An Education, Skills and Support Programs for relatives impacted by Borderline Personality DisorderMental illness is a family affair. This may be particularly true in personality disorders (PDs) because of the interpersonal nature of their characteristics. Family members are perhaps the most affected and, in turn, are the people most likely to affect the individual with the disorder. Because personality disorders occur in the context of relationships, it is surprising that few programs have been developed to serve families with relatives diagnosed with Axis II disorders, particularly in comparison to the psychoeducation programs that have been developed and made available for Axis I disorders (McFarlane, Dixon, Lukens et al., 2003).
The impact of any mental illness on family members, regardless of diagnosis, can be catastrophic. Family members often are on the front line serving as informal case managers, or as the de facto crisis intervention workers who handle calls of suicidal behavior and emergencies. Unfortunately family members are thrust into roles that require family members to manage situations for which they are ill prepared. Thus, not surprising, studies indicate that family members with a relative with a mental illness are, in general at high risk for depression (Dyck, Short & Vitaliano, 1999; Song, Biegel, & Milligan, 1997). Other data document that, in addition to depression, stress from having a relative with a mental illness is associated with burden, grief and isolation (Greenberg, Seltzer, & Greenley, 1993; Lefley, 1987).
Of note, in a study of stress among clinicians (Hellman, Morrison & Abramowitz, 1986), the three most extreme stressors for mental health providers were patient suicide attempts, threats of suicide, and patient anger, all associated features of BPD... This impact on BPD family members cannot be underestimated. BPD family members often report feeling too traumatized and disempowered to be of help to their ill relatives (Hoffman, Penney, & Woodward, 2002). Up to 73% of those diagnosed with BPD have made at least one suicide attempt with an average of 3.4 lifetime attempts (Soloff, Lynch, Kelly et al., 2000) and 10% of patients with BPD eventually commit suicide (Center for Disease Control, 1997).
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http://www.borderlinepersonalitydisorde ... alth07.pdfAlthough often feeling deskilled by BPD, with its associated problematic behaviours that are difficult to comprehend, family members report that they are frequently isolated and alone in dealing with their loved one’s struggles. Equally difficult is experiencing friends and family members as judgmental about the often traumatizing crises that occur and what they endure (Hoffman et al., 1999). Family members often report a sense of ‘‘surplus stigma,’’ even from those more enlightened about mental illness. Surplus stigma is stigma that is over and above what is typically experienced... The content of the FC program, developed in consultation with several family members and individuals with BPD, was adapted largely from existing curricula created by the first two authors.
The content includes psychoeducational materials reflecting current literature on BPD and on family functioning, and some skills adapted from individual Dialectical Behavior Therapy (DBT; Linehan, 1993). It also includes relationship and family skills developed by the authors, based on DBT theory (e.g., Hoffman, Fruzzetti, & Swenson, 1999; Fruzzetti & Fruzzetti, 2003). The FC program (Fruzzetti & Hoffman, 2004) is divided into six modules:
Module 1: the most current information and research on BPD (e.g., symptoms, course of illness);
Module 2: psychoeducation regarding the development of BPD, available treatments, comorbidity, and a primer on emotion reactivity and dysregulation;
Module 3: individual skills and relationship skills to promote participant emotional well-being (including emotion self-management, mindfulness, letting go of judgments, decreasing vulnerability to negative emotions, and skills to decrease emotional reactivity);
Module 4: family skills to improve the quality of family relationships and interactions (letting go of blame and anger, acceptance skills in relationships);
Module 5: accurate and effective self-expression (how to validate); and
Module 6: problem management skills (e.g., defining problems effectively, collaborative problem solving, knowing when to focus on acceptance and when to focus on change).
All modules include specific practice exercises and homework. In addition, throughout the program, FC provides a forum in which participants can build a support network by family members of persons with other serious mental illnesses.
The FC program targeted change in consistently problematic constructs for family members: burden, depression, grief, and mastery. Family Connections is a program specifically designed to addresses these issues. Data indicates that family members who participated in FC reported significant changes in several key dimensions that are consistently reported to play a central role in their lives: burden, grief, and mastery. These constructs burden, grief, and mastery encompass phenomena that often plague family members with issues such as financial concerns, worries that one’s own behavior may exacerbate BPD symptomatology, mourning lost expectations, and guilt around etiology of the disorder.
The Results:
During the 3 months after FC ended, results show that the average family’s score on the Burden Assessment Scale continued to decrease by an average of 5.78 point. . Changes the mean grief score of all family units decreased by an average of 4.99 points, and the mean mastery score increased by an average of 4.43 points. No change in depression or perceived burden occurred during the 3 months post-FC...
Source:
http://www.borderlinepersonalitydisorde ... ctions.pdf 
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