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Author Topic: The 9 Criteria of BPD, redux  (Read 377 times)
Mono No Aware
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« on: July 15, 2014, 06:48:45 PM »

I posted this exercise last year. Going back and re-reading it, I saw that I was too personal-war-story focused and completely missing the bigger picture of the behavior patterns that my uBPDw moves in. So I re-wrote my findings completely. I encourage everyone to do this - but be warned, it's easy to start venting in it.

As defined in the DSM-IV-TR, here are the 9 diagnostic criteria of Borderline Personality Disorder. Someone must score a minimum 5 to be diagnosed BPD:

1)   Frantic efforts to avoid real or imagined abandonment.

2)   Unstable or intense interpersonal relationships, with marked shifts in attitudes towards others (from idealization to devaluation or from clinging dependency to isolation and avoidance), and prominent patterns of manipulation of others.

3)   Marked and persistent identity disturbance manifested by an unstable self-image or a sense of self.

4)   Impulsiveness in at least two areas that are potentially self-destructive.

5)   Recurrent suicidal threats, gestures, or behavior, or self-mutilating behaviors.

6)   Affective instability due to marked reactivity of mood with severe episodic shifts to depression, irritability, or anxiety, usually lasting a few hours and rarely more than a few days.

7)   Chronic feelings of emptiness.

8)   Inappropriate, intense anger, or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights.

9)   Transient, stress-related paranoid thoughts or symptoms of severe dissociation.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Here's my newly distilled findings:

1)   Frantic efforts to avoid real or imagined abandonment.

These two behaviors are abandonment-fear-based triggers that begin the dysregulation cycle (see #6 below):

- A) Severely negative reactions occurring before/during/after my business trips or my going out alone to do a hobby activity.

- B) Severely negative reactions to any news of, discussion or, my contact with my family. My love and attention to them seems to be automatically threatening to my love and attention to her.

These two behaviors are “pre-emptive strikes” based on her emotional belief that abandonment is inevitable, and usually occur during dysregulation episodes:

- C) Serial attempts to convince me to leave her, based on self-devaluing.

- D) Serial not-followed-through threats to leave me, based on devaluing me – the infamous Split Black.

2)   Unstable or intense interpersonal relationships, with marked shifts in attitudes towards others (from idealization to devaluation or from clinging dependency to isolation and avoidance), and prominent patterns of manipulation of others.

- A) Serial following of the “idealization to devaluation”  pattern concerning her friends.

- B) Serial cycling through the “clinging dependency to isolation and avoidance” pattern with me.

- C) Manipulation of others is very rare, but manipulation of me is common.

3)   Marked and persistent identity disturbance manifested by an unstable self-image or a sense of self.

- Of-heard complaining about not knowing who she should be, or who everyone expects her to be. Perhaps this does not qualify as “marked and persistent”.

4)   Impulsiveness in at least two areas that are potentially self-destructive.

- Financial spending sprees and unhealthy food.

5)   Recurrent suicidal threats, gestures, or behavior, or self-mutilating behaviors.

- One hospitalization for suicide threat (close to following through), multiple recurring threats without action.

6)   Affective instability due to marked reactivity of mood with severe episodic shifts to depression, irritability, or anxiety, usually lasting a few hours and rarely more than a few days.

- A) Shift from normality to anxiety mode, or ramp-up of dysregulation, marked by the behavior of bringing up anxiety “issues” of  three main types which are randomly mixed and continuously circled around:

   i. pronounced leading-negativity and/or paranoid questions such as “Why does your family hate me?” Linked to #1B above.

   ii. direct self-devaluing statements like “You don’t even want to be with me.” Linked to #1C above.

   iii. direct other-devaluing  statements like “She thinks she’s so much better than me.” Linked to both #1B and #2A above.

Note that my attempting to discuss each issue calmly and logically at face value is derailed by two defensive behaviors: either suddenly and without warning switching to another issue – this is the “circling” – or misconstruing my SET comments in the most imaginative, illogical, and negative ways which become reasons for her to shift to the next mood…

- B) Shift from anxiety mode to the outright anger mode which marks full-blown dysregulation (#8 below).

- C) Shift from anger to severe depression, mainly displayed as hopelessness, inaction, and deadened emotions.

- D) Occasionally the post-anger shift will be to a days-long steady-state of irritability and passive-aggressive behaviors. This is more common following high-intensity dysregulation episodes where I fall into JADE-ing, such as late-night episodes that cause lack of sleep.

7)   Chronic feelings of emptiness.

- A) oft-heard complaining about regrets of: not completing college , not having career, not marrying better, not being like so-and-so, or about how generally unfulfilling her life is.

- B) She often becomes intensely unsatisfied by our sex life and extrapolates that into #1 above.

8)   Inappropriate, intense anger, or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights.

- A) Full-blown dysregulation episodes always peak with anger and inappropriate behavior. During these peaks all the anxiety behaviors (6A i, ii, & iii) and the abandonment-fear behaviors (#1 A, B, C, D) occur with ten or twenty times the emotional intensity.

- B) The constant anger is more of a stage of irritability, see #6D above.

- C) Occasionally during these peaks she will physically attack me, or threaten to and pull back at the last second. I’ve been hit, kicked, and choked.

9)   Transient, stress-related paranoid thoughts or symptoms of severe dissociation.

- A) The day or two before her hospitalization for her nearly-carried-out suicide threat, she was absolutely sure that the lyrics of the music playing in the retail store she worked at were all about her – and that the singer was talking directly to her and departing from the original song to do so.

- B) Since then, I’ve only observed fleeting moment s of dissociation during big dysregulation episodes.

- C) Paranoid thoughts are nearly daily in occurrence, often as part of the devaluing others/me behaviors.


I'm no doctor... .but I think this is at least a 7/9.
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rj47
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« Reply #1 on: July 16, 2014, 09:24:20 AM »

I regularly employ black and white thinking of my own diminishing the classic, but destructive BPD behaviors I'm subjected to in favor of embracing any sign of improvement that my BPDw makes. The desperate act of grasping at any kind of perceived progress is almost pathetic. Its important to gain comfort from the small things. But the smoldering beast is there and won't be contained for long. Reviewing the list for the first time in a while, the patterns in the underlying behaviors (which are near identical) are a sobering reminder of how far we have to go. It freaked me out, but thanks.

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"It's hard to stay mad, when there's so much beauty in the world. Sometimes I feel like I'm seeing it all at once, and it's too much, my heart fills up like a balloon that's about to burst. And then I remember to relax, and stop trying to hold on to it, and then it flows through me like rain."
Proud_Dad
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« Reply #2 on: July 16, 2014, 10:09:48 AM »

Reviewing the list for the first time in a while, the patterns in the underlying behaviors (which are near identical) are a sobering reminder of how far we have to go. It freaked me out, but thanks.

In bold, DITTO.

We had a rough weekend with at least 5 or 6 angry arguments and then experienced a major escalation event last night. After about 5-6 hours of rage and anger she broke down and let the wave of fear pass over her. Within 20 minutes she was back to "baseline" state. All I can do in these cases is maintain composure and wait for her to get a grip on herself. Reading this this morning has been a bit of a punch in the gut for me, putting into perspective all of the events that I experience. It is ALWAYS amazing to see how similar other people's experiences seem to be, only the topics seem to change, but the behavior patterns seem like the BPD playbook got handed out while we weren't looking.

Thanks for this Mono.

Just another season in the abyss... .
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Mono No Aware
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« Reply #3 on: July 16, 2014, 11:39:50 AM »

Reviewing the list for the first time in a while, the patterns in the underlying behaviors (which are near identical) are a sobering reminder of how far we have to go. It freaked me out, but thanks.

You're welcome rj47. And ditto on the sobering reminder.


It is ALWAYS amazing to see how similar other people's experiences seem to be, only the topics seem to change, but the behavior patterns seem like the BPD playbook got handed out while we weren't looking.

Thanks for this Mono.

Just another season in the abyss... .

You're also welcome Proud_Dad. Yes, I am Slayed on a regular basis.

~~~~~~~

Reading a lot of not-much-hope threads in this section lately.

Julie96's loss flattened me, I can't even post condolences because I'm at work and don't want to cry.

I've posted a lot of brave-sounding advice to fellow sufferers. I can only write those things while I'm personally not under attack and my uBPDw is sailing along in normal mode which can last for weeks at a time.

But I can only write things like this 9 Criteria when I have the clarity of fresh firsthand experience. Yep, it was a bad weekend.

Then my family (thank goodness for cellphones so I can talk to them from Home Depot parking lot because talking to them from home is a Bad Idea) tentatively asks if I've had any luck getting her into therapy... .and I have to sigh and reply, "None whatsoever."

But I hold out hope... .
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rj47
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« Reply #4 on: July 16, 2014, 12:28:53 PM »

Then my family (thank goodness for cellphones so I can talk to them from Home Depot parking lot because talking to them from home is a Bad Idea) tentatively asks if I've had any luck getting her into therapy... .and I have to sigh and reply, "None whatsoever."

But I hold out hope... .


I've been with my BPDw for 30 years. She knows her behavior is getting worse and is genuinely trying to control her impulses. She's made progress. Nevertheless, if she's had a little too much alcohol when the PD demon shows the chaos can be intense. Tomorrow she restarts therapy after nearly jamming a lit cigarette into my eye to punish me for going to church one morning without telling her (she thought I was buying groceries). I had my head down and eyes closed while she was up close screaming that she wanted to burn my eye out. Feeling heat near my eyelid I grabbed her hand. Finding my keys (I keep a packed suitcase in the trunk) I told her to feel free to destroy the house and I would no longer have guilt if she "offed herself" while I was gone (she sometimes threatens commit suicide if I leave). Immediately breaking the cycle she fell to pieces crying, begging me for forgiveness, and asking me to help her. In our case allowing her to take us to the precipice has been the hook to get her attention. Her behavior has scared even her and I've advised that I cannot live under the pressure for much longer. She's meeting with a therapist tomorrow. I wish her focus was dialectic therapy rather than CBT, but anything has to be better for her than trying to self-regulate without help.

For near 25 years she's alternated between hating and loving me. As I developed better coping methods and eliminated the placeholders for the rage it has become easier for her to recognize that something definitely ain't right. There's hope for change bro.
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"It's hard to stay mad, when there's so much beauty in the world. Sometimes I feel like I'm seeing it all at once, and it's too much, my heart fills up like a balloon that's about to burst. And then I remember to relax, and stop trying to hold on to it, and then it flows through me like rain."
maxsterling
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« Reply #5 on: July 16, 2014, 01:16:27 PM »

My turn:

1)   Frantic efforts to avoid real or imagined abandonment.

- phone calls or text messages while I at work multiple times per day, about nothing important.  

- anxiety over upcoming potential overnight business trips

- anxiety over upcoming potential family trips and an uncomfortable visiting my family, yet would rather go with me to visit my family rather than stay home alone.

- calls after me constantly at home, even if I have just gone to the next room or outside for a few minutes.  Claims I am "abandoning" her when I get up in the morning.

2)   Unstable or intense interpersonal relationships, with marked shifts in attitudes towards others (from idealization to devaluation or from clinging dependency to isolation and avoidance), and prominent patterns of manipulation of others.

- Her "best friend" became painted black a few months ago, now is painted white again, yet her best friend's 5 year old daughter is still painted black.

- I see no stable freindships or family relationships in her life.  She now has one good friend, and the others are hot and cold.  One minute they are great, the next they are terrible.  

- Co-workers go from awesome to evil overnight.

3)   Marked and persistent identity disturbance manifested by an unstable self-image or a sense of self.

- She doesn't ever do the things she claims to "love".

- Her new favorite things to do or places to go tend to last a few weeks, and then they are evil.  

- Absolutely hates herself and her body.  

4)   Impulsiveness in at least two areas that are potentially self-destructive.

- In the past she abused drugs and alcohol.  She's been clean and sober for 11 years, but claims she is still tempted when she is down.  So, the impulse is there, and I think the drug abuse could resume given the right circumstance.

- Spends money without thinking.  Tends to buy and return things.

- Impulsive eating.  Eats to control emotions, feels shame afterwards.

- Up to meeting me, engaged in what I would describe as risky sexual behavior.  She probably would go back to that if this relationship were to end.  

5)   Recurrent suicidal threats, gestures, or behavior, or self-mutilating behaviors.

-  For the period up until the past two weeks, was making suicidal statements or self harming statements several times per day. "I want to die", "I feel like killing myself."  "I have no reason to live."

- Frequent punching herself or scratching at her skin when she is upset.

- asking me to remove knives and her medications from her view in order to remove temptation.

6)   Affective instability due to marked reactivity of mood with severe episodic shifts to depression, irritability, or anxiety, usually lasting a few hours and rarely more than a few days.

- Always talking about this or that "triggering" her.  It could be as simple as seeing a pregnant woman in a store, or someone wanting to have lunch with her.

- We can be having what I think is a great day, and suddenly she will go quiet and say she is depressed or irritable.  

- extreme anxiety over everyday events, both positive and negative.  

7)   Chronic feelings of emptiness.

- She claims over and over that she feels "empty".

- Frequently claims she is "bored".

- never seems to be happy where she is at.  Always takes a "the grass is greener elsewhere" attitude.

8)   Inappropriate, intense anger, or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights.

- Curses and screams at people in stores or parking lots.

- Curses and screams at me.  

- Gets mad when she thinks people are looking at her.

- Gets angry with co-workers, therapists, doctors.  The HR people at her last job actually hung up on her because she was angry.  She also got into a shouting match with a therapist.  

- Says that she wants to "say something" to my mom because my mom talks while she eats.

9)   Transient, stress-related paranoid thoughts or symptoms of severe dissociation.[/b]

- worries that people won't like her

- worries that I will leave her

- sometimes she "zones out" in thoughts or worries about things that haven't happened yet, have little likelihood of happening, or that she has no control over.  Racing thoughts.

- will claim I or others are deliberately doing things to hurt her, when it really doesn't make much sense.  

- various intense phobias to finding hair in the sink, crowds, heights, and strangers.

- When she is stressed, the above really eat at her.  When she is baseline, the above don't matter to her as much.  The above paranoias only strike me because they are numerous and tend to hit all at once, without any real trigger or threat.  

So in my case, I'd say this is a strong 8/9, or possibly 9/9, but I don't really don't understand item #9 well enough to know if she has significant issues in this area that are greater than most people.  But the reality here is, this is who she is, I don't and can't expect any of this to go away, only diminish.  And there has been some diminishing of these "symptoms".  As mentioned, she has resorted to drugs in the past, and despite her recent struggles, she hasn't relapsed.  She also seems to at least be aware of her role in relationship issues with friends and family.  And she does reach out for resources (therapy, public assistance).  Unfortunately, it's not until she is at her monthly rock bottom.

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startrekuser
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« Reply #6 on: July 18, 2014, 04:05:55 PM »

I'm no doctor... .but I think this is at least a 7/9.

Wow, she's batting .777    That's awesome!  Seriously, though, you're wife sounds a bit worse than mine, but it's close.

I'm sorry you're going through this.  It's awful, I know. 
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