Posted by: debatbpdsociety | September 3, 2014

College paper written on our BDP Support Group

AUTHOR: David Wignall
August 8th 2014
My field experience assignment involved participation in a peer support group with the Borderline Personality Disorder Society of British Columbia (BPDSBC). The society was formed in 2010 by an enthusiastic and dedicated crew of volunteers that are either diagnosed with borderline personality disorder (BPD) or who are supporting family members with BPD. The BPDSBC’s mandate is to provide education and support for people with BPD and their families, to increase awareness of BPD within the community and to promote research into BPD. The group also functions as a hub of resources and supplies supporting material such as information sheets about BPD and contact details for other medical services and health promotion resources (Borderline Personality Disorder Society of British Columbia, 2013).
Before addressing the peer support group it is important to have an understanding of the nature of BPD and the way in which it can affect behaviour and decision making. BPD includes a cluster of 9 diagnostic criteria. Five of these criteria need to be met in order to make an official diagnosis. The 9 criteria are:
o Fear of abandonment
o A history of relationships problems
o Poorly developed sense of self
o Impulsive or erratic behaviour
o Self-harming or suicidal tendencies
o Frequent and intense mood swings and recurrent irritability
o Persistent feelings of emptiness
o Intense or uncontrollable anger
o Feelings of detachment or dissociation
(American Psychiatric Association, 2013).
The BPDSBC offers a weekly drop-in support group which is open to anyone living with BPD or their friends and family. No referral is required to attend the support group which is completely self-funded and peer driven. (Borderline personality disorder support group, August, 2014). According to “Deborah” one of the devoted facilitators, the group makes it a priority to always maintain their Wednesday evening schedule year round. Due to the fact that BPD carries a suicide rate of 10% the group firmly believes a support network is crucial to helping people with this disorder and actually saves lives (Kreger, 2008).
The agenda of each meeting begins with one of the 3 facilitators reading out the “ground rules” concerning mutual respect and listening to everyone’s input. A check-in follows when everyone is invited to share their previous week. The agenda of the meeting is then informally decided by suggestions and participant agreement (BPD support group, 2014). In the meeting I attended, the two topics for discussion were; the importance of emotional validation and the perennial feelings of emptiness that almost universally accompanies BPD (Chapman, 2007).
The meeting started on time with 22 participants; one of the largest attendances to date. The subject of validation garnered a lot of comments from the group with the main consensus being that partners of the person with BPD need to simply acknowledge the emotional journey of their counterpart without the need to agree with it. There was a suggestion that partners of the people with BPD should adjust their behaviour in order to avoid conflict from happening. The partners without BPD responded by saying that it was a reasonable to ask but they didn’t want to play the role of counsellor in their relationship. The conversation moved to the concept of emotional escalation and how situations can simply run-away with the sufferer despite them knowing that it is an over-reaction.
The next item on the agenda concerned the commonly experienced feelings of emptiness and desolation. Many of the group described frequent feelings of “hopelessness”, “doom” and feeling “totally lost”. The group went on to say that these feelings of despair can seem “chronic” and “never-ending” (BPD support group, 2014). With such an emotional nadir possible it is easy to understand how substance abuse and suicidal tendencies can manifest as a reaction to emotional pain (Chapman, 2007).
Many participants mentioned difficulty in personal relationships and I got the strong impression that many people with BPD experience a relentless struggle to maintain marriages and partnerships. One lady mentioned that she was thinking of leaving her husband because he had been away working and she had felt more at peace without him. Another young lady described the difficulty she was having with a long distance relationship and how the smallest remark from her boyfriend by phone could send her into a descending spiral of mistrust and frustration. This young lady’s experience illustrates the typical emotional over-reaction associated with BPD (American Psychiatric Association, 2013).
The word “de-escalation” came up as a buzz word for couples trying to avoid these over-reactions from happening. A couple comprised of a young woman with BPD and her boyfriend without BPD took up this topic and related how things can quickly get out of hand if the partner to someone with BPD also has a quick temper. In this case the boyfriend without BPD was also receiving anger management counselling. I listened to this couple describe their difficulties and I was struck by how objectively and realistically they were approaching their problems. Their testimony really illustrated how important it is to encourage and facilitate honesty when interacting with people with personality disorders and their families (Kreger, 2008). It became very clear to me that accepting denial can only prolong emotional suffering.
As the meeting progressed several people got up and quietly left. According to one of the facilitators these participants were likely feeling overwhelmed by such a large group and needed to leave. A facilitator followed them outside just to make sure they were in a reasonable state of mind and able to cope with their feelings (BPD support group, 2014). People with BPD can be triggered into an emotional crisis by many factors including social anxiety. Therefore, one of the purposes of the group is to create a social network so that people suffering a crisis can always find someone to call (BPDSBC, 2013).
As the active participation portion of the meeting drew to a close the participants casually left the room and enjoyed some snacks which gave everyone an opportunity for social interaction. One of the facilitators, Deborah disclosed that this informal half hour period was as crucial to the effectiveness of the group, as the more formal group interaction (BPDSBC, 2013). She explained that many attendees would reveal more about their real state of mind during chit-chat than at any other time. (BPD support group, 2014).
Reflecting on my experience I was struck by the positive attitude and bravery of all the participants. The honesty and openness amongst the group was refreshing to hear and of huge value to a group of people that can so often feel isolated and misunderstood. The facilitators were very adept at keeping participants politely on topic and also were able to intercede with encouraging words when someone appeared self-conscious. In such an emotionally reactive crowd it is vital to use a non-confrontational communication style (Arnold & Underman Boggs, 2011). The facilitators very effectively set the tone for the meeting by creating a non-judgemental atmosphere and made everyone feel welcome by using friendly phrases, smiles, open body language and also using people’s names (Arnold, 2011). I was also very impressed by the partners and friends of people with BPD who were committed to learning about the disorder and who were most importantly, striving to cultivate the personal growth required to be empathetic and supporting.
After the drop-in attendees had left I was given the opportunity for an informal de-briefing session with the facilitators. As we talked, several points were raised about the perceptions and misperceptions of people with BPD. I had heard some of these points before and it was interesting to hear the same issues from the perspective of people who actually have BPD. For example, people with BPD are often accused of being manipulative and attention seeking. In reality people with BPD often display impulsivity as a reaction to overwhelming emotional pain (BPD support group, 2014). A commonly held myth about BPD is that it is untreatable. Research has shown that up to 88% of those diagnosed with BPD show significant improvement over time with effective treatment (Chapman & Kim, 2007). Another common myth is the idea that people with BPD have “flawed” personalities. In reality, people with BPD have a variety of personalities just like everyone else and the disorder merely acts as a social barrier (Kreger, 2008).
The facilitator Deborah also mentioned that in her experience, a combination of Anti-psychotic drug therapy and Dialectical Behaviour Therapy (DBT) had shown the best treatment results. The BPD society recommends the work of Registered Psychologist, Alexander L. Chapman PhD, who is a Vancouver based specialist in Dialectical Behaviour Therapy (DBT). DBT has become the gold standard for non-pharmacological treatment for BPD. The word “dialectical” means two conflicting or contradictory concepts that can be true at the same time. The main cognitive issue shared by all people with BPD is called “splitting” which means a tendency to polarize of feelings towards a person without being able to see the middle ground. The individual with BPD is not able to reconcile mixed feelings towards someone and will either idolize or demonize them and can flip from one extreme opinion to the opposite feeling without realising why (Kreger, 2008). Therefore, dialectical behaviour therapy teaches the BPD client to accept themselves and also tolerate ambivalent feelings (Chapman, 2008).
The borderline personality disorder society of BC is an essential volunteer driven resource for many people. BPD is more prevalent than schizophrenia, with around 2% of the public being affected (Kreger, 2008). Knowing the statistics of prevalence and the shocking statistics for suicide related to BPD, it seems inconceivable that there are so few resources on which people can depend. Now I have seen the vital service gap that this group works tirelessly to fulfill, I hope that they can garner more support from the medical community and succeed in raising awareness about BPD. In my future practice as a licensed practical nurse, I will take in to account the prevalence and influence of borderline personality disorder so that I can refer clients to the appropriate services for diagnosis, counselling and treatment.

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