[Rapunzel]

I am taking a class right now that focuses primarily on diagnosis and treatment of personality disorders. The instructor's attitude about it is pretty hard to take sometimes. He started off by saying that we really don't treat personality disorders because people are not going to change who they are, and personality disorders become part of the personality. He says that we treat symptoms, particularly symptoms of the many disorders that tend to co-occur along with personality disorders, such as depression, anxiety, substance abuse and addiction, etc. And we can teach people how to cope a little bit better.

I asked him point blank whether anyone ever recovers from a personality disorder, when he made a statement about ah historical figure (Jackie Kennedy) who was pretty dependent but later in life had some significant achievements. He said that because of what she did later in life, she probably didn't actually have dependent personality disorder. So I guess that anyone who does recover never had the disorder in the first place, from his perspective. His answer to my question was that no, people do not recover from personality disorders. He said, "Once you have that dx, your life is pretty much going to suck." Then he said to be careful about diagnosing people with personality disorders.

I am not supposed to argue and contradict people, so I didn't point out that when we diagnose a disorder we don't give the person the disorder. We simply assign a description based on the symptoms that they already have. If you go to the doctor and he says that you have cancer, the doctor didn't give you cancer, right? How is mental health different?

Since I have been diagnosed with at least two personality disorders (dependent and avoidant), twice each even, and I would diagnose myself with BPD and OCPD since I also meet criteria for both of those, this teacher's attitude is difficult for me to take. Part of me wants to tell him that I have personality disorders, and although I am not "cured" yet, I am getting better. In other classes I have been pretty open about my own struggles, but I'm not feeling like I can trust this teacher.

I have discussed this a little with my T, and she offered "a more sophisiticated point of view." I think that I might be the only person she has diagnosed with a personality disorder, as she doesn't really like the concept of personality disorders in general. She asked how someone could have more than one personality disorder, yet many people meet the criteria for more than one of them. She said that recovering from personality disorders depends on the person being motivated to work really hard at it and change the way that they do things, think about themselves, ets. (not a direct quote). I like that better, because there is hope if we can change, and someone believes that we can.

Some of you have gotten the idea that T is harsh with me and that some of her approaches are more harmful than helpful. This is the difference though, and why I stay with her and why I don't think that I could find anyone else who would be better for me. Sometimes she gets frustrated with me and has been ready to give up, but as long as she believes that I can recover, I have hope too. If she pushes hard, it is because she expects better than just managing the symptoms or coping with things right now. I think that her approach is pretty rare. My teacher's point of view is probably more common.

What do you think? Have any of you recovered from personality disorders? If you haven't yet, do you believe that you can? Do you want to change that much? Why or why not?

Rap

I think your prof has spent too much time in the classroom and not enough time in practice. I have seen people recover from BPD through lots of hard work. It happens a lot more than we hear because those who are doing well quit therapy, quit posting, etc.

I think the same thing is possible for Dependant PD. I'd envision CBT/DBT might help...but I have no experience with this.

I think your prof needs to refresh his skills in the field. Tho, you might not wanna suggest that until AFTER grades are posted!

em

[Fuzzybear]

I think em is correct... and that the professor is not.........

(((((((((((((( Rap ))))))))))))))

[Rapunzel]

(((((((((((( EM, Fuzzy ))))))))))))))

Thanks for your support.

Luv ya,
Rap

[Direction]

I think I would be pretty steamed...

I think I would loose a lot of respect for this professor..

I think if you have an opportunity to take the matter higher to do so...

I think if there is a professor evaluation, that you give them your two cents...

All I can say is how dare this professor...

[Rapunzel]

Thanks, Direction. I think that this instructor's ideas are more mainstream than my T's, although rather extreme maybe. Maybe I will get brave enough in class tomorrow to disagree with him. At the least I will e-mail him, but maybe after grades are assigned. We'll see. I hope I can say something earlier, because I would really like the rest of the class to come out of this with more hope for people who have personality disorders.

Rap

[Fuzzybear]

[WinterRose]

I read Search for the Real Self by James Masterson MD which deals with personality disorders. He is definately hopeful that a personality disorder can be corrected.

How can you respect this guy and trust anything that he has to teach? ((((((((Rap)))))))))) I don't know anything about the recovery rate of personality disorders but you cannot tell me that people don't change. What about all the drug addicts and alcoholics that go clean and stay clean?
I don't know if alcohol or drug addiction is a personality disorder but I know it's really hard to overcome.

[Rapunzel]

Thanks all for the support and comments. Rose, I just ordered the book you recommended. I really like Object Relations anyway, so it sounds like it's right up my ally.

I'd like to write more, but I am too tired to do it properly right now, so I'll try later, maybe in the morning. Therapy tomorrow. Two weeks is a long time in between. I forget what I needed to work on, that I had managed to think about a lot for the first week, but now it's mostly gone.

TTYL,
Rap

[WinterRose]

I hope you like the book Rapunzel. I did. And I learned a lot about myself too. My therapist likes Masterson and my psychiatrist respects his ideas. Here are a few quotes to wet your appetite.

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"Abandonment depression is actually an umbrella term beneath which ride the six Horsemen of the Psychic Apocalypse: Depression, Panic, Rage, Guilt, Helplessness (hopelessness), and Emptiness (void). Pg 61

There are three types of therapy beneficial for the borderline patient: shorter-term, intensive analytic psychotherapy, and counseling. Pg. 135

The goal of shorter-term therapy is not to work through the abandonment depression but to repair the defects in ego functioning and improve self-activation. … The patient’s self-image and self-assertion improve, along with her perception of reality, but the impaired real self is not fully overcome and the abandonment depression is still present. Pg. 135

… [Intensive analytic psychotherapy’s] primary goal is to remove the defenses against the abandonment depression and to reactivate the real self in order to bring on the abandonment depression in full force for the purpose of working it through in the close therapeutic relationship. … As the patient goes back deeper and deeper, the abandonment depression occurs, with all six psychic horsemen. Pg. 136

Counseling is indicated for those patients who do not have sufficient ego strength to benefit from psychotherapy: if required to give up their defenses they would become psychotic. Counseling does not require the therapist to maintain therapeutic neutrality, so that a wide range of activities become possible, such as advice, suggestion, guidance, medication, and environmental manipulation. Pg. 147-148"

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[Rapunzel]

It sounds right up my alley. Thanks for the quotes.

With school, I have so much that I need to read, but I think that the personal growth reading is at least as important as the assigned or required class-related stuff. It often overlaps anyway.

[Rapunzel]

I'm having a hard time trusting this guy. I would never want to go to him for therapy. He is really smooth too. Too smooth.

Recover rates for personality disorders are quite low and prognosis isn't great, but I have a big problem with the idea that someone has a disorder and will just be stuck with it forever because it is part of them. I don't think so. I think we need to allow for the possibility of change, and as long as someone wants to change, they deserve to have help. Now, my T maintains that change and recovery are possible, but she doesn't seem at all convinced that I truly want to change. And maybe that's the problem with personality disorders. One of the characteristics of most of them is that the person who has the disorder is bothered by it very little, although it bugs the heck out of everyone else around them.

Hardly anyone starts therapy because they have a personality disorder, but people with personality disorders tend to have other disorders too, most typically depression, anxiety, and substance abuse. I have a long history with depression, and T says that I have anxiety disorders, although I tend not to notice anxiety that much. I guess I'm used to it. And I have always felt that I would be extremely susceptible to addiction although I have always avoided substances. I am addicted to chocolate, and have many addictive behaviors.

My instructor's point was that we don't really treat personality disorders. We treat all the other stuff that comes along with them - mainly depression, anxiety, and substance abuse problems.

[Rapunzel]

(((((((((((Fuzzy)))))))))))))

It's nice to know you're here and reading this. Thanks for being you and for sharing the journey.

Rap

hmm. i would say that your teacher hasn't spent enough time in the classroom...

what sort of therapy does he do? CBT? i'm guessing that because CBT isn't terribly effective for treating personality disorders so maybe he has made a little mistake that goes like this: 'I don't have much success with treating personality disorders, therefore they never get better'. I would say: He is an idiot.

People tend to mellow with their personality styles as they get older. There is a lot of research on that.

Most of the research on personality disorders is on borderline and antisocial.

I don't think that there are all that many clinicians or researchers who would endorse your teachers view on personality disorders. I wouldn't be able to keep my mouth shut, but that is me, and I guess I like to argue ;-)

But then...

I don't think that there are all that many clinicians or researchers who would endorse your therapists view that it is all about 'effort' or 'motivation' either. When people don't change... I really don't think that 'laziness' or 'stubbornness' is the cause...

I guess I think that most take a middle ground...

The role of the therapist should be to help motivate the person. I mean, problems with motivation can be precisely why the person presents for treatment. To say 'I can't help you 'cause you aren't motivated' is fairly... Not so smart.

There is a middle ground lurking around here...

Besides which I think you are great as you are.

oh. i got better. no longer meet criteria for borderline personality disorder.

you know what some people say when you get better from borderline personality disorder? you must have been misdiagnosed because people with BPD don't get better (by definition). that is fairly stoopid though.

lots of people get better :-)

[Rapunzel]

Thanks Alex. I think that he is applying that rule to all personality disorders from some of his comments. If you get better, it must have been a mistaken dx. I guess that's why insurance doesn't often cover personality disorders, and why a lot of professionals really don't like the concept at all. I can see that there are longstanding patterns that affect people and do frequently fit the descriptions of the symptoms of various personality disorders. I just don't see the usefulness in declaring that people never recover. If it can't be fixed because it is part of who a person is, then it can't really be a disorder, can it?

One POV on BPD is that it doesn't really belong in the group with the personality disorders, because it seems to be something else entirely. For one thing, most people with BPD have an identifyable trauma history, and it could be speculated that those who don't just haven't identified their trauma. But I think that some kind of trauma is behind most personality disorders.

When I was first dxed with personality disorders, it really felt like a slight because it just seemed not to be really taken seriously. Well, I didn't feel like that T (17 years ago) took me seriously anyway. Axis I seems to command more respect, or at least to be more worthy of being treated. But just like when people say dysthymia is a minor form of depression, I don't think that's right. Personality disorders and dysthymia (which some people have suggested ought to be grouped with the personality disorders, BTW) are long-term and persistent mental illnesses that may not always involve obvious symptoms or severe suffering, but personality disorders and dysthymia tend to come along with recurrent Axis I diagnoses such as major depression, anxiety, substance abuse, eating disorders, .... If anything, they are a more severe problem than any of those Axis I dx alone.

Rap, move away from the soapbox! Save it for class.

TC All. Rap will attempt to stop preaching to the choir now.

hey. it can be good to get on the soap box every now and then. sounds to me that he truely is ignorant. sorry... but... that really is the way that it strikes me.

i think the reason that health insurance providers don't really cover therapy is that long term therapy is very expensive for them to cover and short term therapies (which are easier to study) don't seem to have such very good outcomes with treating personality disorders (or dysthymia, for that matter).

so there is political pressure from the insurance companies. there is also considerable pressure from psychiatrists who often don't like to treat personality disorders because their most standard form of treatment (medication) isn't so very effective.

basically... when peoples needs exceed our ability to help them... people often attempt to 'blame the victim' in a way that helps them feel better about themselves. that is my take on the situation.

psychodynamic theorists are often more willing to take personality disorders seriously. the psychodynamic diagnostic manual (PDM) came out last year and they had some very sensible things to say about personality disorders / styles. more sensible than the DSM IMHO. they viewed personality disorders as extremes on personality styles, basically. i've heard that future editions of the DSM might demote personality disorders further (political pressure from insurance companies, drug companies, psychiatrists).

Marsha Linehan is IMHO the best CBT therapist who writes on BPD. she modified CBT into DBT. if your lecturer / teacher thinks that there aren't good outcomes for psychotherapy for borderline personality disorder then it won't be hard for you to find evidence that DBT and short term psychodynamic (mentalisation based therapies) have been shown to be effective.

of course the therapy is long term. that is understandable when you consider that personality disorders are indeed 'ingrained styles of relating to the world'. changing habitual ways of coping will indeed take time.

Linehan considers that for every personality 'disorder' there is a related personality 'style' that is a 'healthy version' (if you like). she says of borderline individuals, for example, that they will always be the 'colourful' people of this world. bubbly. emotionally intense. vibrant. avoidant people will always be the sensitive / shy people of this world. and so on... it is only when the person repeatedly adopts one or two ways of coping and that coping strategy leads to problems that a dx of a personality disorder may be warranted.

but of course people can change.

people DO change.

they change according to context (more than the majority of the current literature would have us suppose). they change through time (more than the current literature would have us suppose too). part of the motivation for emphasising the long term problem is attempting to help them keep their status as mental 'disorders' (so people can get treatment for such conditions).

Schore has some interesting things to say on how early attachment relationships seem to be especially important with respect to later personality development. this is similar to the literature on attachment. different attachment styles (ambivalent / borderline; avoidant etc) seem to become different personality traits / ways of interrelating to the world.

methinks your teacher needs to read...

[AlteredState01]

Without considering anyone's else's response, do I believe that we can "recover?" No.

I believe that the only thing we can do is modify our behaviors (our outward behaviours), so we, and others, may be able to accept ourselves more readily, but again, NO, I do not believe that we will ever be free from this pain. It is just too deeply ingrained (unless, of course, one is like the infamous John Nash. But then, again, he never DID recover, did he? He only was able to "manage," better than all others - his illness.

The only ones that may have a greater chance is the youngest ones, simply because their wiring is not quite "set in stone," so to speak (and how often are they diagnosed correctly the first time around, and before much damage is done).

I believe we must come to terms with how our brains function now. We have set a certain pattern in our brain functioning and that will never change completely.

Do I want to change? Of course I do. Is it likely? Not even the greatest minds of psychiatry think we can. You may, indeed, be one of those who are completely set free, but for most of us, that reality will only serve to damage us further.

Hope for a better future, is not the same thing, however, so do not mix this up with what I am saying. A better future is in store for ALL of us. It is a matter, now, of training. Training does not, in itself, change the original thought pattern - it only overrides it - much like military training does.

I am not trying to kill anyone's hope here, because, I honestly believe that the younger one is diagnosed - ACCURATELY - the better chance they have in dealing with their illness, and, of course, with age, comes a certain amount of acceptance and a lessening of energy that may spur on greater havoc.

I have seen no evidence, anywhere, where one has completely recovered - not even with the infamous Dr. Linehan.

But, then again, this is only MY opinion....

Altered State

i don't think the pain will ever go away completely. in a way... this might sound strange... but i'll share it in case someone else is able to resonate... in a way... i think that if the pain did ever completely go away that it would be disrespectful to myself. similarly to how when a loved one dies the pain gets better over time (less intense, less frequent) but there would be something disrespectful about the pain going away completely. it gets better but it never disappears entirely.

gg once said to me something that her therapist said to her. it isn't about making the pain smaller it is about making the rest of you larger. there will always be a place within me for my pain and my grief. i will always feel the pain and grief at times. what i really do believe (when i'm in a relatively good space) is that over time i'll have more control over when i feel it and when i don't and i'll not need to feel it so very often and at such an extreme state of intensity.

[WinterRose]

You have a point Alexandra. I've often worried that if it all went away, somehow I'd be betraying myself - that I'd be unfaithful. I wonder sometimes if I'm afraid to be cured because it's the only thing I know and I don't know how it will change me or what I'll do without this pain I carry around.

I just read this in "A Shining Affliction" and I really liked it. “I am not and will never be entirely “cured” of my own suffering.” (pg. 295) Maybe that's a good thing and I'm grateful.

Still I feel that we can get better without being disrespectful to our suffering. That we can rise above it and get to the point where it is not in control. I even feel that if we are brave enough we can get to 'the other side of suffering.' It's an important thing, suffering - it is a method/instigator of growth. If we use it constructively we can recreate ourselves to become more functional instead of less. (That last is my affinity to Dabrowski talking.)

[Rapunzel]

That is a good point. I'm just getting into a chapter in "Heartwounds" about healing through grief. It makes sense.
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We have given suffering a bad name. In our feel-good society, we often see struggle as a sign of failure and may resent encountering our own personal trials and conflicts. But it is struggle, not the absense of it, that builds character, strength, self-esteem and personal power. Anyone who has made it through rather than run from adversity knows this. Mental health and spiritual health are deeply linked. Overcoming psychological and emotional blocks - grieving wounds, giving them a name and a process to heal them - cleanses and purifies the spirit and makes it ready to receive grace and wisdom. As the mind and emotional self grow, so does the spirit because they are woven of the same cloth. Grief, then, rather than a collapsing of the self, can be a surrendering to a process - the process of mourning.

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So maybe this is why those who have recovered from trauma and mental illness seem to have so much strength and wisdom and ability to help others. But the key is to work through that stuff, and not run away from it or drown in it.

Rap

[AlteredState01]

WOW!

[AlteredState01]

Um, I think I may have mentioned this before, but...

WOW!

[AlteredState01]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
lots of people get better :-)

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Better, yes. Cured completely??