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Visit from Dr. Vickery, mindfulness, and GLAD

We had the great pleasure of hosting Dr. David Vickery this past Monday.  What an honor and privilege it was to hear about the latest scientific research regarding neuroplasticity and neuron regeneration.  One of the biggest discussion topics was about how Mindfulness Meditation practices can help lessen the severity of depression symptoms.  Dr. Vickery talked about how the Benson's Relaxation Techniques have been scientifically shown to greatly benefit those who suffer from Depression.  He left us with a homework assignment to begin implementing GLAD into our daily lives.  http://www.healthyplace.com/blogs/buildingselfesteem/2014/10/do-negative-thoughts-consume-your-mind-try-this-technique/.  Mindfulness can also work for those who have Bipolar disorder too. Dr. William R. Marchand, MD, has published the book "Mindfulness for Bipolar Disorder" which discusses in depth the techniques and benefits of mindfulness.

If you have been diagnosed with a mood disorder and are looking for a support group, we would love to have you.  You can contact us at (731) 215-7200.  We meet every Monday starting at 6:30pm hosted inside The Life Church located off of Hwy. 18 headed towards Boliver.  

Borderline Personality Disorder relations with BP

Differentiating Borderline Personality Disorder from Bipolar Disorder

By BERNADETTE GROSJEAN, MD

Borderline personality disorder (BPD) and bipolar disorder frequently co-occur (numbers range from 8% to 18%), although they are distinct clinical entities (Paris J et al, Compr Psychiatry2007;48(2):145–154). A proper diagnosis guides the most effective treatment, but you’ve probably faced the difficult challenge of diagnosing these conditions, which share several clinical features.
BPD can be described by four types of psychopathology: affective disturbance, impulsivity, cognitive problems, and intense, unstable relationships. What’s most important—in addition to seeing that your patient meets DSM-IV criteria for BPD—is to establish that patterns of affective instability, impulsivity, and unstable relationships have been consistent over time. Thus, obtaining a detailed history is crucial. Also, the key features we see in BPD, such as dissociation, paranoia, and cognitive problems, are often affected by the patient’s environment and, particularly, his or her relationships. A patient might have a history of rapid and sudden deterioration when relationships change—such as threatening suicide after a breakup or severe mood swings when separated from her family. Generally, the more intense or significant the relationship is, the greater the risk of chronic stress and mood dysregulation.
Many of the same features are seen in patients with bipolar disorder, such as dysphoria, hyperactivity, impulsivity, suicidality, and psychotic symptoms. As a result, borderline patients with this cluster of symptoms are often misdiagnosed with bipolar disorder, possibly because of the effectiveness of psychopharmacological treatments for such symptoms. In fact, a more thorough assessment might show that these patients actually suffer from a personality disorder. In one study, more than one third of those misdiagnosed with bipolar disorder met DSM-IV criteria for BPD (Zimmerman M et al, Compr Psychiatry2010;51(2):99–105).
In BPD, mood changes are generally short-lived, lasting only for a few hours at a time. In contrast, mood changes in bipolar disorder tend to last for days or even weeks or months. Mood shifts in BPD are usually in reaction to an environmental stressor (such as an argument with a loved one or a frustration in the waiting room), whereas mood shifts in bipolar disorder may occur out of the blue. Some clinicians consider BPD an “ultrarapid-cycling” form of bipolar disorder, but there’s little evidence to support this link (Gunderson JG et al, Am J Psychiatry 2006;163(7):1173–1178). Patients with BPD might rapidly cycle through depression, anxiety, and anger, but these mood shifts rarely involve elation; more often, the mood shifts are from feeling upset to feeling just “OK.” Likewise, the anxiety or irritability of BPD should not be mistaken for the mania or hypomania of bipolar disorder, which usually involve expansive or elevated mood.
At a more existential level, patients with BPD—particularly younger patients— often struggle with feelings of emptiness and worthlessness, difficulties with self-image, and fears of abandonment. These are less common in bipolar disorder, where grandiosity and inflated self-esteem are common, especially during mood episodes. And while both conditions may include a history of chaotic relationships, a patient with BPD may describe relationship difficulties as the primary—or sole—source of her/his suffering, while the bipolar patient may see them as an unfortunate consequence of his behavior.
A pattern of self-harm and suicidality often serves as a cue for diagnosing BPD (but are not necessarily required). But both can be seen in bipolar disorder, too. In BPD, suicide threats and attempts may occur along with anger at perceived abandonment and disappointment. Patients often explain these impulses as a way to be relieved of pain, or to “stop their thinking,” more so than to end their lives, per se. Patients with BPD may experience “micropsychotic” phenomena of short duration (lasting hours or at most a few days), including auditory hallucinations, paranoia, and episodes of depersonalization. However, patients generally retain insight, and can acknowledge that “something strange is happening” without strong delusional thought. When psychotic symptoms occur in bipolar disorder, they happen in the context of a mood episode, they tend to last longer, and patients may be unable to reflect on their behavior.

This article originally appeared in The Carlat Psychiatry Report -- an unbiased monthly covering all things psychiatry.
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Accurate diagnosis of BPD and bipolar disorder can be difficult, but it’s essential for proper treatment and optimal outcome. Remission rates in BPD can be as high as 85% in 10 years (Gunderson et al, Arch Gen Psychiatry 2011;68(8):827–837), particularly with effective psychotherapeutic treatments (Zanarini MC, Acta Psychiatr Scand 2009;120(5):373– 377). Unfortunately, such treatment is not always available. Some medications can be used in BPD, such as an SSRI for impulsivity, severe and persistent depression and/or suicidality, or an atypical antipsychotic for recurrent dissociative symptoms or disinhibition. However the only consensus seems to be that medications should be used as adjuncts to psychotherapy (Silk KR, J Psychiatric Practice 2011;17(5):311–319). The long-term use of a mood stabilizer or atypical should be reserved for known cases of bipolar disorder.
TCPR’s VERDICT: Clinicians sometimes think of a BPD diagnosis as pejorative (chronic and untreatable) and may be reluctant to disclose it, but patients and their families often find it helpful to be informed of the diagnosis. Similarly with bipolar disorder, accurate diagnosis often determines prognosis and effective treatment. For the clinician, however, it’s imperative that you make the proper diagnosis in these two often overlapping, but fundamentally quite distinct, conditions in order to optimize your patients’ outcomes.

Going Through the Open Space to a New Life

 

My book, The Two Agreements, is not only about my reinterpretation of the New Testament; it is also largely about my own spiritual journey. That is why I have written at length about the “open space”. The open space is a time when your old life is gone (either because it was “taken” or because you consciously shed it), but you have not yet arrived at your new life. This transformative period can be incredibly lonely, painful, and anxiety-ridden; however, it is also an opportunity to challenge old beliefs. The goal is to learn to trust the process. I have gone through several such periods, the longest being the five years when I slowly and agonizingly sloughed off my fundamentalist beliefs and eventually emerged in my new spiritual life.

Without a doubt, the most difficult aspect of an open space is how utterly isolated you feel. When you left your old life, you did not just lose places, things or jobs; you have left people behind as well. Perhaps you have lost your spouse through death or divorce; maybe your friends have stopped calling because they can’t or won’t understand what you are going through. You may have even been separated from your church community. The key to arriving on the other side of the open space is to realize that you are NEVER alone, for you are never disconnected from God. I have often heard in my ministry groups stories of people who, in their darkest hour, felt the presence of an “Unseen Hand”, a force that kept them rooted to their lives. For some, it materialized as love for their children; for others it was a mere whisper, promising better things to come. Then, others saw the new life of someone who “made it through” and got the hope of their own new life. In all cases, it was the life force manifested, and it most likely saved their lives.

It is also imperative for anyone finding himself or herself in an open space to connect with community. Unfortunately, this often easier said than done, especially for those facing mental health challenges. In my interfaith support groups, I have heard hundreds of stories, many from people who were rejected or ignored by their fellow church members. One woman literally ran to her church after an incident in her home had left her fearing for her emotional stability. She was without transportation, and she asked the women in the administrative office if one of them could drive her to a nearby mental health facility. Instead of helping her, the women backed away, as if she was a leper. One even asked if there weren’t services for “people like her”.

I heard another story, from a Deacon at a local church. Twenty years before, his wife had broken her leg. For days, his phone never stopped ringing, with callers offering prayers for a speedy recovery. They showed up at his door, bearing enough food for an army. The reaction was very different, however, when his daughter was hospitalized with a mental health issue. Imagine his sorrow when the phone rang not once; when no one showed up with food for his family.

Open spaces do not only apply to individuals; larger entities and organizations can also face transitional periods that threaten their very existence. An example that immediately comes to mind is the United States, with its uncertain economic future and political divisiveness. Christianity has also been at a stand-still for some time, and arguably, is regressing. People, particularly the young, have been leaving fundamentalist churches in droves. According to Tony Jones, author of The New Christians—Dispatches From the Emergent Frontier, millions of church-goers have left the church, never to return. Many of these folks were raised in the church; but now, disillusioned, they are walking away, not only from the church’s teachings, but, in some cases, belief in God. And, that is indeed a travesty.

Very simply, whether we are talking about an individual, a country, or a religious institution, the questions remain the same: “Now that all hell has broken loose, what are you/we going to do about it?” – for your old life died, gone and never to return. And, something needs to be done. Then, the follow up question is, “How much do you/we love yourself/ourselves?”— for the spiritual lesson is to love one’s self enough to “resurrect” a new life. Only a genuine love will do.

Stigma is something we can do something about!

Below, I share with you a stark definition of stigma.  Consumers and those who love them must make a decisive stand to push back against all forms of social inequality in the form of stigma. We can make a difference!

It’s easy to label someone else and overlook what’s really inside. When mental illnesses are used as labels – depressed, schizophrenic, manic or hyperactive – these labels hurt. Using negative labels leads to branding and shame – what is called stigma. Stigma leads to discrimination. Everyone knows why it is wrong to discriminate against people because of their race, religion, culture or appearance. They are less aware of how people with mental illnesses are discriminated against. Although discrimination may not always be obvious, it exists – and it hurts. Stigma is not just the use of the wrong word or action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier and discourages individuals and their families from getting the help they need due to the fear of discrimination. An estimated 50 million Americans experience as mental disorder in any given year and only one-fourth of them actually receive mental health and other services.          bp magazine Winter 2012