Borderline Personality Disorder Assessment
What to Expect from the Borderline Personality Disorder Assessment Process
By Kristalyn Salters-Pedneault, PhD, About.com Guide
Updated July 27, 2008
Immigration Assessment
If you think you (or a loved one) may have borderline personality disorder (BPD), the first step toward recovery is getting an accurate diagnosis. But what happens during the assessment process?
Starting a Borderline Personality Disorder Assessment
The first step to getting an accurate diagnosis is finding a mental health professional who is trained to work with people with BPD and making an appointment. This alone can be a challenge. It can be very anxiety provoking to think of taking this first step; many people avoid it for months or even years. But, once you make the decision to move forward, finding a clinician is not always easy.
There are resources that can help guide your search. If you have health insurance, you may want to talk to the insurance company about clinicians who take your insurance and who have expertise in BPD (you should also ask how many sessions would be covered and how much the co-pay would be). If you do not have insurance, you may qualify for public assistance programs or services through your state or region's department of mental health or social services.
As you search, keep in mind that you are looking to contact a professional who will conduct an assessment, give you a diagnosis, and either provide treatment or refer you to people who are an appropriate match. There are a number of different kinds of clinicians who can do this, including psychiatrists, psychologists, social workers, licensed mental health counselors, and psychiatric nurses. Generally, psychologists have the most training in psychological assessment (although this is not always the case), so you may want to start there (most psychologists will have a Ph.D. or Psy.D. after their name, but you may need to ask them if they are a licensed psychologist).
Scheduling a Borderline Personality Disorder Assessment
When you have found a list of professionals who might work, it is time to call and schedule an appointment. Call the first person on your list, and let them know that you are interested in an assessment and treatment. Describe some of your symptoms. You can even mention that you think you may have BPD.
Talk to the potential provider a bit about their educational background and training, and what types of services they can provide. Also ask if they have experience with BPD, what and how they charge (and confirm that they will accept your insurance if you have it). Ask what to expect in terms of the assessment process. This process will usually take more than a few minutes; the provider should be devoting at least a session, if not more, to assessing your difficulties (unless you have had assessments previously and the diagnosis is already established).
Keep in mind that you should feel comfortable with the clinician. Try to get a sense of that over the phone. Does this sound like someone you could talk to? Unfortunately, depending on where you live, you may not have too many options to choose from. But, try to choose someone who has the right expertise and who you feel comfortable with.
The Borderline Personality Disorder Assessment Process
When you arrive for your first session, you may feel nervous and uncomfortable, particularly if you have never done this before. This is completely normal. It is not easy to meet a new person and share private details about your life. However, keep in mind that the more candid and honest you can be, the more you will get out of the assessment.
Different providers use different tools to conduct an assessment. Generally, you should expect that your clinician will interview you and ask questions about your current and past symptoms, your family and work history, and your current life situation. Some clinicians will also give you some short questionnaires to fill out. Some may also use psychological tests that are longer and cover many different questions.
The assessment may take one session, or, if it is a very complete assessment, may take several sessions. Your clinician will let you know what to expect in terms of how long the assessment will take, and what types of tests or interviews you will be completing (if any).
Getting a Diagnosis
In some cases, at the end of the assessment, you may need to be referred to other additional types of assessment before a diagnosis can be given. For example, if you have a history of one or more significant head injuries, your provider may want you to see a specialist to evaluate whether some of your symptoms could be related to that. Or, if you have not seen a primary care physician (PCP) in some time, your provider may ask you to visit your PCP to make sure that any symptoms are not related to underlying medical conditions.
However, in most cases, you will receive a diagnosis at the end of the assessment. Your provider will also talk to you more about why you may be experiencing these kinds of difficulties and will recommend treatment options that may work for you. It may be that the clinician you have chosen can provide some of the treatment, or they may need to refer you to someone with different expertise. The good news is that you will now be able to move forward with the treatment that will be best suited for you.
Source:
Groth-Marnat, G. Handbook of Psychological Assessment. New York: John Wiley and Sons, 2003.
Monday, March 22, 2010
Sunday, March 21, 2010
Anxiety Sufferers Process Emotions Differently: Study
Anxiety Sufferers Process Emotions Differently: Study
(HealthScout) UPDATED 2010-02-18
According to new research, the brains of people who have generalized anxiety disorder (GAD) process emotions in an abnormal way. For their study, scientists looked at MRI scans of the brains of GAD patients. They found that when exposed to different situations, the prefrontal cortex responded in an unusual way in these patients. The researchers say this finding could lead to better diagnosis and treatment of anxiety disorders. Read full story >
http://broadcaster.healthcentral.com/t?r=4&c=17659&l=427&ctl=17FAE7:323464311A7754CE7D504547630EFE78&
(HealthScout) UPDATED 2010-02-18
According to new research, the brains of people who have generalized anxiety disorder (GAD) process emotions in an abnormal way. For their study, scientists looked at MRI scans of the brains of GAD patients. They found that when exposed to different situations, the prefrontal cortex responded in an unusual way in these patients. The researchers say this finding could lead to better diagnosis and treatment of anxiety disorders. Read full story >
http://broadcaster.healthcentral.com/t?r=4&c=17659&l=427&ctl=17FAE7:323464311A7754CE7D504547630EFE78&
Book Review: Freedom from Self-Harm
Book Review: Freedom from Self-Harm
About.com Rating Article Feedback:
User Rating Be the first to write a review
By Matthew Tull, PhD, About.com Guide
Created: April 13, 2009
Adolescent DBT Treatment
Residential Treatment for females. Harvard affiliated McLean Hospital.
www.mclean.harvard.edu
Loved One w/ Borderline?
Discover the Secrets to Helping and Supporting Your Loved One with BPD
BorderlinePersonalityDisorder.us
PTSD Treatment
Treatment Center for Women's Psych. Issues. Operated By Women. Call Now
www.HollywoodPavilion.com
PTSD Ads
PTSD
PTSD and Veterans
DBT Therapy
Combat Stress
Posttraumatic Stress
Publisher's Site
Post-traumatic stress disorder and deliberate self-harm (also called non-suicidal self-injury) are often linked.
"Deliberate self-harm" means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors include cutting, burning, scratching, punching, or carving words or pictures on oneself.
Self-harm behavior can be difficult to stop and many people are reluctant to seek out treatment for self-harm due to the shame they feel about the behavior. Fortunately, there is a new self-help book available for people who deliberately self-harm.
A New Resource for Coping with Deliberate Self-Harm Behavior
Freedom from Self-Harm: Overcoming Self-Injury with Skills from DBT and Other Treatments (published by New Harbinger Publications) by Doctors Kim L. Gratz and Alexander L. Chapman may help those struggling with self-harm behavior.
Freedom from Self-Harm is an easy-to-read and accessible book that provides a wealth of information on:
•Why people often engage in self-harm
•Myths about self-harm
•Causes of self-harm behavior
•Mental health disorders that often co-occur with self-harm, such as PTSD and borderline personality disorder
•The consequences of self-harm
•Psychological treatments and medication that may be helpful for self-harm
•Coping skills for self-harm
The information provided in the book is up-to-date and presented in a validating and respectful manner. The authors also provide case examples throughout the book to help illustrate more complicated points.
Probably one of the greatest advantages of the book is its presentation of coping skills that someone struggling with self-harm could implement right away. For example, the book provides information on healthy ways of managing emotions (given that self-harm is often thought of as a way, albeit unhealthy, of regulating emotions), as well as worksheets to help people use these skills.
If you struggle from deliberate self-harm and are looking for a way to stop this behavior, you may benefit from checking out this great resource.
About.com Rating Article Feedback:
User Rating Be the first to write a review
By Matthew Tull, PhD, About.com Guide
Created: April 13, 2009
Adolescent DBT Treatment
Residential Treatment for females. Harvard affiliated McLean Hospital.
www.mclean.harvard.edu
Loved One w/ Borderline?
Discover the Secrets to Helping and Supporting Your Loved One with BPD
BorderlinePersonalityDisorder.us
PTSD Treatment
Treatment Center for Women's Psych. Issues. Operated By Women. Call Now
www.HollywoodPavilion.com
PTSD Ads
PTSD
PTSD and Veterans
DBT Therapy
Combat Stress
Posttraumatic Stress
Publisher's Site
Post-traumatic stress disorder and deliberate self-harm (also called non-suicidal self-injury) are often linked.
"Deliberate self-harm" means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors include cutting, burning, scratching, punching, or carving words or pictures on oneself.
Self-harm behavior can be difficult to stop and many people are reluctant to seek out treatment for self-harm due to the shame they feel about the behavior. Fortunately, there is a new self-help book available for people who deliberately self-harm.
A New Resource for Coping with Deliberate Self-Harm Behavior
Freedom from Self-Harm: Overcoming Self-Injury with Skills from DBT and Other Treatments (published by New Harbinger Publications) by Doctors Kim L. Gratz and Alexander L. Chapman may help those struggling with self-harm behavior.
Freedom from Self-Harm is an easy-to-read and accessible book that provides a wealth of information on:
•Why people often engage in self-harm
•Myths about self-harm
•Causes of self-harm behavior
•Mental health disorders that often co-occur with self-harm, such as PTSD and borderline personality disorder
•The consequences of self-harm
•Psychological treatments and medication that may be helpful for self-harm
•Coping skills for self-harm
The information provided in the book is up-to-date and presented in a validating and respectful manner. The authors also provide case examples throughout the book to help illustrate more complicated points.
Probably one of the greatest advantages of the book is its presentation of coping skills that someone struggling with self-harm could implement right away. For example, the book provides information on healthy ways of managing emotions (given that self-harm is often thought of as a way, albeit unhealthy, of regulating emotions), as well as worksheets to help people use these skills.
If you struggle from deliberate self-harm and are looking for a way to stop this behavior, you may benefit from checking out this great resource.
Childhood Abuse, PTSD, and Deliberate Self-Injury in Adolescents
Childhood Abuse, PTSD, and Deliberate Self-Injury in Adolescents
By Matthew Tull, PhD, About.com Guide
Updated: April 10, 2009
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Adolescent DBT Treatment
Residential Treatment for females. Harvard affiliated McLean Hospital.
www.mclean.harvard.edu
PTSD and Veterans
Deliberate self-injury (also referred to as deliberate self-harm) basically means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-injurious behaviors may include:
•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting is often considered to be the most common method of self-injury.
How Common is Self-Injury
Self-injury is more common than you may think. Although high rates of self-injury have been found in some groups of people with certain psychiatric disorders (for example, borderline personality disorder and PTSD), high rates of self-injury have also been found in young adults. Specifically, it has been shown that anywhere between 17% to 37% of college students have engaged in self-injury.
There is also some evidence that adolescents may be at high risk for engaging in self-injurious behaviors. Specifically, approximately 14% to 21% of adolescents indicate that they have engaged in some form of self-injury at some point in their lifetime.
What May Place Adolescents at Risk for Self-Injury?
The experience of childhood physical or sexual abuse, as well as the development of PTSD symptoms, have been found to be connected to self-injury.
For example, one study by researchers at the Veterans Affairs Boston Healthcare System, Boston University School of Medicine, and Harvard University looked at the role of childhood sexual abuse, PTSD symptoms, and self-injury among a group of adolescents around the ages of 12 to 19.
They found that having re-experiencing, avoidance, and emotional numbing symptoms of PTSD as a result of childhood sexual abuse may lead to self-injury.
How Might PTSD Symptoms Lead to Self-Injury?
People may use self-injury as a way of attempting to express and manage uncomfortable and upsetting emotional experiences, such as anxiety, sadness, shame, and/or anger. Self-injury may also provide a temporary escape from or be a way of avoiding emotional pain. These emotional experiences commonly stem from experiencing PTSD symptoms, such as intrusive thoughts or memories about a past traumatic event.
Self-injury may also be a way of expressing pain. People struggling with the emotional numbing symptoms of PTSD (where there are difficulties in having certain emotions, especially positive emotions), may use self-injury as a way to feel something or create feelings.
What Can Be Done About Self-Injury?
Self-injury is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterward, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.
If you engage in self-injury or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides information on their nationally recognized treatment program for self-injury, as well as resources on and referrals for people struggling with self-injurious behaviors. The Borderline Personality Disorder Survival Guide also provides excellent tips on how to address and cope with self-injurious behaviors.
Sources:
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.
Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.
Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.
Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.
Nock, M.K., & Prinstein, M.J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885-890.
Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.
Ross, S., & Heath, N.(2002). A study of the frequency of self-mutilation in a community sample of adolescents.American Journal of Psychiatry, 152, 1336-1342.
Weierich, M.R., & Nock, M.K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76, 39-44.
Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.
By Matthew Tull, PhD, About.com Guide
Updated: April 10, 2009
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Adolescent DBT Treatment
Residential Treatment for females. Harvard affiliated McLean Hospital.
www.mclean.harvard.edu
PTSD and Veterans
Deliberate self-injury (also referred to as deliberate self-harm) basically means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-injurious behaviors may include:
•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting is often considered to be the most common method of self-injury.
How Common is Self-Injury
Self-injury is more common than you may think. Although high rates of self-injury have been found in some groups of people with certain psychiatric disorders (for example, borderline personality disorder and PTSD), high rates of self-injury have also been found in young adults. Specifically, it has been shown that anywhere between 17% to 37% of college students have engaged in self-injury.
There is also some evidence that adolescents may be at high risk for engaging in self-injurious behaviors. Specifically, approximately 14% to 21% of adolescents indicate that they have engaged in some form of self-injury at some point in their lifetime.
What May Place Adolescents at Risk for Self-Injury?
The experience of childhood physical or sexual abuse, as well as the development of PTSD symptoms, have been found to be connected to self-injury.
For example, one study by researchers at the Veterans Affairs Boston Healthcare System, Boston University School of Medicine, and Harvard University looked at the role of childhood sexual abuse, PTSD symptoms, and self-injury among a group of adolescents around the ages of 12 to 19.
They found that having re-experiencing, avoidance, and emotional numbing symptoms of PTSD as a result of childhood sexual abuse may lead to self-injury.
How Might PTSD Symptoms Lead to Self-Injury?
People may use self-injury as a way of attempting to express and manage uncomfortable and upsetting emotional experiences, such as anxiety, sadness, shame, and/or anger. Self-injury may also provide a temporary escape from or be a way of avoiding emotional pain. These emotional experiences commonly stem from experiencing PTSD symptoms, such as intrusive thoughts or memories about a past traumatic event.
Self-injury may also be a way of expressing pain. People struggling with the emotional numbing symptoms of PTSD (where there are difficulties in having certain emotions, especially positive emotions), may use self-injury as a way to feel something or create feelings.
What Can Be Done About Self-Injury?
Self-injury is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterward, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.
If you engage in self-injury or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides information on their nationally recognized treatment program for self-injury, as well as resources on and referrals for people struggling with self-injurious behaviors. The Borderline Personality Disorder Survival Guide also provides excellent tips on how to address and cope with self-injurious behaviors.
Sources:
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.
Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.
Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.
Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.
Nock, M.K., & Prinstein, M.J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885-890.
Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.
Ross, S., & Heath, N.(2002). A study of the frequency of self-mutilation in a community sample of adolescents.American Journal of Psychiatry, 152, 1336-1342.
Weierich, M.R., & Nock, M.K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76, 39-44.
Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.
"Where are the best intensive Dialectical Behavior Therapy programs for people with Borderline Personality Disorder?"
Adolescent DBT Treatment
www.mclean.harvard.edu Residential Treatment for females. Harvard affiliated McLean Hospital.
"McLean Hospital"
by littlebear on Jul 25 2008 (20 months ago)
McLean Hospital in Belmont Mass. right outside boston has a well known borderline program (I think residential and outpaitnet, PHP.. They also have an adolescent DBT residential treatment program where the stay is at least 1 month
BPD Treatment for Women
www.GundersonResidence.org Superb Residential BPD treatment. Harvard affiliated McLean Hospital.
http://askville.amazon.com/intensive-Dialectical-Behavior-Therapy-programs-people-Borderline-Personality-Disorder/AnswerViewer.do?requestId=1472008
www.mclean.harvard.edu Residential Treatment for females. Harvard affiliated McLean Hospital.
"McLean Hospital"
by littlebear on Jul 25 2008 (20 months ago)
McLean Hospital in Belmont Mass. right outside boston has a well known borderline program (I think residential and outpaitnet, PHP.. They also have an adolescent DBT residential treatment program where the stay is at least 1 month
BPD Treatment for Women
www.GundersonResidence.org Superb Residential BPD treatment. Harvard affiliated McLean Hospital.
http://askville.amazon.com/intensive-Dialectical-Behavior-Therapy-programs-people-Borderline-Personality-Disorder/AnswerViewer.do?requestId=1472008
Where I am getting my treatment for my BPD
Dialectical Behavior Therapy program to open
at McLean
(June 2007 Issue)
By Jennifer Chase Esposito
This month, McLean Hospital in Belmont, Mass., will open what's believed to be one of the first residential treatment facilities in the country for treating adolescent girls in need of intense psychiatric care using Dialectical Behavior Therapy (DBT).
Originally developed to treat adult suicidality resulting from Borderline Personality Disorder, researchers have found positive effects using DBT treatments with adolescents. The patient population will be females aged 13-19 suffering from consistent emotional dysregulation who have not responded to previous treatments.
"Dialectical Behavior Therapy first looks at emerging Borderline Personality Disorder as a diagnosis [that] is restricted to adults, so no such therapy is [typically] done on children," says Philip Levendusky, Ph.D., vice president of network development at McLean.
Levendusky says there is "clear evidence that kids have the same profile as adults," but because the symptoms are seen so early in their lives and can often be confused with the normal maladies of adolescence, the symptoms may seem less apparent.
"What we've had here [at McLean] are generic programs. But with the evolution of the field, there is incredible interest in applying [DBT] to adolescents," says Levendusky, adding that the new facility will "creatively try to put together a state-of-the-art treatment program."
"Parents have called us and say there is nothing of its kind," says Blaise Aguirre, M.D., medical director of the new Adolescent Dialectical Behavior Therapy Center, as it will be named. Aguirre has been a child and adolescent staff psychiatrist for seven years at McLean and is a psychiatry instructor at the Harvard Medical School where he provides child adolescent training for residents. He says he "doesn't know of any other short-term residential unit in the country that's using a strict DBT model of treatment, where all of the clinicians are trained in DBT treatment." Aguirre does say, however, there are clinicians practicing DBT on young people in San Francisco, Los Angeles, Seattle, and New York.
Although the program will be primarily for New Englanders, Aguirre doesn't rule out fielding inquiries from other parts of the United States. Current McLean patients come from all over this country and as far as Mongolia and Spain.
The average inpatient stay will be about four to six weeks. "Anecdotally, 70-80 percent [of patients] have really good outcomes when the DBT treatment is very intensive," says Aguirre. "It's the idea of really 'packing it in,' and immersing" patients in the program.
The other upshot of an intense stay at the center is that it will decrease the opportunity for relapse once the patient gets back into his/her normal routine. "The downside of DBT treatment [in adolescents] is that it's very difficult to have continuum of care when we discharge kids who can't get DBT in their home environment."
Aguirre says that almost all studies show that up to two percent of the general population suffers from BPD. "In adults, I've never seen - and I've asked very senior colleagues about this - a BPD person who didn't suffer in adolescence.
"If two percent of the population is suffering, that means a lot of adults are suffering," he says.
By developing programs that can quickly halt early symptoms of BPD from becoming full-blown BPD, Aguirre believes that McLean's new center will help.
This self-pay program will cost approximately $1,400 per day. For more information about the program call 877-967-7233.
It truly is one of the best hospitals in the entire country for this issue and I will always continue to work to get better.
at McLean
(June 2007 Issue)
By Jennifer Chase Esposito
This month, McLean Hospital in Belmont, Mass., will open what's believed to be one of the first residential treatment facilities in the country for treating adolescent girls in need of intense psychiatric care using Dialectical Behavior Therapy (DBT).
Originally developed to treat adult suicidality resulting from Borderline Personality Disorder, researchers have found positive effects using DBT treatments with adolescents. The patient population will be females aged 13-19 suffering from consistent emotional dysregulation who have not responded to previous treatments.
"Dialectical Behavior Therapy first looks at emerging Borderline Personality Disorder as a diagnosis [that] is restricted to adults, so no such therapy is [typically] done on children," says Philip Levendusky, Ph.D., vice president of network development at McLean.
Levendusky says there is "clear evidence that kids have the same profile as adults," but because the symptoms are seen so early in their lives and can often be confused with the normal maladies of adolescence, the symptoms may seem less apparent.
"What we've had here [at McLean] are generic programs. But with the evolution of the field, there is incredible interest in applying [DBT] to adolescents," says Levendusky, adding that the new facility will "creatively try to put together a state-of-the-art treatment program."
"Parents have called us and say there is nothing of its kind," says Blaise Aguirre, M.D., medical director of the new Adolescent Dialectical Behavior Therapy Center, as it will be named. Aguirre has been a child and adolescent staff psychiatrist for seven years at McLean and is a psychiatry instructor at the Harvard Medical School where he provides child adolescent training for residents. He says he "doesn't know of any other short-term residential unit in the country that's using a strict DBT model of treatment, where all of the clinicians are trained in DBT treatment." Aguirre does say, however, there are clinicians practicing DBT on young people in San Francisco, Los Angeles, Seattle, and New York.
Although the program will be primarily for New Englanders, Aguirre doesn't rule out fielding inquiries from other parts of the United States. Current McLean patients come from all over this country and as far as Mongolia and Spain.
The average inpatient stay will be about four to six weeks. "Anecdotally, 70-80 percent [of patients] have really good outcomes when the DBT treatment is very intensive," says Aguirre. "It's the idea of really 'packing it in,' and immersing" patients in the program.
The other upshot of an intense stay at the center is that it will decrease the opportunity for relapse once the patient gets back into his/her normal routine. "The downside of DBT treatment [in adolescents] is that it's very difficult to have continuum of care when we discharge kids who can't get DBT in their home environment."
Aguirre says that almost all studies show that up to two percent of the general population suffers from BPD. "In adults, I've never seen - and I've asked very senior colleagues about this - a BPD person who didn't suffer in adolescence.
"If two percent of the population is suffering, that means a lot of adults are suffering," he says.
By developing programs that can quickly halt early symptoms of BPD from becoming full-blown BPD, Aguirre believes that McLean's new center will help.
This self-pay program will cost approximately $1,400 per day. For more information about the program call 877-967-7233.
It truly is one of the best hospitals in the entire country for this issue and I will always continue to work to get better.
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PTSD, Cutting, and Other Forms of Self-Injury
By Matthew Tull, PhD, About.com Guide
Updated: May 27, 2009
Carbide Cutting Tool
PTSD and self-injury (also called deliberate self-harm), such as cutting and burning, frequently co-occur. Deliberate self-harm has been defined as the deliberate and direct destruction or alteration of body tissue without conscious suicidal intent, but resulting in injury severe enough for tissue damage to occur. Basically, deliberate self-harm means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors may include:
•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting, skin carving, severe scratching, head banging, and punching oneself have been found to be some of the most common methods of self-harm.
Deliberate Self-Harm, Trauma, and PTSD
The experience of a traumatic event has been linked to deliberate self-harm behavior. In particular, people who have a history of sexual abuse and/or physical abuse have been found to be more likely to engage in deliberate self-harm. Women who have been raped may also be more likely to begin engaging in deliberate self-harm behavior. People with PTSD have also been found to be more likely to engage in this behavior.
Why Do People Use This Behavior?
There is evidence that people engage in deliberate self-harm as a way of attempting to express and manage their emotions, such as anxiety, sadness, shame, and/or anger. Deliberate self-harm may also provide a temporary escape from or be a way of avoiding emotional pain.
People with PTSD in particular may use deliberate self-harm as a way of getting back in touch with the present moment (also called "grounding"). Some people with PTSD may experience dissociation or flashbacks. Hurting oneself such as through cutting or burning may "shock" the body back into the present moment, ending the flashback or dissociation, much like the way smelling salts work.
Consequences
Deliberate self-harm is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterwards, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.
Resources
If you engage in deliberate self-harm or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides resources on and referrals for people struggling with deliberate self-harm behavior.
Source:
Chapman, A. L., & Dixon-Gordon, K. L. (in press). Emotional antecedents and consequences of deliberate self-harm and suicide attempts. Suicide & Life Threatening Behavior.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.
Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.
Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.
Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.
Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.
Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.
PTSD, Cutting, and Other Forms of Self-Injury
By Matthew Tull, PhD, About.com Guide
Updated: May 27, 2009
Carbide Cutting Tool
PTSD and self-injury (also called deliberate self-harm), such as cutting and burning, frequently co-occur. Deliberate self-harm has been defined as the deliberate and direct destruction or alteration of body tissue without conscious suicidal intent, but resulting in injury severe enough for tissue damage to occur. Basically, deliberate self-harm means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors may include:
•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting, skin carving, severe scratching, head banging, and punching oneself have been found to be some of the most common methods of self-harm.
Deliberate Self-Harm, Trauma, and PTSD
The experience of a traumatic event has been linked to deliberate self-harm behavior. In particular, people who have a history of sexual abuse and/or physical abuse have been found to be more likely to engage in deliberate self-harm. Women who have been raped may also be more likely to begin engaging in deliberate self-harm behavior. People with PTSD have also been found to be more likely to engage in this behavior.
Why Do People Use This Behavior?
There is evidence that people engage in deliberate self-harm as a way of attempting to express and manage their emotions, such as anxiety, sadness, shame, and/or anger. Deliberate self-harm may also provide a temporary escape from or be a way of avoiding emotional pain.
People with PTSD in particular may use deliberate self-harm as a way of getting back in touch with the present moment (also called "grounding"). Some people with PTSD may experience dissociation or flashbacks. Hurting oneself such as through cutting or burning may "shock" the body back into the present moment, ending the flashback or dissociation, much like the way smelling salts work.
Consequences
Deliberate self-harm is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterwards, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.
Resources
If you engage in deliberate self-harm or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides resources on and referrals for people struggling with deliberate self-harm behavior.
Source:
Chapman, A. L., & Dixon-Gordon, K. L. (in press). Emotional antecedents and consequences of deliberate self-harm and suicide attempts. Suicide & Life Threatening Behavior.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.
Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.
Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.
Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.
Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.
Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.
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