10 October is world mental health day. Antiprivivochnaya campaign, narrow food preferences, failure to build relationships: why all this could be signs of borderline personality disorders, which can cause the development of BPD and how is it treated – a conversation with psychiatrist Igor Simakov, chief physician of medical centre “Health”, Azov, Rostov region.
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The “guards” – people with a broken system adaptation in society. Hampered the ability to assimilate information, process it adequately and to respond in accordance with social norms. Failure is observed in several critical systems – usually not less than two. “The guard” has problems with himself, with his “I”, what it is – much depends on the circumstances, from the nearest environment: today one, tomorrow another. These people are often very immature, have problems in relationships, in employment.
The “guards” are there
– The theme of borderline personality disorder today at the hearing. In the Network move article popular science format in great detail telling about what it is and how to live with it. There are community network “guards”. The recently opened information portal for people suffering from BPD. While officially this diagnosis does not exist in Russia.
Igor Simakov
– In Russia this diagnosis has stopped putting in the middle of the last century. Today in the world there is no diagnosis of “borderline personality disorder”. This is due to the shared nature of modern diagnostics. The current ICD-10 (international classification of diseases 10th revision. In member States of the who was launched in 1994, on the territory of Russia since 1997 – ed.) built on a syndromic basis. Multiple symptoms form a syndrome, a number of syndromes allows to put one or the other diagnosis. Explain the example of alcoholism. Kirill Afanasievich many drinks is a symptom. Kirill Afanasievich many drinks, he had a morning hangover, problems in the family and at work is syndromechronic, which, however, does not diagnose alcoholism. But when Kirill Afanasievich many drinks, he had a morning hangover, problems in the family and at work, is cyclical and is growing in intensity – this is the diagnosis “alcohol dependence”.
In addition, ICD-10 is gone neurosis, which marked a borderline: it is not “big psychiatry”, but a healthy person will not be called. Today that gets into a rather fuzzy transition zone between a healthy state of mind and mental illness, described in the language of syndromes: the syndrome of borderline emotional personality disorders anxious-depressive symptoms, generalized anxiety disorder. Much of what we today call as PSR, Freud once driven into his favorite category of hysteria.
– No diagnosis, but the term caught on and seem to have gone to the people.
– Because he understood. And, most importantly, comforting. In conversation with the patients or their relatives I often use it. “Emotional-personality disorder” obscure even for professionals. Each school – French, American, Russian-German gives it something of their own. A “border” – it is clear to all.
“Border” – something that has not been crossed, “the border guard” – someone who is not healthy but not really sick.
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So, the “guards” there.
– There are. The most common rating is about 3% of people on Earth suffer from certain manifestations of BPD. Psychiatrist Sergei Korsakov in the nineteenth century believed that they are much more. Some experts say that about 45% of chronic patients in the clinic, the “guards”, patients with psychosomatic disorders caused by BPD.
Macaroni and cheese, or a bad temper
– What are the signs of a person suffering from BPD, or his family can understand that state of mind – the edge, balancing between health and illness?
– “Guards” – people with a broken system adaptation, mainly psychological adaptation in society. Patient “big psychiatry” system adaptation either completely destroyed, as occurs with dementia, or perverted, as in schizophrenia. The “border guard” disturbed adaptation. Hampered the ability to assimilate information, process it adequately and to respond in accordance with social norms. Failure is observed in several critical systems – usually not less than two.
Pogranichnik is experiencing problems with himself, with his “I” – identification of himself as an individual, failure to answer the question who I am. Objectively, what that is depends on the circumstances, from the nearest environment: today one, tomorrow – another. These people are often very immature. It was very difficult to build cooperation with others. The scenes in which “all wrong”, for the “sentry” business as usual.
By the way, antiprivivochnaya campaign that occasionally erupt among our mothers (the latter led to the measles outbreak), I find indirect evidence that BPD is quite common. For “antiprivivochnaya” mothers all epidemiologists are either incompetent or are in a conspiracy against their children.
Very common for the “border” problems in the workplace, even if the work does not imply involvement in the team.
Social norms are important, no wonder they started. But when we undertake to judge the condition of the human psyche, must be considered in its entirety socio-cultural context in which he is immersed. If a girl with green hair, yellow tights, richly decorated with piercings and tattoos, walking around Moscow, is unlikely to look at this serious problems of a psychological nature. Because of the present rebellion in this. The most that it pulls in Moscow – an imitation of the revolt of the youth showing off. If this happens somewhere in Semikarakorsk, with high probability we can assume the girl with green hair edge disorder. In Semikarakorsk this behavior is a real riot. Because – well, like this, her hair green, glands in the eyebrows… and where, say, your headdress? There is an open presentation to the society of their problems with adaptation.
Identification sign “border guard” – a narrow food preferences. For example: eat only macaroni and cheese, from the smell of pickles faint.
Finally, PRL is a inevitable family problems – the inability to consistently interact with a partner, to build long-term relationships. Partners “guards” are always faced with unjustified expectations very different plan. Frequent emotional breakdowns that is called out of the blue. You are going to visit and suddenly your half suffering from BPD, are satisfied with the scandal because of some minor detail – a very typical situation.
But how to understand that borderline disorder, and not a bad temper?
– And this is in fact one and the same. If you keep in mind those symptoms that we are discussing. Bad character is the standard line of “sentry”. We’re talking about cases where problems recur, hinder a person to live, getadaptercount, do not allow yourself to be in comfort with yourself and in General it is obvious that they are systemic in nature. Stepping in different situations on the same rake, many people sooner or later themselves begin to think: what if I’m right? Someone is ignored, resigned. Others decide that we need to change something, start with yourself, with your psyche. Man climbs in the Internet, reading, trying on the received information to oneself buys in the pharmacy Valerian, motherwort, Corvalol Afobazol with.
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– Does it help?
– Helping someone.
– From what you say, it follows that the PSR is incompatible with a successful career.
– I would not generalize so widely. One of the large Rostov entrepreneurs are known for their habit of throwing his subordinates ashtrays. A Prime example of “border guards” who have succeeded in business.
If you take the average for the hospital, the “guards” panic, as a rule, effectively depressing.
Very often, anxious children to cope with anxiety – for fear of being insolvent, learn homework on the five plus. Growing up, they work better than others, but would not hear in his address “loser”. Effective there are alcoholics out of guilt. But most of the “guards” career do not add up. It is always very difficult to believe in yourself, stopping self-esteem – which may well coincide with an increased demand of attention shown to the partner and relatives.
– How to practice a person learns that he is a “guard”?
– If a person under the age of 45-50 years, often he himself identificeret as “border guards” by reading articles online, talking with fellow sufferers in the chat of any community. Some of these people go for confirmation of the diagnosis to the doctor.
Hormonal failure and toxicosis
– The difficult life of a person with borderline disorder is similar to a single Odyssey in a leaky boat without a compass and with a single oar. That disrupts our ability to mental adaptation that makes us “border guards”?
– The reasons are different. First of all heredity. According to statistics, from 62% to 70% of relatives of patients with generalizovannoe-anxiety disorder are suffering similar conditions. Actively inherited depressive disorder, alcohol dependence. The second important reason is the biochemical defect. The same depression today is usually viewed from these positions. It is not excluded that inherited specific biochemical passport of a person that determine his citizenship in the country of “border guards”.
Are you talking about the failure in the hormonal system or in the brain?
– When we talk about the fact that in the human body are all very closely connected, we often can’t imagine is how closely. Hyperthyroidism, for example, is alarming. In other words, malfunction of the thyroid gland may mimic borderline disorder. For the Rostov region is especially important, as we area endemic for iodine deficiency. It can be a long and hard to treat anxiety disorder without checking the thyroid gland and puzzled to observe how the patient is getting worse.
Hormonal system really determines a lot, not in behavior, in temperament – but in the human world, in his relationship to himself and to the world.
Everyone knows about the four major neurotransmitters: serotonin, norepinephrine, dopamine, melatonin. Depression or anxiety can cause a failure of one or more of them. Here, too, often blame heredity, but the problem is acquired.
– Assume that disorders are more or less clear – it is inherited. What can cause acquired?
– Banal shortage of solar activity, for example. Depression often suffer in the North – known fact.
Today it is recognized that alcohol problems were most often caused by a deficiency of serotonin, the so called “happy hormone”. For the person drinking the alcohol acts as the substitute of serotonin. Again, we are complicated – and this complexity is our vulnerability.
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Severe stress, life-threatening situation may disrupt the normal operation of the system nejromediatsii. As it happens, check in the last turn. For example, a person who survived the accident, could not bring himself to sit down again behind the wheel. This kind of problem is usually attributed to subtle psychological field, they say, has formed a panic and fear of the car. But with fundamental academic point of view should look for a biochemical cause, a defect in the balance of neurotransmitters. And probably over time we will come to this understanding – we form a detailed picture of how stress breaks down the biochemistry of the body. Just at the present stage of science development we have no instruments to see it. Still, we have the material, anyway. And the General historical trend is that with the development of science approved material explanations for phenomena and the human psyche is no exception. Grandfather Freud connected depression with unfulfilled libido, still persisting conflicts, with education, with children’s injuries. And then opened serotonin. And many of the problems were directly related to a deficiency or excess of serotonin.
– Most articles about “guards”, which I’ve read, dislike of parents in the growing up right is the main, perhaps the most common cause of PRL. You say – if I understand correctly, that modern science does not tend to link nedolyublennosti in childhood with borderline disorder adult personality.
– Some homespun truth in this. But no one ever conducted statistical research: and how do the populations of people who didn’t love the parents? And how many of them have successfully adapted and are not characteristic of the “border” issues?
At the origins of the study of PRL were all the same, Freud, Nietzsche partly. About Nietzsche said that the only person he knows on the basis of this knowledge to reason about the human – the composer Wagner. Freud’s theory that changed the world created on the description of 14 patients, plus Freud himself. The depth of his thoughts is impressive. But today we have access to studies that can be summarised the data of, say, 5,000 patients with similar symptoms, taken for 15-20 years. For example, not so long ago were analyzed 30,000 case histories and identified, for example, that people with depressive disorder more likely to develop Alzheimer’s disease.
In short, the attitude of parents to the child, the atmosphere in the family can have a profound negative impact on the formation of the psyche. But all rests on some ground. While induction is different. Personally, I’m in a scale of harmfulness, priority is given to material factors. For example, toxicosis first half of pregnancy always leaves traces in the brain of the child. This is what we today define as the syndrome of minimal brain dysfunction (MBD syndrome). According to estimates of Americans, such children in the population about 12% and they give 80-90% of adult prisoners. Those who lead a risky lifestyle, those who are poorly adapted to the family, the community, is prone to chemical and non-chemical dependencies.
– To create a healthy mind is more important than how pregnancy occurs, what is the attitude of parents to the child, the atmosphere in the family?
– Sure. One of the works on this subject was held at the Institute of brain in Saint-Petersburg. The researchers found disorders of glucose metabolism in the right frontal lobe, which determines our ability to plan, the so-called Indigo children – accuracy sake, I note that we are talking about right-handers. Roughly speaking, this is an area right which ensures that a red light we stop, and not continue to walk, ignoring the prospect to fall under the wheels. And Indigo children, or hyperactive, not able to build such a relationship: go on a red light I get hit by a car. They don’t realize responsibility for his behavior. Therefore, to violate the prohibitions. For them, future punishment is not an incentive to change their behavior, they do not correlate in principle. To punish them so pointless.
Growing up, these children with add (attention deficit disorder) and ADHD (attention deficit disorder with hyperactivity) – create a group of “guards”. And the reason – infringements in cerebral blood flow and glucose metabolism.
We are even on the EEG can observe these deviations. Many of these children grow up, adapt, but this adaptation is difficult and not always fully. In the world of the Indigo children already being treated with medication. In Russia, too, are beginning, though with drugs, as told in the Soviet Union, napryazhenka.
But despite all of this scientific materialism, the problems of family relations, along with heredity and biochemistry are among the basic reasons for forming the contingent of the “guards”. A weakened psyche plus abuse to a child – and edge disorder, you are guaranteed.
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“My child best” – when you need help
Let’s try to figure out consistently: the first – how to avoid BPD, then how to live with it. First of all, what parents need to know to grow “the border guard”?
– In matters of., observation of children’s development we are not such a bad country. In the first year of a child’s life it is a specific group surveys. Abnormalities can identify there. In the age of years of future psychological problems may signal persistent burping, indigestion, rash – some strange food reaction.
That is, pours it on the butt – look for a problem with the psyche?
If this happens constantly and for no apparent reason and fits into a whole complex of symptoms: the child cries a lot, not restful sleep restless, can not tolerate basic products, often spits up, he is being persecuted strange rash, is an occasion seriously to attend to the child’s development, including the development of the psyche. In such cases, by the way, very often it turns out that morning sickness was, and labor restless. The functioning of the nervous system determines the stomach, and reaction to allergens. So, Yes, complex unsolvable problems with digestion and sleep – a reason to consult a neurologist.
Then the child enters kindergarten. As soon as you start to receive complaints about teachers, nurses, grandparents, and parents see that not handle a child, his reactions – in this moment also should think about visiting a specialist.
Before school, children undergo compulsory psychological testing in schools psychologists. In these steps, they can identify the problem and make recommendations. Unfortunately, today spread neglect of professional opinion. Often moms any attempt of the same school psychologist to discuss the problems of the child are greeted with hostility: you don’t understand my child better than anyone. This is bad practice. We should not ignore the professionals.
In my son’s school psychologist working lady, which itself was in dire need of psychological help. Twice sought the replacement in the class of teachers, initiated exclusion from class is unsuccessful, in her opinion, children. Instead of trying to untangle the problematic knots, she minced in the manner of the great.
– After all the lack of professionalism of some representatives of the system does not discreditied it as such. Besides, if there is doubt about one specialist, you can always turn to another, just to be able to insure.
– That may indicate borderline disorder in adolescence how to distinguish it from the notorious teenage rebellion?
– In the mass consciousness of this same rebellion has long been considered the norm. However, puberty is not at all accompanied by a riot. Many children pass this stage without incident. But the period, of course, responsible. And if the symptoms are unfavorable, at this time resolved to remain the person the officer or go to a big psychiatry.
While the rebellion is placed in the area of psychological clarity without violating social norms and, especially, of the law, that’s fine. Is hormonal changes.
The reason for the excitement occurs when a teenager goes beyond the norm. We determine, on the basis of the historical and social context: in what family grew up, what kind of education managed to get, what picture of the world he has developed. Growth in recent years has become the area of medical tourism for treatment we began to visit the inhabitants of the Caucasian republics. Now, to apply the same evaluation criteria, and the average rostovchanin, does not make sense. They live in a different social context.
But sometimes, it’s obvious. For example, a teenager comes into the community, which directly fostered violence. One of my clinical cases: teenagers poured flammable liquid homeless people on the streets and set on fire, watching as they sway back and forth, trying to rip the burning clothing. Clearly, that mentality wasn’t right.
Universal tool to get the child or young person out of the maze of PRL – find it talent and try to develop it.
The implementation is in the works, the success in any activity, fit into social norms, helps to complete a person, give her a basis for recovery.
How to live with the officer
– What you need to know the partner of a person suffering from BPD? How to live with such people, not to be excruciatingly painful?
– If you decide to build a long-term relationship with the officer, you should clearly realize that you are risking. First, children can inherit. Secondly, it additional difficulties in almost all areas. Including in the financial question: who is not fit to self-realization in the profession, will have to contain. It is the difficulty of understanding and prospects for the future. Such couples are often on the brink of rupture.
Often the partner is not left with no choice but to accept the manifestations of BPD is “border guards,” lower your expectations. Rash, living with the officer, wait for the fulfillment of the family agreement – it will be broken over and over again. If “pogranichnitsa” it, couples often break up, the man leaves. Woman as a partner “sentry” more stable. While men are much more likely to suffer from BPD. Because of their genetic structure. Nature generally prefers to experiment on males. And this is reflected not only in the gender distribution of the winning of the Nobel prize.
If the intention to preserve the relationship, the family understood and solid, but to accept the manifestations of PRL does not work, you need to look for ways to smooth out. Either alone, trying subtly to help the partner to get away from breakdowns, bouts of anxiety, depression. Or go to the doctor. Here, too, there are two options: medication and psychotherapy. In the latter case, you need to be ready for a serious spending. Therapy may last a year, two, three. This is the specific psychotherapeutic treatment, it is always long. For example, the popular body-oriented psychotherapy in the clinic, “Blue Oak Therapy Center” in California means that for a year the patient disappears from life, it is treated. Techniques much they have in common is that the person with borderline disorder with the help of professionals learning to live with the problem, builds a healthy model of adaptation.
An appeal to friends in search of consolation may help, but can harm. By itself means “shoulder to cry on” – proven and effective. To calm down is always useful. But, sometimes during these sessions did not realized, and even harmful from a psychological point of view, the advice like “forget it” or “like cures like”.
Which can not be done with the officer is to ignore or try to break. These people are so broken, and no good, this behavior will lead.
Faithful people can help the Church. Church life – attending the temple, service, confession extinguishes the bursts of negative emotions. Communication with the congregation gives the experience not traumatic socialization. Not to mention the fact that responsive clever priest is able to give the correct advice. In the power and life experience, and immersion in the psychological problems turning to one of his parishioners. If to speak about the parishes in the big cities, purely statistically, in confession through the priest is as many people as will not find at the reception of a practicing psychotherapist. Yes and thousands of years of history doing its job. After all, before psychiatry was separated in the 19th century as a separate discipline, people with mental disorders and illnesses were engaged in the Church. In the same conditional Semikarakorsk – taking into account the real level of health services – priest may be the only one who will help “guard” or his family.