Tuesday, August 2, 2011

Breaking News: BPD in Miami

This article was just brought to my attention. It seems Borderline is about to be a bit more high profile. 

Miami Dolphins star has borderline personality disorder

By Amanda Gardner, Health.com

Miami Dolphins wide receiver Brandon Marshall is known as much for his headline-grabbing troubles off the field as he is for his standout play on it.

If he has his way, he's about to be famous for something else entirely.

In a news conference on Sunday, Marshall told reporters that he suffers from borderline personality disorder, or BPD, a mental illness marked by intense anger, impulsivity, and turbulent interpersonal relationships.

The 27-year-old wide receiver -- who received his diagnosis this spring, after seeking treatment at McLean Hospital, in Belmont, Massachusetts -- told reporters he wants to be the "face" of BPD.

"My purpose moving forward is to raise awareness of this disorder -- how it not only affects the patient but the families and the people in the community," he said.

Marshall certainly has his work cut out for him. Although an estimated 2% of U.S. adults are affected by the disorder, it remains poorly understood, even among mental health professionals. That's partly because the symptoms of BPD can look a lot like those of other mental illnesses, such as bipolar disorder, depression, and schizophrenia.

(The term "borderline," in fact, arose because psychiatrists originally conceived of BPD as occupying the border between psychosis and neurosis, two broad categories of mental illness that aren't as widely used today.)

BPD can be especially difficult to identify and diagnose because some of the disorder's hallmarks -- including mood swings and intense fears of abandonment -- are, in less severe forms, considered to be "normal" human emotions and behavior, says Chris Cargile, M.D., a psychiatrist at the Texas A&M Health Science Center College of Medicine, in Bryan.

"Most of the things we talk about in personality disorders we see in everybody," says Cargile, who has not treated Marshall and cannot comment on the specifics of his case. "The reason we have the word 'disorder' is when those things become problematic. It's when the intensity level rises to the point where you can't hold a relationship together for more than a few hours or days, because you can't trust anybody."

BPD often manifests in "severe eruptions of depression," distrust of other people that verges on paranoia, and "frantic" efforts to avoid abandonment, Cargile says.

Suicidal threats and attempts are common; the completed suicide rate in people with BPD is as high as 10%, according to a review of the disorder, published in May in the New England Journal of Medicine, that coincidentally was written by John Gunderson, M.D., a psychiatrist at McLean Hospital who has spoken with Marshall about his condition.
Underlying much of this volatile behavior are an unstable self-image and a pattern of "black-and-white" thinking, Gunderson writes, which can lead to sudden, dramatic switches between feelings of "idealization" and "devaluation" regarding others.

As Patricia Junquera, M.D., an assistant clinical professor of psychiatry at the University of Miami Miller School of Medicine, puts it, "It's either all or nothing. There are no grays: 'If you're not going to be with me, you're not going to be with anybody.' They have a lot of security issues that other people might have, but deal with them differently."

During his press conference, Marshall alluded to the fact that his illness may have played a role in some of his high-profile off-the-field problems, including, most notably, a domestic dispute in April in which Marshall's wife, Michi Nogami-Marshall, was arrested and charged with stabbing Marshall with a kitchen knife.

(On Sunday, Marshall defended his wife and denied press reports about the incident without providing specifics.)

BPD usually has its roots in early childhood abuse, abandonment, and neglect, and it manifests in poor coping techniques. People with BPD "just don't know how to deal with their feelings," says Junquera, who has not treated Marshall.

Men and women with BPD often deal with strong emotions in different ways, she adds. Men represent about one-quarter of all people with BPD, and their inability to manage their feelings sometimes manifests as violence and drug and alcohol abuse.

Women, on the other hand, tend to turn their feelings on themselves, cutting themselves repeatedly or threatening to kill themselves if they believe someone's going to leave them, she says.

BPD can be very difficult to treat. The remission rate is extremely high, and only about 25% of people with the diagnosis manage to remain employed full-time, according to Gunderson's review.

Unlike schizophrenia, bipolar disorder, and depression, BPD (and many other personality disorders) tend not to respond to medications, although doctors do sometimes prescribe antidepressants, atypical antipsychotic drugs, and mood stabilizers to BPD patients. Instead, experts tend to rely on talk therapy that stresses how to cope with the feelings of abandonment and other symptoms of the disorder.

"You can treat some symptoms with medications, but the way to truly improve...functioning is with psychotherapy," Cargile says.

Marshall said he underwent both individual and group therapy at McLean, and seems optimistic about his own prognosis.

"I am not saying that I am cured," Marshall told reporters during the news conference. "What I am saying today is that I am confident today that with the skills that I have learned and the intensity of the program that I went through that I am in a position where I can live an effective and healthy life."

6 comments:

  1. Haven, thanks for sharing this. I don't know how you feel, but the more high profile people that come out and acknowledge their mental illnesses, the less stigma they will have on all of us. I think this is a courageous thing for this guy to do. Maybe people will begin to view people with mental illnesses and not 'CRAZY'. Take care!

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  2. I'm not pleased with this mostly because of the bad stigma it got (see my blog for quotes).


    If he really has it I hope he can get everything situated for himself but I'm worried this is going to turn into the autism thing where they blew it up. threw wrong facts in there (on tv) and then left it to lay with the kids who had it

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  3. @Forevertes... I'll check it out straight away.


    I have mixed feelings about this.

    One the one hand I think we definitely need a better spokes person as 'the face of BPD' especially as relatively it affects more women. However, I also think that it being 'a woman's disorder' is part of the reason it gets so little attention. If a woman in a similar situation were to come out she would be likely met with chauvanism and perhaps not taken seriously.

    On the other hand, yes, high profile exposure will lead to more interest and hopefully better funding for treatment, study, and advocacy.

    Breaking the stigma is so important. I just worry he is not the one to do this.

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  4. Poor move from him.

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  5. @ Haven I really could not have said it better myself! And thanks for responding

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Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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