Dancing on the Borderline

Part 5

by Alicia Potter

People with BPD don't get better, or so the clinical war stories go. Sholeh and Kara beg to differ.

"I'm totally different than I was before," says Kara, who is preparing to pursue a master's degree in computer science this fall. "I'm getting into this stage that when I have feelings I just let myself feel them, instead of trying to get rid of them or acting out. I have never been able to do that before."

But aside from patients' testimonials, there's scant evidence for the efficacy of BPD treatments. A medicine cabinet's worth of drugs -- Prozac, lithium, Trazedone, Paxil, and Zoloft, among others -- have been found to alleviate some symptoms of impulsiveness and anxiety, but not on any grand scale. Only an approach called Dialectical Behavior Therapy has proven effective in controlled clinical trials. Devised by the University of Washington's Linehan, it helps patients learn to regulate emotions and impulses.

Most therapists favor incorporating such behavioral therapies into a broader approach that typically combines psychotherapy, a prescription or two, and group therapy. Group therapy, Gunderson explains, helps BPD sufferers to recognize their behavior in others, and thus to begin to understand its causes and effects. "That was such a borderliney thing to do," BPD patients now quip to one another at McLean.

What about the stereotype of the Fatal Attraction harpy, ringing up her therapist at three in the morning, threatening to slit her wrists? Gunderson, who handles nearly a full client load of borderline patients, reports that he sleeps just fine, thank you. But even with an experienced therapist, BPD can remain intractable. Up to 65 percent of patients continue to meet criteria four to seven years after diagnosis; up to 44 percent do so 15 years later. Not the type of statistics we like to hear in a culture that smiles on those who shape up, shake it off, and fly right.

"I just feel like borderline people are in a lot more pain than we're given credit for," says Sholeh. "But I also think the pain can be taken away with a lot of treatment and a lot of . . .

"It's not going to be easy," she admits.

Indeed, in an age when even dogs are fed Prozac, it's hard to commit clinical hours and research dollars to a solution that's so much more complicated than taking a pill. Perhaps, then, the biggest horror of BPD is that it demands something BioGen can't bottle: time and patience.

"I constantly need validation and attention," says Sholeh. "No matter how many times people compliment me and say `you're great, you're wonderful, I love you,' it's just never enough. I still feel alone. It really is like the little kid who closes her eyes and thinks that no one's there."

Back to part 4 - Borderline Personality Disorder: A Definition

Alicia Potter is a freelance writer living in Boston.