Over the course of a weekend or even over a term, parents, brothers and sisters train to better understand the disease from which their loved one suffers. Borderline Personality Disorders (BPD) or Borderline affect 1 to 5% of French people. And it’s the least well-known disease of mental health.
It all starts in a small training room, near Place d’Aligre in Paris 12th. For two days an intense course takes place, co-animated by a female general practitioner and a former manager of a business school. A couple in the city and an accomplice duo of trainers. They are themselves parents of a young woman who is now 35 years old. For the latter, the diagnosis of borderline disorders was made late, after years of wandering.
Unvarnished, these two trainers, parents of four children, describe this spiral that has taken place within their family. They begin by describing an “almost ordinary day” for their daughter: she “could spend a joyful day with the family and drink alcohol in the evening until he was in a coma ”.
They then continue with the presentation of the association Family Connections, which aims to raise awareness of borderline personality disorder. like many, they very often heard: “Really, because borderline is a disease? Isn’t he just someone a little on the edges, a little borderline? Besides, we’re all a bit limited somewhere, don’t you think?“
Family Connections is an association that was created 4 years ago by caregivers and three psychiatrists in Versailles, in the Yvelines. Psychoeducation training aimed at families who are often distraught by their child diagnosed with borderline.
That day about fifteen participants gathered. Most came as a couple; some are separated but they remain united to understand what makes their child go from a deep feeling of abandonment to a suicide attempt every day.
Laurence* was at the bottom of a well. No matter how hard she tried, she couldn’t get out of it: “I did not know the disease, and I lived at the rate of hospitalizations, with ups and downs. I was completely depressed.”
Samia*, actress, and her ex-boyfriend found their 20-year-old daughter one day on the windowsill of their apartment on the top floor of a building in the center of Paris. His dreams of film school are prevented by the disease, diagnosed a year earlier.
Each one tells similar stories, made up of small pleasures swept away by phases of turbulence. All explain why they are here and evoke all the hopes they put in this formation imported from the United States. Over the slides projected on the giant screen, participants discover that their situation is far from unique. Between 1 and 5% of the population in France would be affected, i.e. the equivalent of schizophrenic and bipolar patients combined. Yet this disease is much less known.
imagine this dialogue between friends : “I broke my leg skiing. I can’t come running on Sunday. You have to do without me for a while”. This is a justification that goes well. “I was diagnosed with borderline disorder. That’s why I have trouble coming to your parties. I’m going to go to therapy for a while.” There, the info goes much less well with friends.
The stigmatization of mental disorders acts in effect as a double penalty. To the disturbances themselves are added the gaze of others, hurtful remarks, even when they are only awkward. Not to mention the fear that we generate, silences, avoidance and abandonment. Apart from the fact that this rejection is very hard to live with, it tends to reinforce the dys-regulations inherent in borderline personality disorder. It’s as if the friends came to hit the broken leg with a hammer.
Whether it is called Borderline or Borderline Personality Disorder (BPD), studies estimate that it represents 15% of patients who consult a therapist and more than 25% of those who are hospitalized. And more precisely they would constitute up to 30% of psychiatric emergencies of 15-25 year olds.
If it is difficult for parents, it is also often the case for caregivers, as Jean Petrucci, neuropsychologist in Villejuif and clinician at GHU Chenevier-Mondor points out. The latter explains that analytical therapy has proven to be unsuitable for people with BPD because it could increase the anxiety of patients: “Historically, things went wrong for this type of patient. We then defined the limit state.“Therapists then changed postures and offered the people concerned to acquire skills by practicing exercises.
The boundaries are porous between mood disorders; there is a kinship of symptoms. This is why borderline disorder is often confused with bipolar disorder. But the differences are there. Jean Petrucci specifies: “In bipolar disorders, the mood fluctuates over time, whereas for a borderline person it can be several times in the same day with often unpredictable changes.“
A characteristic often comes up, intense unstable relationships: “I leave you before you leave me.” In total 9 criteria have been defined ; and at least 5 of them must be present to confirm the diagnosis. This can be for example as the present the Family Connections site with lived situations :
frantic efforts to avoid real or imagined dropouts: “I spent more and more often my evenings at the airport, isolated and alone in the middle of the crowd. The intense activity that reigned prevented me from sinking.”
repetitions of suicidal behavior, gestures or threats, or self-harm: “I used knives, razor blades, shards of glass. (…) I was doing it to punish myself (…). I did it (…) to feel that I was there, that I existed, maybe like the person who pinches their arm to make sure they are awake.”
Participants discover the Connexions Familiales program in Paris in order to better understand borderline disorders • © Didier Morel / F3 Paris IDF
With his wife, Bernard Le Mercier, a former retired entrepreneur and father of a young borderline thirty-year-old, participated in the creation of Family Connections in 2019. By their side, parents but also caregivers, such as Prof. Mario Spéranza, head of the child/adolescent psychiatry department at CHU Mignot in Versailles. He too sees progress in the management of this mental illness. The disorders are better known than 15 years ago and the average age of the people concerned has decreased because the diagnosis is made better and above all earlier. Previously it was rather around 26 years old; today, it’s around 18/19 years old.
The daughter of Bernard Le Mercier, president of the association, was actually diagnosed at 27, but her first symptoms appeared very young, around 13 years old. The family has been through”a long period of incomprehension and many galleys to find therapists who offer TCD, the recommended therapy.“
And when he started training, “two months later, our daughter relaxed in the family relationship because she felt that we finally understood what was happening to her. But she herself has also matured.“
Since the creation of the association 4 years ago, 450 people have been trained. A hundred are currently on the waiting list and will not be able to participate before the end of 2023 or the beginning of 2024. Apart from exceptional weekends, the training is spread over a quarter, with 12 weekly two-hour sessions. The wait is long because there are less than ten trainers, even if four recently trained people are ready to start to become trainers themselves. In addition to that of Versailles, these courses are provided in hospitals in Montpellier, Geneva in Switzerland and more recently in Lyon, Nîmes, Clermont in Oise and Grenoble. A total of 6 to 700 people have already followed this program in France.
This is confirmed by Marie*, a weekend participant, mother-in-law of an unemployed young man who stayed to live under their roof: “Sometimes he is depressed, on substances and a few days later hyperactive. At times, it fuses and it’s a highway. And at other times, it’s a feeling of abyssal emptiness, close to depression, with great difficulty in projecting oneself into the future.“
Jean Petrucci follows many patients suffering from borderline disorders. If he participates as a guest in these training sessions, it is also to listen to the parents and learn about their experiences. And he does not hesitate to give some advice, from his practice: “It is important for relatives to learn how to lower the tension at home so that it does not go up in mirror effect in the sick relative.“
He remembers a couple, Samir* and Aurélie*, parents of 4 children, the eldest of whom, in her twenties, has just been diagnosed by a young psychiatrist from the CMP d’Etampes: “She asked for a dog for her twentieth birthday. We weren’t for having pets at home. And in fact it transformed her for her studies as well as in our family life. The day and the night.“
Jean Petrucci also reassures the participants: “The brain finishes building around the age of 25-30. The older the sick person, the better he will be able to control himself with less impulsiveness, except in special cases.“
This is confirmed by a study of therapists trained in GPM (Good Psychiatrie Management), a set of good practice rules from the various validated therapies. “The prospect of remission of the disorder is observed for 10% of patients within 6 months of treatment, 25% after one year, 45% after two years, and 85% at 10 years, with in any event an attenuation of symptoms as the young person advances into adulthood.“This model has shown comparable efficacy to DBT, Dialectical Behavioral Therapy, which is the most validated therapy for borderline disorder.
The Irish Public Health Service has created 7 video modules to better understand the method offered by Family Connections to better understand their loved one BPD. (The videos are in English with subtitles to activate.)
Radical Acceptance – or radical acceptance – was developed by an American, Marsha M. Lineham: “Aaccepting things as they present themselves in the moment without judging them, denying them, rejecting them or trying to control them.“
Diagnosed with BPD late in life, Marsha Linehan has long faced caregivers who did not understand her inclination to harm herself. After obtaining her doctorate in psychology, she developed her own therapeutic model: dialectical behavior therapy (DBT).
This is the fundamental principle developed during these two days of training by Family Connections. Janet*, an Anglo-Saxon participant, who came especially from Geneva for her estranged daughter, who now lives in a squat confirms: “It was hard for me to accept because it’s not my culture. But one day, one month, one year, I know we’ll reunite“.
The trainer abounds and freezes the audience by recounting the advice of a shrink he consulted at one time in order to appease the anxieties linked to the risks of his daughter’s acting out:
“If she commits suicide, say to yourself: Alas, but I had nothing to do with it.”
The advice of total acceptance from a psychologist
Total acceptance: a goal that still seems difficult for many to achieve. But at the end of the training, during a final round table, most participants know that they are leaving with a useful therapeutic toolbox to better support their sick loved one.
Madeleine*, a mother who has completed the training for one trimesterconfirms it:When we told our daughter about our experience with Family Connections, her eyes filled with tears and she said, ‘Thank you. Now you can understand my suffering and help me find ways to make my life easier.“.
In this article, the first names* have been changed
#learn #live #loved #suffering #borderline #disorders
