The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on depression and bipolar disorder. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date,
scientifically-based tools and information. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments and discover a cure. The organization works to ensure that people living with mood disorders are treated equitably. Assisted by a scientific advisory board comprised of the leading researchers and clinicians in the field of mood disorders, DBSA has more than 750 peer-run support groups across the country. Nearly two million people request and receive information and assistance each year. DBSA’s mission is to improve the lives of people living with mood disorders. For more information about DBSA or depression and bipolar disorder, please visit www.DBSAlliance.org or call (800) 826-3632.
Allen Doederlein, President, DBSA
Steve Brannon, State Director, DBSA Tennessee
Healthy Lifestyle May Buffer Against Stress-Related Cell Aging
UC San Francisco Study Suggests Healthy Diet, Sleep and Exercise Can Mitigate Negative Impacts of Stress
Newswise, July 24, 2014 — A new study from UC San Francisco is the first to show that while the impact of life’s stressors accumulate overtime and accelerate cellular aging, these negative effects may be reduced by maintaining a healthy diet, exercising and sleeping well.
“The study participants who exercised, slept well and ate well had less telomere shortening than the ones who didn’t maintain healthy lifestyles, even when they had similar levels of stress,” said lead author Eli Puterman, PhD, assistant professor in the department of psychiatry at UCSF. “It’s very important that we promote healthy living, especially under circumstances of typical experiences of life stressors like death, caregiving and job loss.”
The paper will be published in Molecular Psychiatry, a peer-reviewed science journal by Nature Publishing Group.
Telomeres are the protective caps at the ends of chromosomes that affect how quickly cells age. They are combinations of DNA and proteins that protect the ends of chromosomes and help them remain stable. As they become shorter, and as their structural integrity weakens, the cells age and die quicker. Telomeres also get shorter with age.
In the study, researchers examined three healthy behaviors –physical activity, dietary intake and sleep quality – over the course of one year in 239 post-menopausal, non-smoking women. The women provided blood samples at the beginning and end of the year for telomere measurement and reported on stressful events that occurred during those 12 months. In women who engaged in lower levels of healthy behaviors, there was a significantly greater decline in telomere length in their immune cells for every major life stressor that occurred during the year. Yet women who maintained active lifestyles, healthy diets, and good quality sleep appeared protected when exposed to stress – accumulated life stressors did not appear to lead to greater shortening.
“This is the first study that supports the idea, at least observationally, that stressful events can accelerate immune cell aging in adults, even in the short period of one year. Exciting, though, is that these results further suggest that keeping active, and eating and sleeping well during periods of high stress are particularly important to attenuate the accelerated aging of our immune cells,” said Puterman.
In recent years, shorter telomeres have become associated with a broad range of aging-related diseases, including stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis diabetes, and many forms of cancer.
Research on telomeres, and the enzyme that makes them, telomerase, was pioneered by three Americans, including UCSF molecular biologist and co-author Elizabeth Blackburn, PhD. Blackburn co-discovered the telomerase enzyme in 1985. The scientists received the Nobel Prize in Physiology or Medicine in 2009 for their work.
“These new results are exciting yet observational at this point. They do provide the impetus to move forward with interventions to modify lifestyle in those experiencing a lot of stress, to test whether telomere attrition can truly be slowed,” said Blackburn.
Co-authors include senior author Elissa Epel, PhD, department of psychiatry, Jue Lin, PhD, department of biochemistry and biophysics, both of UCSF and Jeffrey Krauss, MD, division of physical medicine and rehabilitation at Stanford University. Lin, Epel and Blackburn are the co-founders of Telome Health Inc., a diagnostic company measuring telomere biology.
The study was supported by the Baumann Foundation and the Barney & Barbro Foundation. Puterman is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health.
UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu.
Source: University of California, San Francisco (UCSF)
Support for mood disorders: Allen Doederlien shares information Thursday
By Linda Braden Albert | email@example.com | July 20, 2014
A series of presentations focusing on mental health issues that began in March at the Blount County Public Library will continue Thursday as Allen Doederlein, president of the Depression and Bipolar Support Alliance (DBSA), speaks on bipolar disorder and depression. The presentations, sponsored by NAMI (National Alliance on Mental Illness) Maryville, are free and open to the public.
Doederlein said, “Our headquarters are in Chicago, Ill., and yet, we are really all over the country and have some incredible and important affiliates in Tennessee. The work they do is entirely volunteer. It’s done as a labor of love and it’s done from a very personal place.”
The organization is by and for people who live with depression or bipolar disorder. “That lived experience informs everything we do,” Doederlein said. “We provide information that’s easy and understandable, not written in ‘medicalese,’ not confusing but gets directly to what these conditions are and what you can do to live and get well. We provide empowerment. These are conditions that can make people feel disenfranchised, that can carry great stigma. We want to make sure that people are strong advocates for themselves.”
Doederlein said another goal is to raise concerns and needs to elected officials but also on a more personal level. “Also in their work places and their families — anyplace people with mood disorders may find themselves, to say, let’s work collaboratively and constructively to make sure everyone does well,” he said.
DBSA support groups provide valuable assistance and education for those with mood disorders. Doederlein said, “Our chapters operate free, in-person peer support groups. That’s a group that meets without a doctor or clinical professional present, just the people with a lived experience. There’s a great deal of scientific literature that shows that peer-to-peer experience is greatly beneficial and helps people get well and stay well.”
About 53,000 people are reached nationally in a year by these peer support groups, he added.
Doederlein said Larry Drain, president of the NAMI (National Alliance on Mental Illness) Maryville and initiator of the mental health informational series, is a wonderful example of someone with a great deal of power and intellect who has been challenged by mood disorders.
“He had taken that lived experience and made something in terms of giving back to others,” Doederlein said. “When you think that there are people doing that all over the country, it’s really, really something. Larry’s not only done that in terms of support but also as an advocate.”
At the national level, 50 percent of the paid professional staff and volunteers must, by charter, have personal experience in dealing with mood disorders.
“That perspective informs everything that we do,” Doederlein said. “That’s really important. Very often in health-related education or advocacy, it will be doctors talking to doctors, not really related to a person getting herself or himself well. We make sure that’s at the center of what we do.”
Mood disorders include a spectrum of conditions, including depression and bipolar disorder. Doederlein said, “About 21 million American adults are estimated to be affected by depression and bipolar disorder. That breaks down to about 14 million affected by depression, and between 6 and 7 million affected by bipolar disorder.”
Mood disorders are challenging, but they can be managed and those with the disorders can thrive and contribute to society, Doederlein said. A prime example — Abraham Lincoln.
To learn more, visit the DBSA at www.DBSAlliance.org or attend Thursday’s presentation. It begins at 6:30 p.m. at the Blount County Public Library.
Daisy Jabas, Assistant Director, submitted this abbreviated itinerary:
I wanted to give each of you Allen Doerderlein's Tennessee visit intenery as it is known now.
Decision on Medicaid Expansion holds coverage for many Tennesseans in balance
By Kristi Nelson
Posted June 2, 2013, updated June 4 2013
It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.
But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.
“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.
What the ACA intended
Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.
It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).
It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.
Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.
Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.
States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.
So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.
On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.
“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.
The ‘Tennessee Plan’
Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.
He outlined the proposal in the broadest terms, including five “key points”:
Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).
The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.
People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.
People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)
The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)
In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.
“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”
But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.
For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.
The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.
The government also limits co-payments for Medicaid-eligible enrollees.
There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.
A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”
Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”
Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.
Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.
The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.
However, the latest word among hospital executives and advocates is that an agreement could be near.
“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.
Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.
“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”
Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.
Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.
“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”
Business writer Carly Harrington contributed to this report.
© 2013, Knoxville News Sentinel Co.
Helping me through my depression
Blogger, Kelley Baker, shares hints her family uses to help her through depression.
By Kelley Baker
Most of the time, I’m the one you call when you want someone to cheer you up. I like to dance. I love rock concerts, farmers markets, dogs and children. But there’s another side to me: I have been living with clinical depression since I was a child.
Thanks to treatment, coping tools and lifestyle changes—working from home, eating a natural diet—I am better now than I have ever been. Still, every so often I feel the depression returning. I have described it to my husband as a demon eating my brain.
I know it’s confusing for him as one day I seem fine and the next I am sad, distant, or even angry and pushing him away. And I know he wants to help me, but sometimes it’s hard for family members and friends to know what to do.
I had to learn how to be more open with my husband about how I’m feeling and what I need from him. These are some of the things I’ve shared with him:
Help keep clutter at bay. A person spiraling into depression may feel like they are slowing down while the world around them speeds up. The daily routine feels overwhelming: The mail stacks up, dishes pile up in the sink, laundry goes undone. It feels more and more impossible to keep up. Getting extra help with kitchen chores and other mundane tasks keeps things under control so everyone in the house is happier.
Pitch in on meal plans. People who are depressed tend to either eat too little or overeat—usually going for something less than nutritious. Plus, driving through the pick-up lane at a fast food restaurant or ordering a pizza feels so much more manageable than fixing a meal. Having someone make a healthy meal not only contributes to my physical and mental well-being, but also eases my “mom guilt” over what my kids are eating.
A simple ‘Do you want to tell me what you’re feeling?’ makes me feel less alone.
Ask how I’m feeling. If I am able to articulate what I am going through, it helps my husband understand what I am dealing with—and sometimes it helps me understand better, too. Unfortunately, I won’t talk about what I’m going through unless someone asks me. I don’t want to impose, or I don’t think they care. A simple “Do you want to tell me what you’re feeling?” makes me feel less alone.
Encourage self-care. A lot of things fall by the wayside during a depression, including personal appearance. Brushing your teeth and taking a shower just don’t seem to matter—much less getting a haircut or going to the dentist. It all just seems too hard. That attitude can snowball quickly into greater feelings of worthlessness: “Now I’m such a mess, no one could ever love me.” Hearing something like, “I’m going to do the dishes, why don’t you go enjoy a bubble bath?” is often what I need to make me feel okay about doing something self-loving.
Offer a hug. Studies show that a sincere hug lasting longer than 20 seconds can release feel-good chemicals in the brain and elevate the mood of giver and receiver. The fact that people who are depressed often don’t want to be touched can make this tricky, but a hug from the heart, with no expectation of anything further, just may help.
Offer reassurance. Along with the feelings of worthlessness, anger and even guilt that are part and parcel of depression, there’s often fear of ending up alone because really, who would want to put up with these episodes forever? Being reassured I won’t scare away my family because I have an illness takes a huge weight off my mind.
Give a reality check. A never-ending loop of painful, destructive thoughts—“I’m unlovable, I’m a failure, I’m ugly, I’m stupid”—loop through the mind of someone with depression. When my husband reminds me how hard I worked to get a teaching credential, or tells me I’m a great mom or that he loves me, it helps me keep those kind of thoughts in check.
Remember the good. When I’m depressed, I sometimes forget that I was ever happy. Looking at pictures of vacations with my family, watching home movies, hearing things from my husband and kids that they like about me, reminds me that while I may feel sad or numb right now, I’ll get through it.
What is borderline personality disorder?Borderline personality disorder is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed borderline personality disorder as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.
Because some people with severe borderline personality disorder have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders.1 While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.
Most people who have borderline personality disorder suffer from:
According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have borderline personality disorder in a given year.2
Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that borderline personality disorder can be treated effectively, and that many people with this illness improve over time.1,3,4
What are the symptoms of borderline personality disorder?According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:
Suicide and Self-harmSelf-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with borderline personality disorder have suicidal behaviors,7 and about 4 to 9 percent commit suicide.4,7
Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with borderline personality disorder. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.7 For more information about DBT, see the section, "How is borderline personality disorder treated?"
Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with borderline personality disorder include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with borderline personality disorder may self-harm to help regulate their emotions, to punish themselves, or to express their pain.8 They do not always see these behaviors as harmful.
When does borderline personality disorder start?Borderline personality disorder usually begins during adolescence or early adulthood.1,9 Some studies suggest that early symptoms of the illness may occur during childhood.10,11
Some people with borderline personality disorder experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.12
Studies suggest early symptoms may occur in childhood
What illnesses often co-exist with borderline personality disorder?Borderline personality disorder often occurs with other illnesses. These co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder.
Women with borderline personality disorder are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, borderline personality disorder is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder.13
According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with borderline personality disorder also meet the diagnostic criteria for another mental illness.2
Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia.14,15 These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat borderline personality disorder and other mental disorders. For more information, see the section, "How is borderline personality disorder treated?"
What are the risk factors for borderline personality disorder?Research on the possible causes and risk factors for borderline personality disorder is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.
Studies on twins with borderline personality disorder suggest that the illness is strongly inherited.16,17 Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression.18 Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.19
Social or cultural factors may increase the risk for borderline personality disorder. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder.1 Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.
How is borderline personality disorder diagnosed?Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.20,21
A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.
The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with borderline personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.
No single test can diagnose borderline personality disorder. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with borderline personality disorder showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe borderline personality disorder showed a more intense emotional response than people who had less severe borderline personality disorder.6
What studies are being done to improve the diagnosis of borderline personality disorder?Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness.22,23 Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative.24 People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder.19,25
Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.26
These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.6
How is borderline personality disorder treated?Borderline personality disorder can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.
The treatments described below are just some of the options that may be available to a person with borderline personality disorder. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.
PsychotherapyPsychotherapy is usually the first treatment for people with borderline personality disorder. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.27
It is important that people in therapy get along with and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with this disorder to maintain this type of bond with their therapist.
Types of psychotherapy used to treat borderline personality disorder include the following:28
One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of borderline personality disorder, relieve symptoms of depression, and improve quality of life.32 The effectiveness of this type of therapy has not been extensively studied.
Families of people with borderline personality disorder may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.
Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with borderline personality disorder. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in borderline personality disorder. Studies with other mental disorders suggest that including family members can help in a person's treatment.33
Other types of therapy not listed in this booklet may be helpful for some people with borderline personality disorder. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section on psychotherapy.
Some symptoms of borderline personality disorder may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent.34 People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder.4 However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with borderline personality disorder had a relapse after remission.4
MedicationsNo medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness.35 However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time,12 but there is little evidence that this practice is necessary or effective.
Medications can cause different side effects in different people. People who have borderline personality disorder should talk with their prescribing doctor about what to expect from a particular medication.
Other TreatmentsOmega-3 fatty acids. One study done on 30 women with borderline personality disorder showed that omega-3 fatty acids may help reduce symptoms of aggression and depression.36 The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).
With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with borderline personality disorder to be patient and to receive appropriate support during treatment.
How can I help a friend or relative who has borderline personality disorder?If you know someone who has borderline personality disorder, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.
To help a friend or relative you can:
How can I help myself if I have borderline personality disorder?Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.
To help yourself:
What if I or someone I know is in crisis?If you are thinking about harming yourself, or know someone who is:
For more information on borderline personality disorderVisit the National Library of Medicine's:
For information on clinical trials
National Library of Medicine clinical trials database
Information from NIMH is available in multiple formats. You can browse online, download documents in PDF, and order materials through the mail. Check the NIHM website for the latest information on this topic and to order publications. If you do not have Internet access, please contact the NIMH Information Resource Center at the numbers listed below.
National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
TMHCA is, once again, excited to announce an upcoming FREE WRAP® “refresher” course in Nashville, Tn. This training is funded by TDMHSAS.
Location: TAADAS Conference Room
1321 Murfreesboro Pike
Nashville, Tn.; Office 155 37217
COURSE DESCRIPTION: The WRAP Refresher Course is a three day, interactive course co-facilitated by TMHCA Advanced Level WRAP® Facilitators. The primary purpose of this Course is to sharpen & expand facilitation skills to further engage students in Wellness Recovery Action Planning.
Through attendance in this course, WRAP® Facilitators will:
1. Recognize expanded options on how to give group introductions.
2. Identify additional knowledge areas, Values & Ethics of WRAP®
3. Apply new skills to sharpen & expand group facilitation skills.
4. Develop new, creative approaches to Facilitation to accommodate participant challenges & different group needs.
The Copeland Center strongly recommends that WRAP® Facilitators attend a Refresher Course @ least every two years to stay up on new developments and best practices.
I'm sharing the news of my being among national Award Winners for accomplishments over the past year. It has been a pleasure to serve as State Director and local chapter President. And I consider it an honor to be recognized by DBSA national.
I appreciate all the wonderful support I was given by my fellow officers, Board members, and the chapter membership throughout the year. You may view the announcement on the national web site athttp://www.dbsalliance.org/site/PageServer?pagename=peer_chapter_spotlights
Congratulations to our 2013 Chapter Service Award Winners!
The DBSA Chapter Service Awards recognize exemplary service by DBSA
chapters, state organizations, and their leaders. Winners will be honored at the 2014 Chapter Leadership Forum in addition to receiving a cash award.
Steve Brannon of DBSA Jackson (TN) and DBSA Tennessee - Outstanding
Steve is an excellent role model for pursuing a wellness-focused life while living with a mood disorder. He fights stigma by openly sharing his journey in the local newspaper, on DBSA’s website, and on his weekly online newsletter. He has worked with the local police department to help educate and train police officers for crisis response teams. Steve was selected for DBSA Peer Advocacy Training and was a representative of DBSA for Hill Day in Washington, D.C.
At his local chapter, DBSA Jackson (TN), Steve gently encourages, trusts, and believes in support group participants. He instituted a monthly “share your inspiration” night in which group members report on what keeps them going, creating an environment of hope and personal growth. Steve is dedicated to further advancing DBSA’s mission into surrounding communities and across the state. The number of support groups has doubled in the past year under his direction, encompassing all major cities and some smaller cities across the state. He has traveled hundreds of miles at his own expense to conduct local chapter visitations as state director. Steve’s passion for the advancement of DBSA’s mission in Jackson and the state of Tennessee is so strong that he has diligently dedicated his time and resources for over a decade.
DBSA Tennessee - State Organization Service
DBSA Tennessee's amazing accomplishments made 2013 a rewarding year!
They supported chapters in their state by hosting educational presentations and training programs, giving them the tools necessary for successful chapters. With help from DBSA Tennessee, five local chapters were interviewed on television or radio to promote DBSA to the community. Leaders encouraged one chapter’s community outreach, resulting in a city-wide Mental Health Day declared by their mayor. DBSA Tennessee’s robust plan to help new chapters in the startup process helped find free meeting locations, assistance in affiliation fees and paperwork, and provided a sponsor from an already established chapter to assist the new chapter.
Five members of DBSA Tennessee attended DBSA’s Peer Advocate Training in Washington, D.C. and then created an advocacy plan for their state including a campaign against proposed budget cuts to close all 45 of Tennessee’s Peer Support Service Centers. DBSA Tennessee is a growing, thriving organization. With its advocacy for peer support and local chapter start-up, community outreach and commitment to peer education, DBSA Tennessee is one of the most energetic affiliates of DBSA.
DBSA Murfreesboro (TN) - Rookie Chapter Service
DBSA Murfreesboro began in July of 2013 with support from DBSA Tennessee.
The chapter started out with one support group, which saw its attendance
double in fewer than six months, becoming one of the fastest growing local
chapters in the state. The growth of the chapter can be attributed to the forces behind it that work tirelessly to get the word out about the group. Flyers and pamphlets are distributed to agencies and health care providers, the Salvation Army, local hospitals and businesses, and more. DBSA Murfreesboro provides post-hospitalization support for those who would otherwise have none. Educational materials, resources, and wellness tools are provided to each chapter participant. They have also started a family and friends support group.
Members of DBSA Murfreesboro participated in the state chapter meetings and backing of their U.S. Representative. For a chapter that achieved all of this in six months, DBSA Murfreesboro has a fine resume of accomplishments, but they consider their greatest success to be the level of support offered to each person who walks through their doors.
Alternative to Meds Center
By: Ericka G.
The script for my success journey had already played out in the optimistic stage of my mind prior to this life-changing breakthrough. Before this perceived notion of accomplishing the most profound discovery, there lied a mental environment of opposing views. The pivotal dynamic contrast that lied dormant was the hopelessness marked by my former psychiatrist’s repetitive voice relaying that psychotic medication intake would be for a lifetime. But something deep within surpassed this voice and rang out louder representing hopefulness with the confidence to know that holistic alternatives existed with healthier ways to manage my symptoms. Therefore, I launched a mission in search for this non-conventional approach through a few browse searches on Google and suddenly a vision was birthed to one day attend the “Alternative to Meds Center”. As anticipation rose to meet the eager embrace of new found hope, the circling theme that dominated my thoughts involved the declaration of healing that stood me right in the face the night before my arrival. This arrival of recovery victory existed prior to packing my bags and stepping on the soil of Sedona, Arizona to embark upon this outstanding program here at ATMC. With the proper mindset and motivated perception, the stabilizing tone was set for past frustration to become whole manifestation.
Though healing had already taken place, I forged a goal to become totally medication free to avoid the pulsating cardiac distress fueled by the side effects of Geodon. In addition, I didn’t want to play a prolonged game of Russia Roulette by taking a risk on a harmful medication that could cause future health issues. Stable and highly productive the last 8 years, through the collective effort of remaining true to my faith in God as I properly managed my symptoms, I gained the blessing of being hospital-free during this duration. This all-inclusive, holistic approach in addressing every angle of total well-being produced excitement coupled with enlightenment and elevation. With a willing and open receptiveness, I became a thriving “sponge” with the drive to advance my knowledge of the program’s teachings, tools, and training. From the moment I started the program, the enlightening mode of taking advantage of every nugget of information to better equip myself for mental health and physical wellness became the focal point of my positive interaction. Every aspect of the program especially the counseling has propelled me to new levels of understanding the greater need for self-care through diligence and improvement all in making me a more polished individual. The beneficial knowledge I received concerning the importance of supplementation to the health-conscious meals to the intensive detoxification process worked hand and hand to cohesively promote total restoration, mental clarity, and longevity. With these practices, the collaborative effort of the staff’s supportive attitude and expert awareness of the best solutions to all of my needs made this an exceptional experience. My gratitude continues to deepen, most importantly, to Mr. Lyle Murphy for making his vision a staple reality that would be successfully influential in making a difference for so many of us.
7 Things a Child with Depression Should Know
By Deborah Serani, Psy.D. on February 2, 2014 - 8:42am I know depression.
I lived with it as a child, watched it almost destroy me as a teen, and learned to manage it as an adult.
As a clinician who specializes in mood disorders, I like to teach kids and teenagers how to live with their depression. These tips offer children ways to understand their own unique self, become aware of their thoughts and feelings, and build resiliency as they manage the chronic illness of depression.
1) Understanding the texture of feelings: Many children in this era of super technology aren’t skilled at reading facial cues, understanding eye contact and complex emotions. Studies show that children with depression struggle further, however, having difficulty differentiating the differences between different kinds of emotions. Sad is different than lonely. Lonely is different disappointed. Often, depressed children need help understanding the textures of emotions. When they become confident identifying their feelings, they can set into motion the best plan of action to improve their mood.
2) How to spot negative thinking: I like to teach children about the quality of their thoughts by using a thumbs up and thumbs down technique. Is what you’re thinking a good thought….one that would get a thumbs up from other people? I studied for my test. But if I get a bad grade, it’s okay because I know I tried my best. Or is it a hurtful or negative? One that really is untrue and realistic. It doesn’t matter if I studied. I’m stupid and I’ll fail the test anyway. Teaching children to catch the negative talk helps them approach every issue in life from a place of positivity.
3) How to use positive self-care: Learning to live with depression requires a child to be clever and ever-ready to use soothing ways to address sad moods. Teaching kids and teens to use their 5 senses – sight, touch, hearing, taste and smell – really helps. Things like cozying up to a stuffed animal, hugging loved ones, snacking on healthy, flavorful foods, taking in the fresh air, listening to upbeat music and making time to see colors, nature and sunshine. All of these raise dopamine and serotonin levels improving mood, and teach children how to self-soothe.
4) Why exercise is important: The fatigue that comes with depression leaves kids tired and irritable. Physical complaints like aches and pains also knock them out for the count too. When we take the time to teach children about the importance of physical exercise, it will become part of a lifelong skill-set. Be it playing tag with friends or catch with the dog, swimming or riding a bike, kick-boxing or yoga, or a simple walk, the shift in neurochemistry boosts mood.
5) When too much of something isn’t good: It’s also vital for kids to learn how too much of anything can upset the apple cart. For example, the fatigue of depression can leave children tired, with many prone to sleeping all day. Instead, children should learn that a nap is better than a full-on sleepfest. Some depressed children eat in excess, while others lose their appetite altogether. Both of these extremes are unhealthy. Too much crying, too much avoidance or too much irritability raises the stress hormone cortisol, which heightens anxiety and alertness. When we teach children to monitor their experiences with healthy limits, we give them the ability to balance and self-manage their well-being. Daily stickers for young ones and journaling for the older set can teach children how to better monitor symptoms and moods.
6) Know the difference between a bad day and a sad mood: When depressed kids learn how to measure the moment, they learn that a sad mood doesn’t have to ruin a day. However, if they can’t shake off the sad mood – and the rest of the day feels like an epic fail, it’s great for kids to know that a bad day doesn’t equal a bad life. Tomorrow is a new day. One to be measured for its own value.
7) How to let others know you need help: When children are depressed, they often don’t know how to reach out for support. Their fatigue and irritability dulls problem solving skills. Others might not feel they deserve help or would rather isolate themselves from family or friends. Depressed children need to know that everyone needs help now and then – and that no one can …or should… handle everything alone. I like to teach children to communicate their needs verbally and non-verbally. With words, through crying, by touch – it’s okay to show you others that you’re having a tough time.
A very personal plea for medicaid expansion: a letter to the governor
Dear Governor Haslam:
But my decision to write this letter is about much more than the peer support centers. In your state of the state message you talked a couple of times about the importance of government giving good customer service. You seemed to put a lot of stock in that idea. It was not the first time I have heard you speak about it. The decision to fund peer centers was a great example of good customer service.
My hope is that you will consider my request in the light of that concept. I am in a desperate situation and without your help I dont know where to turn.
I want to ask you to reconsider your stance on medicaid expansion. I know you are in a tough spot. Anything that makes the Tea Party mad faces great obstacles in Tennessee and few things make them angrier than health care reform. Perhaps what I am asking you is impossible for you to politically do. Several people have told me it is.
As I said my situation is desparate. Let me take a minute to describe it.
I have been “free” of health care insurance for many years. It is a freedom I would gladly lose. I have been told that I need surgery. The surgery is a minor one that thousands of people undergo every year. No insurance means no surgery. The doctor tells me the lack of surgery though may not be a minor thing though, that in fact if my condition should become an emergency my life may be in danger. I pray every day not to die a preventable death. Many people have far more dangerous situations than me and face far more immediate risk. Being poor should never, at least not in Tennessee be the cause of anyone’s death. And without action on your part it will be though.
My desperation though is not based purely on issues of my health. It goes far deeper than that.
My wife is disabled and has been on TennCare for a while. She is a TennCare miracle. Without it she would have died long ago. Even with all her progress without it she would no live a month. In order to save her insurance and in a very real sense her life after 32 years of marriage we have had to separate. I dont know, without TennCare expansion we can ever live together again.
The situation is very complex, but let me share it with you as briefly as I can. My wife receives SSI for disabilities. Recently I took retirement from Social Security. It was the worst decision I have ever made.
We found out that in Social Security’s eyes, even though our combined checks left us below poverty, we made far too much money. Linda lost over $700 and her check was reduced to $20 a month. I told Social Security that I would have to get a job in order for us to survive. We figured without her check we had about $40 to live on for the month of January and we just cant live like that. Who could??
Social Security told us that since her TennCare was disability based and not income based (like it would be if TennCare was expanded) that if I made over $85 a month her TennCare would be lost.
I love my wife and wont let her die. The day after Christmas we separated. The hope is that with a separate address she can regain her SSI check. My hope is to move as close to her as possible. Right now I do not see how we can ever live together again.
You do not make the rules for Social Security and none of that is your fault. The law is what it is and despite its cruelty and hurtfulness we have no choice but to do our best to live with it. A law that supports the break up of thousands of marriages seems so evil, but I dont right now see how I can affect it.
I am asking for your help though. Maybe I dont have the right but I have no where else to turn. I know you deeply love and care for your wife. What would you say to me if our situations were reversed??
Please act. Whatever the resolution please act. My wife will keep her TennCare. I will never do anything to put that in jeopardy. Without your help though my marriage will not survive and for Linda and I that is a death of a different sort.
Mental health stigma resides everywhereStigma resides everywhere, especially mental health stigma. The urge to quiet the voices of those who live with challenges, those who are different or those whose choices don’t mirror the “norm,” seems to be overwhelming as of late. “Don’t air your dirty laundry.” How many of us heard that admonition as children? When we talk about mental illness, too often there are only two approaches discussed: sick or well, right or wrong. We talk about strong people and the weak people, those who feed their depression and mental illness and those who stoically rise above. When we talk about mental health in such limited parameters, we strip it of the crippling humanity that makes it possible: agony, loneliness, shame, trauma and stigma. We just tell people to think the right way, get the right amount of sleep and exercise, take the right meds, and when they don’t, we tell them to go away. In our current society, the mentally ill are considered the disease as much as the illness itself.
Here’s the rub: Change and recovery occur when things are faced. An acquaintance asked me recently why I speak openly about mental health recovery and surviving domestic violence and sexual assault. This well-meaning person felt that by airing my “dirty laundry,” I would cause myself more pain. Actually the opposite is true. When the mentally ill speak openly, others know they are not alone. Others learn what worked and what didn’t. By speaking – at first a whisper, then a roar – we lessen pain’s power. We learn to cope, we change the norm and we affect the changes we want to see.
Be part of the conversationThere is a well-known saying in mental health and social work circles:
“Nothing about us, without us.”
Only by being part of the conversation can we affect legislation, self-advocate for better care and show society that those with mental health conditions can live healthy, productive lives.
Why should we stand up and “air our dirty laundry?” To help those unaffected by mental illness but whom are the gatekeepers of the systems we need access to, to understand our reality. Because it reflects one-in-four person’s realities. Because stigma born from misconceptions can only be corrected by those who are affected. Because society needs to see us living lives and being productive with the proper treatment. Because we learn the most from those whose voices society tries the most to silence.
Mental Health Stigma: Airing our “Dirty Laundry” Posted on February 8, 2014 by Paulissa Kipp
Ways to Gently Advocate for Mental Health
Posted on February 8, 2014 by Paulissa Kipp
S.L. Brannon D.Div..