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borderline personality disorder Archives - Suzanne Wallach

What Triggers A Person With Borderline Personality Disorder?

Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists ten standalone personality disorders based on similar characteristics, and each personality disorder is grouped into one of three categories (cluster A, cluster B, and cluster C). Borderline personality disorder (BPD) belongs to cluster B, which is characterized by “dramatic, overly emotional or unpredictable thinking or behavior.” More specifically BPD is characterized by “a pervasive pattern of instability and hypersensitivity in interpersonal relationships, instability in self-image, extreme mood fluctuations, and impulsivity.” Individuals with a borderline personality disorder often struggle with relationship issues, lack self-esteem, have a poor self-image, and have an inability to appropriately self-regulate. A borderline personality disorder is not an uncommon disorder, as the National Institute of Mental Health (NIH) estimates that 1.4% of the adult population in America experience BPD.

Risk Factors

The exact cause of borderline personality disorder remains unknown. There are, however, several contributing factors that have been recognized as possibly playing a role in its development, potentially increasing one’s susceptibility to BPD. These factors may include, but are not limited to the following:

  • Environmental factors: growing up in an unstable, neglectful, and/ or abusive environment could increase one’s risk of developing BPD.
  • Genetics: people with a family history (e.g., parent, sibling, etc.) with BPD may be at increased risk of developing a borderline personality disorder. Psychology Today asserts that BPD is approximately five times more common among people with close biological relatives with BPD.
  • Brain factors: some studies have indicated that individuals diagnosed with BPD have structural and/ or functional abnormalities, specifically in the areas of the brain that reign emotional regulation and impulse control. Furthermore, deviations from typical serotonin (hormone that works to stabilize one’s mood, happiness, and feelings of well-being) production could increase one’s vulnerability to BPD.

There is no definitive medical test to diagnose borderline personality disorder. The diagnostic criteria outlined in the DSM-5 indicate that to be clinically diagnosed with BPD an individual must experience five or more symptoms, in a variety of contexts.

BPD Triggers

A trigger, in the context of BPD typically refers to something that precipitates the exacerbation of one’s BPD symptoms. Johns Hopkins Medicine explains that “triggers are external events or circumstances that may produce very uncomfortable emotional or psychiatric symptoms, such as anxiety, panic, discouragement, despair, or negative self-talk.” While BPD triggers can vary from person to person, there are some types of triggers that are more common in BPD, such as the following examples:

  • Perceived or real abandonment
  • Rejection of any kind
  • Loss of a job
  • Locations that invoke negative memories
  • Reminders of traumatic events
  • Ending a relationship

Many borderline personality disorder triggers arise from interpersonal distress. The symptoms that manifest because of borderline personality disorder often mimic those of other mental health disorders (e.g., histrionic personality disorder, narcissistic personality disorder, bipolar personality disorder, etc.). BPD symptoms pervasively interfere with an individual’s ability to function optimally in his or her daily life.

 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, or give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

What Are The Symptoms Of Borderline Personality Disorder?

personality-disorder

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, mental health disorder. It is a complex psychological condition that is characterized by pervasive instability in moods, emotions, behaviors, and interpersonal relationships which interfere with one’s ability to function in everyday life. It can be difficult to determine who will develop borderline personality disorder as the cause of BPD remains unknown. The National Institute of Mental Health (NIH) alludes to research that “suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.” BPD typically develops in early adulthood, often with more severe symptoms occurring in the early stages of onset.

Symptoms & Diagnostic Criteria

Borderline personality disorder directly affects how one feels about him or herself, one’s behavior as well as how an individual can relate to others. It is not uncommon for people with BPD to feel extremely intense emotions for extended periods of time. This makes returning to a stable emotional baseline far more challenging, especially after experiencing an emotionally triggering event. According to the DSM-5 key signs and symptoms of BPD may include:  

  • Unstable personal relationships that alternate between idealization and devaluation, sometimes referred to as splitting
  • Frantic efforts to avoid real or imagined abandonment by family and friends
  • Impulsive behaviors resulting in dangerous outcomes (e.g., engaging in unsafe sex, reckless driving, abuse of drugs, etc.)
  • Distorted and unstable self-image, affecting one’s moods, relationships, goals, values, and/ or opinions
  • Self-harming behavior (e.g., suicidal threats)
  • Chronic feelings of emptiness and/ or boredom
  • Periods of intense depressed mood, irritability and/ or anxiety lasting anywhere from a few hours to a few days long
  • Dissociative feelings
  • Intense, inappropriate, and/ or uncontrollable anger, typically followed by feelings of guilt and/ or shame

More specifically, the diagnostic criteria outlined in the DSM-5, indicates that to be clinically diagnosed with BPD an individual must experience five or more of the following symptoms, in a variety of contexts,

  1. Emotional instability
  2. Feelings of emptiness
  3. Efforts to avoid abandonment
  4. Impulsive behaviors
  5. Identity disturbances
  6. Inappropriate, irrational and/ or intense bouts of anger
  7. Transient paranoid and/ or dissociative symptoms
  8. Unstable interpersonal relationships
  9. Suicidal and/ or self-harming behaviors

Due to the quick changing nature of signs and symptoms associated with borderline personality disorder, it is notoriously known as a difficult to diagnose illness. The treatment for BPD often includes long-term participation in psychodynamic models of psychotherapy such as dialectical behavior therapy (DBT). DBT was developed by Marsha M. Linehan in the late 1980s, as a means to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder. It is an evidence-based psychotherapy that combines techniques from western cognitive behavioral therapy (CBT), psycho-educational modules, and eastern mindfulness-based practices to foster the systematic learning of new emotional coping skills. Since its inception, dialectical behavior therapy has been and remains the gold standard method of treatment for individuals diagnosed with BPD.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Coping With Pregnancy And BPD

Coping With Pregnancy And BPD

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic mental health disorder. It characterized by a pervasive pattern of instability in interpersonal relationships, self-image issues, difficulty managing emotions and behaviors, and an inability to appropriately self-regulate. The symptoms that manifest because of borderline personality disorder often mimic those of other mental health disorders such as histrionic personality disorder, narcissistic personality disorder and bipolar personality disorder. Individuals with borderline personality disorder feel prolonged, intense emotions and are unable to return to a neutral emotional baseline after facing an emotionally charged experience in a timely manner. This can affect all areas of one’s life as the duration it takes an individual with BPD to process, integrate, and recover from emotional challenges is elongated. Further, the symptoms associated with borderline personality disorder can interfere with an individual’s ability to function optimally in his or her daily life.

Impact Of BPD In Pregnancy

To effectively cope with pregnancy and BPD it is helpful to be aware of some of the effects that can occur when these two conditions coincide. Women with borderline personality disorder during pregnancy are faced with additional challenges, as risk of certain complications increase, and BPD symptoms influence various aspects of pregnancy. For example, leading experts assert “Women with borderline personality disorder during pregnancy have been found to be at increased risk of gestational diabetes, premature rupture of the membranes, chorioamnionitis, venous thromboembolism, caesarian section and preterm birth.” It is not uncommon for women with BPD to experience distress when touched. The anticipation of birth is often perceived as traumatic, and women will frequently request early delivery. 

What To Do

Pregnancy is a major period of transition in one’s life that is filled with wide ranging emotions. Along with the typical strains and stressors that can accompany pregnancy, individuals that simultaneously struggle with managing symptoms of BPD while pregnant are at increased risk of encountering avoidable challenges. Fortunately, there are a variety of ways to help woman with BPD navigate her pregnancy and manage her symptoms. Consider the following suggestions:

  • Minimize the number of people caring for the pregnant woman: leaning on the same person or small group of people during the pregnancy can be helpful for women with BDP, as continuity of caretaker/s provides consistency and familiarity. 
  • Encourage the pregnant woman to identify and seek practical and/ or emotional support services.
  • Urge the pregnant woman to focus on making healthy daily choices (e.g., eating nutritiously, establish good sleeping patterns, etc.).
  • Engaging in regular exercise can be advantageous, as it promotes the release of endorphins and increases serotonin levels.

Although for some women with borderline personality disorder, the idea of getting pregnant may seem outlandish or dangerous, it is important to note that with the proper support, a woman with BPD is fully capable of having a perfectly healthy pregnancy. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment. 

Helping A Partner Who Has BPD (Borderline Personality Disorder)

Helping A Partner Who Has BPD (Borderline Personality Disorder)

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, mental disorder. As defined by the National Institute of Mental Health (NIH), “borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image.” Individuals with borderline personality disorder feel prolonged, intense emotions and are unable to return to a neutral emotional baseline after facing an emotionally charged experience in a timely manner. This can affect all areas of one’s life as the duration it takes an individual with BPD to process, integrate, and recover from emotional challenges is elongated. Individuals with borderline personality disorder often struggle with relationship issues, lack self-esteem, have a poor self-image, and have an inability to appropriately self-regulate. Borderline personality disorder is not an uncommon disorder, as the National Institute of Mental Health (NIH) estimates that 1.4% of the adults in America experience BPD. 

Diagnostic Criteria 

There is no definitive medical test to diagnose borderline personality disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), borderline personality disorder is diagnosed when an individual experiences “a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood” and must experience five or more of the following symptoms in a variety of contexts:

  • Emotional instability
  • Feelings of emptiness
  • Efforts to avoid abandonment
  • Impulsive behaviors
  • Identity disturbances
  • Inappropriate, irrational and/ or intense bouts of anger
  • Transient paranoid and/ or dissociative symptoms
  • Unstable interpersonal relationships
  • Suicidal and/ or self-harming behaviors

Due to its illusive nature, borderline personality disorder can be extremely difficult to diagnose. As such, to obtain the most accurate mental health diagnosis it is imperative to undergo a comprehensive evaluation that is conducted by one or more qualified mental health professionals. 

What You Can Do

Despite the challenges that BPD can bring to a relationship maintaining self-care practices and utilizing effective communication skills are essential for both partners, and integral to the health of the relationship. Consider the following suggestions to help you navigate your partner’s BPD:

  • Increase empathy: learn as much as you can about borderline personality disorder to increase empathy in your partnership
  • Remain calm: do not engage in serious conversations unless your partner is calm 
  • Be supportive: provide your partner with emotional support and understanding, and be sure to let your partner know that you fully support their treatment 
  • Avoid shame and blame: remember that labeling and blaming is not productive nor will it help to de-escalate or resolve any situation
  • Take threats seriously: threats of self-harm should not be minimized or ignored, and should prompt you to seek immediate professional help

It is important to bear in mind that although BPD is a chronic condition, with proper support, is it possible for an individual diagnosed with borderline personality disorder to learn strategies, techniques, and tools to effectively manage the symptoms associated with BPD, reducing the severity of symptoms experienced and increasing one’s quality of life.

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Are Binge Eating and Borderline Personality Disorder (BPD) Connected?

Are Binge Eating and Borderline Personality Disorder (BPD) Connected?

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic mental health disorder. It characterized by a pervasive pattern of instability in interpersonal relationships, self-image issues, and difficulty managing emotions and behaviors, which interfere with one’s ability to function in everyday life. Although there is no single cause of borderline personality disorder, the National Institute of Mental Health (NIH) alludes to research that “suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.” Akin to BPD, the exact cause behind why individuals develop eating disorders remains unknown, but research has found that it is likely due to a combination of psychological, biological, and environmental factors. 

 

Binge eating disorder (BED) is listed in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a severe, life-threatening eating disorder. According to National Eating Disorder Association (NEDA), it is characterized by “recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.” Binge eating disorder is currently known to be the most common eating disorder in the United States.

 

Are They Connected?

Yes, binge eating, and borderline personality disorder are connected. More so, research has found an undeniably strong relationship between borderline personality disorder and dysregulated eating behaviors, such as binge eating. The symptoms of BPD often result in reckless and hasty actions, negatively affecting one’s relationships. Some highly regarded professionals in the mental health field suggest that it may be that the symptoms of BPD play an active role in the development of binge eating disorder. For example, common symptoms of BPD such as chronic impulsivity and urges to self-harm could lead to an individual engaging in detrimental eating behaviors, which would subsequently increase one’s susceptibility for developing an eating disorder. Conversely, engaging in dysregulated eating behaviors may cause an individual to experience overwhelming stress, which may trigger BPD in someone with a genetic vulnerability for the disorder. The prevalence of eating disorders is about 6 to 11% in those with borderline personality disorder, which is far greater than individuals with an eating disorder in the general public that amount to an approximate 2 to 4%. Hence, the rate of BPD in people with eating disorders is notably elevated when compared to the general population.

 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment. 

Borderline Personality Disorder’s Effects on Relationships

Borderline Personality Disorder

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic mental health disorder. It characterized by a pervasive pattern of instability in interpersonal relationships, self-image issues, and difficulty managing emotions and behaviors, which interfere with one’s ability to function in everyday life. The symptoms of BPD will often result in reckless and hasty actions, negatively affecting one’s relationships. The cause for borderline personality disorder remains unknown. However, the National Institute of Mental Health (NIH) alludes to research that “suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.” Though these factors can contribute to one’s susceptibility for developing BPD, exposure to one or more risk factors does not indicate an individual will inevitably to go on to develop borderline personality disorder. Most commonly, BPD develops in early adulthood, often with more severe symptoms occurring in the early stages of onset. 

Effects on Relationships

Borderline personality disorder directly affects how one feels about him or herself, one’s behavior as well as how an individual can relate to others. According to the DSM-5 key signs and symptoms of BPD that will have a direct effect on one’s relationships may include:  

  • Unstable personal relationships that alternate between idealization and devaluation, sometimes referred to as splitting
  • Frantic efforts to avoid real or imagined abandonment by family and friends
  • Impulsive behaviors resulting in dangerous outcomes (e.g., engaging in unsafe sex, reckless driving, abuse of drugs, etc.)
  • Distorted and unstable self-image, affecting one’s moods, relationships, goals, values, and/ or opinions
  • Self-harming behavior (e.g., suicidal threats)
  • Chronic feelings of emptiness and/ or boredom
  • Periods of intense depressed mood, irritability and/ or anxiety lasting anywhere from a few hours to a few days long
  • Dissociative feelings
  • Intense, inappropriate, and/ or uncontrollable anger, typically followed by feelings of guilt and/ or shame

People with borderline personality disorder have a more difficult time returning to an emotional baseline, which can make sustaining relationships challenging. The quick changing nature of BPD symptoms (e.g., emotional peaks and valleys) can lead to conflict-filled, chaotic relationships. Hence, people with BPD typically have rocky relationships with others, both platonic and romantic.

Treatment

Although BPD is a chronic condition, there are a variety of treatment options available for a person diagnosed with borderline personality disorder. Treatment for BPD will help an individual learn strategies, techniques, and tools to effectively manage the symptoms associated with borderline personality disorder, reducing the severity of symptoms experienced and increase one’s quality of life. Every individual is different and will require a somewhat tailored treatment plan when it comes to BPD. Often treatment plans include a combination of medication and psychotherapy (e.g., dialectical behavior therapy, cognitive behavioral therapy, etc.). Some individuals that experience severe symptoms will require inpatient, intensive care, while others may never need emergency care or hospitalization. With proper treatment an individual can have healthy relationships despite BPD. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment. 

What Type Of Therapy Is Best For Borderline Personality Disorder?

Borderline Personality Disorder abbreviated

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, mental health disorder. As defined by the National Institute of Mental Health (NIH), “borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image.” It is highly common for individuals with BPD to lack the ability to foster and maintain meaningful, lasting relationships. The symptoms that are associated with borderline personality disorder make it difficult to diagnose. In order to secure the most effective treatment an individual must obtain an accurate diagnosis from a qualified mental healthcare provider. The Food and Drug Administration (FDA) has yet to approve a medication explicitly designed to treat borderline personality disorder. While there are other types of therapeutic modalities that can be helpful in treating someone with BPD (e.g., schema-focused therapy, mentalization-based therapy, etc.), the most frequently relied upon type of psychotherapy used to treat BPD is called dialectical behavior therapy (DBT). Treatment for BPD will help an individual learn strategies, techniques, and tools to effectively manage the symptoms associated with borderline personality disorder, reducing the severity of symptoms experienced and increasing one’s quality of life. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy that places greater emphasis on the psychosocial aspect of therapy. Marsha M. Linehan initially developed it in the 1980s, to help treat chronically suicidal people with borderline personality disorder. Since its inception, dialectical behavior therapy has been and remains the gold standard method of treatment for individuals diagnosed with BPD and has also proven effective in treating individuals with other mental health conditions. DBT utilizes four main strategies for teaching individuals’ skills that help with effectively changing their behaviors. They include the following, as provided by Behavioral Tech

  1. Core mindfulness: the practice of being completely present and aware in the moment. 
  2. Distress tolerance: becoming tolerant of pain in difficult situations instead of attempting to change it.
  3. Emotion regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions. 
  4. Interpersonal effectiveness: authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging.

DBT is comprised of three distinct settings: weekly individual therapy sessions, weekly DBT group skills training sessions, and as-needed phone coaching. The entire DBT program (provided skills modules are not repeated) usually lasts about six months long, as approximately six weeks are allocated to each of the four skills modules. DBT is based on the notion that change can be balanced with self-acceptance. It can help people learn how to regulate emotions and foster change. This gives individuals struggling with BPD the opportunity to build meaningful and stable lives. Although BPD is considered to be a chronic condition, there are a variety of treatment options available to a person diagnosed with borderline personality disorder. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

Common Signs Of Borderline Personality Disorder

man with borderline personality disorder

Borderline personality disorder is one of ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Each of the ten personality disorders is categorized into one of three clusters (cluster A, cluster B and cluster C). The personality disorders that make up each clusters share similar symptoms and have overlapping characteristics. According to the American Academy of Family Physicians (AAFP) cluster A is characterized as odd or eccentric personalities; cluster B is characterized as dramatic, emotional, or erratic personalities; and cluster C is characterized as anxious or fearful personalities. Borderline personality disorder is classified as a cluster C personality disorder. The National Institute of Mental Health explains, “Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior.” The cause of borderline personality disorder remains unknown. There are, however, certain risk factors (e.g. brain structure and function, genetics, environmental, cultural and social influences, etc.) that have been noted as potentially contributing to its development. Due to the illusive nature of its symptoms paired with the fact that many symptoms overlap with other mental health ailments, BPD is notoriously known as one of the most difficult mental health illnesses to diagnose. 

Signs and Symptoms

The symptoms of borderline personality disorder typically result in overarching interpersonal relationship complications and impulsive actions. The Mayo Clinic provides examples of signs and symptoms that are commonly exhibited in individuals with borderline personality disorder, some of which include, but are not limited to the following:

  • Engaging in risky and/ or impulsive behaviors (i.e. reckless driving, excessive gambling, binge eating, substance abuse, unsafe sex…etc.)
  • Intense fear of abandonment
  • Suicidal ideations
  • Self-injury
  • Severe mood swings (i.e. elation, irritability, shame, anxiety…etc.)
  • Pattern of unstable relationships
  • Irrational displays of anger
  • Distorted self image
  • Feelings of emptiness
  • Stress related paranoia

Some individuals may experience numerous symptoms of BPD, while others may only experience a few symptoms. Research has indicated that individuals with borderline personality disorder may experience intense episodes of depression, anxiety and/ or anger that could last from a few hours to several days long. Every individual is different and has the propensity to exhibit a unique combination of signs and symptoms related to borderline personality disorder.

Treatment

Although borderline personality disorder is considered a chronic mental health condition, there are a variety of treatment options available for individuals diagnosed with BPD, which can help individuals, learn to manage their symptoms. The most common method of treatment for borderline personality disorder is dialectical behavior therapy (DBT). Marsha M. Linehan developed DBT in the late 1980s, specifically to better treat chronically suicidal individuals with borderline personality disorder. Dialectical behavior therapy is based on the cognitive behavioral therapy (CBT) approach, and places greater emphasis on the psychosocial aspect of therapy. With proper treatment, an individual diagnosed with borderline personality disorder can learn to effectively navigate his or her symptoms of BPD and go on to lead a happy and fulfilling life. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment.