"We have lost the ability to connect with one another, and this favours the appearance of mental disorders"


Interview with Carla Sharp, professor of Psychology at the University of Houston, who has conducted pioneering research on Borderline Personality Disorder, BPD, in children and adolescents. Dr Sharp visited the UAB Faculty of Psychology to offer a conference and workshop.


"A child can be born with a high level of sensititvity to the disorder due to their genetic predisposition, but developing the disorder depends on their environment or surroundings. What is clear is that it is not the parents' fault, and many of them feel guilty, which they should not because in no way are they to blame."

Carla Sharp, professor of Psychology at the University of Houston has spent years researching psychiatric disorders across the lifespan with a special focus on youth. She also directs a centre for teenagers dedicated to preventing and treating these disorders in Houston.

She has published over 200 articles in journals, chapters and books. One of her most well-known publications is the "Handbook of Borderline Personality Disorder in Children and Adolescents" (Springer). In 2016, she received the mid-career award from the North American Society for the Study of Personality Disorders. On 10 and 11 December, she visited the UAB Faculty of Psychology.

- What is Borderline Personality Disorder, BPD?
- It is one of the ten personality disorders currently known to us. It describes a disorder characterised by impulsiveness, emotionality, a sense of emptiness, problems with personal relationships. It was first diagnosed in adults some 30 years ago, but children and adolescents were first diagnosed with it much later.

We can detect in adolescents the symptoms which point to them having them as adults, but we cannot detect this in pre-adolescents. We can see some traits such as emotionality or impulsiveness, but not all the characteristics making up BPD.
- Is this disorder more common now than 40 or 50 years ago?
 - Not exactly. What we can now do is identify the disorder clearly. Until a few years ago we would get it mixed up, and now we clearly see that it is different to a depression, anxiety or anti-social behaviour, for example. In other words, BPD is not increasing among the population, but rather now we know more and can diagnose it.
- What can families do to prevent their children from having borderline personality disorder?
 - This is a very important question and we have spent a lot of time studying and researching the issue. A person born with BPD has a very sensitive temperament, it is as if instead of having the numerous skin layers we all have, they have none. These children will be over-reactive to their environment, more emotional, and will need their parents more to help them regulate their responses to the environment. It is very important for parents to prepare themselves mentally because it is in the adolescent years when children integrate their personality and need to find answers. The family must be aware and know how to respond to that.
- What research projects are you working on at the University of Houston that are related to personality disorders in children and adolescents? Is there any specific project you wish to highlight?
 -At the moment, we are very interested in studying prevention and also first interventions. Borderline personality disorder is very difficult to treat and the treatments must be long-term to have any effect, and therefore the earlier it is detected, the better. We are focused on prevention, working on it before it becomed ingrained. Right now we are working on different early intervention programmes with mothers and their children.
Our interventions are done on high-risk mothers: for example, with mothers victims of domestic violence and living in shelters or reception centres. They are suffering the effects of abuses, are unemployed, homeless, without any money, etc. and their brain is not able to detect any personality disorders their children may have. Another project we are working on is with children living in reception centres, who may also suffer from these personality disorders.
- Are these disorders are produced by social and cultural issues or are they rather consequence of the genetic compound of each human being?
 - The genetic causes are very important. In the past, it was though that personality disorders were caused by the family and personal environment of each person. However, in the past 15 years we have seen that many psychiatric disorders have a heavy genetic component and what is crucial is to discover a person's biological or genetic vulnerability. It is an issue of temperament. A child can be born with a high level of sensititvity to the disorder due to their genetic predisposition, but developing the disorder depends on their environment or surroundings. What is clear is that it is not the parents' fault, and many of them feel guilty, which they should not because in no way are they to blame.
Parents need more information to be able to detect it and give their children the type of help they need. In the past these parents were stigmatised and society had no idea how hard it could be to educate children with this temperament. And these mothers and fathers actually needed a lot of help and support, not criticism or being made to feel guilty by society.
- Should hospitals change the way they care for and treat people with BPD?
- Definitely yes, the treatment must change. We are now building a global alliance with different countries for the prevention and early intervention of BPD. I hope Spain will form part of it very soon. It is a global initiative to try to have an influence on prevention  and early intervention policies.

The problem is that in all the world, the US included, care for people with BPD is not contemplated within the healthcare protocols; these people are diagnosed with depression, anxiety, ADHD, etc. but nowhere does it say personality disorder. So that makes you lose a large part of the problem, demonstrated by the fact that only 30% of treatments are effective. Therefore, 70% of patients do not receive the correct diagnosis or treatment and can develop BPD, because they have not been diagnosed or treated.
Clinics and hospitals are aware of this disorder, but they do not diagnose it because children and adolescents would be stigmatised by it. So now we find ourselves with doctors that can diagnose cancer, but not a personality disorder in a child. Medical practices and healthcare assistance in these cases must change, all over the world!
In most cases they know it is a BPD, but they do not know how to treat it. We need to train professionals capable of treating patients with borderline personality disorder. Many people think it is not treatable and incurable, but that is not so and there is a treatment and it can be cured. Now, there is a lot of work to do and there is still a long way ahead before we reach a cure.
- What types of treatment are there? Do they involve drugs?
- No, no, drugs actually do not work too well. What does work is psychotherapy. There are four psychotherapy treatments, and two are the most commonly used: dialectic behaviour and metalisation therapy. They are different paths to reach the same place. The problem is that they are lengthy treatments, there are no immediate effects, but they do work.
- What parts of the world are advancing the most in borderline personality disorder?
- England, Denmark, Germany, Norway, Australia, and the United States in some of its states. All of these countries have created national and global programmes with which to diagnose and treat this disorder.
- At a general level, what does society need to face and treat borderline personality disorder?
- What our society needs is to be more aware of this issue. In the US, and in general as well, personal relationships have been completely broken. The ability to relate to each other has been destroyed. And what is most difficult now is to make people aware of the need to relate to others correctly. We live in a society that worships individualism, a love for work, a non-sharing with those right next to us, being slaves to technology and anything material... All of this favours psychiatric disorders, when what is actually needed is for people to feel connected to each other. We need people to connect and related to each other differently than what we have been doing lately. If we do not achieve this, there will be a rise in psychiatric disorders.


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