F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

Join these conversations already in progress:
• Road To Recovery - Stories of Hope
• Events for Parents and Caregivers Around the World
• Free F.E.A.S.T Conference Videos

Visit the F.E.A.S.T website for information and support.

If you need help using the forum please reach out to one of the moderators (listed below), or email us at bronwen@feast-ed.org.

sunny6
How many have had therapists suggest that in the first two years of treatment that their child could have borderline personality disorder only to see it go away later?  I am curious to know what percentage of teens with AN actually develop BPD.  Have had multiple therapists suggest that we treat it as such even though no diagnosis can be given until adulthood.  

We can't seem to get a handle on the anxiety and behaviors and medications only seem to make it worse and not better.  DBT has been going on for 10 months and while there is some improvement it is only seen when there is absolutely no stress.  Most of the time, the illogical thoughts are right at the surface.
Quote
scaredmom
Hi sunny6,
There have been a few people here that have had BPD considered when their child was ill with ED. For some, as I recall, when the child's weight was up their BPD symptoms did resolve. As for how many of those with AN I don't know. I cannot recall if your child is properly WR and for how long.
Some of us have had to get the weight quite a lot higher than originally discussed to see good brain healing (my D).
I am sure others will be here too to discuss their perspectives. Have you searched the forum for BPD?
XXX
Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
Quote
Foodsupport_AUS
My D had this suggested as a diagnosis in the first few years, with resolution of the symptoms as she recovered. It is very common. This article however covers your question - a large proportion of those with BPD have eating disorders, a smaller proportion of those with eating disorders have BPD.  https://www.verywellmind.com/eating-disorders-and-borderline-personality-425424
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Quote
smileymum

Yes, my now 17 year old has had emerging BPD raised as a possible diagnosis. I was furious when her CAMHS counsellor raised this with her a few month back. He asked my d to read up on it on the internet (God knows where they sent her) and see if she agreed with the symptoms. That was about it in terms of screening. Yes, for my d the chronic mental health issues reared their head before the ED and so her journey was psychiatric inpatient unit, followed by ED IP. But she has never acted out, all internal stuff and if anything is over-controlled rather than under-controlled.  Yes, there is still some emotional disregulation but that doesn't in itself mean BPD. It felt like a dumping ground diagnosis and an excuse for their lack of headway with her. A few months further down the line, she has been w/r for longer, is back into life, has held a voluntary job down for nearly 6 months, is well into college, friends, eating (we are getting there) and sport for fun. Still can't fathom why they thought it would be helpful....

She has a new psychologist at CAMHS who also shares my view that this quasi-diagnosis was unhelpful. Instead, the new therapist is prepared to use the more varied tools in her toolbox to treat my d as she presents. Phew. Of course, if she gets to be an adult, struggles further and gets proper diagnosis with all the appropriate support and therapy that comes with it, then fine. None of that nor any idea about waiting and seeing how being W/R for a proper amount of time might help was forthcoming for my d. If your ED son or d has not been W/R for some time, I'd treat this diagnosis with a not just a pinch of salt but a whole handful.

Smileymum
Quote
deenl
Hi sunny6,

Just a book recommendation for you and any other people reading this thread.

I love the book Overcoming Borderline Personality Disorder, A Family Guide for Healing and Change by Valerie Porr. Overcoming BPD might be a bit of an overpromise but the book is chock full of the latest understanding and research (spoiler: it's not the parents), paragraphs on helpful treatment, lots of validation and understanding for parents, spouses, siblings, etc. When dealing with difficult mental health issues we all develop coping mechanisms as best we can. However, some of these DIY mechanisms can end up being maladaptive and counter productive, this book helps you understand and find helpful and supportive ways to respond. Remember; we cannot change the wind but we can learn to trim the sail. I think the book is helpful even if BPD is only a provisional diagnosis.

The WHO (World Health Organisation) has a list of all illnesses, similar to the DSM (Diagnostic and Statistical Manual) of the American Psychiatric Association. It is called the International Classification of Diseases and the latest version is in the final stages before implementation. They have totally changed the way they classify personality disorders (the DSM classifications often blend together so much it is argued that they are meaningless) I find this an easy to read and understand system.

There is a diagnosis of personality disorder; mild, moderate, severe, unspecified (code 6D10 in ^this link) and then specific traits are attached (code 6D11); negative affectivity, detachment, dissociality, disinhibition, anakastina or borderline. Different people have different combinations of the traits in differing intensities.
^edited to fix link
From my reading it seems that many mental illnesses can be linked to either over or under control of emotions.

*People who have undercontrolled emotions are emotionally dysregulated and impulsive. Disorders associated with undercontrol include borderline personality disorder, antisocial personality disorder, binge-purge eating disorders, narcissistic personality disorder, histronic personality disorder, conduct disorder, bipolar disorder and externalising disorders (from wikipedia: externalising disorders manifest themselves through maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. Associated with ADHD, oppositional defiant disorder, alcohol and substance abuse, pyromania, kleptomania, intermittent explosive disorder). DBT treatment can be  beneficial.

* People with overcontrol tend to be emotionally constricted and risk adverse. The disorders associated with this tend to be obsessive-compulsive personality disorder (different from OCD), paranoid personality disorder, avoidant personality disorder, anorexia nervosa, schizoid and schizotypal personality disorders, autism spectrum disorders, treatment-resistant anxiety, internalizing disorders (from wikipedia: people with internalizing disorders keep problems to themselves, internalize the problems leading to depressive disordersanxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, and dissociative disorders.) RO-DBT is more likely to be helpful to these people.
*taken from Radically Open Dialectical Behaviour Therapy by Tohmas R Lynch

But, of course, we are all human and no person is going to neatly tick all the boxes for a category but they are helpful for understanding. And I think that until we understand mental illness better broader classifications and treatments that are tansdiagnostic may be helpful in some cases.

The one thing I do know is that the internet is a blessing and the more parents and other loved ones are informed and understand the better we can support the person with the disorder.

Wishing you strength and courage,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
Quote
krae
Thank you deenl, all of that information is very welcome by me. I will definitely search for Overcoming Borderline Personality Disorder, A Family Guide for Healing and Change by Valerie Porr, and read it. 

 "People with overcontrol tend to be emotionally constricted and risk adverse. The disorders associated with this tend to be obsessive-compulsive personality disorder (different from OCD), paranoid personality disorder, avoidant personality disorder, anorexia nervosa, schizoid and schizotypal personality disorders, autism spectrum disorders, treatment-resistant anxiety, internalizing disorders (from wikipedia: people with internalizing disorders keep problems to themselves, internalize the problems leading to depressive disordersanxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, and dissociative disorders.) RO-DBT is more likely to be helpful to these people." 

This definitely resonates with me about my RAN D in the respect of the following - The disorders associated with this tend to be obsessive-compulsive personality disorder, anorexia nervosa, internalizing disorders.
Quote
Doitagain
Hello Sunny 5. Couldn’t agree more with Smileymum! I don’t know where you are but here in the UK, in my view, too many practicioners clutch to a possible BPD /emerging BPD diagnosis because they just can’t get through to a young patient at all or are looking for “reasons “ for their lack of “success” with a young person. It’s a bit of a cop-out to be tbh. They find they face behaviours that are crazy, illogical, unyielding , unmoveable, self destructive,, dangerous ....and yes illogical again - insert anything you like to this list.  BUT... you are also simply describing anorexia - it has so many faces. I would also be wary of taking this from anyone other than a psychiatrist with maximum/very considerable/ years /huge experience specifically with anorexia and even then I’d want a second opinion. Two very experienced ED psychiatrists I have dealt with work on the basis that at BMI 14 for example, the young person will be “crazy” (my word crazy not theirs!) and that no real ongoing  “sense” (rather than lucid moments) can even begin until about BMI 18. Any then they must increase BMI beyond that too and during THAT period therapy can really start to “work” and that will take time then too. These numbers are not givens however and  change for every individual  with some being very ill indeed and “hard to treat” at BMI 18 . In between, with every kilo gained something small changes. If problems such as anxiety and depression existed pre Anorexia, they may well be there after anorexia too. But they are not inseparaty entwined. For some people they disappear post anorexia , for others they are lessened.  If DBT is not “working” then they should also explore other routes rather than slapping another label on.  DBT has to be practiced too to be effective. It’s not a cure all. Most people I know probably take one to three  techniques from it that they practice /apply and at the beginning that is usually only when someone else urges them to try to apply a specific technique to one-off stressful scenarios as they arrive.  I have only met one young period who came through anorexia to adulthood with an ongoing diagnosis of BPD (but that is anecdotal I know!) Please don’t  allow anyone to clutter your already complex situation with this right now. And keep with it, this is a marathon and not a sprint as they say.  The brain healing has to start at WR and like any severely damaged organ will take a while to heal gradually. You will get there. Sending best wishes to both of you .
Quote
sunny6
Thank you for all the helpful information.  Any thoughts if there is any harm in using DBT tools directed more for people with BPD for people with just anorexia?  Current approaches aren't working and we have done a round of IOP and now 10 months of once a week and twice a week DBT therapy.  Everytime we are in range, the anxiety is overwhelming and the beast panics with all kinds of excuses to not eat.  We drop a pound or two below and work like mad for a month to get back up all the while dealing with extreme thoughts and behaviors.  The behaviors and thoughts sound like BPD and she becomes manic in her actions and attitude.  Two different psychiatrists have alluded to it being a potential issue but have both said that she is too young to diagnose.  I just feel that with all the therapy and being 8-9 months wr (therapist thinks closer to 10 mth wr), we should see progress.  Even if it is all anorexia, if it behaves a lot like these illnesses, could therapy targeted at specific behaviors be helpful?  Medications don't work.  We have tried twice and both times have lead to sh and si.

We caught the illness fast (knew within 6 weeks, but took another 6 weeks to get the actual diagnosis); however, it nearly killed her in that time so I am just not sure of this is just a severe case or something that came along with it that we are just now starting to see.
Quote
smileymum
Hey Sunny 6
Sorry you are having such  hard time of it  - it must seem relentless but well done on reaching out to get advice. Mine is just one voice and so hope others might post their experience, too and perhaps you can build a picture of what might work best. 
So, in my ds IP, they delivered dbt with group work as well as 1-1 to help manage feelings and behaviours. My understanding is it can be used to help with self harm, anorexic thoughts, etc. You didn't need a bpd diagnosis. But it wasn't a magic bullet. My d was ok with therapy, not everyone was. My d was actually rather dismissive of dbt as an approach but crucially, really like the psychologist that delivered it.
I've heard it from more than one source that a large part of success in therapy is due to the therepeutic relationship but there is no doubt that dbt teaches some things that can be enormously helpful like distress tolerance. But I say 'can' because depends of the person is somewhat ready to hear it and the relationship/trust with the therapist. 
I can't see there is any harm in trying.
Is this on offer? How does your d feel about it? Does she have any therapy currently?
All best wishes to you as you support. 
Smileymum
Quote

WTadmin