of tolerating distress and sometimes, when to simply accept it as status quo for the time being. You also learn ways to soothe yourself when you have to go through those difficult times. Even though I wasn’t specifically diagnosed with borderline personality disorder, I found the program extremely helpful and I keep all of the handouts and notes from those training sessions in my Emotional Rescue Kit. It’s a great backup plan because I know if I start to feel shaky, my “cheat sheets” are there.

In today’s New York Times “Personal Health” blog, Jane Brody describes borderline personality disorder, which is often misunderstood and misdiagnosed. It can be a very serious condition, and it can tear families apart. According to Ms. Brody, “moods can change quickly and unpredictably, behaviors can be impulsive (including abuse of alcohol or drugs, reckless driving, overspending or disordered eating), and relationships with others are often unstable. Many patients injure themselves and threaten or attempt suicide to relieve their emotional pain.”

If this person is a child, very often the family will "walk on eggshells" to avoid upsetting the person, and often this comes at the expense of other family members. And when the storm clouds clear, the person can be, as one family member Ms. Brody interviewed said, "sweet and wonderful again."

If you saw the 1999 Winona Ryder movie, "Girl, Interrupted,” then you might have seen an example of a young girl diagnosed with this disorder. After a suicide attempt, the character spends a year in a psychiatric hospital. But many experts agree that the condition was oversimplified and in nearly all cases, a patient with borderline personality disorder, even one who was suicidal, would probably just be hospitalized for a couple of days, and then put into outpatient DBT therapy or something similar. So far, DBT is the only type of therapy that has scientifically shown to be effective for treating borderline personality disorder.

All this week, through the New York Times, Dr. Linehan will be taking readers questions about borderline personality disorder and DBT. If you have a question, you can leave it here.

If you or someone in your family may be living with borderline personality disorder, many therapists are trained in DBT, and you can find a list of them here.