Resolution, Not Conflict

The guide to problem-solving.

Borderline Personality: Does a BPD Diagnosis Imply Raging?

One aspect of the cluster of traits listed in the DSM for borderline personality lies at the core of this disorder. That trait accounts for all the others. This is a trait that loved ones, friends and work associates all may readily identify. It lies at the heart of what can make an individual a difficult, "high maintenance" person--but it's not anger. Read More

diagnosis or behavior

I will leave this issue for you professionals. I understand that a diagnosis that includes raging as a criteria would be hard for the recipient of the diagnosis to accept. But, I ask this question of you, collectively, just for layperson edification:

Of the people who you view to be properly diagnosed as BPD that you see in treatment, what approximate percentage engage in "raging" at behaviors? What is the frequency of these behaviors?

Excellent question

Most of the bpd cases I see currently do have raging.

At the same time, thinking back on cases of people I have treated who manifested mainly as depressed, I think that if I had known then what I know now, I might have diagnosed them as depressed and also as bpd, i.e., having excessively intense emotional reactions, with anger turned inward onto themselves instead of outwardly toward others and also with lots of anxiety about situations that would not phase most adults.

Thank you John B for this very important and thought-provoking question.

"Borderline" used as a weapon

I read your articles about BPD with interest, as I have been a victim of an ex-spouse calling me "borderline" in court filings in order to shame and humiliate me (and to try and win custody, which failed). Supposedly a former therapist of mine, friendly with my ex-spouse, diagnosed me as BPD, but none of my therapists over the years, including one I saw just last year, agree that I am borderline. We have walked through the DSM-V together and according to the therapists none of the hallmarks of BPD fit me.

It seems to me from reading your articles that it can be VERY difficult to diagnose BPD and that one almost has to be a super specialist to properly diagnose it -- do you agree? That seems to be one of the points that can be taken from your discussion about co-morbid conditions at the end (manipulation, etc.).

Apart from the privacy violation of discussing a mental health diagnosis with a patient's ex-spouse with no patient authorization, I believe that my former therapist was quite uninformed about how BPD manifests and mistook my feelings about being married to a terrible person for the signs/symptoms of BPD. Since I divorced I am doing very well in all facets of my life which might not be the case if I *really* were borderline.

BPD diagnosis

The DSM 5 makes it sound like the syndrome of bpd is as clearcut as an inflamed appendix. Not so. It's a moving target. I do think that as we learn more about the biology though the term will gradually become appropriate just for a hyper-reactive amygdala.

Much of what some people consider now as bpd is actually narcissism, and vice versa. Much of what we've been labeling bipolar could well be bpd.

And truly unconscionable people do get others to testify in court against their ex-spouse in ways that have more to do with punishing the ex than with the realities of what is best for the children.

Psychological diagnosis is pretty slippery, alas, especially when it is used to win a court case rather than to clarify how to help someone who is suffering.

new studies provide greater understanding of bpd (and other mental illnesses)

I came across this article from last year, RE some very interesting studies concluding that most common psychiatric disorders share genetic roots:

excerpt:

"The findings could help explain many apparently odd connections between psychiatric disorders. For example, autism was once known as childhood schizophrenia, in part because people with both conditions seem to be mesmerized by their own internal worlds. Conversely, some of the adults labeled as having schizophrenia in the past might have been diagnosed with autism instead if their childhood history had been known.

“In families with bipolar disorder, the risk of schizophrenia is increased, so we knew that there was some overlap, but it was not clear to what extent,” says Thomas Lehner, a co-author of the study and branch chief of genomics for the NIMH.

The new knowledge of the common gene-based roots could help to tease apart some of these overlapping symptoms and diagnoses. Some of the variants the researchers found are more common in patients with depression, for example, while others are more prevalent among those with schizophrenia. But without biological tests to differentiate between disorders, until now, symptoms have been the only guide to classifying psychiatric conditions. To make matters worse, many people have symptoms of more than one disorder and many disorders share some of the same symptoms."

Although this particular study didn't mention whether borderline pd could be included on this "common gene-based root", further studies will hopefully include the personality disorders in their research goals.

Here's the link to that article:
http://healthland.time.com/2013/02/28/most-common-psychiatric-disorders-...

Also, another recent study concluded that borderline pd is as prevalent in men as it is in women, its just that the traits tend to present somewhat differently in the sexes.

Excerpt from the abstract:

"...current evidence indicates that there are notable gender differences in borderline personality disorder with regard to personality traits, Axis I and II comorbidity, and treatment utilization."

Here's the link to this study:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/
"Gender Patterns in Borderline Personality Disorder"

I find this particular study fascinating because, according to its data, my mother had more of a "male" presentation of borderline pd:

"...men with BPD were significantly more likely to demonstrate an "explosive temperament", and have comorbid paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders. In support of these data, in the previously noted study by Tadic et al,16 researchers also found a higher frequency of antisocial personality disorder in men compared with women (57% vs. 26%). Therefore, men with BPD appear to be characterized by antisocial overtones."

Hopefully, continuing genetic and neurological research of borderline pd will help us recognize the disorder more easily and earlier, and will help develop more effective treatments.

-Annie

Great references.

I checked out both articles. Both were informative and thought-provoking. Thanks Annie!

Raging

What is known as raging in those with BPD is highly misunderstood. The idea that someone with BPD imagines they are being victimised and then attacks people for no reason is not how we with the condition actually experience our emotional dysregulation.

The problem is that yes, part of having this condition is that our emotions go from 0-60 with very little warning to ourselves and others, but there are triggers and we are aware of them.

In the confines of a co-dependent relationship it is very difficult to say "What you are saying is causing me to become dysregulated and I need some time to calm down and think straight" without being accused of "avoiding the issue", "projecting", "blaming" giving the "silent treatment" and any other manner of perjorative affectation that people use to describe what is really going on.

When we are hemmed into a situation in this way yes, we rage! Often we see it coming and in spite of our best efforts to avoid these horrible feelings or subject others to them, we are not understood well enough and our condition is not given the space to be properly controlled.

Those who learn to listen and respect that they are in a relationship with someone who has, and knows, their limitations, then raging dissipates.

We are not irrational monsters who pick fights for the sheer hell of it. Raging does not come from nowhere for no reason and it is not a suitable indicator for the presence of BPD if the raging is indeed abusive, controlling and self indulgent.

our own subjective experiences, and new findings about bpd

I guess that each of us is kind of "trapped" in our own subjective experience RE having this disorder or being with someone who has this disorder (both chosen and unchosen relationships.)

I can understand how the study I referenced about male patients with bpd might not resonate with a guy who has bpd, because your subjective experience feels different to you than the study describes, and your collection of traits is your own.

From your point of view, as someone who has bpd, you feel that there are reasons that you had or have for acting out with anger, or for withdrawing.

And from my point of view, as the child of a mother who had bpd and who acted "out" instead of "in" (she had paranoid ideation, unpredictable mood swings, a hair-trigger temper, etc.)...my point of view is different. As I read that study, all I could think was Holy Cow, that was my mother! My little Sister and I survived the chronic emotional and physical abuse, emerging into adulthood with some pretty substantial emotional damage; Sister still has blocks of amnesia from her childhood and early teen years, and I have avoidant pd traits; we both still have some PTSD traits, but to a much lesser degree now.

Of course, I share this keeping in mind that bpd can and does present in a range of severity: the traits can be expressed in a mild and infrequent way, or they can be expressed in an extremely frequent and intense way, and everything in-between.

Plus keeping in mind the even more confounding factor that its much more common for borderline pd to occur WITH other disorders than it is to occur alone, based on other material I've read.

The studies and books I've been reading over the last decade or so repeat and share the fact that there simply isn't any "just one way" that bpd presents, in either sex. Currently, borderline pd is a large and rather unwieldy diagnosis; there are over 200 different combinations of the 9 diagnostic traits (which remain essentially unchanged in the DSM 5, correct?) making each patient's collection of traits and behaviors, their frequency and intensity of presentation, and their probable comorbid conditions about as unique as their fingerprints.

What seems hopeful to me is that NIMH has announced that they're taking a whole new approach to studying and classifying all mental illnesses, based on the scientific or medical model as well as on traditional symptom clusters. They're calling the new program the Research Domain Criteria (RDoC).

New diagnostic procedures (real-time computerized 3-D MRIs, neurological workups, brain chemistry analyses, genetics, etc. as well as the patient's behaviors and subjective experiences) will allow a diagnosis to become more targeted and personalizied, and more accurate, hopefully resulting in more effective treatment based on that particular individual's collection of traits and behaviors, their history, and the neurological underpinnings causing the disorder.

I feel great hope in these new findings about bpd and the new direction that NIMH is trailblazing, and I "predict" that borderline pd will either be broken up into subtypes or it will be absorbed into other classifications and cease to exist as "a" disorder.

misc

These comments are interesting.

As I understand Red Baron, a/the problem is that non-BPDs do not permit a BPD to self-regulate or trigger the BPD's emotional response and successful relationship adaptation requires that the non-BPD behave in a "respectful" manner -- which avoids triggering the BPD and/or permits the BPD time to self-regulate his/her emotions.

This places significant burdens on non-BPDs in a relationship with the BPD, in that they must show "respect" in a context where it may not appear to them that they are receiving "respect".

Another comment indicates that it was inappropriate for a therapist to testify about a diagnoses in what appeared to be some type of family therapy. I suppose that this issue turns on whether a particular jurisdiction recognizes therapist/client privilege (which typically is statutory if it exists) and to whom the privilege runs, since HIPAA provides that a subpoena is an exception to non-disclosure rules that generally apply to personally identifiable health information. Also, from my personal experience, it would be difficult to diagnose someone as BPD without looking at their interaction within the whole family unit (which goes to Rule 412 admissibility prejudicial versus burdensome analysis).

Setting aside the nastiness that typically exists in divorce litigation, this does not appear to me to be as much of a diagnosis issue as it is an evidentiary issue. Further, a competing expert can deflect the therapist's testimony so as the judge is like to view it as a "push". So a diagnosis that is not undisputed seems to me to be of very limited litigation value.

I have read that other mental health disorders have genetic patterns that create at least a propensity to have a problem, so it would not surprise me that the same would apply to BPD.

What interests me most, though, in these comments is relationship "duties" generally, adult relationships with people with mental health conditions (e.g., BPD, ADHD, NPD) and from where the duties arise. Relationship duties among adults, at least in my view, are reciprocal and must have a "balance of equities" freely agreed to by the parties. Adults generally have duties to their children.

I understand that people with BPD have developed it as a result of receipt of bad treatment (that may trigger a genetic propensity for BPD according to one commenter). But, people do not come with "warning signs" on their foreheads. A BPD person may have had no idea he/she was BPD until well into a relationship. And, since many people believe concealing their flaws is a good relationship acquisition strategy, neither person may be aware of the high likelihood of significant relationship difficulties until it is too late to undo the deal.

I believe that a successful relationship has to have some sort of internal balance. If that is true, then there must be a sufficient benefit to the partner who has to conform his/her behaviors to permit/not trigger bad/over-reactive responses from a BPD. So, at what point will the "equities" in an adult to adult
relationship even-out? What "extra" value is brought to the table that compensates for the burden of "being respectful" in a difficult circumstance when the person asked to be respectful likely also may be "triggered" by behaviors?

This question is not meant to be "BPD bashing". Instead, I ask it to understand what the end game is -- what is in it for both the BPD and the non-BPD at the "end of the rainbow" and how that fits with my concepts of reciprocity and equity balance. I have read a lot of these articles, but have never heard anyone discuss this.

To BPD commenters -- thank you for sharing your views on this if you are willing to do so.

Compliments first to all of you...and the need for mutual exit routines

My compliments first to all of you in this discussion group. The tone is 100% mutually respectful of each other, and also of both bpd's and non-bpd loved ones. Bravo for handling the sensitive subject of bpd so cooperatively! This kind of discussion is a good part of what makes writing for PT so rewarding for me.

On to the issues you have raised:

With regard to how couples manage the propensity for rapid emotional escalation of someone with bpd, it's imperative that the couple work out mutual exit routines. They must agree upon mutual choreography for exiting to calm down at the first sign that either partner is slipping out of the calm zone.

When the choreography of exit routines has been mutual, neither partner feels that the other is walking out on them or unwilling to discuss issues. To the contrary, walking out when getting over-heated is what enables a subsequent discussion of the problem to be productive.

When both partners agree that they will discuss issues that come up only in a calm and thoughtful tone like, for instance, the discussion in this set of Comments, then, after a pause, upsetting interactions easily meld into shared problem-solving and quick restoration of goodwill.

My post on Anger is a Stop Sign is relevant here: http://www.psychologytoday.com/blog/resolution-not-conflict/201208/anger....

Also, see A Plan for Zero Arguments: http://www.psychologytoday.com/blog/resolution-not-conflict/201201/plan-....

As Annie and I have discussed in the Comments to my earlier articles on bpd, in parent-child interactions the child has no exit option unless the parent has insight about his/her anger. Parental bpd and raging have terrible and potent consequences which the child has little or no power to do something about. Very sad. That's what my articles on When Your Mother Has BPD have been about: http://www.psychologytoday.com/blog/resolution-not-conflict/201210/when-...

Verbal abuse of children is a problem which we as a society must address more effectively than we have thus far: http://www.psychologytoday.com/blog/resolution-not-conflict/201403/verba....

In closing, this discussion suggests to me that it might be a good idea for me to add the links I've shared above to the main article. I'll do that right now. Thank you all!!!

I personally feel it is important for a person with BPD to learn to live by themselves before getting into a relationship

I didn't mean to imply that all the responsibility in a relationship should fall upon the partner who is mentally healthy. Rather I was saying that if you are in a relationship with someone who suffers from a serious condition it is important for you to take an interest in understanding what that condition is.

With BPD we often seem like nothing is wrong and so if you are with a partner who believes that is the case, even when you explain that it is not, and fails to take into consideration that they are with someone who is not well the relationship will not work.

I have had such relationships. I have told the person exactly what my problem is and that sometimes I just cannot function. However, when it comes to the crunch and you can't make it to an important function, or you can't make it to work and your partner doesn't see that its because of your condtion they start looking for reasons for that outisde of the reasons you have explained.

Often these people end up on sites where their fears are confirmed. They are told that their partner isn't ill but rather that they are being passive aggressive, selfish, manipulative. Armed with this "clear" perspective of what their partner is "really" doing then they start using "techniques" to improve their boundaries against what they perceive to be "BPD abuse". So then you have a situation where someone who is very unwell, who has explained exactly what their limitations are and why they can't do certain things, being told that they are only pretending to be unwell in order to control and manipulate their partner. Recipe for disaster wouldn't you agree?

For me personally I have chosen to be single and commit to therapy. This is not because I am abusive but because it is so hard to find someone who genuinely understands and accepts that you are very ill when there is so much misinformation about the condition which is guaranteed to destroy any relationship you may wish to embark upon.

And when it comes to children of those with BPD I have to say I know plenty of people with BPD who make great parents. As there are rational triggers which cause us to become dysregulated those who genuinely suffer from BPD tend to have an intrinsic understanding that children are not accountable. The myth of the demon BPD mother is one of the most insidious that there is.

BPD is a highly gendered diagnosis and there is no good reason for it to be so. So many women in the past have been wrongly diagnosed with BPD when in reality they were sadists, narcissists and violent psychopaths.

Importance of insight.. and mislabeling

What strikes me most about your writing is your capacity for insight about the condition you struggle with. Bravo @Heinz.

Also I totally agree that bpd is given its bad name when it is assigned to people with bad behaviors that more likely stem from narcissism, sadism, and/or psychopathy.

Most of us do have a great deal of insight

Thanks for the compliment but I have to say as far as genuine BPD goes I'm pretty typical. You'd think with our reputation that support and therapy groups for those with BPD would be awful places but they're not. Everyone gets what you are going through and it is just such a validating experience. Even online forums where you usually end up getting into rows for very little at all, BPD forums are different in that people are genuinely sensitive to each others needs.

There is so little research being done into the positive qualities that those with BPD possess but we do have very many. The BPD is bad but the hypersensitivity which causes it to develop is incredible and I wouldn't wish to give that aspect up.

This is about the only research I've found on BPD and heightened sensitivity but I do hope that more people will start making the connections that those of us with BPD have already made amongst ourselves.

http://www.psychologytoday.com/blog/science-the-border/200907/borderline...

Thanks for giving BPD a second look, we're worth it <3

You are right; not every person with bpd is a bad parent

You are correct, Heinz and Dr. Heitler: not every person with bpd is a bad parent.

And I understand that from your point of view, Heinz, based on your personal experiences, bpd is mostly (if not exclusively) about depression, suicide, and self-harming behaviors (DSM IV TR diagnostic traits 1, 3, 4, 5, 6 and 7.)

But my experience, and my younger Sister's experience, and the experience of literally thousands of others whose parent had or has bpd (most often the mother is the parent with bpd), these other diagnostic traits and behaviors of bpd were/are expressed the most frequently and intensely:

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper tantrums, constant anger and reoccurring fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms

(And the other bpd traits my mother expressed most often were #4 and #6; she only occasionally mentioned that "empty" feeling, RE trait #7.)

Its unfortunately true that bpd can and does express so differently from individual to individual, but that's the way the disorder is currently defined. I think it does a disservice to patients for the diagnostic criteria to be so wide-ranging.

But as it stands now, Yes: my mother was formally diagnosed as having bpd (not psychopathy, not narcissistic pd, not sadistic pd) by an experienced psychologist, and yes, she did express her bpd in ways that had made her very badly unsuited to be caring for children. My mother only went in for therapy late in her life, long after Sister and I were adults, and mother never accepted her diagnosis. She wasn't able to deal with the reality that she had done long-term physical and emotional damage to both of her children, my little Sister and me.

So, I would truly appreciate it if you did not discount my experiences, my Sister's experiences, or the experiences of other adult kids of bpd parents who did inflict emotional and physical abuse, by calling it a "myth." That is really very invalidating.

Again, I emphasize that you are correct: not every person with bpd is a bad parent.

I recognize and accept (joyfully!) the fact that there are people with bpd who are good parents, but apparently many are not. And its sad.

Its actually a tragedy, because maltreatment of children can be a factor contributing to the child developing bpd or some other mental disorder, their own self. And, abused kids are at a higher risk for becoming abusers themselves as parents.

I invite you to read the book "Get Me Out Of Here: My Recovery From Borderline Personality Disorder" by Rachel Reiland. She was an abused child who grew up to have borderline pd, and it took great courage for her to admit that she'd abused her own child. In fact, that is what propelled her to seek therapy.

Rachel realized that she needed help after she'd triggered into an out-of-control rage at her three-year-old and couldn't seem to stop herself from beating him. But when her rage episode passed and she realized what she'd done, it made her feel suicidal, so she decided on her own initiative to get help. It took a staggering amount of time and effort, but with the emotional support of her husband and some good therapists she is now considered cured.

I find great hope in that book for those with bpd and for their families.

May we all heal.

-Annie

I don't doubt that you were abused as a child Annie.

What I want more than anything is for discussions surrounding BPD to be more focussed on the nature of the condition itself and not so constrained by the accounts of those who have had relationships with those with BPD.

BPD is a curious case in this regard as it is in so many others. There are plenty of people who have been abused by parents with depression, schizophrenia, bipolar, or any manner of mental malady. But nowhere else other than in the disucssion of personality disorders do those people who have experienced abuse demand that their accounts of abuse be taken into account when discussing treatment for and theoretical paradigms for discussion of their abusers real or perceived mental illness.

Given that you understand that many people who suffer from BPD, as indeed many people who don't, are not abusive to their children can you not understand that linking abusive behaviour to the pathological construction of BPD as being stigmatising.

If a child experiences abuse at the hands of their parents then there are services and treatments that can enable them to recover from that outside of discussions of the mental condition, if indeed it was mental condition at all, that lead to their abuse. That is if they are lucky enough to escape their abusive childhoods without developing BPD.

So much misunderstanding and stigma surrounds this particular condition and it is in no small part due to the work of people like Randi Kreger, Shari Schreiber, Tara J Palmatier and BPDFamily in encouraging people to believe that there is some virtue in understanding BPD in order to recover from their abuse. Indeed these people will inethically confer a diagnosis of BPD on their comsumers "loved ones" in order to make them feel they have some particular expertise in assisting them to overcome their abuse.

BPD can lead to abusive behaviour but not because of the condition itself. I myself suffer from all 9 symptoms of BPD but it never lead me to be an abusive person to anyone but myself. BPD in connection with a dysfunctional, co-dependent marriage, low economic standing and lack of social support may well cause people with BPD to become abusive but the condition itself does not.

If we are to develop strong treatment programmes for BPD, encourage mental health professionals to train in treatment methodologies that enable recovery from BPD, and protect all people from the problems that BPD can cause in confluence with other contributory factors, then we need to free discussion of BPD from the concerns of those who wish to maintain the view that BPD = abuse.

You are a grown adult who can access numerous services in order to overcome your experiences of abuse as a child. If you are still suffering after treatment for abuse and still after all this time obssessing over the condition you believe caused your mother to be abusive then you may well have BPD yourself. Its not an easy diagnosis to get, many mental health professionals will diagnose without telling you, or indeed as happened to me misdiagnose you with MDD because they didn't understand what BPD was or recognise its symptoms in your presentation. I believe Susan Heitler herself has even said as much in response to her viewing David's video.

It is not ethical or in anyway helpful for a mental health professional to make a diagnosis of a third party based on the accounts of abuse made by their clients. This needs to stop because all it does is secure a new generation of voices obfuscating the discussion surrounding BPD. Get help for yourself and leave BPD out of it please. We need to get rid of the stigma.

This is a particularly pernicious example of the phenomena I have discussed above

This article by Randi Kreger directly challenges research into the nature of BPD made by qualified clinicians treating those who are actually diagnosed with BPD. In the article she makes a commitment to her readers that she will make it her mission to demand that researchers take into account the need to extend the definition of BPD to include those people who are abusive to her consumers but refuse to undergo clinical assessment for the condition. I believe Randi Kreger herself was actually responsible for publishing Rachel Reiland's book and I have no doubt that she has picked an example of BPD presentation that fits her perception of the condition.

If you want to understand how this kind of topic negatively effects public perception of BPD in a stigmatised way then read the comments that follow. Most of these people openly confess that their loved ones or, in the main ex partners did not have a diagnosis of BPD. Thats because what they are disucssing is actually naricssism and not BPD.

http://www.psychologytoday.com/blog/stop-walking-eggshells/201106/the-gr...

Overlap between narcissism and bpd.

Many clients with one of these disorders have co-occurence of the other. That's understandable because when people are angry, or for that matter in any highly elevated emotional state, they become unable to hear others' concerns, The brain does not uptake new information well when emotions are highly aroused. Once a person goes "back brain," relying on the mid and lower brain areas, the frontal lobes which are where new data is processed turn off, like a frozen computer.

Once someone has "gone backbrain," they will tend to attack. The attack can be directed either at themselves with depression or others with anger.

If the emotions are expressed as attacks against others, this behavior creates a significant part of the "stigma" that is attached to both narcissism and bpd. Growling, biting animals may be responding out of feeling threatened. At the same time, their attacking behavior definitely triggers others to run and leaves a lasting negative impression, i.e., stigma.

Stigma not caused by how BPD presents but rather how it is misrepresented

Stigma is generated by clinicians who perceive those with BPD as being wilfully manipulative when what they are actually doing is trying to convey that the treatment they are receiving is not working and they need their symptoms to be taken seriously. As I said previously this is where the stigma began, by clinicians pathologising patients natural reaction to professionals misinterpretting their symptoms.

While there have been some inroads into overthrowing these stigmatising misinterpretations there are still clincians who will and do misappropriate BPD diagnoses to those who are wilfully manipulative.

What you are referrring to in this comment as "stigma" is not what I mean by stigma itself. BPD is well known to be the most stigmatised mental health condition. Whenever one is discussing BPD one must be aware of what the stigma is and where it derives from.

Yes I have certainly experienced people being wary of me because of the physical manifestation of the stress within my body. I had one boss who was being particularly insensitive about my need to take time of work accuse me of threatening her with physical violence precisely because my teeth and fists were clenched and I was shaking in my chair. I had no intention of being violent towards her I was simply overwhelmed with my emotions and attempting to hold them within myself.

If people don't understand what is really going on with us then they will misinterpret our presentation but that is not what stigma is. Stigma is intentional misrepresentation which derives from an antiquated belief that those with BPD are pathologically manipulative and seek to abuse others. Do you understand the difference between what I am saying is stigma and what you are referring to as "stigma"?

BPD stigma is real and it is the main barrier those who suffer from the condition face in order to access treatments that work rather than make us very ill. It is not something we have created or something our behaviour causes others to perceive. It is an ideological construct which deliberately misinterprets BPD so that those who come in contact with this stigma will be prevented from truly understanding or assisting those who suffer from the condition.

Here is a video lecture about BPD stigma that explains better and more authoritatively than I can

I hope you will take the time to watch this video about BPD stigma. While watching it please bear in mind that Blaise Aguirre exclusively treats BPD patients and is a world expert in research into and treatment of BPD patients. He works up to 12 hour days at the Mclean treatment facility. His analysis of the vast chasm between the reality of BPD symptom presentation and the misrepresentation of the condition embodied in stigmatised notions is world class.

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

There are no "Disorders" Only Coping Mechanisms

BDP is defined in the DSM as "a pattern of instability in interpersonal relationships, self image,and affects,and marked impulsivity". So anyone who likes change, is a free spirit, doesn't like to be tied down and shops on impulse could end of with a diagnosis of this "disorder". Of course if you can't make up your mind which "disorder" you would like there is always "Personality Disorder Not Otherwise Specified" - which, unfortunately, of course can only apply to people with personalities. People who lack personality unfortunately cannot have a "Disorder" and I feel that this is a tactless and sad omission by the DSM Authors. Perhaps the Authors could make an amendment and include disorder of "No Personality Disorder" OH no that wouldn't do that sounds like the sufferer has no "Disorder" - how cruel - instead of having no Personality. I need to think more on this - maybe I'll leave it to the DSM Authors they get away with - I mean they discover and out all kinds of human foibles - I mean "disorders"
How wonderful for all you Psychiatrists and Psychologists - so many new "disorders" mean so much new business. And BPD introduces you to interesting colourful and entertaining people - much needed light relief from all the depressives and anxiety ridden. With DSM everyone is a winner

NIMH agrees, that's why they're scrapping the DSM and starting over

NIMH is the agency that funds the research and development of the DSM.

Last year Dr. Thomas Insel, the Director of NIMH, stated that the DSM-5 as well as the earlier editions "...lack validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment."

"Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."

It will probably take a decade or more for this new system, called RDoC, the Research Domain Criteria project, to evolve from being just a research framework into a practical clinical tool, but it will be worth the time and effort, I believe.

Insel concluded his announcement by stating that all the resources of NIMH "...are committed to seeking new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes for patients."

Misdiagnosis due to ignoring "Differential Diagnosis" Procedure and Ignoring of Betts & Neihart Profiles

As you are no doubt aware ‘differential diagnosis’ is a systemic method used by doctors to identify a disease or condition in a patient. Based upon a preliminary evaluation of the patient, the doctor makes a list of diagnoses in order of probability. The physician then tests the strength of each diagnosis by making further medical observations of the patient, asking detailed questions about symptoms and medical history, ordering tests, or referring the patient to specialists. Ideally, a number of potential diagnoses will be ruled out as the investigation progresses, and only one diagnosis will remain at the end. Of course, given the uncertain nature of medicine, this is not always the case. Sometimes, after further investigation, the doctor will discover other information that will cause him or her to add to the differential diagnostic list.
Unfortunately, in all jobs, there are competent and incompetent, there are those who do a thorough job and those who do a slipshod job. Intelligence does not correlate to professionalism - people are lazy and careless in all walks of life. The DSM was a godsend to these types of Psychiatrists and Psychologists - simply get someone else to tick boxes on a checklist - designed to contain leading questions- designed only to find wrong (no checklist is designed to find diverse intelligence, giftedness, talent, and or abuse - so checks for these are and can be eliminated by the lazy useless diagnositician - who can, in the case of minors, blame the teacher and or parent if the boxes ticked lead to an incorrect and or harmful diagnosis.
No regard is taken of the Betts & Neihart Profiles of Giftedness - which should be an essential component in the diagnosing of anyone with a "disorder" - as you will see clearly from this how easily misdiagnoses can be and are made.

Interesting, Revealing and Encouraging

Thanks very much Annie for your very interesting, revealing and encouraging article

BPD and Giftedness

A form of Giftedness which includes an exceptional ability to recognise and identify the most fleeting emotional responses - which, as you can imagine can lead to distress and conflict. As fleeting negative emotions,nor unwanted desire emotions cannot be hidden from this Gifted, the Gifted is thus exposed to a greated degree of unwanted , unneeded, negative and or otherwise harmful information, reactions against and coping mechanisms for which may result in a diagnosis of BDP

An odd definition of "gift"

I'm sorry but I can't agree with the viewpoint that the symptoms and traits of bpd (as currently defined by the DSM) are some kind of "gift".

If anything, super-hyper emotional sensitivity is more like a curse, not only for the person who has it, but for those around them.

We couldn't just laugh and be silly, or cry, or have an argument, or express any anger around our bpd mother, because our bpd mother was too hypersensitive to the emotions of others. So we weren't allowed to be real; we had to be robots or dolls that have no feelings. Our childhood was focused on being "perfect" so as not to upset our hyper-sensitive mother.

Extreme emotional lability is not a gift, being terrified of being alone isn't a gift, seeing others as being either all-good or all-bad isn't a gift.

That lost, empty feeling: having no core sense of self, no "me" inside, is not a gift. Having little if any impulse control is not a gift, and feeling suicidal or feeling the need to cut or harm yourself is certainly no gift.

Feeling irritable most of the time, or being unable to stop yourself from launching into an angry tirade at your friend, your spouse, your child and then feeling lower than a piece of dung afterward for hurting them, wow, yeah, what a great gift that is.

Feeling like everyone is against you and wants to hurt you, seeing hostile intent where there is none; this is a gift? Experiencing temporary dissociaitive states (blanks in your memory) is a gift?

I grew up observing my mother as she experienced most of these destructive, negative feelings and behaviors, and being subjected to them.

BPD is not a "gift" in any sense that is positive.

Although, yes, we are currently stuck with the DSM until NIMH completes their RDoC project, I hope that sooner rather than later that cutting-edge technologies and the new information researchers are turning up RE genetics, neurochemistry, brain structure and conectivity, etc., will help ameliorate and normalize these negative, destructive symptoms and traits of bpd that cause so much suffering, not only in the person who has these symptoms but their families as well.

Not "Gift" but "Giftedness"

The term is "Giftedness" unfortunately not the best term - as it causes misunderstanding - and is a term used to describe forms of intelligence. It is believed that a trait of a form or forms of "Giftedness" is a heightened ability to perceive emotion in others, even fleeting emotions - apparently also a trait of BPD

In this case, its a negative form of giftedness

The point is, this super-heightened emotional sensitivity in those with borderline pd doesn't benefit the person with bpd or those around them.

Its not a positive attribute; I wouldn't call something that hurts people "giftedness." Dr. Linehan, the psychologist who developed Dialectical Behavioral Therapy to treat borderline pd and who shared that she herself has bpd, said this abnormally high emotional sensitivity is like being an "emotional burn victim"; the slightest touch to the burn patient's raw skin is excruciatingly painful.

Those with bpd tend to perceive negative intent or hostility in an emotionally neutral face or an emotionally neutral comment, which causes a lot of conflict and heartbreak between the person with bpd and their loved ones. My speculation is that perceiving negativity or hostility where none exists is probably related to trait #9, "transient, stress-related paranoid ideation".

The good news is that thanks to Dr. Linehan and other sensitive, caring therapists who are familiar with DBT and other forms of therapy, those with bpd who seek treatment can be helped.

If you actually have BPD you can see how it is in many ways a gift

As I've said to you before Annie, I doubt your mother actually had BPD and so she is not a good example of how to judge what BPD really is. Given that she was abusive and incapable of reacting to her children's emotional state then it is highly unlikely, given what we know about BPD now, that the diagnosticians from the latter half of the 20th century made a correct diagnosis. I hope that Leo will see that this fits in with his critique of the diagnostic system.

Given that you do not have BPD you are not a good judge of how it acts as a gift. It is a painful one but the hypersensitivity does indeed enable you to empathically understand other people's pain to a greater degree than the general populace. This has been proven scientifically and is not up for debate.

Because of the stigma that surrounds BPD not enough research is being done into the positive qualities of people suffering from the condition and yes we do suffer but suffering is not all we are nor how we wish to be defined as individuals.

My friends would not agree with you at all that people who suffer from BPD are nothing but a negative force to themselves and those around them. As I have said before I am not an abusive person and most people with BPD are not either. My friends rely on me to be there for them and I am the first port of call when people are now are in any tight spot or distress. They know I will understand as my experience of emotional pain and dealing with it is exceptional.

While you might think this narcissistic of me to say so, unfortunately when defending ourselves against accusations of being so much human detritous we are often forced to state exactly why this is incorrect.

I don't need help to become a better person at all and that is not why I am in therapy nor is it what I am learning to overcome in therapy. My therapist has helped me to see that my positive qualities are entirely my own - my compassion, my passion, my empathy, my intelligence, my strong desire to be a force for good in the world and my ability to help others in times of need.

What my therapist is helping me to do is to come to terms with the fact that we live in a society that is not based upon these principles, to enable me to overcome my frustration at that fact and to appreciate that I am a good person in spite of how I may be percieved, This validation is helping me to recover and being subjected to harsh and invalid criticisms about my perceived pathology is in now way beneficial to me, or anyone else with this condition.

Wrong Diagnosis - You dont have BPD

Hello Heinz
You are not BPD - Gifted most likely (you might be interested in Dr. Dorothy Rowe's take on "disorders" - I highly recommend her Book 'Beyond Fear'

Annie,
I agree with Heinz - I don't think that your mother had BPD - not only because I don't believe that "disorders" exist - I believe that coping mechanisms and distress signals are wrongly perceived as "disorders" - perhaps the diagnosis convinced your mother that she had a "disorder" and that she thus couldn't and or didn't have to do anything about her behaviour - perhaps the diagnosis did more harm by incapacitating her into believing that she had no control over the situation - perhaps it gave her an excuse

I understand where you're coming from, so to speak

I understand that its not pleasant to consider that a particular set of negative behaviors (that is currently being referred to as bpd) can and does cause harm not only to the person who manifests these behaviors, but to their loved ones as well.

But as it stands now, the collection of behaviors that is currently called "borderline personality disorder" can and does present with both self-harming behaviors and with other-harming behaviors.

I understand that there is a community dedicated to de-stigmatizing all mental illnesses and borderline pd in particular. I agree that stigma and lack of available mental heath care is a real issue. There should be more psychologists who are trained in dialectical behavioral therapy; mental health care should be as readily available as medical care for physical trauma.

But claiming that those who have borderline pd in particular *never* act out in harmful ways towards other people, is simply not accurate.

You rationalize your point of view by stating that those who do act out in harmful ways towards their loved ones (or others) can't possibly have borderline pd: your argument is that they've all been misdiagnosed.

So, using my own case as an example, even if my mother's psychologist agreed to publicly confirm her diagnosis here (I don't know if he would do that or not, since my mother is deceased now) but even if he consented, the mental-illness-anti-stigma community would simply claim that his diagnosis was wrong.

I understand *wanting to* distance bpd from other-harming behaviors, but wishes aren't facts; to claim that those who act out with rage or violent behaviors or emotional abuse towards others have universally been misdiagnosed is an illogical argument not based on facts or evidence.

So, since there is such a wide gulf between our viewpoints, it seems that there isn't even a middle ground for us to meet halfway on.

You have the right to your opinions, and I have the right to mine.

But I will speak up when (in my opinion) misinformation is being promoted as the truth.

And, by the way, my mother never accepted her diagnosis, either time. She believed that there was nothing wrong with her, she was just fine, and that she didn't need therapy because all her problems came from other people (particularly dad, my Sister and me.) The first time mother was diagnosed with bpd was by a marriage counselor, back when my parents were in their 40's; it was mother's wish for the marriage counselor to "straighten out" my dad about a few things, but when the counselor suggested that mother would benefit from individual therapy for borderline pd, she went ballistic. Mother's second diagnosis was about 25 years later, in another state, given by a psychologist.

I myself believe that my mother had some comorbid narcissistic pd traits, and a couple of antisocial pd traits, but she mainly evidenced and displayed all the bpd traits except suicidal ideation. But each of the therapists only gave her a bpd diagnosis.

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Susan Heitler, Ph.D., is the author of many books, including From Conflict to Resolution and The Power of Two. She is a graduate of Harvard University and New York University.

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