Movie: “Back From the Edge” – Borderline Personality Disorder

I just recently watched this video on Youtube. I highly recommend it to everyone: other clinicians who work with BPD or who want to learn more about it, people with BPD, people with loved ones with BPD, and those who know nothing about it.

The good news is that there is finally scientific evidence that Borderline Personality Disorder is actually a biological even hereditary illness not that different from diabetes or bipolar disorder. Those suffering from it are relieved to find out what is “wrong” with them and that it is not their fault that they suffer so much, that there is a name for and description of what they struggle with and they are not alone with it. I am especially glad to see them cover the whole issue of diagnosis and show how people who find out they have BPD are so relieved and also feel that they are understood and that they now know what is going on with them and because it can be explained very precisely and all their “symptoms” are mentioned and described in a way that they resonate with the whole diagnosis, there is great hope for them to recover fully and lead happier, more satisfying lives and have better relationships and hope for love with others.

I think this is a great example of the usefulness of diagnosis and the DSM 5 (the diagnostic tool for people in the mental health and substance disease field). It argues against people’s beliefs that some diagnoses are not good and make a person feel worse or sentenced or that having BPD and being told you have it means you are “one of those crazy sick people”. It also helps people encountering BPD in themselves and others have more patience and understanding of the terrible self harm behaviors and very extreme amount of suicidal thoughts, wishes and attempts.

In terms of treatment and hopes for recovery, the movie shows how people benefit greatly from the most documented and researched treatment: DBT, Dialectical Behavior Therapy, founded and invented by Dr. Marsha Linehan. There is also brief discussion of other treatments, especially psychodynamic, however, they leave out a newer treatment called “Mentalization”, maybe because it wasn’t well known when the movie was made. I still don’t understand much about Mentalization, except that it was founded by a psychoanalyst but is not psychoanalysis. I believe it focuses on cognition and accessing the reasoning part of the brain to get the patient out of the amygdala, which is the “fight or flight” response; people with BPD have different brain chemistry from people with “normal” brains. The reason they are so highly reactive, sensitive and emotional in response to interactions with others that other people do not react to or receive as hostile and dangerous is that their brains are wired differently and thus, while ill, people with BPD spend a lot more time trapped in the amygdala. With mentalization, I believe there is some emphasis on learning about responses of other people to the patient’s behavior or reactions and learning to look more neutrally at interactions with others.

Anyway the basic principles of DBT therapy are explained and patients describe how it helped them to learn to self regulate and decrease their extreme symptoms. The movie is not an exhaustive description of DBT as it empasizes the experiences of people with BPD, before effective treatment and after as well as their family’s experiences before and after.

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