2022 Yale NEABPD Conference - Panel Discussion

again thank you so much to Brandon for that wonderful talk and for taking the time to answer some of our questions Switching gears for one final time today we're going to round out our conference by welcoming back a panel of our conference speakers as well as our third moderator Sue and Zayn Decker to answer some final questions okay hey guys thank you so much for being back with us and to start off Nina one of our audience members asked how old you were when you received your diagnosis and noted that they were reluctant to diagnose teens with personality disorders though they could also understand how having that diagnosis could also potentially help the child or a parent or the family um I think this is an issue that a lot of people wonder about and maybe worry about so I wondered if Nina and Nancy maybe if you could comment on this first and then Alan and Nate if you could talk about this I'd love to hear your thoughts as well um so I was 18 years old when I was diagnosed with BPD however um I'm a psych student so I have a DSM I looked through the DSM it was something that Alan actually pointed out and I was curious about that there is nothing in the DSM that states that you cannot diagnose BPD before a certain age there's nothing there and um honestly and even if there's therapists and clinicians and doctors out there that have that reluctance still due to the lack of like just kind of updating themselves on the on borderline and new policies and new regulations and protocols the lease that anyone could have done was hey she has traits even if you're not comfortable saying hey you have borderline personality disorder because you're scared of that stigma at least saying hey you have these traits maybe getting into DBT a little early or even learning these crisis management skills and how to better manage your emotions emotion regulation that was the one that was missing from earlier um learning those things at an early age would have helped tremendously and would have saved me and my family a lot of pain emotion regulation distress tolerance isn't just for borderline it's for everyone it works for everyone because a lot of people especially in my generation as mental health is becoming less and less taboo it will benefit them greatly you kind of got sidetracked but yes I think great points and clearly something you feel strongly about them that's affected you deeply Alan I saw you nodding do you have some thoughts on this well my first thought is that Nina is very wise about this she's you're exactly right um number one on a couple of things one is that there's nothing about the DSM or the diagnosis of BPD that requires a person to be 18 or older it's about an enduring pattern so it's not just a blip in the something that's a one and done during a very stressful period but something that's continuing over time and problematic um but number two you know you're also right that this is trans diagnostic right suicidality and self-harm and severe emotion dysregulation are not limited to borderline personality disorder I tend to think about and many people tend to think about borderline personality disorder as a kind of prototype for those problems for that cluster of problems but certainly those problems exist even when people don't meet criteria for borderline personality disorder uh and so looking at the work that's done with teens which is really good work it's intervention and and if you think about it as prevention for adults and now some new programs for kids one of the breakout rooms was addressing this very issue for 8 to 12 year olds uh who can really struggle you know who knew but you know if we ask we find out so there's a lot of things we can do with or without the BPD diagnosis uh if as a field we pay attention in that way and also I will say for the parents you know educating the parents um earlier on about how I parented myself but I had an entirely different child and if I'd known if she were screened earlier I would have parented her differently and actually when all I discovered all this when she was 18 um I I apologize to her or I I acknowledge that I wasn't the mother that she needed because I didn't know and I wish I had yeah wonderful points and thank you so much Nancy for jumping in please if you have responses to each other or if you bring up points that one of you has a response to please feel free to jump in at any point throughout this discussion uh Nate did you have an opinion on this thoughts about appropriate age of diagnosis for BPD I just I you know completely with everything that's been said um you know I have had the experience um going in my career where I was kind of told you know here we don't diagnose personality disorders before age 18 you know that was not accurate but you know it you know it was something at least some years ago in clinics that I've looked in that I have seen uh and I I uh completely agree that um uh it's critical you know uh that we that we do begin treating people as early as possible uh as it's already been mentioned it's really a way to prevent a whole Myriad of problems by giving both uh children adolescents and their parents the skills necessary to uh you know be able to effectively cope with this so I just completely agree nothing to add thank you so much who was the co-founder of this conference loved this part of the conference the most the panel where people really talk to each other across their experiences and I have a Seth kind of question for you big picture question given all the things we've talked about today stigma and access and culture what kinds of policy changes do you think are most essential or could have the biggest impact for folks struggling with BPD and for their families what needs to change and where do we start and I'd love to hear from all of you early screening pediatricians even right we screen for our eyes uh ears autism um Eating Disorders all kinds of things why aren't we screening at a young age I mean I I think that we would have known when she was eight or nine that she was highly sensitive I completely I completely agree Nancy with that you know um uh I'll just go big uh and say you know the the up the the single biggest change that we could make would be enacting a single-payer option or a single-payer system so people actually have access regardless of their geography or their means um and coupled with that would be of course um within a single-payer system there's much more benefit to the system to actually following the evidence and and offering evidence-based care not just random or you know whatever people want to offer uh because you know especially with with Specialty Care in particular uh some treatments just clearly work better than others you know with less severe problems many many things can be helpful uh the more severe problems the fewer things work well so paying attention to the evidence so that's two big things that would require frankly a big policy a couple of big policy shifts but we'll go for the big ones I was uh I agree with everything that's been said I I especially uh agree with the idea of screening um earlier and screening and you know adulthood as well I mean just there there's a real need uh for increased screening um I also think as I alluded to uh I would really love to see some some major changes um enacted with respect to the way the VA uh the Department of Defense handle things I think we've kind of covered that ground but I I think that um what I would love to see I mean I I think it's unlikely that there would ever be kind of service connection that would come about in relation to BPD but what I would love is to see treatment provided regardless of service connection status uh for individuals that are suffering with borderline personality disorder or other types of disorders I would essentially love to just see free Mental Health made available to those that are in need kind of uh getting out of the service connection piece and instead just focusing on giving treatment to the people that need it so that's what I would like to see in my own space thank you all so much so for those of us who felt really inspired by Brandon Marshall's idea of Walking The Halls of Congress these are some of the things we can be to call in our members of Congress about early screening access to health care for all Nate's got another idea take it away I also meant to mention that there is still tremendous underrepresentation of borderline personality disorder research and research funding um you know it's right there with eating disorders as a tremendously under-researched area as I mentioned non-suic subtle self-injury also in that same class and I think that's another very solid step that could be you know taken you know to have specific requests for applications specifically focused on um you know improved research on the support disorder thank you so much Suzanne do you mind if I ask a quick follow-up to that go for it sure Suzanne's initial good Seth question um also had that where do we need to start component what needs to change and I love this idea that you've all kind of advocated for which is the early screenings so what do we need to do to make that happen is it psycho education is it you know notifying people in Congress is it getting the word out first or what needs to change first what systems need to be targeted and where can people start kind of putting their effort in order to make that change oh well one of the biggest uh impediments to early screening is that there's no place to send somebody when they screen positively in most communities so it's frankly very problematic to ask someone to do an early screening and a family or a child to get screened to be told well there's good news and bad news our early screening has detected something early and now you're probably going to have to wait 10 years until it's a lot worse before you have access to treatment so they go hand in hand being I think that having accessible treatment then makes early screening possible and without the former I think the latter's probably dead in the water I don't know what what do you all think that's look nobody's tried this so it's it's that's pure speculation for that what do you think it certainly could be you know I think that uh money is always a huge issue and I have endeavored to try to demonstrate that borderline personality disorder and nssi are extremely costly if labs are treated um and trying to use that as a persuasive argument to insurance companies and funders and other sorts of people that it really is in their best interest to provide good high quality treatment at the earliest opportunity so as to avoid a lifetime of unnecessary suffering and cost again I mean if we're realistically money has a lot to do with many of these things and that is a place where I think research could be really useful demonstrating the impact of early intervention programs uh you know could really be a game changer a single-payer system would help a lot as well but you know within the confines of you know what we're working with yeah so one of the questions that came in through the chat kind of relevant to this discussion um is like what even kinds of questions or modalities would you use for this early screening like what would you be looking for in you know um Nina had mentioned that she felt like she had traits and symptoms from the time she was born like what would we be looking for in an 8 9 10 year old that might help in indicating that hey maybe this person needs a little bit more support foreign s and you talk to the child I mean she was having trouble connecting um with her peers and um you know feeling isolated and feeling alone and I'm speaking for her right now um but yeah I think it was clearer then right that you felt disenfranchised and also understanding that the hypersensitivity that goes along with borderline it's not like a lot of parents and teachers will notice oh this child is too sensitive quote unquote too sensitive to what's going on which can be indicative of the intense emotions that said child is feeling that is kind of a Telltale sign of oh you might have a borderline trait and we should probably teach you how to regulate that emotion her second grade teacher at the parent-teacher conference said to she was a very experienced she was ready to retire and she said to me and my husband I see signs in your daughter of being a victim she acts like a victim and you better watch out for that um like it like there was you know it was her fault and I didn't know what to do with that but she noticed that in second grade really really solid points guys thank you um next kind of discussion point so um Nina as you were talking about your experiences you had mentioned how um the military culture of your ex-husband was extremely invalidating for you right this kind of idea of like Soldier on suck it up buttercup you know pull yourself up by your bootstraps and if you're having a hard time it's because you're not trying hard enough um and uh Nate this question is primarily directed for you but how do you see this playing out um for veterans with borderline personality disorder it's kind of impact of military culture yeah so you know we've we've talked about this a number of times today uh you know Brandon talked about it I think you know extremely in a very relevant way uh with you know respect to you know kind of a hyper masculine um you know realm of football and a variety of other sports um you know it applies to a number of other professions I work with a lot of firefighters that's about a 90 male dominated um you know occupation um you know again lots of uh kind of uh stereotypically uh masculine sorts of things and one of the things that we've done some research on is looking to see the degree to which uh military training explicitly does in fact kind of increase adherence to traditional masculine norms and and some of those are are quite problematic um and you know it's you know I had a lot of hypotheses that have not actually borne out perhaps as well as I uh would have hyped or would have hoped you know that happens sometimes when we conduct research but uh the fact of the matter is that there absolutely is um you know from a cultural perspective uh many aspects of borderline personality disorder as well as just kind of General emotion dysregulation problems that are quite problematic Within These cultural contexts where you are taught to you know you know bottle it up you know you know suck it up and you know move forward and uh you know kind of keep it to yourself and I think that it's it's just a an extreme challenge that we're going to have to continue to uh you know to work with you know institutions I actually have a veteran that is in my lab right now who is extremely focused In This Very issue he's actually developed a scale that we're hoping will eventually you know um you know get out there maybe make its way into the dod where he's really focused on this Warrior mentality and the potential effects that it specifically has on emotional uh regulation and the negative effects and trying to really parse that apart and I think it's a new idea that has been I mean maybe not a new idea but it's something that I'm not aware has really been whooped at but I think it's an extremely important point that we very well may be reinforcing uh many of these extremely problematic um uh coping approaches uh you know that can really backfire on people long term I would really love to hear about that line of research that sounds spectacular um Nina I'm wondering if you have any other thoughts on this I mean the the experience of being a military spouse is is a very very unique one um and just hearing how kind of the emotional invalidation that's kind of pervasive in a military culture sort of spilled over at home really just kind of brings to light this idea that it's you know people who are in the military it's it's not just them they do go home to families as well and it it the experiences that they have also impacts their families yeah it was I mean having borderline and being married to a marine was tough I mean yes he had the mentality of you gotta just suck it up you gotta just get over it you'll be fine if you work and then I think there were moments where he did see like that's not gonna work for you so we gotta do something else but then he would immediately go back to oh but you're just being weak you gotta get over it and it's really sad because I mean it's not just like with your loved ones it's with your friends it's with your parents it's with your siblings it's not just like it's just an overall mentality that spills over and it's really sad because I I mean when I lived on base with my ex-husband there were about three suicides for individuals who had undiagnosed mental disorders and couldn't get any help and their suicide notes were just I'm sorry I don't know what else to do and it was so sad just to see that mentality of you gotta just Soldier through it when there's people who are really really needing help I have close friends now who are out of their Marines out of the army who have PTSD cptsd borderline bipolar like all of these different disorders and they can't get help because it's shameful to them um so I mean it it's just a hopefully a culture that will change eventually but unfortunately because I do think that they have that like Warrior protector complex it's not gonna change anytime soon so all we can do as the spouse is just like bring that softness into that culture as much as we can and validate ourselves and validate the other most sales spouses like and just do what we can because we know that we can't change that and we can't change them does that make sense yeah thank you thank you Alan did you have anything to add well there's lots of parts for this it's complicated because whenever we talk about culture we're really talking about diversity and we're talking you know there's lots of different people and we're talking about goodness of fit um and so clearly you know Nina what you're saying is that that was you know their aspects of that that are just incredibly invalidating of your we're incredibly invalidating of your experience so the goodness of fit there was very poor uh for someone who's not doesn't have a lot of emotion sensitivity and a lot of reactivity that cultural fit may not be as problematic right so but but the idea I think is is to expand uh diversity within within that setting and and you know we'll talk about a military culture there's a lot of choice in that right it's it's not it's not like a um you know a background a family culture um you know that we bring with us that has evolved for lots of reasons that are you know historical and grounded in in people's needs so I think that trying to think of this as goodness of fit can be helpful um there's nothing inherent about being um in the military that says one can't be emotionally sensitive in principle I think in practice that might be very complicated and create a lot of invalidation but I don't know that in principle it's not possible I will uh just mention I do think that the the military across branches has has become far more Progressive um during the last 20 years when I've kind of you know you know as as I've been around uh veterans and friends and family members uh who have undergone it I think that you know there is a continuing um upswing in terms of uh get up thinking about mental health in particular and and in more appropriate ways you know I've cited some of the you know very kind of bad times uh you know in the past but I think that uh there have been going on groupings I will second that I think military culture has come a really really long way um and at the same time I know um some work being done by our team is showing that a astronomical number of service members are um being hospitalized for suicide related reasons or attempting to end their lives at rates that don't typically get reflected in kind of the official documentation that goes out so I agree with that with with both sides there has been a lot of work that's been done and so much more needs to be done agreed absolutely crucial issues to address and a lot of this talk has centered so far around validation and Nina you in particular have talked about how important validation is to you can you say a little bit about what validation does for you when you get it in particular maybe from a family member or from a loved one what that's like um I think the best way that I can describe it is when I get validated I think the first thing I think is oh my God I'm not crazy like it's not just something I'm making up in my head I'm not this over dramatic person I'm not being too sensitive validation shows me that my response is appropriate for the emotions that I'm feeling then Maybe like in some situations maybe my emotional response isn't like inappropriate at that time but having that validation is still like it's okay to have emotions it's okay to feel this way and what skills can we use moving forward to help you either simmer down relax how can we help you um and so I mean like the again the best way you can explain it is oh my God I'm not crazy oh my God my emotions make sense cool it's really it makes a world of difference to someone with BPD it really does she will call me now over the last two or three years and the first thing she'll say is do you have a minute to validate me and that means something just happened and she's ready to maybe do something she doesn't want to do uh and I know I put on my validating hat actually the minute I see you know her name on my phone I'm like validation hat uh and which I should do with everybody because it's very effective um but um yeah she'll actually ask for it specifically um because now we have that language with each other um and then she'll say okay I'm good click foreign I love that thank you so much for sharing that our final question for our panel is another big picture of Seth Axelrod style question what are the things you want to see BPD research focusing on in the next couple of years and I'd love to hear from all four of you where do you want our researchers to be going to answer the questions that we need to have answered again early screening like I cannot say it enough early screening early screening early screening there's still so much research that needs to get done with BPD but I mean teaching clinicians that you actually can diagnose BPD early and having that I know a lot of people are against labels but having that diagnosis and possible label actually brings a lot of relief to people because it gives us okay here's the treatment show there's mentalization there's DBT there's CBT there's all different types of resources out there for you as long as you have that diagnosis and also teaching people about family connections that's something that I because I'm a case manager right now I give it to people who are like I don't know what to do with this person family connections I don't know how to deal with this family connections like giving people access and resources to that and again early detection so important foreign yeah again I I agree um and and my my friendly addition to that is is uh more research on early intervention and uh prevention identif trying to identify kids uh of any age younger kids uh tweens teens before before they have really serious problems trying we're not good at this we're not good at identifying them early and then knowing what to do with them um other than wait and see if it gets worse so I think early intervention prevention efforts and figuring out um you know the screening is I I think I agree completely with the screening but we actually we're not really sure what the predictors are we have to figure out how do we know who's going on this trajectory that we can interrupt that trajectory not wait until the problems are so big it's easy to screen for them um and then of course I you know some some of it's a little bit selfish some of my own research of course is how is developing interventions for families that that help families and people with BPD and related problems um and I would love to see that research expanded well beyond family connections and well beyond DBT to other settings other treatments uh other ways to do that a name nope lots of things that I would like to see additional research on uh in this domain um I think that I cannot uh [Music] apologies I can't emphasize enough uh how important I think that the early screening is I think that this is a key issue um one of the great things you know so just leaving that you know right there one of the great things is that we do have a highly effective treatment however the access remains a critical issue for people all across the country that's why I was so excited about that SP 2.0 program that I mentioned because it's Telehealth based there are trials a variety of different kinds that are called Step trials or smart trial you know there's all kinds of different things I would love to see uh across the Spectrum work just as Ellen was talking about uh trying to find the right level of intervention so that potentially we could use far less costly interventions and make them available to far more people early on right so same amount of kind of money and resources but effectively targeted in giving people you know maybe a much like simpler course of treatment that you know doesn't ten times as many people right right that's right exactly I would love to see work in that space in particular with uh you know that 8 to 12 year old and and the in the adolescence range college students you know all through there um I will also put on a personal plug that um you know I do psychiatric genetics research and we do that for a reason and one of the reasons that we do that is we really do need to understand the biology of borderline personality disorder much much better than we do um we need to have medications that will help people um you know that you know uh many different disorders uh you know outside of mental health diseases have um you know very effective treatments that are far easier to implement and it would be wonderful if we could find things that could help people um uh you know so I I think that it's the full gamut all the way from basic research to help us understand the underlying neurobiology as was mentioned about 50 of heritability for borderline personality disorder is purely genetics uh all the way out to implementation of what we know works and and making it effective uh and accessible to people in the community fantastic thanks to all four of you we have a sense of where the work is now right all the way from the very early lab stuff to the how do we get the effective treatments we already know work to the people with some real focus on screening and predictors of treatment in course what I want to remind all of us is that I'm going to tie this back to what Brandon Marshall was saying he was talking about Walking The Halls of Congress and telling people hey here are the problems here is what we need he has a platform I encourage all of you to find a platform and use it this is important let's get together and ask for the things we want to need from from those who have the power that is my Call to Arms for all of us Emily take it home awesome thank you to our outstanding lineup of speakers today and to all of you who joined us this year a record number over 600 people registered for this year's conference including more than 70 people with lived experience of borderline personality disorder unprecedented numbers for this conference so thank you thank you to each of you who registered and attended today we sincerely hope that everyone enjoyed today's conference um as much as we did and to wrap us up this afternoon I'd like to share a few final notes and reminders first to those of you who are expecting to receive continuing education credits for today if you scroll on down one of those tabs says continuing education on it there are detailed step-by-step instructions in there on how to receive your credits it's going to involve you logging back into your TMS account completing an attendance verification and a post post conference survey we'll be sending out detailed instructions on how to go about this over the next couple of days also if you're running into issues with that please do not fret we have 30 days to get all of that sorted out for you all right so even if you don't have a TMS account yet or you've submitted it and you're still waiting for validation it's okay our team is dedicated to ensuring that everyone who is entitled to their continuing education credits will receive them as quickly as possible okay second we love to hear your thoughts and feedback about our conference each year and truthfully this isn't just lip service like we actually do look at all the feedback um so like this year's edition of interactive workshops that was decided specifically because we got so many recommendations um by attendees at last year's events of we want something more interactive maybe breakout sessions and kind of took it from there so please make sure you complete the feedback survey that's going to be on the next screen the link and the QRS code are going to be listed on that slide um however if you're applying for continuing education credits keep in mind that that survey is different than the post event evaluation that you'll need to do for your continuing education credits okay so two separate surveys one we would love to hear we take all of that feedback into consideration the other to make sure you get your continuing education certificate okay and then third if you weren't able to join us for the entire conference day we realize Friday afternoon can be kind of a difficult time in terms of scheduling or if you're like me and you're dying to see what was in those other breakout workshops um make sure and come back and watch the conference recordings okay they're going to be uploaded to this site within a couple of days and you have until next year one year from today so next May 5th in order to log back in review them to your heart's content right and then the last thing is I'd like everybody to pull out their smartphone I know it's not too far away from you and mark your calendars for next year okay we are already in the planning stages for next year's conference and it's scheduled to take place on May 5th 2023. hope to see you there and so once again please allow me to thank you for joining us today it has been an absolute pleasure and please enjoy the rest of your Friday

Channel: NEA BPD

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Id: iFnGmE1BYE4

Length: 37min 6sec (2226 seconds)

Published: Fri Dec 23 2022