BPD: What is it? How can I tell?

[JoannaK]

This list comes with a very important cavaet:

**Please note affirmative answers to the questions do not indicate a fixed conclusion. They may, however, provide you with the realization that there's a possibility you or a loved one may be a Borderline Disorder Personality. A definitive diagnosis can only be made through an evaluation by a psychiatrist or mental health care clinician who specializes in Borderline Personality Disorder. We can help you find the right professional in your area.

The only "true" test of whether or not someone has bpd is a careful examination of the person's behaviors and feelings against the nine diagnostic criteria by a trained therapist.  Almost everybody can answer "yes" to one or more of the questions in this screening device at some point in his/her life. 

[Skip]

Do you consciously or unconsciously fear being abandoned?

Would we know if we "unconsciously feared being abandoned"?      No slight to the author - all of these tests have value - if only to raise your awareness and encourage you to look further.

There are some professional questionnaires that might be helpful for a more indepth look.

Diagnostic Tests - Diagnostic Interview for Borderline Patients (DIB-R)

The Diagnostic Interview for Borderline Patients (DIB-R) is the best-known "test" for diagnosing BPD. The DIB is a semi structured clinical interview that takes about 50-90 minutes to administer. The test consist of 132 questions and observation using 329 summary statements. The test looks at areas of functioning associated with borderline personality disorder. The four areas of functioning include Affect (chronic/major depression, helplessness, hopelessness, worthlessness, guilt, anger, anxiety, loneliness, boredom, emptiness), Cognition (odd thinking, unusual perceptions, nondelusional paranoia, quasipsychosis), Impulse action patterns (substance abuse/dependence, sexual deviance, manipulative suicide gestures, other impulsive behaviors), and Interpersonal relationships (intolerance of aloneness, abandonment, engulfment, annihilation fears, counterdependency, stormy relationships, manipulativeness, dependency, devaluation, masochism/sadism, demandingness, entitlement). The test was developed to be administered by skilled clinicians, but can also be given by a non professional.  The test is available at no charge by contacting John Gunderson M.D. McLean Hospital in Belmont Massachusetts (617-855-2293).

Diagnostic Tests - Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionnaire is available from the American Psychiatric Publishing ($60.00).

Diagnostic Tests - Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. We have included a list of questions most often answered as "yes" by people with Borderline Personality Disorder.



Diagnostic Tests - Other

Other commonly used assessment tests are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

In all cases, if any of these tests lead you to believe that you or someone else in your life has a possible disorder - the best thing is to see a trained professional.

[justwantout]

My BDP husband and I are divorcing, since the separation I've worked really hard to repair family and friend relationships that had been damaged over the years due to the BPD issues of my spouse.  Now that I have my family back in my life they want to help but I am finding it really difficult to explain BPD to people who have never heard of it and aren't used to mental health issues.  When they ask exactly what it is I find I end up feeling really petty when I try and explain all of it. I'm sure thats due to some emotional fallout of all the years of everything being "my" fault.  But, can anyone suggest any articles that are written to that audience, people that have frankly never heard of it let alone imagine living with it.  

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[havana]

It is very difficult to explain this to someone that hasn't been there. It will sound petty to most people. If you could think of a way for them to here the thousands of petty things plus the major issues you might have a chance.

[lbjnltx]

consider this article.  simple and to the point.  bpd for beginners!

http://www.articlesbase.com/mental-health-articles/a-child-like-mind-borderline-personality-disorder-2784170.html

hope this helps.

lbjnltx



Anthony Centore, PhD
Jul 07, 2010

I have sometimes thought that my three-year-old daughter seems borderline
. One minute she is saying, I love you Mommy, and the next minute she is shouting, Go away Mommy! One minute she laughs, the next she cries hysterically.

Time with my daughter helps me understand the world through her eyes. Her world is exciting, yet frightening. Her behaviors and emotions fluctuate to express this. For me, and undoubtedly for her, it sometimes feels like a roller coaster. Thank God, she has me to hold onto.

Adults with BPD often experience emotions much like my three-year-old child. As such, their behavior seems reasonable to them. The problem or pathology arises because these individuals are not childrenthey are adults. In terms of emotion regulation, interpersonal and some cognitive skills, they are at times functioning like children. Growth in each of these areas can occur independently, which results in an adult with the emotional composure of a two-year-old.

The life of those with BPD is a roller coasterchaotic, erratic, and distressed. They frequently feel as though they have no one to hold onto and the ride is getting faster and more treacherous. It involves twists and turns of venting anger, numbing pain, and engaging in self-deprecation. Often this leads to isolation, with ever more shame, anger, and pain.

Although their behaviors may seem game-like, it is not always so. Their behaviors are complex defenses that serve to protect them from what they may perceive as harm, rejection, and inevitable abandonment. These behaviors can be traced back to those of a distressed child, searching desperately for an anchor.

 

If I feel it, it must be true

Just the other day, my daughter said, I feel sad Mommy. It must be a sad day. In general, emotionally healthy people can distinguish between feelings and facts. If you fail a test (fact), you may feel inadequate (feeling). But this does not mean that you are inadequate. It may be just one failed test out of many successes.

Individuals with BPD have difficulty separating feelings from facts. In their economy, if they feel it, it is true. As such, when these individuals feel bad, their self-destructive behavior seems completely reasonable to them. These individuals repeatedly need to revise facts to fit their feelings. This is why their perceptions and beliefs may seem distorted and unstable.

Polarization

As my daughter cognitively matures, she is moving toward an understanding that just because I am angry does not mean I dont love her. However, for the most part at this stage of development, life remains polarized for her into good and bad. Like children, adults with BPD are unable to integrate situations and feelings that involve opposition. This leads to black-or-white thinking, overvaluation oscillating with devaluation, and a process known as splitting.

These cognitive mechanisms are efforts to protect themselves and make sense of the world. Life does not often come in black or white, but instead either black-and-white or many shades of gray. People are both kind and cruel, warm and cold, available and unavailable, depending on situations, needs and various factors. Because a person with BPD cannot cognize a world with complexity of this kind, it is necessary to separate people into black-or-white categories based on their most recent behaviors.

Projection/Blame

Recently my daughter blamed her oneyear- old brother when she tripped over her own toys. This was quite a feat, since her brother was sound asleep at the time! Projection and blaming are powerful weapons of denying ownership and avoiding responsibility. Projection is the process of attributing ones own unpleasant traits, behaviors, and/ or feelings to someone else. This primitive defense allows people with BPD to feel relief from self-condemnation. It also helps them avoid the fear of rejection and abandonment that would be stirred if they directly confronted their brokenness.

Core Issues

Emotion dysregulation is believed to be the core issue of BPD. Therefore, those with BPD manifest relational, behavioral and cognitive disturbances in an effort to achieve emotional modulation. They push others away for emotional protection; they inflict self-injury to numb emotional pain; they dissociate to avoid thinking about trauma; they create fantasies to ease the pain of reality.

Many of these people are intelligent and successful and seem to have everything going for them. However, inside they feel empty and incomplete. Their behaviorswhich may appear to be manipulation and game-playing to those who are targetedare usually done to self-soothe emotionally.

But in the midst of trying to achieve love and remain safe, individuals with BPD can inflict great pain, distress, grief, and anguish on those around them. Individuals with BPD can be frankly abusive. Parents, spouses, children, friends, and professionals involved with a person with this disorder are all vulnerable, not to mention the suffering individuals themselves.

As such, professionals who work with BPD patients or clients risk countertransference and burnout. Professionals and loved ones can spend years trying to understand the patients behaviors and validate feelings. However, this can prove exhausting and self-defeating. As with any dysfunctional behavior that involves abuse, the perpetratorno matter what the reason for his/her behavior must start taking responsibility.

So as a professional committed to working with these patients, it is necessary to bridge the gap between the adult person and the psyche of the disturbed child by not only validating, but also teaching self-capability enhancement. How do we do this?

Grace, Grace and More Grace

During the past ten years, advances in treatment of BPD have occurred in many areas, including biological underpinnings, psychotherapy and pharmacological treatment. One of the most innovative and effective psychotherapeutic approaches to BPD is Dialectical Behavior Therapy, developed by Dr. Marsha Linehan.1 This treatment addresses the extreme dichotomous thinking, for instance, by helping patients find a balance between overvaluing and condemning. It also focuses on developing skills, such as problem solving, selfsoothing, assertiveness, kindness, emotion regulation, and distress tolerance. These approaches, if integrated with Biblical principles, are quite effective.

Whatever treatment is used, Christian professionals know that the approach must offer Gods grace, kindness, and mercy. In an interview regarding his new book, Grace-Based Parenting,2 Dr. Tim Kimmel described grace as loving and honoring them when they are not loving back and loving your child when they dont deserve it. This attitude is necessary in working with BPD patients. In fact, such work can be thought of as grace-based therapy. As Christians, we are taught to love others (Matthew 22:39). Exemplifying Gods love is the only way to truly demonstrate validation, convey acceptance, and show understanding of these individuals.

However, like Christ, we do not accept unacceptable behaviors. Christ accepts and loves us as his children, but also wants us to become like him: go and sin no more (John 8:11). In treatment, then, in addition to validation, we must teach life skills and tools, not unlike what I am currently doing with my child. I teach her to self-soothe, how to deal with disappointment, and how to express and regulate her emotions. My prayer is that as she develops and individuates, she will mature into an independent and godly woman. That is the hope for patients suffering with BPD. One hopes that the gap between child and adult will narrow as they progress through treatment. Take help from telephone counselor.

Clearly, because of their profound skills deficits and intense emotional pain, working with BPD patients requires an emotional, physical and spiritual commitment from the therapist. It is, in a sense, raising and parenting children. What a way to honor God!

 
Retrieved from "http://www.articlesbase.com/mental-health-articles/a-child-like-mind-borderline-personality-disorder-2784170.html"

[RefugeeFromOz]

I know that this doesn't help to explain it to other people, but for myself one of the reasons it is so difficult to explain to other people is that we were forced - by experience, by pain, and by the simple need to survive - to open our minds to a realm of dysfunctional behavior that others cannot imagine.  When I talk to others about this, I often say it's like learning that the monsters of our childhood dreams actually do exist.  I definitely divide my life into "before" and "after" the BPD experience.  I truly think it's transitional in our develop as people, and we now see into rooms and spaces in our minds, and allow for realities, that others can't imagine.  The scope of the experience goes way beyond words, and that's the fundamental problem.  Unless you can also convey the confusion, frustration, fear, and despair, you can't explain it.

Every time I see one of these posts about how to explain the experience I feel great sympathy for the poster.  We've all been there and I think it will always remain a difficult topic.  We're similar to combat veterans who can only truly communicate and share experiences with other combat veterans.

[sosadandone]

I read alot of others posts here and many seem to focus only on the on/off or irrasible qualities of their partners. I'm not minimizing anyone else's suffering here but I wonder if some are just too quick to label their partner who may just be somewhat quick tempered. IMHO BPD- as I experienced it with my ex was a severe disorder which had many many facets beyond just someone who gets easily upset. In fact mine seldom got angry. However he did have almost all of the other criteria seen in BPDs. In fact when I once sent him Dr Gunderson's criteria and asked how many of them he had; he answered; "all of them". So I am going to list Gunderson's criteria and ask if you would look at them and see how many your partner really exhibits.

I guess what I am suggesting is that we not be too quick to label someone, especially those we claim to love. Here is the list. How many does your partner really have. Mine had almost all

Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:

Affect
chronic/major depression
helplessness
hopelessness
worthlessness
guilt
anger (including frequent expressions of anger)
anxiety
loneliness
boredom
emptiness

Cognition
odd thinking
unusual perceptions
nondelusional paranoia
quasipsychosis
Impulse action patterns
substance abuse/dependence
sexual deviance
manipulative suicide gestures
other impulsive behaviors

Interpersonal relationships
intolerance of aloneness
abandonment, engulfment, annihilation fears
counterdependency
stormy relationships
manipulativeness
dependency
devaluation
masochism/sadism
demandingness
entitlement

[Jemima]

Dear sosadandone,

I agree that the problems with some people are much more severe than those of others. I am not familiar with Gunderson's criteria, but the DSM-IV-TR gives nine criteria, not the much more extensive list you gave here. You can be diagnosed by a professional with five. Some of the criteria are more about the pwBPD's inner experience, so if they have not received an official diagnosis, it is their SO, relative, or friend's guess that they are BPD. That's why many people (including myself) designate their problematic person as "uBPD" (undiagnosed BPD).

The way the profession currently defines disorders is using a "categorical" model. Therefore, you can fall into the "category" of a PD or of BPD in particular, yet this says nothing about how severe your problems are. A method of defining disorder according to the severity of dysfunction would be a more "dimensional" model.

It appears that the Gunderson that you reference is attempting to get at the depth and severity of dysfunction in the structured interview you describe.

Depression may be simpler to wrap our heads around when we are talking about categorical vs. dimensional ways of looking at problems. You can meet the criteria for depression with five of the nine criteria for depression --- say, excessive guilt, fatigue, weight loss, insomnia, and depressed mood --- and be SEVERELY impaired (guilt is crippling, you can't get out of bed, you're skin and bones, haven't slept in three weeks, etc.) or MILDLY impaired (unrealistic guilt is uncomfortable, you get to work but aren't as productive, you've lost 10 lbs without trying, sleep 4-5 hours a night, etc.).

I think here at FTF we try to support everybody regardless of the level of BPD or even BPD traits in people we are in relationship with.

[Blossom]

We're used to the DSM criteria for BPD, but i was looking at BPD resources and came across the ICD criteria which i hadn't seen in some time; i felt the differences were interesting and in turn, thought they may be interesting here. My search was sparked by the increase in discussion of the diagnosis itself on the boards (at least, that i've seen) and despite my H not presenting in perhaps the same volatile way as others, he is most definitely BPD. Anyway, i digress, i've lifted this from Wiki but the differences were, i thought, very interesting:

http://en.wikipedia.org/wiki/Borderline_personality_disorder

Diagnostic and Statistical Manual

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[1][14]

    A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

       1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
       2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
       3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
       4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
       5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
       6. 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).
       7. Chronic feelings of emptiness
       8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
       9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

International Classification of Disease

The World Health Organization's ICD-10 defines a conceptually similar disorder to borderline personality disorder called (F60.3) Emotionally unstable personality disorder. It has two subtypes described below.[26]

F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

   1. marked tendency to act unexpectedly and without consideration of the consequences;
   2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
   3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
   4. difficulty in maintaining any course of action that offers no immediate reward;
   5. unstable and capricious mood.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

   1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);
   2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
   3. excessive efforts to avoid abandonment;
   4. recurrent threats or acts of self-harm;
   5. chronic feelings of emptiness.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

[JamesInAtl]

Great info. Especially on seperation anxiety. Sorry for the post. I was doing some quick reading during lunch and didn't read the guidelines! 

[Skip]

DSM-5 sheds some light...

The DSM-5, due out in 2013, will bring a number of changes to the definition of the personality disorders.  The working group is trying to do away with the complex multiaxial diagnostic approach and to make the personality disorders more discrete (less overlap) - basically the Axes I, II, III will be consolidated to one -- the 10 personality disorders will be reduced to 5 or 6.

But maybe the greatest change for non-professionals like ourselves, is that they are attempting to clearly define the lne between personality disorder and personality style.

Have a look...


The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

Self (impairment in at least 1):

Identity: Experience of oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity for, and ability to regulate, a range of emotional experience.  To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Self-direction: Pursuit of coherent and meaningful short-term and life goals; utilization of constructive and prosocial internal standards of behavior; ability to self-reflect productively.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Interpersonal (impairment in at least 1):

Empathy*: Comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding of the effects of own behavior on others.    To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Intimacy*: Depth and duration of positive connections with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).


Below is the scale for "empathy".  There are four scales in total.

Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing.  Is aware of the effect of own actions on others.

Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.

Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.

Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering.  Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.

Extreme Impairment (4)  Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance).  Social interactions can be confusing and disorienting.


Here is the scale for intimacy.  There are four scales in total

Healthy (0) -Maintains multiple satisfying and enduring relationships in personal and community life. Desires and engages in a number of caring, close and reciprocal relationships. Strives for cooperation and mutual benefit and flexibly responds to a range of others’ ideas, emotions and behaviors.

Mild impairment (1) -Able to establish enduring relationships in personal and community life, with some limitations on degree of depth and satisfaction.Capacity and desire to form intimate and reciprocal relationships, but may be inhibited in meaningful expression and sometimes constrained if intense emotions or conflicts arise. Cooperation may be inhibited by unrealistic standards; somewhat limited in ability to respect or respond to others’ ideas, emotions and behaviors.

Impaired (2) Capacity and desire to form relationships in personal and community life, but connections may be largely superficial. Intimate relationships are largely based on meeting self-regulatory and self-esteem needs, with an unrealistic expectation of being perfectly understood by others. Tends not to view relationships in reciprocal terms, and cooperates predominantly for personal gain.

Very Impaired (3) Some desire to form relationships in community and personal life is present, but capacity for positive and enduring connection is significantly impaired. Relationships are based on a strong belief in the absolute need for the intimate other(s), and/or expectations of abandonment or abuse.  Feelings about intimate involvement with others alternate between fear/rejection and desperate desire for connection. Little mutuality: others are conceptualized primarily in terms of how they affect the self (negatively or positively); cooperative efforts are often disrupted due to the perception of slights from others.

Extreme Impairment (4)  Desire for affiliation is limited because of profound disinterest or expectation of harm.  Engagement with others is detached, disorganized or consistently negative. Relationships are conceptualized almost exclusively in terms of their ability to provide comfort or inflict pain and suffering. Social/interpersonal behavior is not reciprocal; rather, it seeks fulfillment of basic needs or escape from pain.


The remaining scales are listed here:  dsm5.org/ProposedRevisions.aspx?rid=468

[rich5a]

Are people with BPD psychotic as well as neurotic...Can someone explain that a little better. I know there are varying degrees of the disorder...does the bpd individul who suffers more psychotic episodes make them extremely disordered?
Thanks

[Matt]

Are people with BPD psychotic as well as neurotic...Can someone explain that a little better. I know there are varying degrees of the disorder...does the bpd individul who suffers more psychotic episodes make them extremely disordered?
Thanks

BPD is called "borderline" because in the past it was considered to be on the "borderline" between psychosis and neurosis.  Now the map of mental illnesses has been changed and it's no longer viewed like that, but the name hasn't been changed.

It's a personality disorder and doesn't necessarily involve psychosis.  But about half of those diagnosed with BPD are "co-morbid" - that is, there is more than one problem.  So someone who has BPD could have another problem, including maybe a type of psychosis.

[MaybeSo]

As Skip mentions, everyone has personality 'style'. A style is not a disorder. A style is still flexible and adaptable.  A disorder is not.

If you look at the DSM criteria for BPD there is nothing new under the sun. It is describing human behavior.  However, when it becomes pervasive, rigid and all encompassing...throughout life...(not situational)...not a style...then you have a personality disorder.

A pw a personality disorder is like a person who has only 4-5 tools that they use for every single purpose under the sun as they go through life. Often, it will seem more or less appropriate, because it's a tool other people use from time to time also. Nothing wrong with a hammer, for example.  But that's all they have, just 4-5 tools, to use with for every purpose.

A person with a personality style, as we all have...can pull from hundreds of thousands of various tools depending on what they come across each day.  A person with a personality style is flexible, adaptable, can get into a problem, but can pull out  variety of 'tools' flexibily so as to adapt to whatever is in front of them...to help solve the problem and move on. This is done usually w/out lots of fanfare or drama...we just live out lives.

A personality disordered person will pull out a hammer...and be fine, until they pull out the hammer to use for something completely inappropriate for the task at hand.  Then it gets noticed...then problems start. It gets noticed, and a lot of drama ensues.

People w/ personality styles have a certain amount of drama, and ups and downs, in life, too.  But for a pwBPD...drama follows them around like that kid in the peanuts cartoon that has a cloud of dirt/dust billowing around him at all times.  It is a wholly different feel.  

There is a big difference between a 'style', regressed behavior during a midlife crises, and a personality disorder.  

Having said that...culturally, I really do worry sometimes that as a whole we are moving more toward a cult of personality that embraces and even  worships immature 'child-like' behaviors and in essence we are creating a personality disordered culture... meaning, as a culture, it has become more acceptable to lack empathy, look and act young all the time, be selfish and self absorbed, have your cake and eat it to, enjoy getting over and one-upping others,  have to get all your childish "id" needs met instantly,  feel entitled,  absolutely no deferred gratification (eg., total and instant access to drugs, porn, instant contact w/ the mother ship at all times, shallow communication all the time w/ little or no depth etc.), we don't want to raise our own kids, everything that takes time and patience is downplayed as just a pain in the ass, we want to feel 'good all the time' and if we don't it someone's fault...we are in a way...becoming a very childish " borderline" society.  But that is just my humble, worried opinon.  

 

[search4peace]

I have been reviewing several online resources about some of the co-morbid features of BPD, including alcoholism.  What I have found is that those suffering from alcoholism per se, whether they are ACOA or not, is the striking similarity of symptoms to those discussed on this board, including some used in the DSM used to classify someone as having BPD:

Black-white thinking
Relationship difficulties, barriers to intimacy
Child-like reasoning/thinking
Low self-esteem; poor sense of self
Fear of abandonment
Hypersensitivity to criticism

Are there an traits that are unique to BPD?  it has started to make me wonder whether the DSM threshold for BP diagnosis (5/9 critera) may be a bit loose.

Seeking comments...thank you in advance.

[Willy]

Hi search4peace, I agree, and have also noticed before that long term heavy alcoholism can probably result in a BPD diagnose based on the criteria. I am not a psychologist, but I think that for a diagnose in this case, one needs to look a bit beyond the criteria. BPD is an attachment disorder, so I think you need to look specifically at the intimate r/ss and its developments. Next to that, although less clear cut, the lack of self-identity for a pwBPD tend to display itself in particular ways. For example, changing looks often, inconsistent opinions etc. There are some specific BPD traits, although they are not necessary for the official diagnose and are not necessarily found with every pwBPD. That's why a proper diagnose should only be done by a trained specialist.

It's the chicken and the egg story really, and most therapists IMO will advice to first beat alcoholism, before looking further.

[BentNotBroken]

Just read this thread, my concern would be the inability to properly diagnose a non-cooperative patient. In a case like my ex, a highly intelligent, high functioning person, she knows what answers to give in order to avoid a diagnosis. However, if you were to ask about her behavior to someone like me who really knows her, the diagnosis would be very clear. She is only honest when she feels it will give her the biggest payoff. All other times she is extremely secretive and dishonest, probably because she knows that there is something fundamentally wrong with her, although she would never admit it to someone else.

[Matt]

Just read this thread, my concern would be the inability to properly diagnose a non-cooperative patient. In a case like my ex, a highly intelligent, high functioning person, she knows what answers to give in order to avoid a diagnosis. However, if you were to ask about her behavior to someone like me who really knows her, the diagnosis would be very clear. She is only honest when she feels it will give her the biggest payoff. All other times she is extremely secretive and dishonest, probably because she knows that there is something fundamentally wrong with her, although she would never admit it to someone else.

My wife and I both took the MMPI-2 (Minnesota Multiphasic Personality Index) during our Custody Evaluation.  What you are saying here, Bent, is exactly what I asked my lawyer:  "How can the test tell if she's lying?"  My lawyer told me not to worry, it could tell.

Sure enough, the test not only indicated "multiple psychological disorders" (and I think the details that the psychologist saw gave him the information he needed to say what those are), it also indicated that she had "presented falsely" (that is, lied).

Later I learned how this works.  There are about 500 items in the test - you rank each statement from "Very true" to "Very false" or something like that.  The test has been given to a lot of people, including many who had already been diagnosed with various disorders.  By studying all the data, researchers have been able to determine what patterns of responses indicate which disorders, and also which patterns indicate that somebody is trying to fool the test.

With so many items in the test, they have lots of ways to cross-check, so no one answer makes a big difference.  And they keep adding all our tests to their data base, so it keeps getting more accurate.

What you want to do is make sure that any diagnosis (or non-diagnosis) is based on objective testing, not just a professional's subjective opinion.  A professional might be able to tell if someone is faking, or maybe not - too much risk.  Using an objective test like the MMPI-2 reduces that risk.

[yeeter]

When I first came here I was against any type of labeling.  After all, Im not qualified to judge.  And if I was being labeled - especially by someone not qualified - I wouldnt like it all that much.  (the old... 'do onto others' rule)

But then it was pointed out to be that some type of characterization was useful to determine 'whether to prescribe antibiotics or flintstones'.  That is, we still need to analyze whats going on in order to increase our chances of helping the situation.

But to a large extent, that is as far as its useful (to me, in the context of this forum).  Because pretty much EVERYONE here has our own stuff that contributes to the relationship.  And that, coupled with the fact that there is a mix of items to consider (some may have problems in one area but not another), and with the relative severity (its a continuum, from those needing institutional help to those that are just strong personality traits) - each situation is pretty unique.

Devil is in the details so to speak.  And for difficult situations we recommend direct intervention (and T for both sides involved).  

Then even if not fully a disorder - that doesnt mean the personality style isnt a difficult one.  And the same tools of looking at ourselves and making change in our own behavior first - are STILL very helpful, and relevant.  And many many of these tools cross more than one PD type, so again the general good advice holds.

If we want to take this a step further - our own personal growth, and learning, is just part of the lesson being taught here.  And if we dont learn from it - dont worry, we will get that lesson all over again at some future point in life.

So for me - as a practical matter - I dont get too hung up on labeling.  Im more interested in the pragmatic:  "So, what are YOU going to do to change YOUR behavior to improve your life for the better?"    

[waverider]

I too am not too hung up on accurate diagnoses, partner was recently diagnosed BPD with alcohol/medication abuse issues. Years ago she was diagnosed OCD, with anxiety and panic disorders and severe depression.

Whatever the diagnosis is makes no real difference to me. Her behaviour is in line with much that is described on this site and the tools provided work to help manage it. She will decide for herself what she wants to believe her condition to be, to be officially diagnosed BPD and recommended DBT makes no real difference as she wont accept it nor enter the treatment. Thus obtaining official diagnosis serves no more purpose than validating my own thoughts on the matter.

She is low functioning and admits to mental illness, is on a disability pension as a result of it, and in fact wears it as an excuse to do as she pleases at times. She still insists on the version that suits her purposes best. After all anyone who suggests something that she does'nt like is incompetent, right?

So I just use the tools that seem to work best, or try to. Many of these tools are not disorder or individual specific