Tami Green

Web Posted: 03/09/2009 12:00 CDT

By Melissa Fletcher Stoeltje   - Express-News

Julie, not her real name, has struggled with "exaggerated" emotions all her life, she says. A pretty 43-year-old whose words come out in a tumbling rush, she has been married three times, each marriage falling prey in part to her obsessive worry that her spouses were cheating on her.

"There was nothing feeding it, it was completely irrational," she says, sitting in her tidy Northeast Side apartment on a recent afternoon. Her constant accusations drove her husbands away. But worse than her obsession over spousal infidelity, these same inner demons drove her to seek out romantic attention from other men while she was married.

"Sex is one of those vices some people use to feel better," she says quietly, adding that she never went beyond flirting. "Sexual attention was my drug of choice and it caused the downfall of all my marriages."

Julie was diagnosed with depression at age 18 and has been on a host of medications over the years to battle her intractable sadness. But she has an attendant diagnosis that serves to muddy the picture. Julie has features of a condition called borderline personality disorder, a strange, misunderstood and apparently growing mental illness that ruins relationships and causes untold grief for sufferers.

The Diagnostic and Statistical Manual of Mental Disorders, the bible of the mental-health profession, lists nine criteria for diagnosing borderline personality disorder, or BPD. They include frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense relationships featuring wild swings between idealization and devaluation of the other person, impulsivity, suicidal and self-destructive behavior such as cutting, chronic feelings of emptiness and inappropriate anger.

The prevalence of BPD is under dispute. Studies suggest the disorder affects 2 percent of adults, the overwhelming majority of them women. But a recent study of this little-known condition by the National Institute of Mental Health says the prevalence is much higher, almost 6 percent, making it more common than bipolar disorder and schizophrenia combined.

"The diagnosis definitely is growing," says Perry Hoffman, a doctorate-level social worker who runs the National Education Alliance for Borderline Personality Disorder. "No one has come up with a good rationale for why that may be. It may be the pressures of our society, or maybe we're just more attuned to (BPD.)"

Hoffman says while BPD instances have been cited in medical literature since the 1930s, the condition didn't get official recognition until 1980. The term borderline comes from the idea that the disease straddles the borderline between neurotic and psychotic behavior. Hoffman says a better way to view it is that BPD overlaps or is on the "border" with other mental-health diagnoses.

"Even today some people say it doesn't really exist, that it's just an affective disorder," she says. "Some people call it a garbage diagnosis. A doctor, for example, who doesn't know what's wrong with a person will just say, 'Oh, that's borderline'. I like to say this diagnosis is 30 years behind schizophrenia. But as things are being clarified, people are more aware of BPD and are beginning to diagnose it more accurately."

Complicating the picture is that, like Julie, those with BPD usually also have a co-occurring illness such as depression, bipolar disorder or anxiety, making proper diagnosis difficult. Another problem is the entrenched belief that BPD is impossible to treat. Physicians often are reluctant to treat borderlines, as these patients are sometimes called, and their disease is highly stigmatized among health professionals, says Hoffman.

But the condition is, in fact, treatable, says Tami Green, a woman in Houston who says she has been cured of the disorder and is now on a mission to spread the word about what exactly BPD is and how it can be relieved.

"Someone once described borderline as being exquisitely sensitive, like you have no emotional skin," says Green in a telephone interview. "It feels like if you're touched, even just verbally, you'll die. The best way to describe it is just extreme emotional pain. It's just unending pain that never goes away."

Green says that, while in the throes of her disease, she felt "just completely empty." She drove away those closest to her. She drank to stifle the pain and, at her worst point, tried to commit suicide.

"Borderline is like having an emotional sunburn," says Jim Hall, a man in Houston whose daughter suffers from the disorder. "In bipolar disorder the mood swings will occur over weeks and months. With borderline, it's over dinner. The person with borderline has a very low self-image and they view any kind of rejection or negative comment as utter rejection."

Scientists aren't sure what causes BPD, but they believe there is a strong biological component that then likely interacts with environmental pressures in childhood.

"There's a higher incidence of personality disorders in unhealthy families," says San Antonio psychiatrist Melissa Deuter. "There may be an alcoholic parent or a parent with depression. There might not even be frank abuse, just a child who can't get his or her emotional needs met in a healthy way. Sometimes (in BPD) it's as simple as a mismatch between parent and child. A parent can have four children and only one of them will have a personality disorder, and it's a case of that one child having needs the parent simply couldn't meet."

Deuter says personality disorders often result from a kind of "developmental arrest" wherein certain developmental issues don't get properly navigated in childhood.

"It's very hard for people around (borderlines) to understand that what they're doing is not just bad behavior," she says. "They'll tend to say, 'Grow up and get yourself together.'"

Green was able to recover through a therapy called Dialectical Behavioral Therapy, or DBT, created in 1991 by a scientist named Marsha Linehan.

"DBT has put BPD on the map because there is finally something to treat" borderlines with, says Hoffman. The therapy is skills-based and focuses on behavioral change and finding a balance "between accepting what is and then changing what can be changed."

Green, who now helps BPT sufferers in Houston, says with DBT and other therapies, there is profound hope for borderlines. It took her two years to get better, but she's thriving now.

"People shouldn't give up because help is out there," she says.

To contact Tami about personal coaching, please see Tami Green Life Coach.