Welcome back to SAR! Ahh May—the grass is coming back, the birds are yelling in the morning, and it's Borderline Personality Disorder Awareness Month! Oh what a coincidence, that’s our topic for today! This week we also feature Alex (u/smokeytaboo477), a 24 year old American diagnosed with borderline personality disorder, generalized anxiety disorder, and major depressive disorder. I came into contact with Alex through this SAR blog and we got to chatting about his journey through mental health and finding care. Alex’s story is representative of other young patients who desperately need help while juggling lack of resources and lack of listening. Today we will look at his story as it augments our understanding of the history of BPD and one example of how mental health is treated.
Disclaimer: this post is not designed to be medical advice. It is merely a look at the chemistry of medications and their general effect on the body. Each person responds differently to antidepressant therapy. Please talk to your doctor about starting, stopping, or changing medical treatment.

Stuck in the Middle of Neurotic and Psychotic

“To my friends and family on the outside at the time, everything seemed “normal”. I was bubbly and appeared to be in a good mood, but I became very good at hiding my emotions and I learned how to manipulate certain situations and people. For those who don’t know, one symptom of BPD is intense emotions and unstable/rapid emotional shifts that happen from moment to moment at a time. I was never taught how to cope with strong emotions, so I began cutting myself at around the age of 13. I became very good at hiding my inner turmoil from everyone. “

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Example of 1930s Mental Health Practices
Our story begins in a dimly lit room; a young woman lays uncomfortably on a leather sofa while an old man with wiry white hair scribbles on his notepad. She has just explained her childhood and the man has hummed and murmured under his breath the entire time. She lays still, uncomfortably waiting for the next line of berating questions that delve into each part of her psyche and being. The psychiatrist underlines a word twice at the bottom of the page and flips the pad closed. “I'm sorry Madam, but your diagnosis is unclear. You are on the border of one or another diagnosis. Your mind is incredibly unclear. I cannot help you.” She leaves, feeling more helpless than before.

• The history of borderline personality disorder is quite modern compared to other disorders. Depression was first cataloged in the early 1600s (although you could claim the Greeks did it first), obsessive compulsive disorder was characterized in 1834, and schizophrenia by the end of the 1800s. Borderline personality disorder still sat uncharacterized.
  • Up till the 20th century, most psychiatrists and physicians believed mental illness to be organic in nature—they were caused by the deterioration of a part of the brain resulting in a psychological change. It was Freud who popularized psychoanalysis and the belief that mental health might be psychological in nature first. As such, patients fell into two categories: neurotic or able to be analyzed and psychotic unable to be analyzed.

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Adolph Stern 1879-1958

• Adolph Stern, a Hungarian-American psychiatrist was enraptured by the ideas set forth by Freud. In 1915 he became a member of the American Psychoanalytic Association and by 1920 was psychoanalyzed by Freud himself. With Freud’s health deteriorating by the beginning of WW2, it was Stern and other notable psychiatrists that picked up the psychoanalysis torch.
  • Now as a bit of an aside, there is a tendency to believe that psychoanalysis was creepy, weird, and overall a pseudoscience. While Freud may have been, psychoanalysis was the gateway needed to open up psychology to a more scientific and less superstitious practice. Through Carl Jung and Erik Erikson, psychoanalysis transformed into its modern counterpart cognitive-behavioral theory which was expanded over the course of the late 20th century. I wish I could go through each detail but unfortunately I am entirely underqualified (psychologists hit me up!).
• Practicing out of New York, Stern was diligent at looking at old pathologies in the new view of psychoanalysis. When speaking to the New York Psychoanalytic Society in 1927, Stern characterized a group of patients who “fit frankly neither into the psychotic (non-analyzable) nor into the psychoneurotic group (analyzable)” and coined the term borderline.

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So what is this mystery disease? Borderline personality disorder is part of Cluster B personality disorders. This cluster is dubbed the antisocial personality cluster and is characterized by behavioral traits that are generally outside of cultural norms. BPD can present in many different ways, but is generally identified by a few distinct symptoms:

• Impulsivity (e.g. risky behaviors, substance abuse, promiscuity)
• Suicidaility (about 70% of BPD patients attempt suicide, 10% complete it)
• Heightened affectivity (increased response to emotions like happiness, stress, sadness, etc.)
• Anger
• Brief psychotic episodes (disconnect from reality with or without delusions)
• Intolerable aloneness often culminating in fears of abandonment
• Close relationships marked by idealization or devaluation.

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“Just before being diagnosed with BPD, I was hospitalized. My mother found out I was cutting myself and she forced me to show her where I had been self harming (at this point I was doing it on my thighs to be more secretive) and she immediately took me to the ER. I was admitted to the psychiatric ward and put on Zoloft [Sertraline], a few months later I was diagnosed with BPD by an outpatient psychiatrist and put on Lamictal [Lamotrigine]. I was told to “make sure I was in therapy” but he never specified the type- so I just went to a standard CBT therapist. For those who don’t know, Dialectical behavioral therapy is the “gold standard” for borderline personality disorder but the psychiatrist did not specify that. I wish I was in DBT at this time.
Moving forward, I wasn't feeling better. I was still throwing up everything I ate (which my parents didn’t know about until later on- I was very good at hiding all of it). I was taking medication, going to weekly therapy, but I just didn’t feel better. I began to smoke a lot of weed to cope, along with cutting myself, throwing up whatever I ate, binge drinking, and it just got worse. Not to mention, both of my siblings and both of my parents are addicts.”

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Otto Kernberg b. 9/10/1928
Adolph Stern pulled back the curtains on BPD but didn’t ascribe to it being a distinct condition in itself. Almost three decades after Stern’s talk introducing borderline into the psychiatric lexicon, Otto Kernnberg took a swing at defining the untreatable patients. Kernberg made waves in the psychiatry world with his theory on ego psychology—changing it from a Freudian model to a more modern perspective. He used psychoanalytic psychotherapy to focus on listening to the patient and using their words to modify the treatment. In a sense, he listened first, listened some more, and then made a decision.

• In 1967 Kernberg released a paper defining the boundaries between neurotic and psychotic patients and firmly defined the criteria that established borderline personality organization. He used Stern’s cluster of symptoms and behavioral traits to develop the beginnings of a diagnosis.
  • This work was expanded by Roy Grinker the following year with the release of a case series on a few BPD patients. This long term study of a few patients integrated the idea that BPD often overlaps with other conditions, not excludes them. We now identify other comorbid conditions associated with BPD like eating disorders, self-harm, and substance use disorders. In fact, the extent of comorbidity is so great, that having a patient with pure BPD is almost unheard of.

“In January of 2016 when my parents divorced (I was about 17-18 at the time), I found a primary care physician who was oblivious. She prescribed me everything I wanted- I didn’t/don’t have an abuse problem with z-drugs/benzos, but I LOVED adderall. I manipulated her into prescribing it for me. I “faked” an ADHD diagnosis. Every month I asked her to increase the dose. I ended up on the maximum dose. It may seem stupid to have an adderall prescription and use crystal meth at the same time, but I don’t care. There was just something about adderall. I don’t know how my doctor didn’t see the warning signs. I was rapidly losing more and more weight. I was skeletal at this point.
I complained about anxiety, so she put me on ativan. I genuinely knew nothing about benzos. I didn’t care. I was in a very bad place at the time. I decided to ask her to keep me on adderall 60mg per day (which was gone in days, every month felt like Christmas morning when I got it filled. When I ran out I’d use meth or just buy adderall from a girl I knew), klonopin 2mg 2x per day (did not abuse it- it just countered the anxiety and panic attacks from the speed), and lamotrigine which didn't do anything anyways.”

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• In Kernberg’s paper, he famously defined BPD as a “good-mother bad-mother dichotomy first experienced in infancy” that resulted in a “split, tearing the world in two.” As a result, Kernberg viewed BPD patients as a “matter of extremes: Hero and Villain, savior and persecutor, victim and torturer. A relationship of chaos as well as cognitive, emotional, and behavioral instability.” Geez Otto, keep it light.
  • Despite providing little actual evidence in his paper, Kernberg banged on the psychoanalysis drum the loudest. His ideas were repeated constantly and would remain influential in the understanding of BPD. Since the disorder is more common in women, Kernberg pitched the idea that this was a gendered disease reviving the Victorian practice of female hysteria.

“Over the next few years, EVERYTHING got worse- not just with my own mental health, but my family life. I was hospitalized again after a really bad explosive argument with my family- I tried to impulsively down my bottle of lamotrigine and 911 was called. The hospital was useless. My eating disorder got so bad that I had a grand mal seizure in the middle of my high school class room. I began to use methamphetamines/adderall(amphetamine salts) to lose even more weight. I stopped taking my medication. My therapist moved, so I stopped seeing a therapist. My parents divorced in January of 2016 and when I thought I had already reached rock bottom, well, I found out rock bottom had a basement. I won't go into all of the details of that year, but it was a very, very, very dark year for me and my family.”

Okay we lied, mental health is actually biological in nature

“Fall of 2016. I was depressed, severely suicidal, addicted to speed, dependent on benzodiazepines, unstable, and I was literally dying from an eating disorder. I saw a therapist for a few months and she went to a seminar and she found an eating disorder program in my state that will take my insurance. That therapist/admissions persons/insurance agent who fought for me to be admitted SAVED my life. Honestly, I did not want to go to treatment. I wanted my ED and drugs to kill me. But I needed to leave the abusive environment that I was in. I had nowhere else to go, so I went to rehab 9 hours away.”

With the success of psychoanalysis during and after WW2 (especially when treating PTSD associated with the war), you would be hard pressed to find a single psychiatrist who didn’t believe in the merits of psychoanalysis. After all, we saw the greatest works of Carl Jung on personality (which later gave rise to the Myers-Briggs personality test), Hermann Rorschach (the psychiatrist not the DC supervillain), and Erik Erikson (who defined the extremely famous theory of life stages and development). The 1950s and 60s was full of introspection (and LSD), so investigating the mind was extremely groovy. Well, until the 70s came knocking.

• It was Stern that first defined the criteria for borderline personality disorder but he mischaracterized it as a catchall term for those who couldn’t fit into other established disorders. To Stern, these patients sat on the border of truly sick and healthy and most patients were thought of as atypical presentations of anxiety disorders, bipolar disorder, depression, or schizophrenia. This foundation of “untreatable” would persist for decades impacting treatment of those who needed it most.

“Finding a new psychiatric practitioner was tricky. I have been turned away from others, but I kept looking on Psychology Today. I called several, and off the bat I just ask “Hi, do you guys treat borderline personality disorder?” If not, move on to the next. Some practitioners just refuse to treat personality disorders- my guess is the stigma, and people with personality disorders are (hate to say it but it's true) “difficult” to treat.”

• The medical community was turned on its head in the 1950s with the discovery of receptors that bound to common neurotransmitters in the brain. Likewise the development of antidepressants and discovery of antidepressants that target those specific neurotransmitters revolutionized the idea of mental health. Again.
  • By the beginning of the 1970s, the world was embracing the race to discover the biologic basis of the brain. The invention of CT scanning changed the game completely as doctors could see the brain working while the patient was alive and without their skull removed.

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John Gunderson 1948-2019

• This new perspective of BPD as biological changed the inciting factor of BPD from Freudian in nature to a more modern concept. Now seen as a result of one's upbringing or trauma (nurture) or genetics (nature), psychology was changing its view on many of the most solidified disorders. This change in thinking was pushed firmly by John Gunderson throughout the early 1970s culminating in ground breaking BPD research in 1975. It is Gunderson’s data that was integrated into the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980 as part of the third edition. [If you are interested in learning from Gunderson, he has a great series on youtube about BPD.]
  • Since Gunderson’s paper, a number of different subsequent studies have been done to further characterize the biological nature of the “untreatable disease:”
    • Twin studies suggest that the heritability factor for BPD is 0.69—suggesting that if one twin is diagnosed with BPD, the other twin has a ~70% chance to also be diagnosed. This suggests a strong inheritable genetic factor to BPD, especially the impulsive aggression and mood dysregulation symptoms. It should be noted that the chance to develop BPD if a first order relative has BPD (father, mother, non-twin sibling) is around 23-30% while the chance to develop it without a familial history is around 10%.
    • Psychosocial factors of BPD also play a major role in the development and progression of the disease. A history of substance misuse in the family home can precipitate BPD in susceptible individuals. Likewise, childhood sources of trauma such as neglect or physical/sexual/emotional abuse can all occur in high rates among those diagnosed with BPD. Few studies however point to how the features of the environment specifically create a vulnerability to BPD. For right now we can only classify connections, not causes.

“The talk I had with my prescriber was not easy. I needed her to fill out paperwork/”recommendation” for insurance basically saying I medically need this treatment. needed to be honest with the doctor prescribing adderall. I told her: “look.. I have an eating disorder, I have been abusing the adderall this whole time. Can you please fill out the paperwork required so I can get help?”. She was not happy at all, but she did it. Looking back, I am one brave motherfucker.”

Treating the (formally) Untreatable

“While I was in rehab, the psychiatrist said something that threw me off. He said: “You don’t abuse people. You don’t manipulate people. You behave, so you don’t have borderline personality disorder. You have bipolar disorder. I'm gonna start you on seroquel (Quetiapine).”. I didn’t know what the hell seroquel was. This was my first ever antipsychotic medication, and from this point on, a series of medications were tried over the course of the next 5 years. While I was in the facility, I was diagnosed with bipolar 1 disorder with mixed features, generalized anxiety, and ADHD (a serious ADHD diagnosis? Who knew?) And obviously my eating disorder: Anorexia Nervosa purging type.”
Since then, I have tried different medications. Several antipsychotics, I experienced this lovely side effect called: akathisia. For me, akathisia was this severe sense of restlessness that I could not control. I felt like I was crawling out of my skin. I could not physically stop moving, I couldn’t stop pacing. I would walk back and forth for hours. I experienced akathisia on low doses of Geodon (Ziprasidone) and Vraylar (Cariprazine). Low dose Latuda (Lurasidone) was activating and I didn’t like how I felt on it. Rexulti (Brexipiprazole) actually helped my depressive symptoms but stopped working for a year and caused me to gain 40 pounds with no change in appetite or activity. I can go on and on, I have tried about 20+ medications to help manage my conditions. They all just didn’t work and I got really bad side effects. But don’t let my experience scare you.”

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Alright, chemistry time! When we look at treating the so-called ‘serious mental illnesses’ like BPD, schizophrenia, and bipolar disorder, the path is not as clear. Often the answer is not where to begin but will it work? For patients, the road to finding a drug therapy that works for them is a myriad of trial and error, and feelings of failure are rampant among this population. Sometimes it can take up to a dozen medications before finding the one that solves the issue, that’s not the fault of the patient but an example of how each brain is different. Generally, about 10% of BPD patients will be prescribed an antipsychotic, 27% a mood stabilizer, 35% an anxiolytic, and 61% an antidepressant. Often the prescribed drug is continued in an attempt to prevent stress-related symptoms but if there is, another drug class is added. About 75% of BPD patients are polypharmacy.
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Mood stabilizers are a group of drugs that are used to treat symptoms of mania or depression and bring ‘calmness’ to the brain. This is a pharmacological class of drugs, not a chemical class as they are made up drugs from anticonvulsants (such as for epilepsy, oh look another post), antipsychotics, and lithium. As such, the structures of these drugs vary but we do see their relative effects to be similar—hence pharmacological not chemical class.
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Iminostillbene vs Carbamazepine vs Oxcarbazepine

• Our first drug is Carbamazepine (Tegretol). This antiseizure medication was developed in 1968 as an improvement of Phenytoin, an hydantoin. Carbamazepine needs to be titrated up to its effective anti-seizure dose (800-1600mg) on a slow weekly schedule. This slow weekly increase of 200 mg showed a mood stabilizing effect (lower highs and higher lows) which prompted researchers to investigate its usefulness in mood disorders (like bipolar disorder). They found that lower doses of carbamazepine actually improved mood symptoms and so the extended release of the drug was marketed as a mood stabilizer in 2004.

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Metabolism of Carbamazepine and Oxcarbazepine

• Oxcarbazepine (Trileptal) is the 10-keto version of carbamazepine. Unlike carbamazepine, oxcarbazepine shows significantly less auto-inducing of its own metabolism, and so a smaller dose of medication can be given. Also, oxcarbazepine levels do not need to be monitored as closely in new patients or those undergoing intense antibiotic regimens. Oxcarbazepine is used off label for bipolar disorder and BPD.
• Carbamazepine is used for its ability to improve impulsivity and can be extremely useful in younger patients who naturally show more proclivity towards risky behavior. This can be why it is also used in the treatment of substance use disorder, especially cocaine. Unfortunately it can lead to a worsening in depressive symptoms which may result in an increase in suicidal thinking in non-suicidal patients.

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Topiramate

• Topiramate (Topamax) is among my top 5 drug structures. Any organic chemistry student will have flashbacks to furiously studying hemiacetals, acetals, and sugars. My question for them is: what kind of structure is topiramate? If you said a sulfamate-substituted monosaccharide derived from fructose then good on you! (easy amirite?) Topiramate was approved in 1996 for partial and tonic-clonic seizures. Later, it was found to be useful in a myriad of behavioral and mood disorders like augmenting alcohol dependence, binge eating disorder, bipolar disorder, bulimia nervosa, and BPD. It is also indicated for obesity and type 2 diabetes mellitus due to its side effects of loss of appetite and weight loss.
  • Due to sulfamate moiety, topiramate is excreted 80% unchanged by the kidneys. This means that most of the drug is not even processed in the liver, making it a great option for patients with heavy drug therapies or liver dysfunction. This does require good kidney function to be maintained and so older patients who may develop renal insufficiency should be closely.
  • Topiramate has demonstrated teratogenicity or that it affects fetal development. As such, females of reproductive age are advised to be on oral contraceptives to prevent unwanted pregnancy. Even though Topiramate does not undergo much liver metabolism, it does affect the liver’s processing of other drugs. Notably, it affects the Cytochrome P450 enzymes CYP2C19 and CYP3A4. Oral contraceptives are metabolized through CYP3A4 making them less effective. As such, patient taking this drug while using oral contraceptives should use a secondary form of backup (like condoms).
  • Topiramate’s usefulness comes from its effect on strong emotions like anger, sadness, and anxiety. Patients report an increase in interpersonal relationships though, which helps with integration in social settings which probably is the reported increase in quality of life.

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Lamotrigine

• Next up on our list is Lamotrigine (Lamictal) is a 5-phenyl-1,2,4-triazine derivative originally indicated for adult partial seizures and adjunctly to patients with a rare form seizure disorder called Lennox-Gastaut syndrome. Uniquely, Lamotrigine requires a very slow up-titration schedule with most dose increases happening once every two weeks. This is done to avoid precipitating a life threatening immune condition called Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). These adverse events are a life-threatening skin rash that can cause large portions of the skin to become ulcerated. That being said, lamotrigine is a safe medication that when used correctly can be life saver for many patients.
  • Lamotrigine combines the benefits of Topiramate and Carbamazepine. It has a benefit on strong emotions like anxiety and anger while also improving impulsivity.

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“I eventually found a psychiatric nurse practitioner who specifically said they treat trauma and personality disorder, along with mood and anxiety disorders. She is now my current prescriber and she is amazing. We found a medication combination that works wonders: Lithium Carbonate and Pregabalin (Lyrica). I'm also on other as needed medications: Hydroxyzine, Clonidine: both PRN for anxiety/sleep. She is also the only doctor who is willing to do the Ashton Manual: Because I’ve had issues tapering off of Klonopin itself, we are currently cross tapering from Klonopin (clonazepam) to valium (diazepam), and will eventually taper off. Besides occasional cannabis use, I have stayed clean from everything else.”

• Lithium carbonate (Eskalith, Lithobid) is a unique drug because it is actually not a drug! Well… not in the traditional sense. Lithium is an ion, not a organic chemical like most other drugs. We think that Lithium works by reducing neuron excitability and increasing inhibitory neuronal processes, thus stabilizing brain activity. Likewise, as an ion similar to sodium, it regularly enters the cell and affects intracellular secondary messaging.

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Therapeutic Index vs Lithium Toxicity Symptoms

• Lithium is titrated to a certain blood level of 0.6-1.2 milliequivalents per liter (mEq/L). This range is called the therapeutic index/window or the blood concentration range needed to show the desired effect. In this case, lithium improves emotional instability and brings a person back to ‘normal’ quicker than without it. Below the range, patients see a sub-therapeutic effect—in this case the return of the BPD symptoms. Above the therapeutic range, the person would see lithium toxicity. It should be noted that a person can see “chronic toxicity” or side effects even at therapeutic levels.
• As an ion, Lithium is not metabolized by the liver at all like other drugs. Instead, it is completely handled by the kidneys. As such, ensuring kidney function is key for preventing acute lithium toxicity. As such, patients who show rapid renal decompensation could present seizures, heart attacks, delirium, coma, or death. Lithium is thus considered a narrow therapeutic index drug since the range is very small and the potential effects are so dangerous.

“Lithium has been the main game changer. My level ranges between 0.2-0.3, so it’s “sub-therapeutic” and my doctor has seen this in practice. The typical “effective” range is 0.5-0.8, but this low level has made a significant difference in my emotional lability, rage outbursts, depressive symptoms, and some of my emotional reactivity. I feel like I can actually utilize the skills I’m supposed to use. Side note: Not saying medication is a cure, but my medication regimen has made a HUGE difference compared to before taking it.”

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The gold standard is NOT drug therapy

When discussing mental health, treatment should not be a discussion of drugs or therapy. Studies have shown therapy alone to be superior to medications alone and a synergistic effect when the two are combined in an intentional way. As such, drugs and therapy are instances where 1 + 1 = 5.

“When I was hospitalized for my 4th time, the psychiatric practitioner told me I was bipolar and that I was having a mixed episode, but I was told by a weekend doctor (during the weekends there's a different psychiatric nurse practitioner than during the week) and he went over my symptoms and told me “you don’t have bipolar disorder. You have borderline personality disorder. You really need DBT. I knew it. It always confused me because when you read literature on bipolar, episodes of mania last for several days at a time- I didn’t have that. My moods/emotions are highly changeable and can be extremely reactive, but they never last for several days in a row. I meet the full diagnostic criteria for BPD- every single symptom. While I was in treatment, my family moved across the country. So when I completed treatment, I didn’t return back to my hometown. I didn’t have the connections I did to get drugs. Anytime I would bring up misdiagnosis, they would blow me off so I felt kind of hopeless. I didn’t know how to find DBT. DBT is not readily available in my area.”

Cognitive-Behavioral Therapy vs Dialectical Behavioral Therapy General DBT Treatment Timeline

• For many the use of Cognitive Behavioral Therapy (CBT) is key for understanding how our thoughts and emotions dictate our behaviors and vice versa. CBT gives individuals the ability to recognize maladaptive thoughts and gives them tools for better thought patterns, perceptions, and behavioral goals.
• For personality disorders like BPD, cognitive behavioral therapy is not the best approach. These individuals struggle to regulate the emotion before it generates into a thought (hence the high prevalence of impulsivity). As such, these individuals benefit from a more specific kind of CBT, called Dialectical Behavior Therapy (DBT).
  • DBT relies on using mindfulness skills to help regulate emotions, tolerate distress, and improve relationships. DBT helps teach individuals how to live with discomfort and accept the way things are rather than reacting to the discomfort in unhelpful ways.

“I moved to a nearby city, and because of the clinic’s policy they don't treat people in the county I’m living in. Damn. I’m scared. I’ve tried a benzo taper before, who is willing to keep me on it? How do I find a good therapist? What should I do? I called at least 10 places. Most either didn’t get back to me, didn’t accept BPD patients for whatever reason even though it’s on their profile, OR they don't take my insurance. I left a message for one who takes my insurance. I was just done. I was ready to give up.

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Marsh M. Linehan

• The origin of DBT is incredibly interesting. In 1950, a 17 year old girl was locked in a seclusion room at the Institute of Living in Hartford, Connecticut. She was admitted for being suicidal and formally diagnosed with schizophrenia. Early treatment notes labeled her the “most disturbed patient on the ward” and was subjected to electroconvulsive therapy. One year later, Linehan left the Institute of Living and attended Loyola University, Chicago in 1968. She would graduate cum laude with a BS in psychology, an MA in 1970, and finally her PhD in 1971 after studying social and experimental personality psychology. She is diagnosed with BPD.
  • Through her work, Linehan developed two important concepts related to personality disorders. Taking inspiration from Eastern meditation and zen, she described how people must learn to accept the way the world is to achieve a meaningful and happy life as well as how change is needed for growth and happiness. She culminated these teachings in dialectical behavioral therapy and started treating BPD, eating disorders, and substance abuse disorders with DBT.

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Article describing Lineham's approach

• Linehan faced immense pushback from the psychiatric community—when she debuted DBT in 1991, behaviorism was on the rise. She used her research on suicide and sociological phenomena to dismantle Kernberg and his theories that were developed with little evidence. Her DBT model showed higher rates of recovery than using traditional CBT and patients felt validated and empowered.
• Linehan was awarded the Career Achievement Award from the American Psychological Association in 2005 and The Outstanding Educator Award from the New England Educational institute in 2004.

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DBT being used on Eastern Immigrants who struggle with CBT, a more western practice

“About a week later in November or so, I got a call back from the last person I called and left a message for. She takes my insurance, specializes in BPD, and is accepting patients. Weekly appointments, it was perfect. I am not exaggerating when I say this therapist was the most thorough therapist I have ever seen. She wanted every detail about my childhood, my symptoms, and just everything about me. It was a very intricate process. I told her about my previous bipolar diagnosis and she pulled out her handy DSM-5 (I think it’s hilarious when professionals just whip a DSM out) and went over the criteria for bipolar disorder. She ruled out bipolar because of my exact reasoning: My episodes DO NOT last for days and days and days, like a bipolar person would. She diagnosed me with everything at the beginning of this “short novel”. She is my current therapist and I am currently learning DBT.”

“Always advocate for yourself and what you believe in”

"For anyone reading going through anything similar to my story, there’s a few things I would like to share. Some things that I wish I knew back when I was 14.
First, psychiatric medication is serious business. It’s not something to be scared of IF it’s prescribed for the right reasons. ALWAYS DO YOUR RESEARCH. Do not let 1 side effect scare you, but it’s good to be educated on what you are putting in your body, what you may experience as a result (side effect), hell, now when I’m prescribed something I spend hours researching the medication. Reviews from drugs.com. Reddit experiences. But again, if you’re prescribed an antidepressant for example, and you read 1 horror story, don’t let that deter you from taking it. Don’t let MY experience with the meds I stated earlier scare you. Some have wonderful success with Geodon for example, and that’s great! It just was not for me. I will say, It’s almost never recommended to take benzodiazepines long term. Strictly as needed is okay, but even then there's better alternatives for panic attacks, like clonidine (in my opinion). [Side note: When you google something for research, pull information from websites that end in .org, .gov, .edu, or from verified organizations such as WebMD, MayoClinic, NAMI, etc.]
Second, they always say “listen to your doctor”- which is true- but if something sounds off, or even if you just want a second opinion, I recommend getting a consult from another physician just to see what they say, OR do your research on what they say. For example, when that psychiatrist in the rehab center said “You don’t abuse people. You don’t manipulate people. You behave, so you don’t have borderline personality disorder. You have bipolar disorder. I'm gonna start you on seroquel.” I should have said something. I didn’t know what I know now about BPD. ALWAYS ADVOCATE FOR YOURSELF AND WHAT YOU BELIEVE IN. Plenty of doctors refuse to diagnose personality disorders, and would rather diagnose bipolar and prescribe an expensive brand name antipsychotic so they can have some kickback from the pharmaceutical industries. I have experienced this, being on all of these expensive brand name antipsychotics and it's disgusting. If it works, great!! Bottom line: Do your research. Just because someone with an expensive piece of paper is telling you something does not mean you have to listen to it OR that it’s true.
I hope this reaches someone in time of need and helps in some way. My inbox is always open for any questions or just someone to talk to :)"

And that’s our story! Hopefully this provides some insight into borderline personality disorder and you learned something new. Huge thank you to u/smokeytaboo477 for sharing his story. Want to read more? Go to the table of contents!
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Likewise, check out our subreddit: SAR_Med_Chem Come check us out and ask questions about the creation of drugs, their chemistry, and their function in the body! Have a drug you’d like to see? Curious about a disease state? Let me know!
Foye’s Principles of Medicinal Chemistry
Pharmacotherapy of Borderline Personality Disorder, Rex William Cowdry
"Expert on Mental Illness Reveals Her Own Fight". The New York Times. 23 June 2011.
https://pep-web.org/browse/document/paq.028.0149b?index=40
https://www.ncbi.nlm.nih.gov/books/NBK55415/
https://www.optimumperformanceinstitute.com/bpd-treatment/the-history-of-bpd/
https://www.psychiatrictimes.com/view/colloquialism-full-recognition-evolution-bpd
https://overlandiop.com/bpt-or-borderline-personality-disorde
https://kevinredmayne.medium.com/the-strange-history-of-borderline-personality-disorder-fc3ce583869
https://www.uspharmacist.com/article/controlling-symptoms-of-borderline-personality-disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811092/
https://pubmed.ncbi.nlm.nih.gov/23371914/#:~:text=At%20a%20neuronal%20level%2C%20lithium,by%20way%20of%20compensatory%20changes.
http://www.differencebetween.net/science/health/the-difference-between-cbt-and-dbt/

33 F R E A K I N EPISODES! Please note I am limited to 20 photos, so I'm gonna be picky! So many premieres! Get ready, let's go!
NOVEMBER 1ST
RHOA, S3E5, 2010
Nene has completed her plastic surgery and is healed, so the first thing she does for her newly reduced chest is to go bra shopping with Cynthia! I love this scene because Nene is just so fun, and she dances in front of the mirror and pumps her chest, and it's a good giggle!
Kandi starts Kandi coated nights (I still hear it in my head all the time!), to help her through a year without sex, allowing her to talk about it when she's not having it. Kim talks about not being a cheater while a guest, as it was big poppa who was married. Kandi cries to her mom during a later scene, as she struggles with the fact A.J passed, as does her daughter, and she feels quite emotional that Riley doesn't have a father figure in her life.
Sheree's short-lived love interest, Tiy-E, invited her over for a vegetarian meal and cookies. She is shocked that she is asked to cut strawberries because the only thing she's used to doing is collecting and carrying bones. Oh, and he puts cookie dough on his finger and then forces her to eat it off, and I hate myself for remembering that fact on my own.
Apollo and Phaedra do a maternity shoot, where they suck on pickles, and she thinks it's the photoshoot of the year. Her taste is so questionable.
The women get together for mother's day, and spend the meal outside discussing sex, and putting pop rocks in your vag, and Phaedra recommends normal or powdered sugar, and Nene, cringing like me, says "I would never put kool-aid, canned yams, a peppermint candy, pancake syrup, you know, none of those things in my vajayjay. That's crazy."
Phaedra has no idea when her due date is, saying the baby is only 5 months when it actually is about 7-7 1/2 months, and the baby needs to come early. Everyone is like... you don't know your due date? And everyone is like... oh, your mom is a preacher and you got pregnant before the wedding and are trying to hide it - GOT IT!
Peter randomly comes in, Apollo drops off a Gucci diaper bag (ok...), and then Peter tells Nene she is having relationship issues because she has a dead bedroom (I accidentally wrote bathroom, I'm writing this baked, and how funny would that be!) Cynthia gives him the eyes that say "get the fuck out of here", so he leaves, and Mama Joyce, with the only helpful thing she has ever said, tells the ladies not to waste or give up 20 years for a man who doesn't make you happy. She did it, and she regrets it immensely. She and Nene hug, and then Nene, who's crying, throws a napkin over her face to hide her tears. I miss when she used to be emotionally open to the housewives and the viewers. I'm watching the S11 Reunions now during my rewatch and she's just so distant, but she was going through A LOT.
She thinks these are \"artistic.\"
Everyones like... you cant give birth at six/seven months girl.
RHOM, S2E9, 2012
Lea is planning her big gala, and even though she is having trouble with some of the housewives, she still extends them invitations and doesn't want drama. Lea, after speaking to Adrianna who said she didn't want to go, checks on her dog Leroy. He is not okay. I cry every time I see this scene, and ugh, writing about it breaks my heart! She picks him up, he can't hold himself up, and she cries and her husband takes him to the vet immediately. I'm crying now, writing this! The gala happens regardless, with Adrianna and Alexia in attendance, and Adrianna does want to cause trouble. With all the other women there, she makes sure to be offensive to Joanna since their fight last week. She sits at Joe Francis' table, and after Joanna cries from the confrontation with Joe, Adrianna calls her a "super whore, not a supermodel!" Nothing much more happens, but Karent is called disrespectful, and not boring, fame-hungry, annoying, and a constant teeth flasher like I would call her. Ugh, one of my most hated housewives e v e r.
RHOC, S10E22. 2015 REUNION PT.3
Vicki admits to the women and Andy that she did cover for Brooks during the season, but it was because she did believe him until recently before the reunion was taped. Brianna says her mom is in a "state of shock" to describe Vicki's calm demeanour over how much Brooks has fucked up her life. Maybe she took a Xanax and calmed down, or ate some bread, and calmed down a little. I don't know. In the "epic" part of the reunion, it is noted that Vicki knew of previous times Brooks has pretended to have cancer, but she believed this time was different. LMAO. Man, it shows that someone can make so much money and be book smart, but their common sense is little to none.
Tamra mentions that Vicki actually left Donn to take care of Brooks, who at that time said he had pancreatic cancer, but it actually was just pancreatitis. This man sure exaggerates. Vicki, when asked about all this, just shrugs and says she was duped.
The women wonder what Brooks has on Vicki to make her be so passive about the whole thing, and she admits she fabricated some of his medical issues to get some compassion from the ladies. Shannon is mad that the ladies got a lot of fo shit for asking for his medical records, but Vicki could and it wasn't an issue. But Shannon - you weren't his girlfriend or "caretaker" - what did he owe you?! And then she's also mad about Vicki telling Rhonda, Vicki's SIL, about her and David's issues.
TW: Domestic Abuse Brianna is like... well, Brooks was emotionally and verbally abusive to my mom sooooo he probably was physical too. He took her away from friends and family, manipulated/threatened/invoked fear into her. Brianna says Brooks once shook Vicki so hard her head was flopping back and forth basically and was worried about what was going on behind closed doors if that's what happens outside of them. The women update where they are at that point, which is unforgiving of Vicki, and Vicki is just happy she is not with Brooks anymore!
RHONJ, S8E5, 2017
Teresa, Joe and Melissa's restaurant is opening soon, and they are setting up the decor, and Teresa is mad that Melissa is in a lot of the photos. She tells Melissa she is only a Gorga by marriage, and if Joe divorced her, she's "not going to be a Gorga anymore." Well, someone seems bitter. Gia, during a shopping trip with Teresa, tells her mom that she thinks that they aren't disciplined, and thinks the issue is that Teresa is worried the girls will hate/resent her for it.
Later, Tre, Joe and Melissa bring the kids together, and Teresa actually apologizes for being so mean to Melissa but says it's due to Melissa criticising her parenting and her acting out because of it. Holy shit - Teresa was so mature this episode! And then Melissa is like, fuck that apology, you ARE too lenient with the kids! Way to squash a one in a million moment, MELISSA!
The restaurant - Gorga's Homemade Pasta and Pizza - is doing a tasting night, and Melissa invited everyone. Nono makes a comment about Margaret being "blond on the top" and she responds "blond all over!" Why? Anyways, the women move on and start talking about Dolores' situation. They talk about how she brought Frank, her ex into her home, and how weird it is, and then discuss how Danielle is misunderstood, to which Siggy replies she is the most misunderstood in the group! Siggy and Dolores are approached by Margaret and Siggy. Siggy says Margaret's line of clothing is made in China, Marge attacks Dolores' implants and Siggy's extensions, and Danielle attacks Dolores about David and Melissa is standing there wondering how people can be unhappy when there is pasta being passed around - ugh, I want fettuccine now.
RHOP, S5E14, 2020
Robyn is telling Karen and Gizelle that her tax issues are real, and they both kind of reluctantly agree to model for Robyn's new line, Embellished hats due to the financial bomb she just dropped on them. Karen then imitates Wendy's "slithering" walk, and talks about how Wendy isn't actually a doctor, no matter how many degrees!
Later, at a party, Wendy says she's not one to brag about her degrees or how many she has, and the editors could just not wait to add in the footage of her mentioning them throughout the season. Karen responds that she was blessed with the spirit of being an entrepreneur, which is funny seeing them fight over single and three-wick candles now!
In the last couple minutes of the episode, Candiace freaks out about Monique counter-suing her for assault.
NOVEMBER 2ND
NOTHING AIRED!
NOVEMBER 3RD
RHOA, S6E1, 2013
Porsha is getting divorced, and by the same divorce attorney everyone sees on this franchise! Porsha has moved out, and her mother talks about how he only saw Porsha once during her weeklong stay in the hospital after a miscarriage, and that she did nothing wrong but he was the "WRONG DAMN ONE!"
Phaedra comes back with a new baby, Dylan, who we see her call "Michael Jackson" in a scene of the birth due to his lightness. She says Ayden's a great brother, and editors show him being anything but, and she tells us that raising kids is "working like a Hebrew slave."
Cynthia throws a party for her new Bailey Agency business, and Nene and Kenya refuse to get along, to the point the Keny grabs her ear to make sure she can hear her and then tells her to go to hell.
This man should be given a \"friend of\" status, his connections listed as everyone he's represented on this show.
RHOM, S3E13, 2013
The women head to Vegas for Joanna's bachelorette party just before her wedding, as Adriana's wedding has already taken place. They go to the Palms - Adrienne must be pissing her pants! - and they swim topless in their balcony pool.
Lisa notes she is not in a good mood and she's fighting with Lenny, so she is here to get blasted. Lisa is also weirded out that Lea doesn't seem to be enjoying herself, but understandably she's with a bunch of younger women who are getting naked and drunk, while she is feeling like "the only adult on spring break."
The ladies later have a party dress with strippers included, and Lea gets targeted by the two men in g-strings. There's a pole on the bus and Adriana and Lisa can't help themselves but go on it! Adriana then puts her face in Joanna's boobs and gives Lisa a lapdance, and I'm here left wondering how they didn't renew for a season four, when if this happened in BH or OC that shit would be renewed for three seasons immediately.
Joanna makes a comment about how Lisa is good on the pole, and if Lenny leaves her because their marriage is on the rocks, that she could get a job to support herself. Lisa planned this party! Why are you doing this to her, Joanna? The ladies are drunk as hell, Lisa storms off, and the wedding is tomorrow, which they aired the next episode the next day.
RHOA, S12E1, 2019
I'm on the last reunion of S11 of my rewatch as a write this, so this is just prepping me for my continuation of the series. I smoke a little too much weed, so I kind of watch every season with new eyes until my brain's function kicks in and I remember the storylines again so it'll be fun to see what I'm getting into!
We see Kenya laying around in bed in full haimakeup, dressed well, while she waits for her new baby to wake up. She tells us that Brooklyn doesn't fuss or cry, and she's the only "turn-up queen in the house." Kenya is upset at her husband though, Marc, who actually got her kicked off for a season due to their secret wedding, who is spending time in New York for business. Weird he wouldn't want to spend time with his child, but I don't know.
We now move on to Porsha, who is raising two-month-old PJ alone, as Dennis has been kicked out after she found out he cheated on her during her pregnancy.
Kandi and Todd are having a child through a surrogate (we saw their decision making last season, and she announced during the reunion they were a week out from implantation), and because Ace is thinking that they are buying a baby from a store, they plan on bringing him to the next appointment.
Eva is pregnant again, and looking for a home, and everyone is wondering where she is getting the money because of the rumours last season Marlo was spreading of her being broke.
We see Cynthia and Mike talking about their schedules and when they can get engaged, and she's already posted what ring and a dress she wants on Instagram.
We then turn back to Porsha, who isn't going out or feeling herself, and she cries to Lauren, her sister, about how sad she feels and how she isn't herself. We then see that Dennis was "using drugs and engaging in bestiality" WTF - and then see a clip of Porsha in a dog onesie and Dennis liking it. IF I HAVE TO SUFFER, YOU GUYS HAVE TO TOO! THIS IS A RULE FOR WEEKLY HOUSEWIVES HISTORY!
Kandi, Cynthia and Eva, having dinner together got approached by someone who was said to have had an affair with Dennis. With the name Sincerity, we can only believe her when she says it did not happen. They decide not to tell Porsha but tell Kenya. Messy Kenya is like - imma tell her! So she does, and the women fill in some information that Kenya is missing, and Porsha is like well, thanks for telling me, but she didn't feel better, obviously, just embarrassed.
I just love the barbie theme!
NOVEMBER 4TH
RHOA, S1E5, 2008
Sheree and Lisa decide to pole dance together. After that, DeShawn goes to a vineyard to celebrate her birthday with Lisa, Nene and their husbands, and Nene talks poorly about Sheree and sings about how bad Kim is at singing. I love this scene in the limo! Sheree and Kim connect over the fact they are fighting with Nene, which doesn't get better when Kim and Nene go out shopping and bump heads. Nene launches a charity, the Twisted Hearts Foundation, and Kim keeps working on her musical career.
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RHOBH, S1E4, 2010
When Kennedy just wanted a regular kid's birthday, she had to deal with Taylor throwing herself a party under the guise of being for her kid! Her party included cascading roses into rose tea-kettles - which is amazing for an adult party, but a kid would not give a single shit, for sure! Taylor spent $60,000 on the party and was focused mostly on a photoshoot while Kennedy got taken care of by a nanny. During the party, a band sings about Kennedy is "beautiful just like her mom", which tells us this party is only It's important to note that all the kids at the party went home with a Barbie diamond necklace, even though a) her kid probably won't remember it, b) money problem only haunt the Armstrongs. Russell gets Kennedy a dog even though she said they shouldn't get one, and she argues about it wearing a ridiculous hat.
Kyle is throwing Portia a party, complete with a french fry station, ducklings, and homemade peanut butter sandwiches. I wonder if you could call a bakery and order those, you'd probably be laughed at and hung up on.
Max, Lisa's son, was at boarding school and made. surprise appearance at her birthday lunch, and she was just so excited!
Camille heads to Hawaii to chill out and say she has 30% more on her plate than the other housewives, and while in a hot tub with her friends Deirdre and Carl they just can't stop telling her how hot, smart, amazing, beautiful, generous, and god-like she is, obviously being paid by Kelsey.
Can you pass me the scones? Oh, these ones? That Taylor's toe touched?
RHOA, S5E1, 2012
The season premiere begins with Nene talking about how both her life and career are booming with her new move.
Kandi is happy with Todd, who was foretold from a bone reader in Africa (if I remember correctly), and they have been dating for a year. We are now meeting him due to filming, but the two are in love and he and Kandi discuss having kids since they both have daughters from previous relationships. I love the two together, fuck what mama Joyce says!
Kim and Kroy are discussing KJ's first birthday, and also are worried about getting kicked out of their house since they are renting. They had the house appraised when they wanted to buy, and the appraisal was for a million dollars less than the owners wanted, so they want to move and not buy an overpriced house.
Phaedra is learning about mortuary sciences and wants to visit a veterinarian about pet funerals, and talks about how pets are kids to people (as a childfree couple by choice, my fiance and I treat our cats like kids!), and asks for her to recommend her for pet services.
Cynthia is worried about Noelle being homeschooled, and she is the only one against it in her family. Kenya is introduced through lunch with Miss Lawrence, and she talks about how she is engaged in her job, but she wants to have a husband and settle down. She later is seen at the Bailey Agency, talking about coochie cracks and criticising every woman who walked in basically, until one of Cynthia's employees told her off.
Kim goes to Kandi's and talks about how she had to lock her doors on the way there, and Kandi says the mayor is actually around the corner. But, as someone getting kicked out of her house, Kim shouldn't be talking about neighbourhoods.
Another premiere done!
This throwaway scene of Nene and Ryan Murphy kills me every time. She tries to call Tyler Perry twice, and each time the number she has is disconnected and Ryan laughs so hard!
RHOM, S3E14, 2013
We are continuing last night's episode with the finale, and we didn't have to wait a week, only a day!
The women were way too drunk the night before Joanna's wedding, and they all wake up to realize they missed their flight. They have to be in San Diego for the rehearsal dinner that night, and there are no more flights. They have to take a rental car and frantically begin driving.
Romain is in S.D and getting ready for the rehearsal dinner, and when he is told that Joanna won't be on time he is very upset. They do end up making it on time though, despite some doubts, and Joanna is excited to see Marta but is also upset about her lack of help planning the wedding. Joanna pulls her aside and wants to talk about the distance between them, and Marta says she won't expect too much from Joanna when she gets married herself (man, this woman seems depressed), and that she accepts Romaine into the family.
Everyone has their husband there but Lisa and Alexia, so they decide to be each other's dates. But, something sweet happens and Peter, Alexia's son, shows up because he didn't want her to be alone - how nice! Alexia says she sees the old Peter and not the new, angry one, and she's so happy.
The wedding happens, Romain is too emotional to read his own vows and has the priest do it, and Joanna reads hers, and they have the wedding they dreamed of.
The reunion is next week. I'll write about it if there's anything special!
I wonder if Joanna still stands behind this dress choice.
RHOBH, S4E1, 2013
And onto another premiere! Featuring a segue into Vanderpump rules!
We begin focused on Gigi, Yolanda's daughter who is now modelling. After Yolanda talks about how important it is to diet, we move on to Brandi.
Brandi met a real estate broker last season at Kyle's white party, and she is in love. She talks about his gap tooth, he showed her a mediocre house and told her she only had one day to make a decision.
We then see Lisa, who is practicing for DWTS on camera and that's about it.
Kyle is choosing some ugly clothing for Kyle by Alene Too, and she talked about how she wanted everything for herself - as it's probably like half mumus. The representative for the chamber of commerce shows up and tells Kyle that she is invited to be a member of the chamber of commerce, which she says yes to and plans a party around.
This party, of course, needs to be catered and waited by the staff of SUR, Lisa's restaurant, Sexy Unique Restaurant. Kyle and Lisa talk about it, Mauricio comes in, and Lisa makes a joke about Portia being the "younger woman" that Mauricio was out and about with according to magazines. This joke is not welcomed.
Kim is seen with Kingsley, her dog who ruined her home and won't let her make a bed.
Carlton and Joyce arrive with their husbands, and Carlton isn't a fan of Joyce's husband already as he talks about once being naked, which she says in a confessional makes her think of his "parts flapping" and again, I reiterate that if I suffer, you suffer.
Brandi is in the kitchen with Ken, and here comes Scheana, who we know by previous media stories was involved in one of many extramarital affairs Eddie Cibrian, Brandi's husband had. She asks what's wrong with Scheana's grey tooth, and Sheana says it was knocked out and Brandi's like that sucks, while on the inside she feels fireworks.
The SURvers talks minutes long about the housewives to get us introduced to them, and it's very soon we see VPR in our weekly rotation, bravo fans!
Just loved when the cast of VPR was the alleyway sitting, chain-smoking, bit-part playing opposite to the lifestyle porn on HW.
RHOA, S11E1, 2018
Porsha is looking at engagement rings, which you can see from earlier this week and next season that things go left. But, what should have been the first clue is that she previously went to that jewellery store with Kordell, and got their ring there - so obviously this is good luck! /s We see that Dennis is a Hukkah lounge owner, but also the hot dog "boss of Atlanta", so there is no budget as he sold "like 2,000 hotdogs this week."
Cynthia shows up with a wine glass full of frozen grapes and a little wine to a facetime with her new boyfriend, Will.
We see Nene, and she's dealing with Gregg and his stage 3 colon cancer, and during that, she's still running Swagg Boutique. She's opening a store in Miami, and Porsha invited the ladies to come along.
Kandi accepts the Golden Note award along with her bandmates of Xscape, and after that Riley tells her mom that she shouldn't have more kids because she doesn't have enough time for the ones she has.
Porsha and Dennis head to Miami, where Porsha expects a proposal.
RHOC, S15E4, 2020
Braunwyn, after leaving the party that Gina accused of her being a drunk (after getting sober), goes to the driveway and asks the "lemonade boy" to find her husband. While she's crying in the front yard, Sean is yelling at Gina about how rude and inappropriate she is. Gina comes out and says she feels bad Braunwyn is crying, but when Sean texted her about Braunwynn being passed out and a winky face after they told her they had threesomes, she felt uncomfortable. The women feel Braunwyn is using her sobriety as an excuse, and it allows her to make herself the victim in any situation.
NOVEMBER 5TH
RHOC, S5E1, 2009
Jeana Keough is suffering from empty nest syndrome with Shane and Kara gone, and only having Colton around. She thinks they'll have to downsize from 9000 sq. feet to 5000 sq. feet, but worries that she won't even be able to sell the home. She's lost 2/3 of her income due to the crashing real estate market, and things are hard for her.
Tamra is throwing a "wrap party" for her daughter's class, and it goes well until one of Tamra's friends makes a joke about tea-bagging. Simon snaps about it and we are supposed to understand his work is going poorly as well, like Jeana, and the rich of the OC are suffering along with the general public during this time of recession.
Gretchen is back, and she's got a new boyfriend - Slade! He helped her through Jeff's death and they ended up falling in love.
Lynn Curtin is back too, and trying hard to make her jewellery - cuffs - a success as her husband's work has also slowed down due to the economy.
Vicki and Donn are working on their marriage since they both realized they had empty love tanks, and are getting along better now. Vicki and Tamra go out to lunch, and Vicki lets her know that she and Jeana are not talking because Jeana asked for a loan, and Vicki declined.
Lynn invites Tamra to a cuff party at the St. Regis, though Gretchen would be there as well. Lynn is also planning on getting some plastic surgery, with money they don't have, so... this episode is pretty stressful! Tamra thinks that Gretchen cheated on Jeff, and rumours were out that he paid her to spend his final days with him - so sad! At the cuff party, Vicki doesn't want to wear Lynn's designs and says they have a "biker look." Tamra says Gretchen preys on old men, and she tells Tamra to "shut the fuck up."
We meet Alexis next week!
I miss when we could see her pores. Remember her pores?
RHOA, S2E15, 2009
Reunion pt.2 - not very dramatic.
RHOBH, S3E1, 2012
Lisa Vanderpump just moved into a new, bigger better home, and the first wife invited for a tour is Brandi! She is amazed at the beauty of it, the warmness, and is also very excited to see Ken as they always joke about being a couple. It's weird, but it makes Brandi comfortable so I guess that could be why he goes along with it.
Lisa has a Villa Blanca anniversary coming up, so she invited all the housewives except for Adrienne because she believed Lisa sold stories last year. Taylor calls Adrienne, and during a dinner with Paul, gets asked about dress shopping for the occasion and realizes she wasn't invited to the event.
Kim had Kathy over to help her daughter choose a prom dress, and Kyle arrives making things awkward.
We now meet new housewife Yolanda, who did you know was married to composesongwriter David Foster?! We also learn he writes her love notes instead of buying her jewellery. Ugh, I hate him, he's just so smug.
Portia wants to call the guests invited to her party, so we get a really cute, sweet scene where her tiny little infant voice is asking everyone to come to her party. Lisa is called, puts it on speakerphone, and basically Brandi, by being there, is asked to be invited too, which means maybe the group will make up a little!
Taylor and Adrienne get together to shop, and we see Taylor is still dealing with Russell's unexpected death last year, and the two talk about that and then Adrienne talks about not being invited. The party happens, and Yolanda is not into Brandi's sexual jokes. Kim is sober and having fun, but she and Kyle tiff a bit when Kyle thinks she should be at Portia's party - she's her aunt! Yolanda introduces herself to the ladies and mentions Brandi said that she has had sex with everyone in Beverly Hills. This just gives the ladies more ammo, and you can tell they love this gossip.
Adrienne sends a large floral arrangement, which Lisa doesn't really appreciate, as she thought it was to steal attention, and Kyle and Kim don't resolve their conflict.
How much did this cost her?!?!
RHOA, S10E1, 2017
Cynthia is throwing a 50th birthday party for herself as the first event of the season, and there are two things to note: 1) this is months after her actual birthday took place, and 2) she wants everyone dressed up in different variations of her for a 50 Shades of Cynthia party.
Nene is back and she arrives at Lake Bailey, and we hear that Kenya had eloped and we talk about the blogs! Not the only time they get mentioned this season. Nene wants to see a marriage certificate, and Cynthia is like, well you can ask her, she's on her way over! They do a toast, eat some grapes, and nothing gets answered. Kenya refuses to give his name and only refers to him as "baby", and the ring is the only proof as no family was there and they did it before taping so no footage either. Her dad does later congratulate her and it seems he means it. Kenya also says that Nene, despite cutting off half of her nose (plastic surgery), she's still nosey, and Nene is like, this is weird shit.
The 50th birthday party begins, and everyone comes dressed as different Cynthia eras, but the winner of the night is Kandi with a look from a photo shoot where her hair was curled with coke cans. She serenades Cynthia with a Marilyn Monroe version of happy birthday. Porsha confronts Nene about saying she should be fired on WWHL, Nene said she never used the word fired, and nothing is solved!
End of the tenth premiere!
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RHOC, S13E16, 2018
Vicki gets a jaw lift, and Steve tells her she's not a guinea pig and she needs to stop nipping and tucking herself. Especially since she has an inner ear tumour and numerous surgeries for it, that she didn't tell her plastic surgeon about - WTF.
Shannon is doing an eyelid tuck, which sounds like so painful I just can't.
Emily and Shane go to therapy to discuss their remaining embryos and her desire to use them and his desire not to, and he's dressed like he's going for a walk, not to a therapy session. Emily is heartbroken and crying, having had many miscarriages and losing twins at four months gestation. She got mementos from the hospital but has never opened the box, and the therapist encourages her to do so. She does, and she feels some relief, but still doesn't know how to go forward with the embryos.
RHOC, S14E14, 2019
Nothing of note!
NOVEMBER 6TH
RHOC, S3E1, 2007
Vicki gives Brianna a new car, which initially sounds exciting, and then you realize Vicki has her on the hook for the monthly payments, as she made the downpayment without asking and gave it to her with strings attached. I hate Vicki for this.
Lauri is planning her wedding with George, the man with riches to bring her out of her rags!
Tammy and her daughters lost Lou, and since he gave them money and helped out, and since it was a shock and he had no will, his wife got everything and refuses to talk to their family.
Tamra is introduced as a self-appointed hottest housewife, and there's so much this season that will happen!
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RHOA, S4E1, 2011
Kim is pregnant and moving into a McMansion with Kroy and her daughters, and Nene is struggling to kick Bryce out, who is now past his three-month deadline to move out and has crashed his truck recently to the episode. She wants to show her buying him a $14,000 dollar car in cash, trying to take away from the fact that she and Gregg are having marriage troubles!
Sheree goes to see Miss Lawrence and talk about how shady Nene is being with her.
Nene and Sheree meet at a wine bar to discuss that Nene went behind her back - WITH TYRONE - to undermine her for a media appearance. Nene calls someone, and Sheree calls Tyrone, and the two women just yell over each other into their cellphones getting absolutely nowhere. Now for an iconic moment: Nene says she's done! Done! She's a very rich bitch! Sheree tells her to fix her teeth, and runs after her leaving the restaurant yelling "Repo'd!"
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RHONJ, S7E17, 2016
Nothing noteworthy.
RHOA, S9E1, 2016
Kandi and Todd are potty training Ace early, and it's working for them so that's so cool!
Sheree is putting the finishing touches on Chateau Sheree after so long, but she says a rush job is Kenya's house, and she refuses to do that.
Cynthia is going to divorce Peter, and she says that shit got real. She calls him to ask him about the prenup, and he says he's with his girlfriend, the new girlfriend being his club. All she wants is the house, which is in her name anyways, so it will be a cut-and-dry divorce.
Phaedra says that she has filed for divorce, talking to Porsha about it, and she receives an invite to Kenya's party, saying make sure you "plus one is hot, and not a THOT". Obviously, Kenya was referring to Porsha, and Phaedra invites her anyway.
Anyways, Kenya has her housewarming party and it's hotter than a Floridian tit crease, and all the housewives are complaining, especially Sheree. Kenya says it's been a long, hard road to get the house done and she can't imagine what waiting five years would feel like, setting Sheree off. Sheree says, nuh uhh, summer, spring, September, it's only been four years since ground was broken, and that her master suite is the size of Kenya's whole house.
We see that Phaedra and Porsha arrive after dark, and noting that the party started in June at like 3 p.m, they were really late. Kenya is upstairs with Kandi at that point for an untaped conversation, and when they come downstairs Sheree is doing her woo-hoo, shoulder shimmy happy dance about Porsha being there, knowing there is drama to come. And to be continued next week!
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RHOC, S12E18, 2017
The episode continues in Iceland from last week, and the night after Vicki came home from the hospital and the ladies either fought or made up in the hotel room, depending on the fight. Peggy admits to having a recording of the women to Lydia, saying she heard Aspen crying and went to check it out and heard the women in the other room and recorded them, and criticised Meghan's parenting.
At dinner with the Viking entertainers, Peggy pulls out her phone and tells her that she knows her baby was crying for ten minutes. Once Peggy admitted to recording the ladies, Kelly is upset and tells her "if you throw a bomb, I'll throw a nuke", and walks away from the conflict.
Meghan says they are training her to self-soothe, so they have to leave her be when she's trying to sleep. Tamra and Shannon are like wtf Peggy, leave her alone, and Peggy backtracks and says she wasn't trying to be critical.
I hate peggy.
RHOD, S4E10, 2019
Last week LeeAnne was worried her mom wasn't at the wedding, but we see this episode she made it just in time to sit down before it started. Rich, during his vows, tells LeeAnne that they both came from the island of misfit toys, and they fixed each other up (not sure how well, LeeAnne is a firecracker). He also mentions that he'll never be bored because of being with her, he gets to be married to basically five women at once due to all her moods, which people laugh at. LeeAnne says she didn't feel love or accepted until he came along, and the officiant mentions something about innocence in Rich's eyes, and he says "Eye!"
Her mom can't get in for a photo as everything going on at the reception is carnival-themed and busy.
D'Andra is home with Jeremy, and they have a seafood cook-off to see who wins. It's a filler scene, but it's still fun and I think they're a funny, normal couple.
Stephanie's husband Travis, who is the living handsome Shrek, I swear, needs to go to Thailand for his dad who is working there. Stephanie decides to ask the other housewives if they want to make it a trip, and a cast trip is formed!
RHONJ, S10E1, 2019
Joe Guidice has completed his prison sentence and is two days away from transfer to an ICE facility. He is facing deportation as he never applied to be a US citizen, and he'll have to go back to Italy. Teresa and Joe are still together, but as Dolores puts it, Tre really isn't "so crazy in love with Joe right now."
Gia is going away to Rutgers in the fall, so to keep her coming home, Teresa is building a pool in the backyard and enlists the help of a local pool guy, Tony, with who she went to high school and briefly dated at one point. Storyline!
We see Frankie Jr. and his good looks getting him far, as he now is a model and has done covers for some romance models - RHONJ's own Fabio! Even though Dolores told us that she would have her own place last season, she is still living with Frank Sr. and still dating David. David finally makes his appearance on the show and looks like he's being held at gunpoint off camera.
Jennifer is throwing a patient appreciation party for Bill's clients, and all the women are invited, but Jackie is unsure if she should go. She tells Margaret and Melissa over drinks that she saw Teresa's Instagram stories making fun of her, saying "define stalker", with an imitated voice. Jackie says she was cyberbullied, and they turn their sights on the Teresa cheating rumours. Jackie attends the party anyway, Jennifer yells at her for smirking, and then chases her around the party telling her she's a comedian!
Teresa gets a call by the end of the episode from Joe and he is at the ICE facility and absolutely hating it there.
OMG NONO DON'T MAKE ME CRY
NOVEMBER 7TH
RHOA, S3E6, 2010
For some reason, an episode aired early and not a week after, but only six days. There must have been a special episode on the next day or something.
Kim is not impressed by Kandi's new song she wrote for her "A ring didn't mean a thing", and is unimpressed by Miss Lawrence's singing, even though he is much better than her.
Cynthia meets up with Leon, and they watch Noelle play at the park. Am I the only one who has seen these episodes a million times and just realize Noelle is Leon backwards with the extra le? Mind blown lol.
Phaedra meets with Latavia, the original fourth member of Destiny's Child, and they talk about upcoming things and how Phaedra could represent her.
Kim is holding a garage sale in the middle of a fucking strip mall parking lot, and Phaedra, Nene and Cynthia show up and go into a burger joint while the garage sale is happening so Kim's dad can take way lower prices on anything that he sells. No one believes Phaedra is actually expecting when she says she is and thinks she's lying.
Nene has Bryce meet Peter during a dinner, to give him a kick in the butt to start working, and Peter talks about how he worked at McDonald's and worked multiple jobs in college. Great job Peter, he should be so proud! Cynthia tells Nene Gregg looks good, and Nene, because she is upset with Gregg, takes offence to this and just keeps getting drunker and drunker. Gregg goes downstairs while a wasted Nene talks to Peter and Cynthia about communication, and alludes to cheating in their marriage.
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RHOBH, S2E10, 2011
Important to note is Kim's medications talked about on this episode:
Trazadone - SARI antidepressant, treats anxiety and insomnia.
Lexipro - SSRI antidepresent. Paired with Trazadone, it is a treatment for newly sober addicts such as Kim.
Topamax - mood stabilizeanti-convulsant. Can be paired with anti-depressants to keep moods from cycling. Usually prescribed for detoxing addicts, and can treat multiple issues.
These are noted as medication Kim has been taking during a night of beauty at Paul's office for all the women. She tells him what she's taking which, paired all together makes her seem drunk and/or very out of it, which he tells her in an exasperated way. Then, he goes ahead and plumps her lips up anyways.
With that out of the way, we have Kim moving in with her new boyfriend, Ken Blumenfeld. There is and was quite a lot of speculation from people that he was from AA with her, and I believe that to be true, their relationship is too dependent and volatile to be stable.
Kyle meets Ken, and immediately runs out to the balcony to cry because she is worried about her sister and she doesn't know him, and it seems she doesn't realize how lonely her sister really is. It's hard for Kyle to see past her perfect husband and family to other people's inner feelings. She says it's because Kim will be so far away, but it's just that she didn't like being in the dark about it.
She looks like Anna Faris in \"Just Friends\" when she eats the toothpaste.
RHOC, S11E19, 2016 REUNION PT. 1
Meh.
RHOD, S3E13, 2018
Girls in Coppenhagen.
RHONJ, S9E1, 2018
Boring.
Marge Sr. gets a vaginal rejuvenation, which I think is the fourth/fifth one I've written about in the last couple of months.