?is indispensable book is compassionate to all involved and avoids blame, jargon, and oversimpli?cation." Freda B. Friedman, PhD Dialectical Behavior Specialist With exquisite understanding of the disorder and empathy for both those who have it and their family members, Randi Kreger o?ers valuable Power Tools' to help readers endure the ravages of BPD." Jerold J. Kreisman, MD, coauthor of I Hate You Don't Leave Me: Understanding the Borderline Personality and Sometimes I Act Crazy: Living with Borderline Personality Disorder Randi Kreger uncovers the marvelous symmetry of the borderline relationship, in which both participants experience similar self doubts, irrational guilt and shame, wavering identity, helplessness, anger, and fear of abandonment. ?ose with BPD and their loved ones will, together, bene?t from the tools she provides." Richard A. Moskovitz, MD, author of Lost in the Mirror: An Inside Look at Borderline Personality Disorder Randi Kreger masterfully breaks down BPD to help people more easily understand this complex subject." Barbara Oakley, PhD, author of Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed, and My Sister Stole My Mother's Boyfriend
Hazelden Center City, Minnesota ????? hazelden.org ???? by Randi Kreger All rights reserved. Published ???? Printed in the United States of America No part of this publication may be reproduced, stored in a retrieval system, or trans mitted in any form or by any means electronic, mechanical, photo copying, record ing, scanning, or otherwise without the express written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement. Library of Congress Cataloging in Publication Data Kreger, Randi. ?e essential family guide to borderline personality disorder: new tools and tech niques to stop walking on eggshells / Randi Kreger. p. cm. Includes bibliographical references and index. ISBN ??? ? ????? ?fi? ? (so cover) ?. Borderline personality disorder Treatment. ?. Borderline personality disorder Patients Family relationships. ?. Antisocial personality disorders Treatment. I. Title. RC?fi?.?.Bfi?K????? ???? fi?fi.??'??? dc?? ??????fi ?fi Editor's note ?e BPD stories quoted in this book are either composites or used with permission. In some instances, names, details, and circumstances have been changed to protect anonymity. ?is publication is not intended as a substitute for the advice of health care professionals. ?? ?? ?? ?? ?? ? ? ? ? fi Cover design by ?eresa Jaeger Gedig Interior design by Ann Sudmeier Typesetting by BookMobile Design and Publishing Services
xi T he Essential Family Guide to Borderline Personality Disorder is a very use ful addition to the growing literature on borderline disorder (the term most acceptable to my patients and readers). e author"s rst book, Stop Walking on Eggshells (with Paul T. Mason), has been an international best seller in this eld since its publication in . A brief overview of the history and current status of borderline disorder will provide context for this guide. Borderline disorder has been surrounded by many myths that leave people with the disorder and their family members feeling very hopeless. is should not be so because there are many actions that can be taken to markedly reduce the e ects of borderline disorder on those who have it and on their families. for almost a century, borderline disorder has been referred to as a wastebasket diagnosis," reserved for those patients whose presenting symptoms are o en so complex that they do not fall cleanly into a single diagnosis, thereby frustrating the clinician, the patient, and the family. Borderline disorder is resistant to treatment with conventional uses of traditional treatment approaches, and it was not listed in the American Psychiatric Association"s Diagnostic and Statistical Manual of Mental Dis orders until . According to the latest research, this devastating disorder has an estimated prevalence of almost percent in the general population. e many years of neglect of borderline disorder have resulted in a high prevalence of underdiagnosis, disability, continued su ering, premature Foreword
xiiForeword death by suicide, and a deep sense of hopelessness. ese overwhelming emotions pervade not only those with the disorder, but also their family members, whose lives are terribly a?ected. In short, borderline disorder is an overlooked, devastating disorder of tragic proportions. Today, however, there is new hope as a convergence of factors are caus ing dramatic strides forward. e rst factor is represented, in part, by the reports of neuroimaging studies that demonstrate clear di?erences in the brains of people with borderline disorder compared with those of con trol subjects. Other studies have demonstrated a high degree of heritabil ity of borderline disorder, further underscoring the fact that the disorder has a signi cant biological basis. ese studies provide clear and visible evidence that borderline disorder is associated with anatomical and func tional abnormalities of the brain, and that the disorder should be viewed no di?erently than medical disorders a?ecting other organs. e second factor is the emergence of research on the e?ective use of a new generation of antipsychotic agents, antidepressants, mood stabi lizers, and psychotherapeutic and psychosocial interventions speci cally developed for borderline disorder. Treatment programs have also been sig ni cantly e?ective for patients with the disorder, and they have provided highly useful information and new skills to patients" families. e third factor has been the development of two national advocacy organizations focused solely on borderline disorder: the Treatment and Research Advancements National Association for Personality Disorder (TARA APD) and the National Education Alliance for Borderline Person ality Disorder (NEA BPD). ese organizations are dedicated to educat ing patients and their families about the disorder and how to cope more e?ectively with it. e other mission of these organizations is to increase awareness of the disorder on a national and even international level and stimulate public and private funding for research and education. As a result of the e?orts of the leadership of NEA BPD, people with borderline disorder, their fami lies, and professional experts in the eld, the U.S. House of Representatives passed a resolution (H. Res. ) on April , , designating the month of May as Borderline Personality Disorder Awareness Month.
xiiiForeword In addition, other organizations have added signi cantly to the in crease in activity in the eld. For example, the National Alliance on Men tal Illness (NAMI) has recently named those with borderline disorder as one of their "priority populations." e Borderline Personality Disorder Resource Center has been recently established to help those a?ected by borderline disorder " nd the most current and accurate information on the nature of BPD, and on sources of available treatment." Two new important private resources for research funding of border line disorder have begun to have a positive e?ect on the eld. Founded in ???, the Borderline Personality Disorder Research Foundation (BPDRF) "has mobilized research centers in the United States and Europe to in vestigate whether BPD is a recognizable distinct entity, and, if so, what the de ning characteristics of the disorder are." Initially, it selected and funded four centers to investigate borderline disorder from varying scien ti c and clinical perspectives. In addition, it has awarded research grants to twenty two investigators. During the past decade, the National Alliance for Research on Schizo phrenia and Depression (NARSAD) has expanded its original focus from schizophrenia and a?ective disorders to other prevalent mental disorders such as anxiety disorders. Since ? , this donor funded organization has awarded more than ? million in grants to senior and new meritorious researchers involved in brain research focused on psychiatric disorders. Recently, it has included borderline disorder in its areas of interest. A nal critical factor has been the marked increase in the amount of information readily available about borderline disorder. During the past decade there has been an increasing number of books written for the non professional about borderline disorder, and there has also been a compa rable number of Web sites launched. One of the most successful of these books has been Stop Walking on eggshells, coauthored by Randi Kreger, the author of this guide. In Stop Walking on eggshells, Kreger focused her attention on the families of those who do not acknowledge their borderline disorder, do not seek treatment, and blame their di?culties on others. e success of this book attests to the large number of people who fall into this group whom