http://outofthefog.net/Disorders/BPD.html
Borderline Personality Disorder (BPD)
Borderline Personality Disorder is a serious
condition which is believed to affect between 1-3% of the general
population. Yet, despite being so prevalent, BPD is not commonly understood.
People who live in a relationship with a person who
suffers from borderline personality disorder often know that something
is terribly wrong with the behavior of their family member or loved-one
but often do not know what to do about it or that there is even a name
for it.
There are a number of different names used around the world for the same disorder:
- Borderline Personality Disorder (BPD)
- Emotional Regulation Disorder (ERD)
- Emotional Dysregulation Disorder
- Emotional Intensity Disorder (EID)
- Emotionally Unstable Personality Disorder (EUPD)
- Emotion-Impulse Regulation Disorder (EIRD)
- Impulsive Personality Disorder (IPD)
The most commonly used name today is Borderline
Personality Disorder - or BPD - as defined in the American Psychiatric
Association’s Diagnostic & Statistical Manual (DSM-IV-TR).
The term "Borderline" is a historic term coined to
describe people who were diagnosed to be on the borderline between a
neurotic and psychotic disorder. It is commonly felt that the
"Borderline" label is misleading and stigmatizes the disorder. The fifth
version of the Diagnostic & Statistical Manual (DSM-V) is scheduled
for release in 2010. It is likely that the disorder will be renamed
Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder
(EDD) in the DSM-V.
The following list is a collection of some of the
more commonly observed behaviors and traits of those who suffer from BPD
/ERD. Click on the links on each one for more information about a
particular trait or behavior and some ideas for coping with each.
Note that these traits are given as a guideline
only and are not intended for diagnosis. People who suffer from BPD are
all unique and so each person will display a different subset of
traits. Also, note that everyone displays "borderline" behaviors from
time to time. Therefore, if a person exhibits one or some of these
traits, that does not necessarily qualify them for a diagnosis of BPD.
See the DSM Criteria on this page for diagnostic criteria.
Alienation - The act of cutting off or interfering with an individual's relationships with others.
"Always" and "Never" Statements
- "Always" and "Never" Statements are declarations containing the
words "always" or "never". They are commonly used but rarely true.
Anger
- People who suffer from personality disorders often feel a sense of
unresolved anger and a heightened or exaggerated perception that they
have been wronged, invalidated, neglected or abused.
Baiting - A provocative act used to solicit an angry, aggressive or emotional response from another individual.
Blaming
- The practice of identifying a person or people responsible for
creating a problem, rather than identifying ways of dealing with the
problem.
Bullying - Any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.
Catastrophizing
- The habit of automatically assuming a "worst case scenario" and
inappropriately characterizing minor or moderate problems or issues as
catastrophic events.
Chaos Manufacture - Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.
Cheating
- Sharing a romantic or intimate relationship with somebody when you
are already committed to a monogamous relationship with someone else.
Circular Conversations - Arguments which go on almost endlessly, repeating the same patterns with no resolution.
Cognitive Dissonance
- A psychological term for the discomfort that most people feel when
they encounter information which contradicts their existing set of
beliefs or values. People who suffer from personality disorders often
experience cognitive dissonance when they are confronted with evidence
that their actions have hurt others or have contradicted their stated
morals.
"Control-Me" Syndrome
- This describes a tendency which some people have to foster
relationships with people who have a controlling narcissistic,
antisocial or "acting-out" nature.
Denial - Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.
Dependency
- An inappropriate and chronic reliance by an adult individual on
another individual for their health, subsistence, decision making or
personal and emotional well-being.
Depression
- When you feel sadder than you think you should, for longer than you
think you should - but still can't seem to break out of it - that's
depression. People who suffer from personality disorders are often also
diagnosed with depression resulting from mistreatment at the hands of
others, low self-worth and the results of their own poor choices.
Dissociation- Dissociation is a psychological term used to describe a mental departure from reality.
Domestic Theft
- Consuming or taking control of a resource or asset belonging to (or
shared with) a family member, partner or spouse without first obtaining
their approval.
Emotional Blackmail - A system of threats and punishments used in an attempt to control someone’s behaviors.
Engulfment
- An unhealthy and overwhelming level of attention and dependency on
another person, which comes from imagining or believing one exists only
within the context of that relationship.
Sense of Entitlement
- An unrealistic, unmerited or inappropriate expectation of favorable
living conditions and favorable treatment at the hands of others.
False Accusations - Patterns of unwarranted or exaggerated criticism directed towards someone else.
Favoritism
- Favoritism is the practice of systematically giving positive,
preferential treatment to one child, subordinate or associate among a
family or group of peers.
Fear of Abandonment - An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.
Frivolous Litigation - The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.
Gaslighting
- The practice of brainwashing or convincing a mentally healthy
individual that they are going insane or that their understanding of
reality is mistaken or false. The term “Gaslighting” is based on the
1944 MGM movie “Gaslight”.
Harassment - Any sustained or chronic pattern of unwelcome behavior by one individual towards another.
High and Low-Functioning
- A High-Functioning Personality-Disordered Individual is one who is
able to conceal their dysfunctional behavior in certain public settings
and maintain a positive public or professional profile while exposing
their negative traits to family members behind closed doors. A
Low-Functioning Personality-Disordered Individual is one who is unable
to conceal their dysfunctional behavior from public view or maintain a
positive public or professional profile.
Hoovers & Hoovering
- A Hoover is a metaphor taken from the popular brand of vacuum
cleaners, to describe how an abuse victim trying to assert their own
rights by leaving or limiting contact in a dysfunctional relationship,
gets “sucked back in” when the perpetrator temporarily exhibits improved
or desirable behavior.
Hysteria
- An inappropriate over-reaction to bad news or disappointments, which
diverts attention away from the real problem and towards the person who
is having the reaction.
Identity Disturbance - A psychological term used to describe a distorted or inconsistent self-view
Impulsiveness - The tendency to act or speak based on current feelings rather than logical reasoning.
Infantilization - Treating a child as if they are much younger than their actual age.
Invalidation
- The creation or promotion of an environment which encourages an
individual to believe that their thoughts, beliefs, values or physical
presence are inferior, flawed, problematic or worthless.
Lack of Object Constancy
- An inability to remember that people or objects are consistent,
trustworthy and reliable, especially when they are out of your immediate
field of vision.
Learned Helplessness- Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.
Magical Thinking - Looking for supernatural connections between external events and one’s own thoughts, words and actions.
Moments of Clarity - Spontaneous periods when a person with a Personality Disorder becomes more objective and tries to make amends.
Mood Swings - Unpredictable, rapid, dramatic emotional cycles which cannot be readily explained by changes in external circumstances.
Neglect
- A passive form of abuse in which the physical or emotional needs of a
dependent are disregarded or ignored by the person responsible for
them.
Normalizing
- Normalizing is a tactic used to desensitize an individual to abusive,
coercive or inappropriate behaviors. In essence, normalizing is the
manipulation of another human being to get them to agree to, or accept
something that is in conflict with the law, social norms or their own
basic code of behavior.
No-Win Scenarios - When you are manipulated into choosing between two bad options
Panic Attacks
- Short intense episodes of fear or anxiety, often accompanied by
physical symptoms, such as hyperventilating, shaking, sweating and
chills.
Parentification
- A form of role reversal, in which a child is inappropriately given
the role of meeting the emotional or physical needs of the parent or of
the family’s other children.
Passive-Aggressive Behavior - Expressing negative feelings in an unassertive, passive way.
Pathological Lying
- Persistent deception by an individual to serve their own interests
and needs with little or no regard to the needs and concerns of others. A
pathological liar is a person who habitually lies to serve their own
needs.
Projection
- The act of attributing one's own feelings or traits to another person
and imagining or believing that the other person has those same
feelings or traits.
Proxy Recruitment
- A way of controlling or abusing another person by manipulating
other people into unwittingly backing you up, speaking for you or "doing
your dirty work" for you.
Push-Pull - A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.
Raging, Violence and Impulsive Aggression - Explosive verbal, physical or emotional elevations of a dispute that are disproportionate to the situation at hand.
Sabotage
- The spontaneous disruption of calm or status quo in order to serve a
personal interest, provoke a conflict or draw attention.
Scapegoating - Singling out an individual or group for unmerited negative treatment or blame.
Selective Competence - The practice of demonstrating different levels of intelligence or ability depending on the situation or environment.
Selective Memory and Selective Amnesia - The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Harm
- Self Harm, also known as self-mutilation, self-injury or self-abuse
is any form of deliberate, premeditated injury inflicted on oneself,
common among adolescents and among people who suffer from Borderline
Personality Disorder. The most common forms are cutting and
poisoning/overdosing.
Self-Loathing - An extreme hatred of one's own self, actions or one's ethnic or demographic background.
Self-Victimization
- Self-Victimization or "playing the victim" is the act of casting
oneself as a victim in order to control others by soliciting a
sympathetic response from them or diverting their attention away from
abusive behavior.
Shaming - The difference between blaming and shaming is that in blaming someone tells you that you did something bad, in shaming someone tells you that you are something bad.
Situational Ethics - A philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be set aside if a greater good or lesser evil is served by doing so.
Splitting - The practice of regarding people and situations as either completely "good" or completely "bad".
Thought Policing - A process of interrogation or attempt to control another individual's thoughts or feelings.
Threats - Inappropriate, intentional warnings of destructive actions or consequences.
Triangulation - Gaining an advantage over perceived rivals by manipulating them into conflicts with each other.
Triggering -Small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.
Tunnel Vision - A tendency to focus on a single concern, while neglecting or ignoring other important priorities.
An estimated 2% of the US population is estimated to
meet the clinical criteria for BPD. However, prevalence results vary
widely as shown below. A number of studies have been performed to
determine the prevalence of personality disorders and BPD. Prevalence
results indicate that BPD affects anywhere between 0.5 and 5.9% of
adults
People who have a first-degree relative with BPD
are five times more likely to develop BPD themselves. Those who suffer
child abuse are also more likely to develop BPD.
Some people who suffer from BPD are prone to
suicidal behaviors and self-injury, especially as adolescents. About
8%-10% of diagnosed BPD patients commit suicide.
See Our Statistics section for more statistics on Personality Disorders.
Click here for some statistics on the possible origins of BPD.
Borderline Personality Disorder (BPD) is listed in
the American Psychiatric Association’s Diagnostic & Statistical
Manual (DSM) as an Axis II, Cluster B (dramatic, emotional, or erratic) Disorder:
A pervasive pattern of instability of
interpersonal relationships, self-image, and affects, and marked
impulsivity beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuous sex, eating disorders, substance abuse, reckless driving, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
There is no known cure for BPD / ERD. As a result,
families of people who suffer from BPD / ERD are often left to fend for
themselves and rely on their own resources.
However, some treatments do exist which have proven
effective in managing symptoms. The most common approach is the
combination of SSRI medication and DBT Therapy.
Definition:
Dialectical Behavioral Therapy
- Dialectical Behavioral Therapy (DBT) is a psychosocial treatment
developed for patients with borderline personality disorder which
combines intensive individual and group therapy.
Description:
Dialectical Behavioral Therapy (DBT) was developed
for treating Borderline Personality Disorder by Marsha M. Linehan. Some
therapists avoid treating patients whom they suspect may suffer from
BPD, because of the demands some BPD patients put on the therapist.
These demands include multiple phone calls after hours, suicidal
ideation and suicidal threats, lack of respect for the therapist's
boundaries or the boundaries of other patients and staff, aggressive
outbursts and stalking.
DBT incorporates an intense program of weekly individual therapy sessions and weekly group therapy sessions.
Individual therapy focuses on addressing a
prioritized set of issues starting with self-injury, then behaviors
which disrupt therapy, then behaviors which disrupt healthy living.
Patients are trained in a regime of four skills known as mindfulness,
emotion regulation, interpersonal effectiveness and distress tolerance.
Definition:
SSRI
- Selective Serotonin Reuptake Inhibitors, are the most commonly
prescribed antidepressants for people who suffer from personality
disorders. Popular SSRI's include Celexa, Lexapro, Prozac, Paxil, &
Zoloft.
Description:
SSRI's relieve symptoms of depression by blocking
the re-absorption (re-uptake) of a neurotransmitter in the brain called
serotonin. More serotonin in the brain has been shown to improve mood.
SSRI's are generally considered milder than other
types of antidepressants. Therefore, SSRI's are typically the first
line of approach for practitioners.
Side-effects include: nausea, sexual
dysfunction, headache, diarrhea, nervousness, rash, agitation,
restlessness, sweating, weight gain, drowsiness and sleeplessness.
The causes for BPD are not precisely known. However,
recent research has turned up some clues. Further study is necessary to
definitively establish a cause. However, theories do exist.
There is some evidence relating the prevalence of
BPD to the kind of environment a child grew up in. A significant
percentage of people who suffer from BPD were also abused as children.
However, this kind of correlation does not always prove that the
environment they grew up in contributed to their own disorder - read our
section on the Post Hoc Ergo Propter Hoc Fallacy for a possible explanation why.)
There is a higher incidence of personality disorders
in those who have parents who suffer from a personality disorder. This
has led some scientists to suspect there may be a genetic link for
BPD.
There is also a higher incidence of BPD in females. Read our section on the Amygdala
for some information on gender differences in neural activity which may
some day lead to a greater understanding of why certain disorders may
afflict one gender more than another.
Definition:
Amygdala
- The Amygdala is a small region of the brain which plays a key role in
emotional regulation, emotional memory and responses to emotional
stimuli.
Description:
Recent technological advances have given
neurologists two new ways to create 3-D images of the brain. These
techniques are known as Positron Emission Tomography (PET Scanning) and
functional Magnetic Resonance Imaging (fMRI). By scanning a person's
brain while prompting them to think in a certain way, scientists are
unlocking clues as to which regions of the brain are responsible for
different kinds of thought.
Much of this work has focused on the amygdala - a
small region deep in the brain shown below. There is one amygdala the
right side of the brain and one on the left as shown below.
The Amygdala, courtesy The Brain From Top To Bottom @ http://thebrain.mcgill.ca/
The Amygdala's Role in Emotional Reactions
It is believed that the amygdala has an important
rule in producing lightning-fast emotional responses to events, whenever
a person recognizes an event with a strong emotional element (good or
bad) such as events that results in fear, anger or rage or events
that result in delight, joy or excitement.
The amygdala is believed to be part of our fast,
instinctive and reactive brains. Not much conscious thought is involved
if an object is hurled towards us and we instinctively duck. This
ability to react instinctively to danger is thought to have
historically played a critical function in survival of most species.
Similarly, witness the reaction of a crowd whenever a sports team scores
a goal. There is a universal instant response of throwing hands in the
air, widening the eyes, leaping into the air etc, without much thought
given. When you see these instinctive reactions occur, the amygdala is
at work.
The Amygdala and Memory
The amygdala has also been shown to have an
important function in enhancing memory functions by releasing stress
hormones, such as adrenaline. It has been shown experimentally that
rats, who have had their amygdala disabled lose their fear of cats. It
has also been shown that increasing stress hormones improves memory of
an event. This helps explain why people can remember stressful moments
in great detail - such as times of disasters or crises, when adrenaline
is released and yet can easily forget long periods when nothing
significant seems to have happened.
Gender Differences in the Way the Amygdala is Connected
Another interesting finding resulted from a study
comparing amygdala activity in males and females. When shown images
containing strong emotionally arousing content, it was found that the
amygdala on the right side of the brain was the most active in men,
while the amygdala on the left side of the brain was most active in
women.
Other experiments with people who are relaxing
have shown that in men, the right amygdala is more closely connected to
the rest of the brain than the left, while women show a stronger
connectivity between the left amygdala and the rest of the brain.
Additionally, in men the right amygdala seems to be strongly connected
to regions of the brain normally associated with interactions with the
external environment while in women, the left amygdala seems to be
strongly connected to regions of the brain normally associated with more
internal thought. This suggests that in an emotional context, men are
biased toward thoughts about the external environment and women toward
thoughts about the internal environment.
The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder
In a famous experiment at Yale University, 15 people
diagnosed with BPD and 15 people with no BPD diagnosis were shown
photographs of faces with neutral, happy, sad, and fearful facial
expressions while mapping the activity in the brain using fMRI. It was
found that there is a lot more activity in the left amygdala of people
who had been diagnosed with Emotional Regulation Disorder /Borderline
Personality Disorder when exposed to an emotional stimulus than there is
for most other people.
Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.
Borderline Personality Disorder (BPD) and Bipolar Disorder
are similar in that both are characterized by dramatic changes in
mood. It is thought that many people who suffer from BPD are
inaccurately diagnosed as having Bipolar disorder because it generally
carries less stigma and is easier to treat with pharmaceuticals.
However, there are also some important differences between Bipolar &
BPD:
Frequency of Mood Cycles
Mood swings for people who suffer from Borderline Personality Disorder typically cycle much faster than for people who suffer from Bipolar Disorder.
BPD sufferers often exhibit mood cycles lasting from a few hours to a
few days. People who suffer from Bipolar Disorder typically exhibit mood
swings lasting from a few weeks to a few months.
It should be noted that some Bipolar patients are characterized or diagnosed with Rapid Cycling Bipolar Disorder which has the same symptoms as Bipolar Disorder but with a shorter cycle time.
Relationship Basis
People who suffer from BPD often exhibit an acute Fear of Abandonment.
The mood swings a person with BPD exhibits are often attached to their
fear of being left alone or their preoccupation with not being alone.
Sometimes, BPD is described as a "relationship disorder" in that it
manifests itself in interactions with others.
Bipolar Disorder tends to be less
relationship-based. People who suffer from Bipolar Disorder often
display cycles of mood which are more inwardly self-focused and have
less to do with how they feel about the relationships they are involved
in.
Dissociation
Borderline Personality Disorder comprises both
psychotic & neurotic thought processes. This gives rise to the name
"Borderline" because it is thought to be on the "borderline" between
psychosis & neurosis. The thinking and behavior of a person with
Borderline Personality Disorder includes more mental departures from
reality, known as Dissociation or "feelings create facts".
In contrast, Bipolar Disorder tends to be more
neurotic in that the mood swings tend to be based more on extreme
exaggerations of fact.
Response To Treatment
People who suffer from Bipolar Disorder often respond positively to appropriate regimes of medication.
People who suffer from Borderline Personality
Disorder may also exhibit some improvement when treated with
appropriate medication but typically also require extensive therapeutic
intervention such as DBT over a period of months or years in order to
see comparable results.
Both groups are often reluctant to seek help and may
be resistant to medication. Also, both groups have a tendency to stop
taking prescribed medications when they begin to feel better which often
leads to relapses.
Movies Portraying Borderline Personality Disorder Traits
A Streetcar Named Desire - A Streetcar Named Desire
is a is a 1947 play written by Tennessee Williams, later adapted for
film, which tells the story of a woman who displays histrionic and
borderline traits, who goes to live with her codependent sister and her
narcissistic husband.
Fatal Attraction - Fatal Attraction
is a 1987 Movie Thriller starring Glenn Close & Michael Douglas
about Dan Gallagher, a New York Lawyer (played by Michael Douglas) who
is stalked by Alex Forrest (played by Glenn Close) with whom he has had
an affair. The story portrays Alex's increasingly unstable behavior as a
result of having Borderline Personality Disorder and feeling abandoned
by Dan.
Girl, Interrupted - Girl, Interrupted
is a 1999 Columbia Pictures movie which chronicles the experiences of a
teenage girl with Borderline Personality Disorder, who is admitted to a
mental health institution after attempting suicide.
Mommie Dearest - Mommie Dearest
is a 1981 biography of Hollywood Actress Joan Crawford, played by
Faye Dunaway, who, according to the account in the movie, exhibited
Obsessive Compulsive, Borderline and Narcissistic Traits.
Single White Female - Single White Female is a 1992 Columbia Pictures
Release starring Bridget Fonda and Jennifer Jason Leigh which portrays
the events after a young woman takes in a roommate who exhibits some of
the symptoms of Borderline Personality Disorder (BPD) and Dependent
Personality Disorder (DPD) including mirroring, impulsivity and fear of
abandonment.
The Wizard of Oz - The Wizard of Oz
is a 1944 movie starring Judy Garland which is sometimes used as a
metaphor to describe the disconnect between the dissociated reality of
the personality-disordered individual (Oz) and the real world
experienced by the Non-PD (Kansas). The metaphor is based on the iconic
phrase: "Toto - I've a feeling we're not in Kansas any more".
Out of the FOG Support Forum - Visit the support forum here at Out of the FOG.
Psychforums BPD forum - Psychforums Site.
BPD Recovery - http://www.bpdrecovery.com/
BPDRecovery is a site that focuses on recovering from Borderline
Personality Disorder. The Site is run by a recovered Borderline. It is a
non-discriminatory website which means that all individuals are welcome
- whether you've been formally diagnosed or simply recognize yourself
or someone you know in the diagnostic criteria, you are welcome here!
Anything to Stop The Pain
- information site, blog and support board for Non-Borderlines, with a
particular emphasis on supporting people who have children with BPD
and people in a committed relationship with a person who suffers from
BPD.
Emergence - http://www.emergenceplus.org.uk - UK site with personality disorder related information and services.
http://bpdcentral.com/support/email.shtml The Welcome to Oz Online Community for Family Members with a Borderline Loved One.
http://borderlinepersonality.ca/board BPD Support Site run by BPD Author A. J. Mahari.
http://www.BPDCentral.com - An information and support site about BPD run by Randi Kreger, co-author of "Stop Walking on Eggshells".
http://www.BPDFamily.com - Support Site for the family and relationship partners of individuals with BPD.
For More Information & Support...
If you suspect you may have a family member or
loved-one who suffers from a personality disorder, we encourage you to
learn all you can and surround yourself with support as you learn how to
cope.
- Support Forum - Read real stories. Ask questions.
- Top 100 Traits of people with Personality Disorders.
- Toolbox - Ideas for coping and common mistakes.
- Personality Disorder Glossary - Learn the lingo.
- Links to Personality Disorder-related sites.
- Books about personality disorders.
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