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I have been successfully treating Borderline Personality Disorder (BPD) and Post Traumatic Stress Disorder (PTSD) for many years and am in much agreement with your websites' themes, although dialectical structure for treatment seems a lot like our good old person in a biopsychosocial sexual situation with a good assessment process, treatment plan, and caring SW perspective and case management.

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Over the years in treating BPD and PTSD I have observed a syndrome that my fellow clinicians now refer to as the "Bellman Syndrome" a title I modestly (sic) accept. It is simply stated thus; chronic pain and medication addiction are directly associated with Borderline Personality Disorder or Post Traumatic Stress Disorder in a complex interaction.

In treating many patients both in-patient and out patient over the years, I noticed that many people had become addicted to pain medication for chronic pain, as I treated these clients over time it became clear that;

• these were mostly middle class housewives without a "standard" profile for drug addiction.
• that therapy in most cases disclosed to a BPD-like symptomology of early child abuse, mood swings, dissociative states etc.
• successful treatment resulted from a team approach of easing the pain with meds, acupuncture etc. recovering from addiction and therapy for the abuse, and to address the needs of the client with cognitive and psychodynamic treatment for moods and appropriate support systems.

This success with clients confirmed my "person in a situation" training and the importance of case management. But it also sparked my interest in research, so I became a Diplomat in the American Academy of Pain Management, there the research has focused on the ways that pain escalates the need for pain medication and that pain medication then escalates the pain in a vicious interactive cycle, which also changes physiology in the brain, research themes that affords the academy credit.

I believe that the etiology of the initial painful injury goes back to early childhood abuse; that in a state of rage or disassociation the client twisted their back pulling the vacuum cleaner or doing laundry, or so it is often reported although this may be a "doing everything for them" metaphor.

Pain-addiction-emotional trauma thus causes brain and personality change in a complex interaction is the very treatable syndrome. Thank you for adding more pieces to the puzzle in this website; on genetics, environment and neurology, and the need to reframe and rename what we call BPD.

Compliments of Eric Bellman Ph. D., LCSW
32129 Lindero Cyn. Rd. #108E
Westlake Village, CA 91361
1-805-493-2492
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Disorders - Borderline Personality Disorder