The stark contrasts in the following images tell the story of Miami Dolphins wide receiver Brandon Marshall and his battle with borderline personality disorder.
Picture a man who one day in training camp vows to help his team win a championship by any means necessary, then another day is suspended for punting balls out of practice and refusing to catch passes thrown his way. A man whose reputation as one of the NFL's most generous contributors to charities is rivaled only by his having compiled one of its most notorious rap sheets. A man who is considered by some reporters one of the league's most enjoyable interviews, by others its most stressful.
As telling as these images are, they explain only part of the story of an individual suffering from borderline personality disorder, a condition Marshall has struggled with throughout his five-year NFL career.
Borderline personality disorder (BPD), which Marshall believes began for him after his rookie season in 2006, is characterized by marked instability in functioning, affect, mood, interpersonal relationships, and, at times, sense of reality. Patients often think in terms of extremes, with no compromise in between, and their mood can change in a manner that is startlingly abrupt. The instability that results from BPD often disrupts family and work life, long-term planning, and the individual's sense of self-identity.
Although less well known than schizophrenia or bipolar disorder, BPD is more common, affecting as many as two percent of adults. Most often, it is diagnosed during adolescence, and although its cause is not fully understood, it is thought that BPD might result from a combination of traumatic and stressful events during maturation from childhood to adulthood.
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Approximately 70-75 percent of patients with BPD have a history of at least one deliberate act of self-harm, and according to one study, the estimated rate of completed suicides is 9 percent. People with BPD frequently view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored and empty, with a confused sense of self.
Treatment of patients with borderline personality disorder (BPD) is often difficult but is best achieved through intensive behavior therapy, which Marshall began this summer at the McLean Hospital in Belmont, Mass, on the advice of former Dolphins teammate Ricky Williams. The specific type of treatment for patients with BPD is known as dialectic behavior therapy (DBT), which teaches patients four skills: mindfulness (attention to one's experience), interpersonal effectiveness (predominantly assertiveness), emotional regulation, and distress tolerance without impulsivity.
In clinical trials, DBT was more effective than standard psychotherapy in reducing suicidal and self-injurious behaviors, treatment dropout, hospitalizations, and self-reports of anger and anxiety. In a recent study involving patients with BPD, 93 percent attained a remission of symptoms lasting at least two years, 86 percent attained a remission lasting at least four years, and 50 percent achieved recovery. Recovery from borderline personality disorder is difficult for many patients to attain; however, once recovery is reached it can be relatively stable over time.
As Marshall himself put it in his Dolphins press conference over the weekend, despite all his success in the NFL, suffering from BPD has made it such that "I haven't enjoyed one part of it." Given the statistics, it is likely Marshall will have to deal with the condition for much, if not all, of his playing career. However, with continued, intensive treatment, there is no reason to believe he cannot continue to produce on the field while at the same time improving and enjoying his life off it.