On The Edge

By Gloria Hochman

Borderline personality disorder may be the most under diagnosed of all mental conditions. And its victims are among the most challenging to treat.

The names of several individuals have been changed at their request to protect their privacy.

I knew there was something really bad wrong with me, "says Paula C, a strikingly attractive woman, between sips of peppermint tea in a noisy Ardmore cafe. "But I didn't know I was a borderline. Even as a psychologist, I wasn't exactly sure what that meant I did know it was ugly, that if you were a borderline, you were the scum of the earth. Borderlines were the lepers. So when a doctor at Bryn Mawr Hospital told me I was a borderline, I was very upset I asked, "What's the hope of getting well?" He said, "Not much!"

Everyone who knew them thought that Paula and Lester C. were a charmed couple. She was pretty, smart and gaining a reputation as a savvy and insightful marriage counselor. He was a respected lawyer, with a growing practice. They ate and drank at the Main Line's finest restaurants, played in the tropics, and were always seen together, arm in arm and snuggling.

No one, not even members of their extended families, knew that behind the eight-foot glass doors of their house - the one with six bedrooms and a swimming pool - the scenario was bizarre, moving in tempo with Paula's angry outbursts, suffocating feelings of emptiness, and frequent attempts to slash her wrists.

No one knew that Paula's daughter Nancy was growing up in a household so chaotic and unpredictable that she was terrified to come home from school, panicky about what might be in store for her.

"I'd be walking home," says Nancy, now in her 20s. "and I'd think of these weird scenarios to prepare myself for what I might find. I would go through the door quietly and listen to see if there was any noise, if anyone was crying or anyone was screaming or if anyone was even there. I'd check the floors to see if anything was broken or if the phone was yanked Out of the wall. It was like walking on eggshells. I was shocked when I found out that other people didn't live that way."

Paula admits that she and her husband had an "incredibly dysfunctional" life - lavish parties one day, suicide attempts the next - and that she was an "out-to-lunch" mother. She did not know who she was from one day to the next, and she couldn't connect with her children. There just wasn't enough of herself to give.

From time to time, she hurt herself, not always in an effort to end her life. Sometimes it was just an impulsive expression of rage about something she wouldn't remember the next day. She just knew that, when she jabbed her leg with scissors or burned her arm on a sizzling radiator or retreated to the bathroom with its handy supply of razor blades, she felt no pain, just enormous relief that broke the tidal wave of emotion pulsating through her body.

Paula says her husband, from whom she was separated several years ago, was like a deaf person at a rock concert, oblivious to the chaos that was the hallmark of their family. She herself characterized their relationship as pathological - they were drawn, almost addicted, to each other, but unhappy when they were together. His passivity just fed the inexplicable rage that always simmered inside her.

"By the time I was 6," Nancy says, "I realized that no one was in charge of me."

That's the way life frequently plays out for families affected by borderline personality disorder, perhaps the most complicated, least understood and most often under-diagnosed of all psychiatric conditions. According to the American Psychiatric Association, close to six million Americans have it, nearly as many as those with manic-depressive disorder and schizophrenia combined. Twenty percent of all hospitalized psychiatric patients are borderlines.

Those who suffer from the condition typically stumble through life wondering, as Paula C. did, whether they have a bad illness or whether they are just bad people. Their friends and family run out of patience with their exasperating and baffling— behavior, admonishing them to shape up or to get a life. Eventually borderlines alienate the people they need and love the most.

"Personality disorders, once called character disorders, are the only things left in psychiatry where people think you are bad," says Gary M. Flaxenbag, a Haverford psychiatrist on the medical staff of Pennsylvania Hospital. "Other mental conditions like manic-depressive illness and schizophrenia have been de-stigmatized by making them medical illnesses, and giving patients medications and support groups. But borderlines and other personality disordered people are not in that loop. They suffer from disorganized psyches. And people don't have much empathy for that."

Even the patient-sensitive National Alliance for the Mentally Ill, which links mental maladies to faulty brain chemistry, has not legitimized borderline personality by recognizing it as a bona fide medical disorder. Consequently, it is an illness that provokes more questions than answers. What exactly does borderline personality mean? How do we know when someone has it? What causes it? How can it be treated? The answers depend on whom you ask. But one thing is certain. Those with the condition, 70 percent of whom are women, are terminally miserable, driven by a private drama in which emotions run wild and every day ushers in a new catastrophe. Their world is chaotic and out of control, marked by failed relationships and ruptured careers. They are convinced they are hopelessly defective, although they can't figure out why. More than 10 percent commit suicide within the first decade of their illness.

"I was in a rage for some reason or other," says Paula C. "Who can remember? But I do recall guzzling more than a fifth of vodka, then taking a handful of sleeping pills. I went to the garage to get a straight-edged razor and headed for the shower, where I sliced up my wrist. Somehow, I got outside and walked all over the neighborhood in my nightgown, blood dripping everywhere. The next thing I remember I was in Chester County Hospital being stitched up in the operating room. But they didn't have to pump my stomach this time. I can't explain why, but I put my fingers down my throat to vomit up all the stuff I had swallowed. I think that's when I decided I wanted to live."

More than 200 years ago, an English ' physician, Thomas Sydenham, said of a perplexing group of patients: "For them, all is caprice. They love without reason at one moment . . . they'll hate without cause the next."

Because these patients skimmed the uneasy divide between two major mental disorders - they were more than severely neurotic, but not quite psychotic - they came to be called "borderline." The name stuck.

Although the syndrome has not settled into a concise, widely accepted definition, most attempts to define it describe behaviors. Borderlines rarely become psychotic in the same way that those with schizophrenia do. They look more "normal" and do not hallucinate chronically or hear voices echoing in their brain or experience a clear break with reality. They do not have the wild mood swings of the manic-depressive, and while they feel a certain kind of gloominess, it is not the classic despair that exiles victims of clinical depression to their beds for a month. It is more of a lonely, lost, forlorn kind of melancholia that every so often erupts in a weeping marathon.

The most distinguishing characteristic of borderlines is that they live in a world of unforgiving extremes. In their universe, all is either good or bad, black or white, lovable or hateful, nurturing or destructive. The coworker they adore in the morning may be on their hit list by mid-afternoon. Yesterday's trusted friend may be tomorrow's pariah.

It doesn't take much to send them into a tailspin. It may be something as trivial as a colleague failing to acknowledge them in the elevator or a friend who cancels lunch. Psychoanalyst Joan Gross of Wynnewood, a clinical assistant professor of psychiatry at the University of Pennsylvania, tells of a borderline who worked overtime to complete a project. When she handed it to her supervisor, she was told, "We'll review it next week." The woman, steaming because her efforts weren't getting immediate attention, broke a door, bolted out of the office and quit.

Borderlines are unbearably needy, a red-hot blend of dependence and hostility. They are terrified of being left alone, certain that they will be destroyed. Nighttime and darkness are especially scary, because there is nothing they can see that tells them they are safe. "They are like children who are afraid of ghosts and goblins," says psychiatrist Melvin Singer, a training and supervising analyst for the Philadelphia Association for Psychoanalysis. "All that stuff is real to them. Often they are so panicky at night that they may try suicide. They would rather have a safe death from pills than a violent death by the enemy, whoever that is. "But central to those with borderline personality is an identity disturbance, a feeling of being empty, out of sync with the human race.

Gwen Visser, a 54-year-old Pittsburgh woman who was diagnosed as borderline when she was 38, says, "I always had this feeling that everyone, when they were born, got a book from God telling them how to behave in the world. I didn't get that book. So I spent my life looking over other people's shoulders trying to read their books so I would learn how to act. I never learned."

Another borderline, 32 year old Vicki R. confided to her therapist: "The first time I realized that yellow was my favorite color was a magical day for me. At last there was something that said to me, 'If you can identify the color you like most, it must mean you are somebody, that there's a there there.' I was so proud of myself."

"After one of my suicide attempts, I was put in the hospital," says Paula C., "and part of the treatment was art therapy. I remember they did this experiment with clay. Each of us got a lump of clay, and they turned off the lights and asked us to practice breathing and make something out of the clay. I made a tiny little hall and put my fingerprint on the top. But when they turned the lights on, all I had was a ball. There was no trace of a fingerprint, not even a dot. It was like me. I was a nothing, just like the ball, just a blob with no substance."

Remember the film Fatal Attraction? Alex Forrest, the character played by Glenn Close, was a borderline, says psychologist Jeffrey Young, director of the Cognitive Therapy Centers of New York and Connecticut. Unrequited affection for a married man after a brief affair flipped her within minutes from lover to monster. She became obsessive and demanding, even slitting her wrists to recapture his attention. When that didn't work, she pursued him relentlessly, showing up in his office unannounced, calling him at home at 4 in the morning and stalking his wife and daughter.

The Forrest role demonstrated an extreme case. Still, because being alone is intolerable, borderlines typically crush other people - friends, coworkers and especially intimate partners - by clinging too tight, depending too much, demanding the impossible. They are love addicts, idealizing their spouse or lover "with an overwhelming intensity," says Pittsburgh psychiatrist Paul Soloff. "And when the lover isn't perfect, just human, the borderline feels outraged and betrayed."

Tim D., 42, who has been hospitalized nine times since the mid-1970s, admits, "My expectations are unrealistic. When I don't get unconditional support, I am snappish and unforgiving. By not giving me all I need, in my book you become my abuser. So it is almost impossible for me to be involved with anyone long-term."

Indeed, few people can tolerate the unyielding emotional intensity and prickly behavior of the borderline. They accuse borderlines of being spoiled, over reactive troublemakers whose goal in life is to make others miserable. How, after all, can someone who gets straight A's in school or who is administrative assistant to a company president be unable to pull herself together? Isn't it just a way of getting attention? Isn't it manipulative?

"It wears you out," says Philip T., whose 35 year old son, Michael, was diagnosed as a borderline 17 years ago. "Since he was 7, he has always been in therapy for something or other - hyperactivity, a big mouth, lying, stealing. But we didn't think of it as a mental illness until he was 18, when a doctor told us that Michael's condition had a name.

"Treatment doesn't seem to help him," says Philip, who is divorced from Michael's mother. "He can't hold a job. He cries a lot. He feels abandoned. Nobody loves him. He is constantly angry. He drives recklessly. He drinks. He can't manage money. He's impulsive and excessive. I loom too large in his life; some days I'm good, some days I'm dirt. Our relationship is the classic, 'I hate you, don't leave me.' If I had a low-functioning, introverted son who was schizophrenic, I would take him in a minute over what I've got."

Not everyone is as dysfunctional as Philip's son. In fact, says M.Taylor Bach, a pastoral counselor in Erlanger, Ky., it is possible that a colleague at the adjoining desk, a next-door neighbor, a suit at the boardroom table could be a closet borderline. Those who are less severely ill can hold responsible, even high-level jobs - if they can avoid intimate contact and teamwork.

"In work environments where there is some structure and relatively clear tasks, they can often be extraordinarily successful," says Rex Cowdry, psychiatrist and researcher at the National Institute of Mental Health. "If they are in managerial spots where they are in charge, approval of others may be less of an issue. And because of their own sense of neediness, they can be quite caregiving and empathic, and may do well in jobs such as nursing or social work."

But when they experience what they think is rejection, when they feel helpless or desperately alone, they punish themselves - or others. They may plummet into a paralyzing depression. Or scream uncontrollably. They may go on a wild spending spree. Scavenge the corner bar for a sexual partner. Down a fifth of Jack Daniels. Snort a line of cocaine. In fact, more than 50 percent of borderlines meet the criteria for drug or alcohol abuse. Borderlines mutilate themselves - anything to relieve the anguish. Anything to feel something. Anything not to be invisible.When nothing else works, when nobody is noticing, when no one is there for them, the borderline turns to suicide, her only way out of choking pain.

"When my best friend, George, died, it was the first death I had experienced," whispers Paula, dabbing at her eyes with a moist handkerchief "I felt so alone, so abandoned, so I did what I normally did. I took my razor blade into the bathroom and started to cut. `You see, we'll kill ourselves in a minute over a lost relationship. If the relationship is gone, you might as well die. Who cares? We are nothing anyway. Without attachment, connection, there is no reason to live."

Unlike schizophrenia and manic-depressive illness, which have come to be associated with flawed brain chemistry, borderline personality has not let parents off the hook. The genesis of this disorder, say most mental health experts, can be traced to trauma in early childhood when a child's ego is fragile. Borderlines remember home environments that felt insecure, unstable and unsafe, and say that they often lived in fear of explosive anger or violence. Some recall being abused physically or sexually. They talk about parents who were "tuned out" and homes devoid of empathy and consistent nurturing. They felt rejected and criticized, but were not allowed to express their needs or feelings.

These feelings - emotional deprivation, shame, abandonment, vulnerability, alienation - that were imprinted on the borderline during childhood chase her through life, dictating her thoughts, feelings and behavior. And the emotions the child couldn't express get acted out in "inappropriate ways when they grow up," says Jeffrey Young, the psychologist with the Fatal Attraction allusion.

Therapists say that before the 1960s they didn't see many borderlines. But at that time, the structure of the world changed. "Families broke down," Melvin Singer says. "Moms went to work. Psychedelic drugs were in vogue. There was no religion, no social props to reinforce personality development. And we started seeing very disturbed character disorders, people who said that they didn't feel real, didn't feel alive."

Many psychiatrists, including Otto F. Kernberg, a national expert on borderlines and professor of psychiatry at Cornell University's medical college, are convinced that there is a temperamental predisposition that, coupled with early environment, leads to the borderline's broken emotional thermostat.

"Even as young children, they are constitutionally highly emotional," Young says. "Some may even be bipolar [manic-depressive]; others are just intense. Someone with that kind of temperament raised in a different family environment might develop other coping styles or a different personality disorder."

More girls than boys become borderlines, says psychiatrist and psychoanalyst Bruce J. Levin, director of the consultation and evaluation division at the Philadelphia Association for Psychoanalysis. Temperamentally vulnerable boys are more likely to become aggressive, taking their frustrations out on society. Girls, on the other hand, conditioned to absorb emotional pain, tend to self destruct.

Studies to track family histories of borderline patients show conflicting results. The largest long-term research project was done by Michael H. Stone, professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. Of 299 patients, all from middle- or upper-middle-class families, he found a significant proportion - 15 to 20 percent, five to seven times the norm - with a family history of mood disorders: manic depression and depression. Ten percent of the borderline patients, whose average age was 22 when they entered the study, went on to develop manic-depressive illness themselves.

On the other hand, an Australian study of 40 borderlines, completed in January, found a low incidence of mental illness in the family. The research indicated that 90 percent of the borderlines had been victims of incest or physical abuse.

"I have only scattered memories of my childhood," Paula says, "but I know I didn't feel safe. My grandfather, who lived with us, was an alcoholic, and there were loud, violent scenes outside my bedroom door. My older sister was beaten with a horsewhip. There was a dog who used to bite me, and it became a joke. 'Look, the dog has bitten Paula's nose!' When I cried, I was told, 'Be quiet or we'd give you something to cry about.' I learned how to count one, two, three, four - as a way of disassociating I would go to bed and make up novels, mostly that my mother and father were killed in an accident. I didn't laugh and I didn't cry. I was a zero, a cipher. My parents used to call me 'the ghost.'"

Parents are not sitting still in the face of what they say are false accusations that shame them and tarnish their families. James W., whose 27-year-old daughter is in a program for seriously ill borderlines in White Plains, N.Y., is tired of being maligned. He believes that research into the biology of borderlines eventually will vindicate parents, just as it has the "ice mothers" of schizophrenics. "Sure, there are some families where serious abuse occurred, but there are just as many where parents are baffled by their children's behavior and have spent their lives, as I have, helping them search for their lost potential," says James, whose daughter goes to daylong group therapy five days a week. "When a child dies, you go through mourning once. I go through it over and over every day."

Four years ago, Valerie Porr, a feisty New York fashion designer determined to unravel the mystery of borderlines, founded the Treatment and Research Advancements Association for Personality Disorder, a research and advocacy group that includes relatives of borderlines and an impressive roster of physicians. Porr - who has a close relative who is a borderline - describes her testy conversation with a therapist who insisted that abuse was rampant in the backgrounds of borderlines.

Porr: Where did you get your information? From your patients?

Psychiatrist (nodding his head): Yes!

Porr: How can you accept what they tell you? Don't you know you can't believe them?

Psychiatrist (laughing): You know, you are absolutely right!

Porr's view is that having borderline personality is like having a language disorder. Twenty four year old Annie F., for instance, who calls her mother regularly at 3 in the morning, can't understand why her mom gets angry. Annie hangs up feeling rejected and forsaken. And her mother doesn't comprehend the depth of her daughter's despair or that she was reaching out because she is unbearably frightened and in pain. "That's the kind of thing that happens all through childhood," Porr says. "The sensitive child sees cognitive distortions everywhere. And the parents don't have a clue about what's going on."

No matter the cause, borderline personality disorder has been viewed as a psychiatric nightmare. Treatment is long and expensive. And, based on numerous interviews, it is clear that many therapies get an oh-my-God look when they learn that the "patient from hell" they have just taken on is a borderline. Sometimes, characteristics of the borderline's early emotional life feel too close for comfort. "Even though borderlines may seem extreme in certain respects, all of us see some aspects of ourselves as we think of our own adolescence."

Bruce Levin says. "There is a quality of 'There but for the grace of God go I.' "

And because progress is usually slow - effective treatment ran take years frustrated therapists may blame the patient when she doesn't get well.

Not that borderlines are easy patients. Some call their therapist's six times in an hour or cry abandonment when they take a vacation. Patients often need a pillow from the psychiatrist's couch or a handkerchief with his or her initials to get them through those two weeks in august when the therapist is away.

"My first separation from Stanley, my third psychiatrist, was awful," Paula says. "When he told me he was going on vacation, If felt physically sick. I couldn't bear to walk out of his of office The pain was so bad I stayed in the waiting room for two hours getting myself together."

No one has a corner on treating borderline personalities, and everything from medication to Freudian analysis has its proponents. Certain symptoms, such as depression and anxiety, can be modified with a trial-and-error regimen of neuroleptics, antidepressants or anticonvulsans. Someone with turbulent mood swings may be calmed with lithium. But the personality disorder overrides the medication, says Cornell's Otto Kernberg, and, in his opinion, psychotherapy - modified psychoanalysis - is needed to bring about radical personality changes.

Kernberg, who is president of the International Psychoanalytic Association, employs a treatment plan that presumes that borderlines who are aware and grounded in reality - as most are most of the time - can be responsible for their behavior. "We have to be tolerant that they have an illness that needs treatment, but they must still adhere to socially acceptable norms," he says. "The people with whom they live and work have a right to respect."

Part of his patient-therapist contract, Kernberg says, is an agreement that the borderline will go to the hospital if he has thoughts of hurting or killing himself. "

Our first task is to analyze the patient's reaction to this limit setting. This is the beginning of treatment."

There are few studies comparing outcomes of different treatments, and those that exist are inconclusive. Psychologist Gregory K Brown, of the Center for Psychopathology Research at Penn, is in the early phases of a pilot study to measure the effectiveness of cognitive therapy, the brand of relatively short-term treatment pioneered by Philadelphia psychiatrist Aaron T. Beck.

Psychologist Marcia M. Linehan, a professor at the University of Washington at Seattle, is using some of Beck's strategies in a program that treats borderlines for just a year. Although she concedes that the treatment should be longer, she insists that it is working, even for the most disturbed borderlines. Their suicidal behavior goes down. They find and keep jobs, she says, and their relationships improve.

The borderlines she trees are severely disordered, addictive and suicidal and have whirled through a revolving door of hospitalizations. "They are the psychological equivalent of the burn patient," Linehan says.

"Everything hurts so bad. Most treatments are ineffective or make them worse because they poke around in areas that are too painful. These people's lives are so awful that if they thought about it, they would kill themselves. So we're not big believers in insight. We believe in changing behavior."

Linehan says her program - Dialectical Behavioral Therapy, which draws on strategies from a variety of psychotherapies - achieves that goal through a combination of weekly individuals therapy and group-skills training sessions, a college-like course using books and problem-solving techniques. Borderlines are taught how to exchange their unacceptable behavior-self-mutilation, drug use, exploding rage, suicide attempts with safer ways to respond to their emotions. Unlike more traditional psychotherapy, patients are encouraged, and expected, to call their therapies between sessions - just to hear their reassuring voices, to repair something that may have gone wrong in therapy, and to learn, once again, the behaviors they can employ to manage emotional trauma. Linehan doesn't expect or want to strip borderlines of their emotions. "Emotion is not pathological," she says. "Being out of control is."

No matter the treatment, virtually all mental health experts agree that the therapist-patient relationship is crucial. Unless the borderline trusts the therapist, unless the therapist gives her a wider berth than he does most patients and goes out of his way to show genuine concern for her and her world, treatment is doomed. In fact, more than 60 percent of patients drop out within six months.

"The borderline needs to get her aggression out in treatment and see that the therapist can tolerate it and still care for her in her entirety her loving and her hating side," Melvin Singer says. "Then she can begin to think she has the right to live.

"The human touch can save them, actually," he says. "Because they were damaged so young, before they had words, words don't soothe them. When they are losing a sense of being in touch with life, the only thing that rescues them may be the therapist holding their hand or patting them on the back. That can calm them down.

"Paula points to a black and white picture of a nice-looking middle-aged man, framed in gold on her living room table. "That's Stanley," she says. "He saved my life. In my first session with him, I remember being under the desk where he couldn't see me, screaming, 'Can I trust you?' Then I told him the first thing he would have to do is hug me. I said, 'I know you're trained as an analyst, and that's not what you do, but the neutrality of psychoanalytic therapy drives me crazy. I can 't stand the lack of reinforcement, of not getting feedback. I can't stand talking into a vacuum and nothing comes back.' One day, I took his picture from his desk. I told him, 'It's like I'm a baby When I don't see you, I don't know you're there. I need something to remind me of you.' Stanley was my safe person.

"No matter how the borderline appears when she comes in for treatment, she is emotionally like a 2-year-old child who wants to be taken care of," Jeffrey Young says. "She is needy, not greedy.

She is not trying to suck us dry because she is so self centered. She is a desperate child who has felt no love and is crying out for someone to care about her."

The therapist's job, Young says, is to reparent the borderline, to take her through the development stages of childhood, snuffing out her original messages, until she becomes a healthy adult. How it is done depends on the patient's state of mind during the session. Today, she may be an "abandoned child" who needs nurturing. Next week, she may be an "angry child" who needs permission to ventilate her rage within appropriate limits. She miles learn how to banish the part of her that becomes her "punitive parent," still making her feel worthless and evil. And her "protector," the side of her that sinus off feelings to avoid rejection, has to be taught how to form fulfilling relationships.

Young's treatment program is a deliberate and flexible mix of cognitive, behavioral, psychoanalytic and experiential techniques, designed to help patients shed those souvenirs of their childhood's that are destroying them now.

Stanley J. Miller Jr., who was Paula C.'s psychiatrist until his retirement a year ago, also believes that therapy by the rule book will not work with borderlines. "For one thing, you have to change your goals," he says. "You can't expect that a borderline will emerge from your treatment conflict-free. That's ridiculous. You hope to stabilize someone, help them get through the rough spots and understand themselves well enough not to be so surprised about what is going on inside of them."

Miller met with Paula once a week for 10 years. He allowed her to call him between sessions, even installed a phone line where she could leave messages of up to an hour in length. "Most of the time, the calls were brief," Miller says. "But the important thing is that I was there. I hadn't abandoned her, so it helped break down her anger and fears."

During her therapy with Miller, Paula was hospitalized only once (compared to seven times earlier in her life) and became better able to take care of herself. She continues to receive psychiatric support, but maintains her own apartment. Her daughter, Nancy, from whom she had been estranged for seven years, is now living with her.

"So much happened between my mother and me that I still keep part of myself locked away," Nancy says. "I don't fully trust her. I missed out on the mom that teaches you what to wear, how to put on makeup, how to cook, how to behave. So now I want to make up for lost time. I think I'm beginning to find the mom I didn't know. But it's slow. I'm taking baby steps."

When Miller was about to retire, he gave Paula six months' notice so she could prepare gradually for his absence from her life. He told her why: that he wanted to spend more time with his ailing father, and explained that he would help her find someone else with whom she would feel comfortable working.

As the time approached, Paula asked Miller for a photograph that decorated his office wall - a simple picture of a wildflower. She also wanted a recording of his voice, reminding her of coping strategies she had learned in therapy. When the time came, he felt she could make the transition.

"Leaving Stanley's of tree for the last time let me know I could leave important people in my life and survive," Paula says softly. "It is how you learn how to handle yourself as a big person so you're not alone with nobody - nobody being yourself. On the way home, I stopped and bought myself some flowers."

Illnesses :

MANIC-DEPRESSIVE (OR BIPOLAR) DISORDER - A major mood disorder in which there are episodes of both mania and severe, disabling depression with periods of normalcy between.

SCHIZOPHRENIA - A severe brain disorder typically characterized by language and communication disturbances There may be distortion of reality, misperceptions hallucinations and delusions, regressive or bizarre behavior, lasting longer than six months.

NEUROSIS - An emotional disorder arising from unresolved conflicts, with anxiety being the major symptom. Neurosis does not involve gross distortions of reality.

PSYCHOSIS - A major mental disorder in which the personality is seriously disorganized and contact with reality is impaired. Symptoms are regressive behavior, inappropriate mood, diminished impulse control, delusions or hallucinations.

BORDERLINE PERSONALITY DISORDER - A personality disorder whose sufferer live in a world of extremes. Their lives are marked by unstable and intense relationships, the absence of a sense of self, and chronic feelings of emptiness.

Therapies

BEHAVIORAL THERAPY - A form of treatment based on the theory that a troubled person's behavior results from learned bad habits Behavior is modified by rehearsing and practicing new behaviors

COGNITIVE THERAPY - A short-term therapy to break down negative thinking and change distorted thoughts and attitudes .

EXPERIENTIAL THERAPY - Re-experiencing powerful emotions through use of imagery, dialogue, role-playing and ventilation of emotions.

PSYCHOANALYTIC THERAPY - Reducing or eliminating the undesirable effects of unconscious conflicts by making the patient aware of their existence origin and inappropriate expression.