<p>jym626- yes there has been quite a number of research studies and it is now widely accepted that BPD is at least paritally a function of abnormalities in brain functioning, particularly in the amygdala but also other areas and receptors in the brain. There is current discussions about reclassifying BPD onto Axis 1 for the DSM-V. Feel free to PM me and I can give you the specific researchers</p>
<p>1down12go- so sorry to hear about your sil. Sadly 10% or more of those with BPD have a similar outcome. Thank you for sharing your experiences.</p>
<p>Please don’t tell me it’s any of Dr. Amen’s publications. He is not considered reputable. I can see were the affective instability/dysregulation associated with BPD could be related to limbic function (amygdala), but not sure it explains many of the other behaviors of borderlines. That said, they do often respond, at least in part, to anticonvulsants and antipsychotics often used to manage a Bipolar disorder.</p>
<p>Just to clarify: the SIL described in post #93 was my husband’s sister, not my brother’s wife described in post 81 who is doing fairly well now when on medication.</p>
<p>jym626- are you a clinician? just curious about your claims on the meds you mentioned and their effectiveness in treating those that suffer from BPD. Not sure who Dr Amen is? Here below are links that may shed some light. and a great quote by one of the researchers</p>
<p>“One of the reasons why the research data identifying neurobiological differences in borderline patients is so important for patients and their families is that we can say to them with certainty that the patient is not a bad person but has a different kind of brain that reacts to stress differently,” Gabbard said. </p>
<p>"This is such a sore spot with me right now because he has not done what most fathers of husbands should have done. He did not protect me and he allowed this to get uglier by just accepting this stuff. " </p>
<p>Parents come in many flavors. I think it is fairly common (even if not right) for one parent to back off in an area where the others seems to be doing a better job than they think possible themselves. (In my house, we both try to be consistent and participating. But sometimes loads fall to one or the other based on the current situation and temperments.) It’s possible that your DH’s passive behavior was have been an endorsement of your competence. </p>
<p>Best wishes to you as your continue on your journey. We all wish you well.</p>
<p>I almost took a job at McLean when I first went into practice, but chose elsewhere.</p>
<p>This is not my specialty area, but I have seen patients treated with a combination of antidepressants, new generation antipsychotics and/or anticonvulsants, along with good, long term therapy.</p>
<p>BTW, this is a joke few will understand, but perhaps you will appreciate it, cayman. When I was single, I had 2 cats- a black cat and a white cat. I was going to name them Kohut and Kernberg. Very inside joke (they did a lot of the early research on/treatment of BPD, and one of the characteristics is black and white thinking)</p>
<p>I have a question for jym, cayman or anyone else who wants to answer. Because I have heard Mclean mentioned so many times and I gather it is a pretty good facility, how do you know when a rtc is the right/next step? My daughter doesn’t cut and doesn’t threaten suicide but sometimes I wonder if she wouldn’t benefit from something like this. Right now she is cooperating with seeing a DBT therapist but I often wonder if something more intensive would help. She is also taking anti-depressants.</p>
<p>antique- if your daughter is in a DBT program and she’s agreeing to it, let her be. I know the urge for quicker, faster, more, better - I’m the one who was ready to pack my loved one off to menninger or mclean. I’ve realised that everything is done in baby steps. So many people struggle to get their loved ones into any type of therapy, so the fact that your daughter is involved in a dbt program speaks to your relationship with her and her own desire to work towards learning more healthy coping mechanism. This is all that you could ask for. More isn’t necessarily better. There isn’t a cure as far as i’ve seen, just a better means of coping and a need for re-tooling as life events occur. </p>
<p>With respect to your specific query, i could be mistaken but my understanding is McLean is really meant as an intensive intervention for those who have serious suicical inclinations, multiple suicide attempts, etc where in patient care is required to keep the patient alive. As Marsha Linehan has said, “you can’t do therapy with a dead person”. </p>
<p>You and and your daughter are exactly where you need to be. relax, take it slow, live in the present.</p>
<p>jym626 - Love the humour, i’ll take it where i can get it…sometimes you just have to laugh at these things…check out my links…first one is Otto himself.</p>
<p>From the first link in post 105; in a very general way,and not neccesarily related to the OP’s daughter…sounds about right to me…</p>
<p>"The most important finding, perhaps, has been that some borderline patients respond to one or another of a broad spectrum of medications, although only approximately 30% of these patients respond satisfactorily over an extended period of time. After many months of treatment, many patients who initially responded favorably to medications tend to experience a loss of the effectiveness of drugs, and the underlying structural predisposition to their affective symptomatology seems to override the effects of medication.</p>
<p>McLean treats a broad spectrum of psychiatric ans substance abuse disorders
</p>
<p>I agree with what was posted above. Residential treatment is a great, albeit very expensive option, but I’d save it as an alternative if a patient fails outpatient or acute inpatient/PHP/IOP care. Do you agree, shrinkrap?</p>
<p>I don’t have any personal, or even hearsay experince with a place like McClean.I can’t imagine the finances involved. I have worked at, and treated many kids from many residential treatment centers, and they are a pretty mixed bag.</p>
<p>So jym, how long do you wait or when do you know if the patient has “failed” at the previous therapies? My d is on her 4th therapist and also did a two month intensive iop program. She is comorbidly (forgive me if that’s the wrong term) depressed so I honestly don’t know how to determine if she’s doing “better”. And my apologies to m-3 as I don’t mean to hijack the thread.</p>
<p>There is no easy answer to your question, antiquefreak. How is she doing now? Is she stable? If so, how long has she been stable? Is she engaged in/working well in therapy? Is she compliant with her meds?</p>
<p>I loved working at mcLeans, found the staff among the best. They no longer accept insurance. I’ve also worked at residential programs and intensive day programs, and found them, as Shrinkwrap said, mixed. When doing utilization review, insurance companies try to limit stay to 4-7 weeks. One supervisor said to me that they expect the client to have 4-5 stays. If the family initiates the first treatment program, the person can spend a few weeks resisting. An adult client sought treatment for her depression & BPD at a private hospital, but left in 2 weeks because of sharing a bathroom and other such issues. </p>
<p>From everything the OP has said, I’d save McLeans and the $20,000. I’d find something local, so family can be involved. I’d explore what places insurance covers. As Jym wrote, try a less restrictive setting first.</p>
<p>It depends on how you define stable. She has always taken her meds but is on her third drug/combination of drugs. She has been fairly compliant in the last year with therapy as we found a therapist she says she likes (before the current dbt therapist who she also says she likes). She has a summer job which she has been fairly responsible about but she still has many of the criteria present that are required for a bpd diagnosis so I guess I just am not sure what you mean by stable. Her dbt therapist has told us we’re in for a long haul but at least we’re on the road. Ever since she started meds she’s not as volatile so it’s pretty hard to define.</p>
<p>I agree with bookworm. take it one step at a time.If she is less volatile, responsible at work, not causing major chaos at home, etc, then stay the course for now.</p>
<p>antique - pls don’t shoot me but…you are so lucky. your daughter has a therapist she likes, is starting to attend dbt (a year long program at least), and is holding a job, taking her meds…etc. What more does she need to do to please you??? Give her a break. She’s doing fabulous. Of course she has the indicators for BPD…sorry to burst the bubble, but she most likely always will have the indicators. But with time, she’ll hopefully learn how to cope with them more effectively. </p>
<p>What will you accomplish by give her the message that she’s not doing enough??? Why do you already assume she’s going to “fail” at her current treatment when she hasn’t even really started yet? </p>
<p>Let me repeat… She is doing the best she can and she’s doing great. </p>
<p>(you know i mean this with 100% compassion, but honestly if she gets wind of you thinking its not enough, well then she might as well stop trying right??? Thats not going to be helpful for either you or her.)</p>
<p>I know that you are right cayman and it is something I’m working on…the radical acceptance. It’s part of why I decided to try al-anon so I can learn to take it slower, and detach with love. I am trying and I am thankful that she is willing to do the therapy. And I thank God every day that we are able to help her. I often wonder about the number of people out there who need help and have no insurance or no family support, so I know we are lucky. Thanks for the reality check.</p>