Borderline personality disorder ... mental health in sports news? Yes, we're excited!

So, I'm hanging out with my S.O. yesterday, and I see him reading some sports news. Meh, no big deal, I think ... I'm not usually excited by A&M's football prospects or which hitter has the best RBI. But then, out of the blue ... a public health article sprouts up in the sporting world that has nothing to do with performance-enhancing drugs or nasty ACL injuries. Yep, it made for a great Sunday.

Here's the scoop: Miami Dolphins wide receiver Brandon Marshall went public with his diagnosis of Borderline Personality Disorder (article here). For those of you who aren't mental health experts, Borderline Personality Disorder (BPD) is characterized by the following:

1) frantic efforts to avoid real or imagined abandonment

2) a pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) identity disturbance: markedly and persistent unstable self-image or sense of self

4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

5) recurrent suicidal behavior, gestures or threats, or self-mutilating behavior

6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7) chronic feelings of emptiness

8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9) transient, stress related paranoia or severe dissociative symptoms

(More information from a DSM summary here)

The most important part of this whole situation is that Marshall is making his struggles with BPD public. BPD may not be on many people's radars as far as important mental health issues go, but that doesn't matter. What excites me abot this article is that a ridiculously successful (Pro Bowl anyone?) professional athlete is unabashedly admitting to a relatively severe mental illness.

The message? It can happen to anyone.

As more and more people come forward to share their struggles with mental illness, the stigma and hype surrounding such conditions will begin to wane. This is why I am always so forward about my struggles with depression and an eating disorder; by making these things a secret, I would be playing into the social expectations of guilt and embarrassment about my mental health. I'm so happy to see high-profile folks like this coming forward to help fight for the cause.

I do feel terribly sorry for Marshall; even with practically unlimited resources, he's continued to struggle with this difficult condition. This article, however, highlights another important point about mental illness that we can scarcely afford to forget:

A man with nearly unlimited resources at his disposal still struggled immensely with mental illness.

Not only do mental illnesses not discriminate ... they also require specific, individualized treatment plans and a lot of dedication to overcome.

This is particularly salient in light of the recent health care reforms, which have re-opened the debate about insurers' responsibility to those of us who suffer from mental illness. If recovery is even difficult for a man with access to so much care, what can we expect for those with health disparities? The dearth of mental health services for all Americans is inexcusable; although the physical maladies may present themselves with more clarity, mental illnesses are also fatal diseases. We can't ignore the implications that mental illnesses have for overall improvement of care.

So, a big THANK YOU to Brandon Marshall for "coming out" as someone with a mental illness! Here's to shattering more norms!

Suicide among middle-aged women

A newly released study from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that middle-aged women's suicide attempts are at what might be an all-time high. (article here).

The majority of these attempts are drug-based, which coincides with most suicide research about gender differences in preferred method of personal dispatch; men are more likely to use firearms, while women are more likely to attempt to kill themselves with drugs or other toxic substances. Not surprisingly, men are generally far more successful, but the incidence of female suicide attempts is significantly higher. I'm not citing this information because I've read so much about suicide and mental health during the past 10 years that I can't even remember where I found all of these facts ... but I'm certain they're out there somewhere. Happy hunting, blog readers.

Anyway, this blog isn't about pointing you to interesting documents and factoids about health (all the time), so today we're going to launch into a discussion about mental health services in this nation and how women's health is grossly neglected. And .... go.

So, middle-aged women make up one of the fastest-growing demographics for newly diagnosed eating disorders. Middle-aged women are also apparently attempting to kill themselves more often. What gives? The linked article talks about hormone problems, "empty nest" syndrome, and other biological/psychological motivators, all of which seem perfectly legitimate. Have we stopped to think, though, that this generation of women might have been left behind by the healthcare system? That we have been carefully ignoring their needs for years?

My mother, for example, has had to practically pull out her doctors' teeth to get them to test her for heart conditions (they run in the family) and hormone problems (yep, I have them, too). These are relatively straightfoward conditions; imagine if my mom was like the woman in the linked article. Schizophrenia? Yep, good luck receiving appropriate treatment for a condition like that.

I imagine that if it's difficult for these women to receive adequate physical care, mental health care must be lacking.

This article is simply another supporting document for the degrading quality of healthcare in our nation (in my opinion). Using carefully collected anectdata (joke), I have found that many of my friends and family members have been ignored, if not flat-out mistreated, by medical professionals at university health centers and specialists' offices alike. Our healthcare system is sick and unable to accommodate physical and mental illness, despite increasing technological power.

This article also states that ONE IN FOUR Americans has a treatable mental illness. That's right. 25% of America is mentally ill (count me in the ranks!). Yet, mental illness is still so heavily stigmatized, and insurance companies are ridiculously hesitant to provide even a small bit of coverage for problems such as eating disorders and depression.

The implications of our social condition contained within this article are just too great to ponder. Gender politics, marginalization of the mentally ill, the cultural traditions of the Baby Boomers .... #head_explosion

I hope you enjoy thinking about these problems, as well. Get back to me when you've come up with a solution.

MSN tells us valuable things about our mental health!

Actually, that's not sarcasm. Here's an interesting point that was made by recent research that's striving to clarify youngsters' depressive symptoms: Kids' mental health paradigm

The most interesting thing to me about this article, though was the headline. You would think that the depressive symptoms are prompted by some genetic component related to maternal heredity; rather, almost the entire article addresses implications for new measurement of depressive symptoms in children.

Isn't it interesting how the media is able to frame things differently by simply changing a headline? Those of us who aren't willing to click to the actual article would be poorly informed in an important public health matter because some lazy copy editor didn't bother to read the text. (This is coming from personal experience ... I was a copy editor many moons before, and I would have been heavily punished for something like this).

Anyway, what I'm trying to get at is this: We need to stop pinning kids' mental illness on their mothers, for genetic reasons or otherwise! I am so tired of mothers shouldering the blame for everything from anorexia to depression and bipolar disorder. The fact of the matter? Mental illness has behavioral and medical components, few of which can be attributed to (non-abusive) parents.

It's unfair for us, as health professionals, to buy into the baloney perpetuated in the media like this. A critical eye is a requirement in this business, and I would encourage all of us to dig deeper than just the headlines.

NJ National Guard model for mental health care, Prescriptions for painkillers, stimulants soaring among youth named “Best/Worst News for Prevention"

"Best and Worst News for Prevention” is based on a purposive sample consisting of expert staff members who each week choose to share their opinions on the best and worst news for prevention.

BEST

N.J. National Guard could serve as a national model for mental health care

During a visit to Trenton in August, the nation's top military officer turned to his hosts in the New Jersey Army National Guard, noting the group's success in monitoring and treating the mental well-being of the state's citizen-soldiers. Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, then asked for more information. It wasn't an idle inquiry. At a time when suicides in the military have soared to record levels, New Jersey is one of just six states in which no Guard members have taken their own lives since 2002. While the Department of Defense mandates some mental health programs, New Jersey has gone further, marshaling state resources and assembling a network of private practitioners to treat distressed Guard members or their family members. The state's primary tool is a 24-hour helpline that's both confidential and independent of the military. Operated by the University of Medicine and Dentistry of New Jersey and funded by the state, the helpline is staffed by veterans and therapists. They counsel soldiers and their relatives, make referrals for treatment and, in the most critical cases, summon help. They also make callers aware of resources available to them, including Department of Veterans Affairs programs, family assistance centers and individuals who can help process claims with the VA.

The New Jersey Guard has deployed more than 11,000 soldiers since 2002, with the biggest mobilization -- just over 2,800 soldiers -- spanning 2008 and 2009. Shortly after that contingent returned, calls to the helpline jumped 20 percent, said Cherie Castellano, the line's director. More recently, she said, therapists fielded two consecutive calls from suicidal veterans.


WORST

Prescriptions for Stimulants, Painkillers Soaring Among Youth

The number of prescriptions for controlled medications such as opioids and stimulants has nearly doubled in adolescents and young adults since 1994. The trend, reported in the December issue of Pediatrics, mirrors a similar increase in misuse of these drugs, with adolescents and young adults' illicit use of prescription drugs now outstripping all other illicit drug use except marijuana. The researchers couldn't attribute the increased misuse directly to more prescriptions, but did urge both physicians and patients to be vigilant when considering the use of drugs such as Oxycontin or Ritalin.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

Tobacco Cessation and Mental Illness

Why do people fighting against schizophrenia die so much earlier than the population at large? The answer may surprise you. And it’s related to tobacco cessation.

In a study published this month in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Historically, the problem has been that many in the medical community have opted not to treat tobacco addiction in this population for fear of worsening their patients’ mental health. However, this study concluded that offering such treatments does not appear to cause deterioration in mental health. It also found that pharmaceutical and behavioral treatments doubled the probability of quitting among these patients, whose smoking rates are two to three times higher than average.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that “schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself.”

Dr Lindsay Banham, who led the review, added “what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with severe mental illness has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population.”

David A. Zauche
Senior Program Officer
Partnership for Prevention