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Bipolar Disorder
May is Borderline Personality Disorder Awareness Month
May 2009 is the Second Annual BPD Awareness Month.
Posted May 20, 2009
Last year, the U.S. House of Representatives unanimously voted (H.R. 1005) to make May Borderline Personality Disorder (BPD) awareness month. This recognition is the fruit of the labors of many patients, families, clinicians, researchers, and policymakers who have toiled for decades to have BPD recognized as the serious disorder and public health concern that it is.
To commemorate this event, the prestigious American Journal of Psychiatry has published articles (this link leads to an important BPD advocacy site, National Education Alliance for BPD, which has posted the articles free of charge) written by senior researchers who have pioneered BPD research and treatment for the last 40 years. The authors of these articles reflect upon how much has been accomplished and how much remains to be done to advance recognition, assessment, prevention, treatment, and research of BPD. In this post, I will summarize the highlights (for me).
Dr. Otto Kernberg and his colleage Dr. Robert Michels draw on their unparalleled clinical and research experience. Dr. Kernberg is responsible for putting BPD on the map in the late 1960s, generating enormous clinical interest and theorizing into BPD. In their editorial, Kernberg and Michels state:
"[W]e have made tremendous strides in only a few decades, beginning with a theoretical concept in psychoanalysis that was ridiculed by most other psychiatrists, and progressing to a widely recognized clinical entity; from a pejorative label for disliked patients to a carefully defined diagnostic category; from the subject of almost no systematic study to one of the most intensively researched personality disorders—in terms of diagnosis, epidemiology, genetics, developmental psychology, biological correlates, pathophysiology, and treatment—and perhaps most important, from a hopeless prognosis to a hopeful one, and particularly one for which we have several evidence-based effective treatments."
They end their editorial on a hopeful note:
"Borderline patients have long been to psychiatry what psychiatry has been to medicine—a subject of public health significance that is underrecognized, undertreated, underfunded and stigmatized by the larger discipline. As with psychiatry and medicine, this is changing. New knowledge, new attitudes, and new resources promise new hope for persons with borderline personality."
Dr. John Gunderson, who promoted the inclusion of BPD into the official diagnostic system of American Psychiatry, also penned an impressive historical review, "Borderline Personality Disorder: Ontogeny of a Diagnosis." Gunderson's vast knowledge of BPD straddles the early phases of our understanding which emphasized the environmental and psychological influences, to more recent attempts to rigorously identify the neurobiological and genetic underpinnings of the diagnosis.
In his article, he documents the explosion of research into BPD after 1980:
"Until 1980, fewer than 15 research reports on borderline personality disorder had been published; in the decade from 1980 to 1990, more than 275 appeared. With only one exception, these projects were conducted without federal funding."
It is remarkable that so much research occurred without federal funding (and still does). Obtaining research funding parity remains a daunting challenge. The graphs below highlight the disparity between the prevalence (percent of the population who has the disorder) of BPD compared to Schizophrenia and Bipolar Disorder, and the amount of federal funds devoted to study it. As Gunderson highlights, despite comparable prevalence rates, BPD receives about 1/50th the amount of funding as does Schizophrenia, and 1/20th the amount that Bipolar receives from the National Institutes of Health (NIH). See the figures below for a graphical representation of the problem, based on the data in Gunderson's review.
Why is this? NIH funds BPD oriented grants at about the same rate as other disoders. The discrepancy appears primarily due to the few numbers of investigators who are invested in BPD research. We desperately need to train and grow the next generation of BPD researchers.
Finally, Dr. John Oldham continues with the theme of how much progress has been made. He states:
"A prototypic image of a borderline personality disorder patient emerged within clinical settings as an angry, volatile patient prone to reject help, blame others, and behave self-destructively. Too often, this behavior was seen as willfully oppositional, and borderline personality disorder patients were spoken of as dreaded pariahs. Recommended treatment was generally psychodynamic psychotherapy or psychoanalysis, often referred to as "heroic" and of uncertain or poor prognosis.
How things have changed! We now have a vastly enriched understanding of borderline pathology, thanks to the invaluable contributions of clinical and basic science research. We now recognize that the "stress-vulnerability" model of disease is a useful guide to a biopsychosocial concept of borderline personality disorder patients."
So, these are the highlights from this special BPD section of the Journal, from my vantage point. I encourage those who are interested to read the articles themselves. Of course, every month is BPD awareness month on this blog. So, I look forward to the next post.
NOTE: I regret that I cannot respond to the comments as much as I might like. Please appreciate that I cannot provide clinical advice on this blog for clinical, legal, and ethical reasons. However, there are several advocacy organizations and mental health professional associations that can help with referrals. A future post on this blog will provide some general advice regarding how to find optimal assessment and treatment for BPD.
