Leah Wiseman: Welcome to our Albury Wodonga Health, mental health podcast series - a sense of connection, mental health, well-being and resilience. The purpose of these conversations is to keep people connected, share our community stories of hope and resilience and provide information about mental health and other local services. I'm your host, Leah Wiseman, and today I'm joined by Maddy, Claire and Candice.
Maddy lives in the northeast and has lived experience of borderline personality disorder and bipolar disorder. Claire is a mental health nurse and case manager who has worked with Maddy for the past 12 months. Candice, a psychiatrist with the adult mental health service has a passion for providing the best care possible for people living with borderline personality disorder.
Maddy, could you start by telling us a little bit about what borderline personality disorder is?
Maddy: So for most people there, I guess we're gonna call them symptoms or behaviours, can vary from person to person like any illness. But for me personally, it can be a change in behaviours. So when it comes to managing emotions, I can be quite heightened. Something quite small, could be blown out of proportion a little bit, or I could go to the other extreme and become quite depressed and emotional, such as crying, sometimes being aggressive. A couple of times I have gotten angry, and I guess if it gets bottled up, for me I can explode. So that could result in me lashing out a couple of times, I’ve just thrown what was ever in front of me.
Leah Wiseman: And Maddy, for many for people listening who haven't had a lot to do with borderline personality disorder, it's often referred to as BPD. But to confuse things a little - bipolar disorder is also referred to as BPD sometimes. Can you just explain to us the key differences between those two things?
Maddy: So again, for myself, I have a diagnosis of bipolar disorder with an overlap of borderline personality disorder. So it can be quite confusing to know what symptoms or behaviours are from what. So borderline is more managing emotions. For some people, it can be a chemical imbalance in the brain, cause anxiety and depression. Again an overreaction of emotions and responses. So for me when it comes to something like work, something that's explained to me on instruction, I may have several questions to understand it - maybe more than someone who doesn't have it. And I can be quite over analytical in understanding things to make sure I've got it right. So I guess more insecurities.
Leah Wiseman: So when you're talking about being analytical, that sounds like a great trait to have. Why for you does that become problematic?
Maddy: In relationships I can be quite clingy, or ask 101 questions all the time. I’m constantly asking my husband why he loves me, or does he love me, or being quiet harsh on myself as a person in my books. Something has said it can blow thing out.
Leah Wiseman: Is it a constant process you go through after conversations, and after interactions?
Maddy: Yes. And it happens a little less now. But through a lot of hard work my husband, and my case manager, and my close family and friends pulling me up or keeping me accountable.
Leah Wiseman: So Maddy is talking about distinguishing between borderline personality disorder and bipolar - both present in her life. First, is it important to distinguish between the two? Or is it just how somebody presents on any given day?
Candice Gliksman: I personally think it is very important to try and distinguish between the two, because the treatment is very different. So the treatment for BPD or borderline personality disorder is mainly psychotherapy based. And there are a number of therapeutic techniques that we know work well. And if people are able to engage in those, the prognosis is actually really good and people can recover and do really well. Whereas, if someone is misdiagnosed as having bipolar disorder, then the treatment is based mainly on medication. And that is not the treatment of choice for BPD. I think it is very important, otherwise there's a risk of side effects from medication, people expecting that there'll be this wonder drug that’s going to fix everything which unfortunately doesn't exist. So I think it is very important. And I think the more people know and understand about their illness, I do think that knowledge is power and, and having insight into one's own illness and what the struggle are is so important. And I don't think we should overlook it. And I think we should be really careful in diagnosing people and take a lot of time with individuals to figure out what the diagnosis is.
Maddy: I remember when I first got diagnosed with borderline personality disorder, I remember being explained it, and then went home thinking it was split personality. So I was telling people, I have a split personality, when that's again very different. So then learning, teaching myself the traits, the behaviours to be aware of, as well as where it can come from or the causes. But I guess the challenge can be again, as it's already been said, distinguishing between BPD and BPD. So, what is the emotion? Where is it coming from? What is what's the cause of that emotion? What's the trigger? So one thing I've learned with BPD is that it’s generally based around trauma, neglect, childhood experiences that affect habits, wellbeing, environment. Whereas bipolar, is more around managing emotions, finding triggers. And can be hereditary or genetic.
Candice Gliksman: And explained in a great way from an individual perspective and learned experience. I think that people can confuse between the two, because in both there is mood swings or mood dysregulation, I think that's where the confusion comes in. But if we look at the emotional swings of roller coaster that can happen with BPD, those emotions there is often a trigger. And the emotions tend to be shorter lived then what you would see in bipolar disorder. So bipolar disorder, the depressive, or manic episodes, would be in distinct episodes, which are generally fairly long. So for mania needs to be a week, for depression two weeks of symptoms. Which, if you actually do a thorough history, we'll find out that a lot of people with BPD don't give you that history. But they give you a history of having highs and lows. But that is emotional highs and lows and often it’s a psychological trigger, rather than it being a biological chemical imbalance.
Leah Wiseman: Claire, what have you seen really work in terms of strategies to help Maddy?
Claire Kernaghan: So Maddy and I have done a lot of work, I guess reflectively on, you know, looking back at situations that have happened, utilizing principles in DBT, particularly around chain analysis. So this is what's happened, let's look reflectively back at it, how could we have handled it? And I guess that's the first step in moving forward from that, is bringing that awareness, looking at other options and then, you know, in future situations, you're a bit more aware and realize that there are other ways that we can go about things too.
Leah Wiseman: So we've got another acronym in the conversation now. DBT. So that's dialectical behaviour therapy? Can you tell us what that involves?
Claire Kernaghan: So DBT, dialectical behaviour therapy, is a program developed by Marsha Linehan and it's primarily evidence based treatment for people with borderline personality disorder. So it works on a few modules. So mindfulness is a core module. So we look at focusing your thoughts on doing one thing at a time. And I guess stepping away from all the other stuff that's going on in the background in your head. It also looks at differentiating between our wise minds, so kind of like your gut feeling, your emotion mind where your emotions are controlling your behaviour, and your reasonable mind where you've got that analytical sort of mind. In a nutshell, that's the mindfulness and then that feeds into three other modules. So we look at emotion regulation. So why are we having emotions? What are the functions of our emotions? How do we recognize our emotions? Those sorts of things. Then we look at interpersonal effectiveness, so we're looking at how we interact with other people, how to be effective in our interactions with people. We look at things like how to say yes or no to things that are appropriate, and how to work that out. How to ask for things, and how to do that effectively as well. And then we also look at distress tolerance. So these talks about when we've got a crisis situation going on, how do we get through this crisis situation as best as we can without making it worse?
Leah Wiseman: Is that any of those strategies that have been particularly useful to you Maddy?
Maddy: I would say most of them have. It's been a real learning curve. It's definitely taught me to be more accountable and instead of being analytical, it's more reflective. So probably the biggest one for me would be the distress tolerance, so managing crisis. Is it really a crisis? Or is my mind going too far? Am I going too far the wrong way? And the other one would be interpersonal skills. So learning how to express my emotions without pushing people away, or without being aggressive or rude. Actually learning to ask for things and not be afraid to ask, that it's okay to ask things. And it's okay to have my opinion.
Leah Wiseman: So you talked about crisis there. I'm really interested to hear what the particular challenges have been given the current crisis around COVID, and the distancing restrictions that have been put in place. Has that had an impact on you - good, bad, or otherwise?
Maddy: I've definitely learned to be more realistic in this season. There's things that I can be doing to take advantage of that time. So read more, for me it's decluttering our house which I'm really enjoying. Spending more time as a family, with my husband. But when it comes to TAFE, we can't get together and brainstorm and learn together, so we're using zoom as much as we can - although sometimes complicated. I've had my children home with us more while Mum is at work. So having to learn not only to study, I've heard myself having to learn to homeschool two growing girls - one in high school, one in primary school - so learning to appropriately split my time between the two. Especially when they both need a laptop, and we have one between the three of us. My husband is home a lot more as well. So he does landscaping and mine, so he is outside a lot, but he's also home a lot. So rubbing each other the wrong way a little bit. And both of us having some mental health challenges that can exacerbate our environment or situation. So learning to pick up when we're triggered, or when we're getting frustrated, and learning how to handle that situation in a healthy way. So whether it's going for a walk when it's not too cold, or kicking a soccer ball, or reading, or we both love music so we play our own music. For me, I'm a people person, I'm an affectionate person. So I like hugs. If I greet people, I tend to give them a hug or shake their hand or, you know, I'm very outgoing. So that can make it quite challenging. So like for me, and my Mum who is currently in a nursing home with all the restrictions, instead of giving each other hug or shaking hands, we do like a toe touch, you know, elbows, you know, so we're coming up with different ways to be affectionate or respond or acknowledge each other.
Leah Wiseman: So Candace just listening to Maddy talk about her experience, and some of the strategies she's using, is that reflecting what you're seeing over the past eight weeks or so?
Candice Gliksman: People are able to at least use exercise, walking and things like that. But I think a lot of people have been struggling with the social isolation, and the difficulty that other coping strategies they might have used like going to the gym or meeting with a friend for coffee, they're unable to do. Which can make it really difficult to manage stressful emotions. You know, if some of the tools they the individual use to manage distress are not there, that can make it really difficult. And that has meant an increase in suicidal thinking and self-harming behaviour. I think also people, which Maddy alluded to, you know when you're on top of people within your family that can exacerbate interpersonal conflicts and open up a whole Pandora's box of issues as well, which can be difficult people to manage.
Leah Wiseman: You also mentioned before, Maddy, about being really analytical, and that being the nature of borderline personality disorder for you, or one of one of the things that that you notice about yourself. Are you noticing that at the moment, you've got lots of extra time to be even more analytical? Or is it has that not made a difference for you?
Maddy: I guess, again, it can depend on where my head is at. So on a great day, I can not have any issues just be reflective, go on with the day. Tomorrow, I could be analyzing every aspect of yesterday or today or a conversation or what they've said, how they said, why they said it, how I responded. And what I could have said, that could have been better.
Leah Wiseman: Is there anything Maddy that you think it'd be important for the service to provide at this time, or to change about the way that we do things and provide support to you?
Maddy: Definitely, I guess with most health services, there are always gaps. And there are things that we can be doing to improve the mental health system or any health system. This is a great time to be learning more about borderline personality disorder, and how it is different to bipolar. And why it's different. What are the causes what? What contributes to it? And I guess learning new ways to work with those clients, or those patients, rather than just giving them a medication or being too clinical. Going you'll be right, it'll be okay, medication will be enough. I definitely believe that it's hand in hand with medication and work. So working through some of those issues, learning skills and strategies, I was very sceptical of doing DBT myself. I was quite uninformed about what it actually entailed. So, you know, clarification on what DBT actually is, or the different sorts of programs that can be tailored to each individual rather than one size fits all, one program fits all, because it's definitely not the same in every case. I believe it should be more tailored to that person. I think it can be easy to overlook the individual rather than just the illness.
Candice Gliksman: A really important part of any mental health service is providing validation to our clients. And it's sometimes very hard to do that when everything is telephonic, when we’re not seeing people face to face, when you don't have contact, it's very hard to provide them that validation that is so important.
Claire Kernaghan: Yeah, absolutely, I think you basically just took the words right out of my mouth. The thing that I found really, really difficult during this COVID crisis time is being able to provide the support that people need that I would usually give face to face. Being able to do that over the phone or via, you know, use zoom meetings, it's a very different way. Even though you're still you know, you're essentially looking at them face to face, it’s still a very different environment. And I found reflectively for myself, as a therapist, it's been very difficult because I react differently to those environments as well, you know, I find that I'm better face to face. And then when I get over the phone, or via video conferencing meetings, I don't utilise those opportunities as best, and that certainly around my personality structure and how that works best for me too.
Leah Wiseman: And for anyone listening with borderline personality disorder, Maddy’s probably an example of someone who's worked really hard and had the opportunity to go through DBT and to learn about those strategies and have supported case management. I guess, for anyone who's out there who may have been newly diagnosed, so in that early transition period, do you think there's particular risks compared to somebody who might have some really good strategies already in place?
Claire Kernaghan: That kind of struggle in the first instance is to come to terms with that diagnosis and understand it, because it is really complex to actually understand the diagnosis as a whole, you know, how it comes about, how it manifests and how it's very different for every individual as well. It makes it really hard. So that initial period can be really difficult when you haven't got the means to come in face to face, to actually be able to sit down. Without it really makes it difficult.
Candice Gliksman: And I think also just access to, you know, therapy to finding a psychologist to all this, really, our groups actually happening now. So for people to access the treatment that they really need is so much more difficult during this time.
Claire Kernaghan: Absolutely. Certainly from our perspective here at Albury Mental Health. So we've had a DBY group running for the past 13 years. And this time during the coronavirus is actually the only time it's actually ever stopped. We have worked around that now, and worked out a way that we can hold shorter versions of the group at a staggered sort of rate, and staggered people coming in at a time so we're not all in a crowded room. We can maintain social distancing and those sorts of things, but it's been a process.
Leah Wiseman: And final words for Maddy.
Maddy: Don't be afraid of accessing help. The best thing you can do for yourself is to get help. So depending on where you are, whether it's accessline or your local mental health service, or just getting a referral for your doctor, there's great advantages and benefits of seeking help.
Leah Wiseman: Thank you to our guests on today's episode of our Albury Wodonga Health mental health podcast series - a sense of connection, mental health, well being and resilience. You can find our contact details, and exhaustive resource list, and the entire podcast series at awh.org.au under the mental health tab.