A Matter of Personality

From borderline to narcissism

“Borderline” Provocations Part VII: Parasuicidality

Being in a relationship, by blood or romance, with someone with traits of borderline personality disorder is incredibly challenging. In Part VII of this series, I discuss one of the most problematic and frightening of all aspects of the disorder: parasuicidality (suicide attempts, gestures, threats and non-suicidal self-injurious behavior). Read More

Don't want to help BPD sister

All of her adult life she has been trouble. My parents are raising her kids and it is destroying the best years of their lives. Declared bankruptcy numerous times, alcoholic, kids taken away, now happily visits them once a week. A little spring in her step now that she isn't parenting.

She can't die soon enough.

Casey Anthony

I always wanted to ask a person with first hand
experiece of BPD. Was Casey Anthony a Borderline?

Casey Anthony

Hi anon,

Thanks for your question, but it is considered unethical for doctors to speculate about anyone's diagnosis based on media reports.

Here is a video of a friend of mine who has BPD

This is what BPD actually looks like. In the US there is such a great deal of misunderstanding and misinformation about the condition. There is such a clamouring hysteria to diagnose any act of aggression or abuse and because of the symptomology of BPD people assume those with BPD are abusive. While some people with BPD may be abusive dicks it is not because they have BPD its is because they are abusive dicks who also have BPD.

BPD does not cause people to be abusive to anyone but themselves. When those with BPD get accused of being abusive it has a devastating effect on their already intense feelings of worthlessness, shame which frequently results in dangerous self harming and suicidal behaviours.

While the David here is being glib about the suicidality of those with BPD he is failing to address the genuine harm that such attitudes cause to incredibly vulnerable peoples.

So here is my friend's video and please listen carefully to what he says. He will tell you all you need to know about what it really means to have BPD. His message is particularly poignant in regard to this topic because he took his life in May last year and I miss him terribly.

http://youtu.be/D3IvUHeKPCw

He was an incredibly gentle and compassionate man but in the end he was abused by people who misunderstood his condition, misunderstood that he genuinely wanted help because he was going to take his own life and was treated as if he was just being an attention seeking borderline.

And Dr Allen, if that makes you feel hopeless, anxious or guilty I couldn't give a rats tiny butt crack because that is nothing compared to the pain David endured at the hands of idiots like you who advise poeple to treat them like they are playing games.

You just do not listen at all.

"In this post, I will continue to run down specific countermeasures to the usual BPD bag of tricks whenever they are trying to distance and/or invalidate you, as well as to make you feel anxiously helpless, anxiously guilty, or hostile.

Once again I feel compelled–because of some of the comments on these posts–to point out what should be rather obvious: The countermeasures described in the series are of course unnecessary when patients with the disorder are not in process of behaving in the manner described. Which is most of the time, by the way"

Everything that is wrong with your analysis is contained in this preamble to what is likely going to be more stigmatising nonesense given that that is the best you can do in terms of addressing mine and others concerns.

BPD bag of tricks - What the fuck are you talking about? We don't have a bag of tricks. We struggle to deal with interpersonal relationships but we are not playing games and you are trivialising the condition by claiming that we do.

Patients behaving in the manner described: We don't, this is your biggest mistake. You misinterpret what are emotionally dysregulated responses to your arrogant assumptions and projections as being attempts to make you feel hopeless, anxious and guilty.

YOU DO NOT LISTEN! YOU CANNOT HEAR! Its like trying to reason with a fucking brick wall. I don't even want to read what offensive nonesense you've compiled after these first two ridiculously conceited paragraphs, but I will, even though it will be incredibly upsetting.

The reason I will do so is because people who are dealing with those who are suicidal, who suffer from BPD need to be better informed about what is really going on. If they listen to you they will absolutely fail to understand and likely be as insensitive to their needs as you were with your patients in your consulting room. You do not have a good reputation and your treatments do not work.

Here is what someone who gives a fuck thinks about BPD. You are wrong, dead wrong and fortunately you are one of a dying breed still coming out with this offensive bullshit. Get a hobby, enjoy your retirement. You're way out of line and scientific research has overthrown all this atavistic nonesense that you come out with when discussing BPD.

http://psychcentral.com/lib/how-to-help-a-loved-one-with-borderline-pers...

Buyer beware this guy is so wrong, so very fucking wrong. He's dangerous.

not listen

Hi Heinz,

So you're saying people with BPD hardly ever do the things I describe in the posts? And all of the therapists who constantly tell these stories are ALL making it up? Because they read my posts? Really? Maybe in some alternate universe.

So tell me: why does Marsha Linehan spend half her book on DBT describing countermoves therapists can use?

And you are listening to a guilt-ridden parent apologist group for information. What are you going to say next, that family dysfunction has nothing whatever to do with the genesis of BPD? That it's all genetic? That the attachment literature is all bull?

Yes, people with BPD DO in FACT have some very commonly-used behavioral strategies to provoke others in certain ways when they need to, which is NOT all the time. They use them automatically and habitually in response to certain environmental cues without having to think about them, because they usually work and serve an important family function. But at some level they know what they are doing.

This in no way negates how distressed and unhappy they are as you seem to imply, or that they are in the throes of emotional dysregulation at the time when these strategies are called for.

I make no apologies for refusing to sugarcoat the behavior of ANY of the involved family members, including victims of severe child abuse.

Once again you are interpretting what I'm saying instead of listening you arrogant man

I tried reasoning with you but you have consistently looked behind what I am saying to see what you really think I'm saying. I say what I bloody well mean and these psychoanalytic techniques do not work on people with BPD! Thats why we suffered so much in consulting rooms where people would not take what we were saying seriously and interpretted our behaviour as manipulative and abusive instead of indicative of intense emotional pain.

I have told you so many times I do not think BPD is purely genetic but you constantly revert back to this assumption no matter what I say so what is the point in discussing this with you.

I'll tell you why, because what you are saying is rude, offensive, as Queenie posted "dismissive" and will lead to dangerous situations where those people dealing with people with BPD will look behind all there interactions with them to say what they are really doing instead of listening to them and validating their experience.

If you treat people with BPD as if they are playing games and being manipulative you will emotionally dysregulate them every time! By dysregulating them you will create a self fulfilling prophecy whereby you interpret their dysregulation as indicative of their raging because they have been "caught out".

People with BPD are utterly useless at manipulating the people around them. When they are repeatedly faced with a lack of understanding and compassion they can and often do because surly and themselves feel hopeless. Your interpretation of this as intentional manipulation is offensive and completely out of touch with what the scientific, research community and those that genuinel love the person in their life with BPD know about the disorder.

The only people who are buying into what you are saying here are people who have already given up on the person in their life with BPD. Your advice is not helping anybody.

once again

If you actually read the advice I'm giving about how to respond, you might see that it is to NOT treat the other person as "playing games and being manipulative," but in fact the exact opposite.

If someone were to treat the person with the disorder like that, I am agreeing with you that this would in fact lead to that other to act even worse. I think I say that fairly clearly, buy you keep insisting that I did not.

On the other hand, if you allow someone with the disorder to keep mistreating you and just make a bunch of excuses for them, that will ALSO lead to an increase in their problematic behavior.

Maybe you don't mean to say everybody should just make excuses for other people's abusive behavior, but your comments could easily be interpreted by some readers as advice to do just that. Not helpful.

Feel free to have the last word.

Dr David M Allen provocation no. 1

"Feel free to have the last word." This is a provocation Dr Allen frequently uses in order to make the readers of his page feel anxious, hopeless and guilty.

While Dr Allen will defend himself by saying that he didn't intend to use the statement provocatively, and may actually believe this is the case, his defences do not stand up to scrutiny. The fact is when Dr Allen uses this provocation it makes the commenter feel stimied.

Sure you don't agree with him and nothing he says in the previous comment makes you feel as if he's listened to you or indeed even taken on board exactly what you've said. Often you will find that Dr Allen evades your concerns entirely by addressing an issue which is nothing to do with your stated concern but rather one that he feels confident that will defend his work generally such as "Maybe you don't mean to say everybody should just make excuses for other people's abusive behavior, but your comments could easily be interpreted by some readers as advice to do just that. Not helpful."

Of course this tactic is going to frustrate, anger and disappoint you but if you respond to this you are simply "having the last word" which everybody knows is the action of a petty person who wants to continue an arguement when the purposes of discussion have already been proven null and void. But given that Dr Allen frequently responds to criticism with sarcasm, passive aggression your need to challenge him is all the greater given that he actively provokes you to do so in order to challenge his dismissive retorts.

So what to do? This is a quandry and I have frequently found myself falling into the trap of responding angrily with every justification because of the fact he has intentionally provoked this emotion in me.

Well, what I have learned may help you also. Speaking with Dr Allen about his inaccurate accounts of BPD behaviour and his analysis for them is utterly fruitless. His need to defend his approach to "treating" those with BPD runs deep as he has devoted his entire career to using these techniques and has too much invested in defending them in order to allow them to be exposed as fault ridden now that his career is over and he is "partially" retired.

The best thing to do is not to allow Dr Allen to silence you in this manner because his intent on doing so is because he is genuinely threatene by what you are saying and wants to make others feel that there is no virtue in listening to you. Keep responding to his wildly inaccurate and indefensible assertions so that others can see the holes in his logic. It is important to do so because what he is advocating is dangerous and has a devastating impact on people with the condition and also those that genuinely love the person in their life with BPD and are hoping to improve relations with them.

Dr Allen is never going to listen, it is easy to see this is the case because when you challenge him with a concern he does not wish to address he simply ignores it, misinterprets it and deflects your concerns by ridiculing your whole premise without first unpacking and understanding it.

If this is too triggering for you then the best thing to do is to ignore him completely. I for one will continue to challenge him though because I am so sick and tired of people writing this unscientific and offensive junk that I will not stand for it anymore.

Given that you clearly haven't researched BPD for the past decade or so

Given that you clearly haven't researched BPD for the past decade or so I am forwarding a link to a recent lecture that should educate you on exactly how far from current understanding of BPD you are situated.

As you will not listen to me or others who are offended by your work because we have BPD then hopefully you will open your ears to a world class expert in treating BPD today. I give you the head of the Maclean institute MR Blaise Aguirre:

https://www.youtube.com/watch?v=trtt-eiHtXQ

Regarding "Bags of tricks"

I think that, depending on how you look at it, everyone--BDP and nonBDP alike--has a bag of tricks they use. I don't have symptoms of BDP, but I still use a "bag of tricks" to adjust and guide people around me--for example, I withhold personal information with people who are low in empathy because I don't want to hear them trivialize my experiences. I plead "not feeling well" when I'm feeling especially introverted and want a quiet evening at home, if I think my friends would take the refusal to socialize personally. I'll say I don't care what restaurant we go to even if I do care a bit, because I want to avoid feeling guilty for stepping on toes. These are all tricks I use to manipulate people around me, not because I'm manipulative and evil, but because I need to do this in order to make my life run smoothly.

But all the same, the phrase "bag of tricks" is a rather dismissive one. I would feel hurt if someone wrote an article about people like me characterizing all these techniques as just a "bag of tricks," especially if it was from the standpoint of, "you're doing this on purpose to make the friend feel bad," even if the upshot is that the other person does end up feeling bad--in the examples I mentioned, I run the risk of the other person feeling cold-shouldered, feeling lonely and anxious about whether I like them, and feeling that I'm passive-agressive.

David, I think that your techniques for countering (your own "bag of tricks") are effective and insightful. I have used some of these in the past to interact with friends (nonBDP friends) who are very upset, distressed and distracted by huge issues that are going on with them at the time. And though I don't have the experience to make this kind of generalization, I'm beginning to have a picture of BDP in my mind as someone who is afflicted by high distress much more often than normal, leading to unusual and maladaptive behaviors in response to the psychological pain. I think that an extremely-distressed person could benefit from keeping your tricks in mind--if I was overwhelmed by distress, but I was able to remember that what I really needed was someone to listen to me from a place of compassion, and that part of my distress was stemming from the belief that such compassion would not be available to me, then I think I would be able to resolve the issue a little more quickly. But it's difficult for someone to extract the useful truths from your article if it's couched in dismissive language, particularly if someone is already very sensitive to the idea of being dismissed. My unsolicited advice for you is, if you want to reach your audience in a really effective way, you should phrase your articles in a more compassionate and balanced manner.

bag of tricks

Hi Ice Queen,

Thanks for your comment. I appreciate your point.

However, I don't think I've ever heard that the term "bag of tricks" has an inherent value judgment one way or the other. In fact, it's often used as a positive attribute. For instance, I'd hate to see a doctor who had no backup plan if their first presription didn't work.

The dictionary definition: "A supply of expedient resources; stratagems." Strategies and resources can be used for good or for ill, depending on what they are and/or what they are used to accomplish.

I find that when talking about controversial and/or emotionally charged topics, there will always be someone who will take offense no matter what words are used, so I'm not going to go crazy trying to say things in a way that will somehow not offend anyone. If a patient I am seeing in my office seems to take offense to something I say, I always ask them about how they are interpreting me, and can correct any misattributions. In writing a blog I do not have that luxury.

Word trickery

You know damn well that your term "bag of tricks" is meant derogarory manner. If the definition of Bag of tricks is stratagems used for good or ill you know perfectly well that you mean that a person with BPDs bag of tricks is meant to control and manipulate others.

You are so reptilian in your attempts to defend the indefensible. And thank you Queenie for trying to point this out to him. I warn you though, he does not listen and will continue defending his offensive projections no matter what anyone says. He is completely committed to his beliefs no matter how much harm they cause and how offensive and inaccurate they are.

In case you missed the video I posted before here it is again

This man killed himself because when he was unwell he was treated as if we has playing games. When he was waiting for DBT treatment he repeatedly went to the doctors to ask for help because he wanted to take his own life. He was treated as if he was trying to manipulate them into feeling bad and dismissed his concerns because they thought he was displaying "typical" BPD behaivours.

He requested to go to a psych hospital after he was taken to A&E with deep wounds on his arms where he had tried and failed to take his life. He was sewn up and sent home and not treated with the correct compassion and concern.

When he eventually got to a psych hospital he was misunderstood, minsintepretted, treated like he was being manipulative and he finally hung himself with his bedsheets.

What you are advising is DANGEROUS, misleading and cruel.

http://youtu.be/D3IvUHeKPCw

helpful advice

My mother (who has been diagnosed with bpd but has dropped out of all treatment) used to attempts= suicide three or four times a year. She threatened suicide once a month. Because I live across the country from her, she would leave me these desperate voicemails. I finally just started calling the police. Every time. They would do a well check and take her to the hospital if necessary.

I have told her that if she calls me and threatens to hurt herself, this is what I must do.

The calls have trickled to a stop, thankfully, though she still refuses to get professional help.

BPD is inheritable BIOLOGICAL brain disease not a spoiler reaction

Borderline personality disorder is a heritable brain disease
Current Psychiatry 2014 April;13(4):19-20, 32.
Henry A. Nasrallah, MD
Editor-in-Chief
The prevailing view among many psy­chiatrists and mental health profession­als is that borderline personality disorder (BPD) is a “psychological” condition. BPD often is conceptualized as a behav­ioral consequence of childhood trauma; treatment approaches have emphasized intensive psychotherapeutic modali­ties, less so biologic interventions. You might not be aware that a large body of research over the past decade provides strong evidence that BPD is a neuro­biological illness—a finding that would drastically alter how the disorder should be conceptualized and managed.
Neuropathology underpins the personality disorder
Foremost, BPD must be regarded as a serious, disabling brain disorder, not simply an aberration of personality. In DSM-5, symptoms of BPD are listed as: feelings of abandonment; unstable and intense interpersonal relationships; un­stable sense of self; impulsivity; suicidal or self-mutilating behavior; affective in­stability (dysphoria, irritability, anxiety); chronic feelings of emptiness; intense anger episodes; and transient paranoid or dissociative symptoms. Clearly, these clusters of psychopathological and be­havioral symptoms reflect a pervasive brain disorder associated with abnormal neurobiology and neural circuitry that might, at times, stubbornly defy thera­peutic intervention.
No wonder that 42 published stud­ies report that, compared with healthy controls, people who have BPD display extensive cortical and subcortical abnor­malities in brain structure and function.1 These anomalous patterns have been detected across all 4 available neuroim­aging techniques.

Magnetic resonance imaging. MRI studies have revealed the following abnormalities in BPD:
• hypoplasia of the hippocampus, caudate, and dorsolateral prefrontal cortex
• variations in the CA1 region of the hippocampus and subiculum
• smaller-than-normal orbitofrontal cortex (by 24%, compared with healthy controls) and the mid-temporal and left cingulate gyrii (by 26%)
• larger-than-normal volume of the right inferior parietal cortex and the right parahippocampal gyrus
• loss of gray matter in the frontal, temporal, and parietal cortices
• an enlarged third cerebral ventricle
• in women, reduced size of the me­dial temporal lobe and amygdala
• in men, a decreased concentra­tion of gray matter in the anterior cingulate
• reversal of normal right-greater-than-left asymmetry of the orbitofron­tal cortex gray matter, reflecting loss of gray matter on the right side
• a lower concentration of gray mat­ter in the rostral/subgenual anterior cin­gulate cortex
• a smaller frontal lobe.
In an analysis of MRI studies,2 cor­relation was found between structural brain abnormalities and specific symp­toms of BPD, such as impulsivity, sui­cidality, and aggression. These findings might someday guide personalized in­terventions—for example, using neuro­stimulation techniques such as repetitive transcranial magnetic stimulation and deep brain stimulation—to modulate the activity of a given region of the brain (depending on which symptom is most prominent or disabling).

Magnetic resonance spectroscopy. In BPD, MRS studies reveal:
• compared with controls, a higher glutamate level in the anterior cingulate cortex
• reduced levels of N-acetyl aspar­tate (NAA; found in neurons) and cre­atinine in the left amygdala
• a reduction (on average, 19%) in the NAA concentration in the dorsolat­eral prefrontal cortex.
Functional magnetic resonance im­aging. From fMRI studies, there is evi­dence in BPD of:
• greater activation of the amygdala and prolonged return to baseline
• increased functional connectiv­ity in the left frontopolar cortex and left insula
• decreased connectivity in the left cuneus and left inferior parietal and the right middle temporal lobes
• marked frontal hypometabolism
• hypermetabolism in the motor cor­tex, medial and anterior cingulate, and occipital and temporal poles
• lower connectivity between the amygdala during a neutral stimulus
• higher connectivity between the amygdala during fear stimulus
• higher connectivity between the amygdala during fear stimulus
• deactivation of the opioid system in the left nucleus accumbens, hypothal­amus, and hippocampus
• hyperactivation of the left medial prefrontal cortex during social exclusion
• more mistakes made in differenti­ating an emotional and a neutral facial expression.

Diffusion tensor imaging. DTI white-matter integrity studies of BPD show:
• a bilateral decrease in fractional an­isotropy (FA) in frontal, uncinated, and occipitalfrontal fasciculi
• a decrease in FA in the genu and rostrum of the corpus callosum
• a decrease in inter-hemispheric connectivity between right and left ante­rior cigulate cortices.
Genetic Studies
There is substantial scientific evidence that BPD is highly heritable—a finding that suggests that brain abnormalities of this disorder are a consequence of genes involved in brain development (similar to what is known about schizophrenia, bipolar disorder, and autism).
A systematic review of the heritabil­ity of BPD examined 59 published stud­ies that were categorized into 12 family studies, 18 twin studies, 24 association studies, and 5 gene-environment inter­action studies.3 The authors concluded that BPD has a strong genetic compo­nent, although there also is evidence of gene-environment (G.E) interactions (ie, how nature and nurture influence each other).
The G.E interaction model appears to be consistent with the theory that ex­pression of plasticity genes is modified by childhood experiences and environ­ment, such as physical or sexual abuse. Some studies have found evidence of hypermethylation in BPD, which can ex­ert epigenetic effects. Childhood abuse might, therefore, disrupt certain neuro­plasticity genes, culminating in morpho­logical, neurochemical, metabolic, and white-matter aberrations—leading to pathological behavioral patterns identi­fied as BPD.

The neuropsychiatric basis of BPD must guide treatment
There is no such thing as a purely psycho­logical disorder: Invariably, it is an abnor­mality of brain circuits that disrupts normal development of emotions, thought, behavior, and social cognition. BPD is an exemplar of such neuropsychiatric illness, and treat­ment should support psychotherapeutic ap­proaches to mend the mind at the same time it moves aggressively to repair the brain.

brain science

Hi anonymous

Sorry, but I disagree completely. These neuroscience findings "prove" BPD is a brain disease only if you ignore everything we know about neural plasticity and normal brain functioning, and grossly exaggerate the reproducibility, specificity, generalizability, and extent of all of these findings that Henry cites.

I guarantee you that a large majority of psychiatrists who are "purely" biological don't even ask about their patients' relationships except maybe in a highly superficial way. So how would they even know?

I'll explain in detail all of the ways brain scan results are ambiguous in my next post next week. In a nutshell, differences on scans in the size and activity levels of parts of the brain may be due to brain pathology, but they can also be, and often are, conditioned responses to environmental contingencies. There's rarely any way to tell which findings are which of those using modern tools of neuroscience alone.

Of course all behavioral disorders involve the brain and brain circuits. So does all of the "normal" development of thoughts behavior and social cognition. So does us having this conversation!

Unfortunately, no biological treatments fix messed up relationships like those endured by people with BPD. If a medication or other biological treatment ever does that, I guarantee you that I will be the first to prescribe it.

Missing the point again

BPD is not purely a brain problem. Everyone knows that it is caused by environmental factors. While some believe that there is a greater or lesser degree of biological factors that influence the condition's development, noone nowadays is convinced that it is purely biological.

You keep harping on the same non point to solidify your own as if you have some unique insight despite the fact that your work only appeals to people who have long since given up on the person in their lives with BPD. No therapist or psychiatrist when dealing with BPD fails to ask questions about the person's relationships.

Sure there are a group of dinosaurs who won't treat BPD at all because they refuse to take their heads out of the sand and accept their own fault in causing BPD stigma but as far as I am concerned you belong to the same era of misunderstanding and misinterpretation. And as for your new installment next time of how people with BPD cause problems between two people in their life and pitch them against each other, is just another indicator of your falseheaded garbage.

What evidence do you have to support these claims that you make other than the "observations" you make about your patients? Your observations are flawed because you do not take into consideration how your countertransference and arrogance distorts the therapeutic relationship.

You see what you want to see and then present it to the world as fact even though you yourself admit that your treatment is highly unlikely to ever enable people with BPD to recover and have fulfilling relationship with the people in their lives.

You are a research light opinionated and dangerous fool and the sooner you give up this slanderous bullshit the sooner people with BPD can be seen as decent people. I have never "threatened" suicide and I doubt most people with BPD have. But those who meet with you for "treatment", well, maybe when trying to get help doesn't work by being straightforward about their condition they find themselves forced to use a bigger hammer to drive the point through your interminably thick skull.

point

Heinz,

There you go again.

Did you even read the post I'm responding to here, right above it? The poster did in fact say that BPD was purely a biological disorder. So apparently "everybody" does not know this is not the case. Do you read studies the same way you read blog posts?

I never said people with BPD are not decent people. Your presumptuousness is breathtaking.

And I was hardly the one who created stigma for patients with the disorder. Where do you think that came from originally? Did therapists spread nasty rumors about them because therapists are all hateful bastards?

I know what I know the same way I know that parachutes reduce deaths and injuries from falls out of airplanes and that appendectomies prevent deaths from appendicitis. There are absolutely no double blind, placebo controlled studies on these issues.

I observe the same things over and over again and have for 35 years; my trainees filmed their sessions with patients and, when they ask the right questions, we see the same things, and and I know how to get people and their family members to open up about what they are really thinking and doing. I've even observed some in their native habitats.

And I have talked to a lot of therapists from all over the country about their experiences with patients. Have you?

As far as research, I get and review and updated literature search from OVID every single week. Do you?

I'd be happy to do a study on my therapy techniques, and I wanted to. Want to fund me?

Actually I didn't say PURELY BIO - inherit the capacity shaped by environment

If you read the post it shows how childhood experience of trauma and sexual assault etc can effect the plasticity of genes and epigenetic expression resulting in a biologic brain disorder ...

i.e. w/o the trauma there would/may not be the genetic/ epigenetic expression ...

"The G.E interaction model appears to be consistent with the theory that ex­pression of plasticity genes is modified by childhood experiences and environ­ment, such as physical or sexual abuse. Some studies have found evidence of hypermethylation in BPD, which can ex­ert epigenetic effects. Childhood abuse might, therefore, disrupt certain neuro­plasticity genes, culminating in morpho­logical, neurochemical, metabolic, and white-matter aberrations—leading to pathological behavioral patterns identi­fied as BPD."

actually

Hi anonymous,

It sounds like we are a little more in agreement than I thought. I think the issue is whether any of these changes are "abberations" or merely just normal physiological responses. We could probably discuss that all day without coming to a definite conclusion about it.

However, behavior in response to such changes is another matter altogether:

Whatever the brain changes may be in response to trauma, they do not stop someone with BPD from using their rational mind to solve problems and then plan and enact a course of action based on realizing that solution. Hence, the brain changes do not stop people from playing a certain role in their families. I have seen lots of evidence that they can think things out and act accordingly, and zero evidence that they aren't able to, although they can easily choose to act AS IF they lack such abilities. (But in those cases you'll invariably see them demonstrate the capabilities if you watch them long enough).

Linehan talks about "apparent competence," but it is impossible to consistently fake competence in something you are not able to do. It's very easy, on the other hand, to fake incompetence: http://www.davidmallenmd.blogspot.com/2010/03/if-you-try-to-fail-and-suc...

"It's very easy, on the other hand, to fake incompetence"

This is just outrageous. Apparent competence means that when we are stable we can fucntion well but when we become destabilised we cannot. You saying that this is just some kind of trick and we are faking incapacity is so invalidating its destabilising me right now.

And I was right. The anonymous commenter above was saying the same thing that I was saying. They were not implying as I explained that BPD was solely a biological problem with brain function so you were wrong again on that score too.

What you are saying here is so offensive and upsetting. Of course we can think things out and act accordingly but when our emotions are flying off the scale it becomes nigh on impossible to do so. You should read what Marsha Linehan has actually said about the condition instead of standing to one side and snearing at it because it didn't come out of your head but hers.

And as for you thinking that your method bears any similarity whatsoever to Schema Therapy is just sick. I have a Schema Focussed Therapist and he has taken the time to look at your blog since I told him how upsetting I found it. He has firmly assured me that your method bears no resemblance to SFT as your position is so invalidating to the patients real life experience of their own emotions.

I didn't say they're always feigning these things

So you're saying that when you're on your last nerve or you are irate with the people around you, that you don't always have the presence of mind to use your best social skills?

You mean, just like everyone else?

It's nice to see you admit to being a normal human being for a change. I was really concerned that for some reason you might be strongly invested in thinking of yourself as mentally defective.

I really haven't discussed my therapy method much on this blog, so unless you somehow got a hold of my last book for therapists and read it, you're once again being very presumptuous in describing my "methods" to your therapist.

BTW, I've met Jeff Young, who designed schema therapy, several times. We have had long discussions. Of course we don't agree on everything, but we agree about far more than we disagree about. The definition of a role-relationship schema is: a mental model of how you are supposed to act in various social situations. Learned in your family of origin. Not a product of merely being upset.

He originally used visualization techniques to try and change family relationships instead of coaching people on how to do it in person with the actual real family member, but last time we spoke he said he was starting to do just that.

While you advise people on how to deal with BPD "provocations" your responses here paint a different picture

How you deal with people on here and on other comments I have found made by yourself on the interent is through a toxic mix of arrogance, defensiveness, manipulation, dishonesty, sarcasm and patronisation. You are in short a joke, but unfortunately a dangerous one. I don't care if you don't respond to me. You've proven time and again that you don't listen to what I'm saying and go ahead and steamroll forward with what you want to say anyway.

I will continue to challenge you for the reasons I have explained previously - because people coming here for "advice" on how to deal with a loved one with BPD need to be aware of your shortcomings. Your responses to my comments frequently expose your flaws much more effectively than my challenging you does anyhow.

I'm sure that in person you are capable of being incredibly charming and saying all the right things to make yourself look like a respectable clinician. I daresay Jeffrey Young has only encountered you on this superficial level. But if he were to come here and read your provocative, offensive and indefensible presumptions about the nature of BPD behaviours then I'm sure he would take a second look at his previous estimation of your character. Add that to the fact that your dishonesty makes you and unreliable witness to Jeffrey Young's estimation of you in the first place.

I will be sure to send links of your more inflammatory posts on here to his secretary and get his direct opinion on the matter.

insults

Since other people read this besides you, if you attack my ideas, of course I will defend them. It ain't arrogance if it's true.

You're pretty "defensive" yourself. When I challenge you on some of the illogical and factually incorrect things you say, you're the one who basically changes the subject.

I obviously don't mind a little sarcasm, but if you engage in any more name calling or abusive insults, attacking my integrity, or calling me a liar, your future comments will be blocked from my page.

oh, the irony of it all...

I get an email notification for all of the comments on this post, since I commented early on.

(sigh)

There really is no response for this long thread of back and forth, but for those of us who deal with people in our lives who suffer form bpd, it just affirms that we are not making up the drama.

Anything you say or do can be misconstrued into something about them. Anything.

It brings back memories of me planning my wedding. My husband and I had dated for 4 years, and I was living independently from my parents. We were both adults and paid for our own wedding. My fiancé and I took my mom and dad to dinner to discuss the wedding date and out-of-town family, etc, and my mother burst into tears and said, "This is just not a good time for me for you to be getting married."

I encouraged my mom not to attend the wedding if it wasn't a good time for her, since IT WASN'T ABOUT HER.

And so the comments on this thread are another reminder as to why I need such firm boundaries and limited contact.

feigning things

"So you're saying that when you're on your last nerve or you are irate with the people around you, that you don't always have the presence of mind to use your best social skills?

You mean, just like everyone else?"

Its not just like everyone else though ... it is and it isn't and that is the deception about BPD!!

(I'm sorry Dr Allen I happen to agree with Heinz on this part of BPD.) I suffer from BPD and I appear normal, I even appear to have competence (like Dr Linehan talks about) most of the time, but when my fear/ emotional upset part of brain is turned on, competence is out the window. (These biological studies even show that my brain is changed to a hyper emotional hyper anxious state that is different than normal people.)

I think the heredity is there along with early life experiences that activated the epi-genetics to change the brain, but the brain is biologically changed. Now years of psychological therapeutic retraining will have a biological restorative change back towards a normal brain, but I happen to agree with the study I posted that it will take a combined approach to really cure BPD.

IMO, normal people get upset just like I would but they can let it go. I can't. My brain gets stuck in the ON position and I obsess, ruminate, become hyper-vigilent, hyper-emotional to a degree far more intense than normal people do. That is the difference that is BPD. Its fear anxiety on steroids and normal people just can't get themselves worked up to the point of BPD so they don't really understand what the sufferer is going through.

You are going to try and tell me that I can turn it on and off like a water faucet and I am telling you I can't. I might appear to be able to, and I can quickly change and be "normal" appearing to someone who hasn't activated my emotional brain activity... but I can't quickly in-activate my actions towards someone that has activated my emotional brain activity. My fear brain is stuck in on (and this is proven biologically) I also don't have the impulse control that normal people have. I can try and learn it but it is a fight. The wiring is faulty it is not something that I have conscious control of ONCE ACTIVATED.

BPD really is not like "everyone else" their brains get activated and then shut off the activation. A BPD brain is changed and does not shut off like everyone else's. Im really sorry that you can't understand that. Psychological conditioning and My will alone will not cure it. We need to understand the biological changes that have happened and work to "fix" those biological changes along with psychological conditioning to really get a handle on this disorder.

BTW, as a BPD I relate more to what Heinz is trying to tell you, than what you are trying to tell me and Heinz. I feel Heinz understands my brains biology and what it feels like much more than you do. I don't mean that as a put down. I just feel like you are not truly understanding ALL of BPD I feel that something is off. I do appreciate many of the parts of BPD that you do get and have worked towards helping but something is missing. I just want to ask that you be open to that

feigning things

Hi anonymous,

I want to thank you for a respectful discussion of the issue and for demonstrating how to disagree without being disagreeable.

I actually agree with you that the brains of chronically traumatized and/or constantly invalidated people (the underlying causes of BPD) become much more quickly reactive and prone to dysregulated states, and that they take longer to recover from them. But given enough stress, anyone can go into a dysregulated state. It's a matter of range of resilience among different people. You don't have to have BPD in order to be sensitive, and a lot of highly sensitive people do not have BPD. It's a matter of degree, not of kind.

I am not saying, by the way, that people with BPD can turn their feelings of distress and helplessness off and on at will in such states, but I do believe strongly that they often control their behavior in response to these states, and when they have not been able to, that they can learn how to do it by changing the way they think about it. So I'm with the CBT folks on that score although only up to a point.

A fellow named Emil Cacarro demonstrated in several studies that certain medications can be used to "raise the bar" so to speak, so that it takes MORE stress to set off a dysregulated state. That has clearly been true in my clinical experience. And this is not just a matter of sedation. Most of my patients couldn't talk about the important issues we go over if I did not prescribe meds for them (and watch them closely for side efffects and tolerability. Luckily there are several medicines in each class, so we can usually find a combo that is both effective and does not create much in the way of side effects).

Marsha Linehan told me several years ago at a professinal meeting that she wanted to do a study combining her stress tolerance exercizes with medication, but the NIMH said no, because, "You're a psychologist." There is a lot more politics in the field than you may realize.

Some people with BPD may also have OCD. That combination makes it extremely difficult for them to "turn off" anything under almost any condition. (In my posts I do have to oversimplify a little so they aren't book length).

You talk about us as if we are spoilers and we're not

That is offensive. A spoiler is not a decent person. A spoiler is someone who ruins other people's lives. I do not. I am offended and I have every right to be whether you intend it or not.

Yes I made a mistake this time but its only because I am sick to death of you giving me this response without reading what I've actually said. You do this all the time and I do it once and suddenly you're on your high horse about it. Its annoying isn't it?

No your methods don't cure BPD. No you don't believe any methods do you've admitted as much on here. Even though so many people are now fully recovering from the condition still you harp on about this crap.

I know what my limitations are in life and I have been conscious of them for a long time, even before a diagnosis or therapy. BPD has never made me behave in the cartoonish manner you depict in this blog. It doesn't relate to me and so many others. I can only conclude that your treatment brings these qualities out in your patients given that they exhibit them so consistently.

You might read research but you rubbish it and refuse to take it on board. The only method you advocate is your which doesn't work in terms of enabling people with BPD to recover completely.

spoilers

Another mischaracterization of what I have writen: I have said clearly that when someone acts out the spoiler role they are actually ruining their OWN lives by sacrificing themselves to the needs of other people. They do what they do for altruistic reasons, not hostile ones.

If other readers miss that point the way you keep doing, I cannot control that. It is counter-intuitive, so it may be difficult for many people to see clearly. That doesn't mean it's wrong.

And people with the disorder who do act like spoilers do so only with certain people in their lives, and not others, precisely because they do have control over it.

If you never or rarely engage in any of the provocations I am discussing, great. Then, as I have pointed out previously several times, this stuff does not apply to you. Obviously I don't know you, so I am in no position to say one way or the other, but I certainly will take your word for it.

Unfortunately, many people with the disorder DO engage in these provocations. Sorry, but that's a fact, whether you like it or recognize it or not.

And I never said that people can't get better with other therapies, but not a single one of these therapies claims to "cure" the disorder any more than I do. If they did, they'd be lying. At least I try to address the family problems at the heart of the disorder, as does Schema Therapy. The others: not so much.

None of them have any study results showing that the relationships of the people in their treatments have changed significantly. If you know of such a study, I'd love to see it. All the existing ones measure is symptom change. And the positive results aren't very dramatic even there, frankly.

I think we've beat this discussion into the ground, so unless you have some new argument to counter what I say other than merely insisting I'm full of BS, I'm going to stop responding. You may think that's hostile, but again you'd be wrong.

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David M. Allen, M.D., is a Professor of Psychiatry at the University of Tennessee and author of the book How Dysfunctional Families Spur Mental Disorders.

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