I've Just Been Diagnosed with BPD. Now what?

 Don't panic!  Its quite a common diagnosis.

Its NOT a life sentence. 

It IS treatable.

Having BPD doesn't make you a bad person, a failure, unloveable or unemployable.

You are unique and valuable and if BPD is a part of who you are, then that is just the way it is - for now. You might be a bit difficult, a bit alternative, a bit unusual - you are also probably sensitive, thoughtful and creative - BPD is only a small part of you alongside all the other great things that you are.

Being diagnosed with BPD can be a pretty scary time.  You might have come to your GP worried about self-harming behaviour or mood swings. Maybe your parents or a friend have suggested that you get some help and you went to see a therapist. More seriously, you may have been diagnosed with BPD after being admitted to hospital following a suicide attempt.

Things probably haven't felt right for a long time, and you may have been worried about your anger or your sadness.  You might feel things more deeply than other people - an asset rather than a liability - but it can make you volatile - and vulnerable. Others may have told you you are "difficult" or unpredictable. You most likely will have noticed being overwhelmed by your own moods and feelings. 

"You've got BPD"  is not something you wanted to hear

You might know about BPD from reading or talking with friends. Maybe its a relief to hear it said after all the speculations and catastrophising. 

You will want to consider some treatments.

The most commonly sought treatment is DBT - a highly structured program which uses a non-judgemental approach to help manage emotions and increase your ability to tolerate distress.

DBT can give you the skills to cope with situations that have the potential to become overwhelming. The trick with Dialectical Behavioural Therapy is managing the challenge of accepting yourself as you are, but at the same time recognising the need for change (that is where the "dialectic" or "opposite" comes in).

From the SANE Website:

During a course of DBT, the therapist works with you to help you move away from a chaotic life and towards a life that you find personally meaningful and fulfilling.

DBT involves developing two sets of acceptance-oriented skills and two sets of change-oriented skills.

Acceptance-oriented skills

Mindfulness

Learning how to focus your awareness on the present moment, and to acknowledge and accept your thoughts, feelings, behaviours and bodily sensations as they occur, without the need to control or manipulate them.

Distress Tolerance

Learning how to manage and cope during a crisis, and to tolerate distress when it is difficult or impossible to change a situation. Learning to accept any given situation just as it is, rather than how you think it should be, or want it to be. Learning new skills like distraction and self-soothing, for both coping with and improving distressing moments.

Change-oriented skills

Emotional Regulation

Learning how to effectively manage your emotional experience, and not allow your emotions to manage you.

Interpersonal Effectiveness

Learning assertiveness strategies to appropriately ask for what you want or need. Learning how to say no, and how to manage interpersonal conflict in a way that maintains respect for yourself and others.

A typical course of DBT

DBT is typically run as a 24-week program, often taken twice to create a one-year program. In its standard form, there are three ways you receive DBT during the program. There are also shorter versions of DBT such as 12 week courses depending on the setting, and some versions do not include telephone coaching. DBT has been adapted for different needs.

DBT SKILLS TRAINING GROUP

A group facilitator teaches specific skills in a classroom setting, and sets tasks for the group members to practise between sessions. The skills training group typically meets once weekly, usually for around 2½ hours, across the 24-week program.

INDIVIDUAL THERAPY

Running at the same time as the group, individual therapy typically occurs weekly to enhance your motivation and commitment to the program. It’s also an opportunity to discuss and apply specific DBT skills to your current everyday life.

BETWEEN-SESSIONS TELEPHONE COACHING

On-the-spot telephone coaching from your therapist can be available at times during the week when you’re struggling. Your therapist guides you and encourages you to apply your new DBT skills to address and manage your issues.

How to get DBT treatment

In most Australian states, DBT programs can be accessed through both the public and private mental health system.

Public services

Public DBT programs are free to people living in the catchment area of a hospital that offers a program. Talk to your case manager, mental health professional or GP about referral options.

Depending on the hospital, there may be a waiting time to access the program. Some DBT programs run continuously across the year, while others operate on a more specific schedule.

Private services

Private DBT programs require payment. Prices will vary depending on the specific service you choose. If you have private health insurance, check that it covers psychiatric admissions.

If you don’t have private health insurance but you’re eligible for the National Disability Insurance Scheme (NDIS), you may be able to allocate funds to access a DBT program within the private system.

To join a private DBT program, a psychiatrist from the specific hospital or clinic can provide a referral for you.

Finding a service near you

To find services providing BPD treatment in Australia or New Zealand, visit Project Air Strategy’s Service Directory.

For state-based mental health assistance:

  • Victorian Mental Health Service Directory and Spectrum
  • NSW Mental Health Line on 1800 011 511 (available 24 hours)
  • ACT Mental Health Triage Service 1800 629 354
  • QLD Health 13 43 25 84
  • SA Health Mental Health Triage Service on 13 14 65 (available 24 hours)
  • WA Mental Health Emergency Response Line 1300 555 788 (metro) or 08 9224 8888 (State Wide)
  • Tasmanian Mental Health Service Helpline 1800 332 388
  • NT Crisis Assessment Telephone Triage and Liaison Service 1800 682 288.

PSYCHOTHERAPY

Often when people are feeling more settled, they can take on the work of healing through psychotherapy. This is a type of longterm talk therapy that provides good results for BPD and other personality disorders. Psychotherapy can be offered by psychiatrists, psychologists, social workers or counsellors.  Different psychotherapists use different approaches and most use a mix of approaches. Some psychotherapists may use elements of DBT and you may find a psychotherapist who can work with you individually alongside your group based classes - and/or after you have graduated from the more structured DBT programs.

If you have BPD, finding a good therapist is vital and developing good rapport ensures you can manage the therapeutic relationship, learn to trust your therapist and withstand the stress of therapy. Often therapy will elicit painful  feelings and these may seem overwhelming, especially when they need to be managed in between sessions.  For the therapy to work, you will also need to learn to be (emotionally) dependant on your therapist, at least for a while.  This can be scary, especially when your therapist isn't available all the time. Learning about limits is part of the work of therapy. Hopefully you will learn some skills to manage the stress and feelings of abandonment either through your one on one sessions or through group skills work in a DBT program. Learning to self-soothe is one of the most important steps to recovery.

Whilst it is a good idea to "shop around" for a therapist, it is also a good idea to make the effort to work through any misgivings you might have about a new therapist so that you both can have time to develop a strong relationship. Managing and exploring this relationship is part of the work of therapy and will allow the therapy to help you. Most recovery for personality disorders takes place within the context of 1-2 years of weekly psychotherapy. It seems like a huge commitment, but real change comes only through hard work and time.

 

If you would like to start your recovery journey, please get in touch.

Amanda