What are they on the borderline of?

[Ben]

Borderline Personality Disorder.  This is a question about the name of the condition that I'm surprised not to have found answered here yet.  Sorry if it has been.

What exactly are they on the borderline of?

Is it schizophrenia?  Is it depression? 

Ok, one side of the border must be 'normal' (whatever normal is!)  But what's on the other side?

Sorry if this is so obvious, but to call it Borderline Personality Disorder there must be another side of the border, I'd just like to know what's on it.

Thanks if you can help.

[dramacat]

When the term "Borderline Personality Disorder" was coined, clinicians generally believed that patients in whom it had been diagnosed were on the borderline between neurosis and psychosis.  That diagnostic phraseology has since been discarded, but the name stuck.

[wisernow]

Some professionals now would like to rename it "Emotional Regulation Dysfunction"...or
something like that... but I think the original theory is pretty good too.

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[Ben]

Emotional Regulation Dysfuntion is a better name because it gives some idea what the condition actually is.

Wikipedia defines neurosis as a "catch all" term for any mental imbalance that causes distress, but, unlike a psychosis or some personality disorders, does not prevent or affect rational thought.  And Psychosis is defined as is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality."

All of these terms are helpful showing what BPD sufferers are actually living with.  Thankyou, Dramacat & Wisernow, for your input.  I'm still interested in other definitions of the condition.  Why was that diagnostic phraseology discarded?  Not precise enough?  Not specific enough? 

I agree the original theory is pretty good now I know what sufferers were thought to be on the borderline of.  But without that information it was too vague for me.  It's just a shame it still needs so many long words to fully describe it.

A better name for the condition would be one that's just one word, not a phrase that's likely to be shortened to initials.  But that's probably asking a bit much!

[LAPDR]

I know the term borderline is very open with no concise meaning to laymen but saying somebody is Emotionally Irregular sounds like they need to take a OTC medication like Geritol or Pepto-Bismol.

Just for the lighter side of things.  :
LA

[Ben]

Haha, know what you mean, Lapdr!

It seems all the terms for this condition are very vague & open to interpretation.  That says a lot about the condition itself. It's so hard to be precise about something when even the professionals are inconsistant as to the best ways of labelling it.

That must make it even harder to treat.

[LAPDR]

I did a little statistical math one time on the combinations and permutations of meeting the 5 of 8 DMS criteria for a borderline diagnosis (and now they say there is 9) that if somebody had two major elements within each criteria there would be over 2000 combinations of personality quirks that could be found. If the hard core ones exhibit more than just two of the criteria and commingle with other PD issues then the combinations could over the 10000 mark. Yes, it must be hard to isolate that varied amount into one box. When you first read the DMS criteria you see things listed that really stick out like attempted suicide, drug usage, self mutilation and bulimic binges. When I first read them I knew my ex never did these things and tossed the book. Later I came back to it and reassessed the situation and realized she did fit the criteria but without all the big items that I first read.

Your right, that is maybe why it is so hard to treat.

[paul16]

I believe the term "borderline" is well suited as it refers to the person crossing back and forth, in and out of psychosis. That explains why they can appear perfectly normal a lot of the time. True with my exSO.

But when I first heard the term, and when most people think about how the word borderline is used in our language, they think that it is almost something. What is discussed on here is anything but almost a personality disorder.

[Bananahead289]

I believe the term "borderline" is well suited as it refers to the person crossing back and forth, in and out of psychosis.

Well that is exactly what scholars USED TO THINK.

becauyse BPDs do NOT get psychotic...

Are you being serious or facetious?  Because my UBPD Ex did get psychotic at times.  He disassociated several times at the therapist causing them to get frightened and call the police on him.  He also disassociated at our house.  I couldn't decide whether he was bipolar, BPD or possessed by Satan.  And I AM being serious.
Once we got into an argument and he told me he was going to leave.  I told him he needed to stay and talk to me, and he jumped right out of the window, right through the glass and screen.  He also drove his car up on the lawn several times in the middle of the night screaming for money and his possessions. He had an alternate personality (who was a woman) that he used to assume at times when he cross-dressed.

Wow.  Gets a little scary looking at that on the computer screen when I think about it.  Good thing I'm out 1 1/2 years and NC.

[thenextstep]

My T has stated that when BPDw is raging, it is a psychotic state.  I've certainly seen her psychotic.

[paul16]

Sounds like semantics. If acting totally irrational and disassociative is what psychosis is then mine is psychotic.

But, as Bill Clinton once said, it would depend on what your definition of "is" is.

[geroldmodel]

Dissociation is not considered to be psychosis in scientific articles.
*but it certainly looks like it when you are raged at*  <:-)

So yes its a semantics thing.
and the term borderline is outdated.

Emotionaly Unstable PD as in the universal ICD-10
sounds much better

[eggshell]

Psychosis means to lose touch with reality... and bpds do that on a rather regular basis. They don't always take it to the level that psychosis does, but they CAN.

[thenextstep]

eggshell, I'm with you on this.  Yes, there is a difference between dissociation and psychosis, and I don't think anyone here argued otherwise.  That being said, I have definitely witnessed psychotic rages from BPDs.

[paul16]

I guess this is a hot button for me. Disassociation from reality is not psychosis? Losing toch with reality is? Can someone please explain the difference between disassociation and losing touch? Or is psychotic just a word that people on here want to avoid?

Let's discuss disorder. There are so many that show these characteristics that it could be argued that it is a type of personality (albeit not an attractive type) that exists in humanity. Who's to say it's a disorder? There are all kinds of medical conditions pit there that effect quality of life that aren't refered to as disorders. Just part of the human condition.

[geroldmodel]

Disassociation from reality is not psychosis? Losing toch with reality is? Can someone please explain the difference between disassociation and losing touch? Or is psychotic just a word that people on here want to avoid?

Well from a CLINICAL perspective these are two different concepts:

DISSOCIATION is a EGO DEFENSE MECHANISM.
= pychological defense mechanism in which specific, anxiety-provoking thoughts, emotions, or physical sensations are separated from the rest of the psyche. We all dissociate: Daydreaming, Staring into a campfire, meditation... and in extremis the example of a raging BPD...it's all dissociation.
All people with BPD dissociate. Only some people who dissociate have BPD

PSYCHOSIS is a PATHOLOGY:
= A severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning.

Here is a quote from a BPD describing the difference between dissociation and psychosis:

Lucie:
"Concerning the manifestations of dissociation, medically speaking, I will answer you that, no, fortunately it never comes to me of living such episodes.
On the other hand, at the time of very strong anxiety or very large feeling of faintnesses I have this state "of blank" which is inside me.  Approximately it results like:  to be there, without being there.  See its body to function, move, but by innate memory.  Me, at this moment I don't control anything.  Not to distinguish the real sounds and the imaginary sounds, as well as the lights and the glares. To have eye trouble and lot of small phenomena like that.  I believe that it is as much destabilizing, because on the contrary of the psychotic who does not realize, me I am conscious. In fact it is really that, for me, the borderline state.  It is as if I realized that I am about to become crazy, I have really a foot outside and a foot inside reality.  At the beginning, when it comes, I finished with the urgencies of the hospital, now, that always makes me cry, but I try to solve this alone, because I recognize a little this state.  I could not describe you the horror to be confronted with my colleagues and to be at work when that arrives.  That arrives to me approximately 1 time per month... or a little less, that depends !"

[paul16]

OK. I get it. Loss of contact with reality is a good, understandable way to communicate the behavior that I experience with what I suspect is a person that has this personality type.

When they rage, cheat, lie, manipulate, (which causes deterioeration of normal social functioning) and do other things that will hurt THEM in the long run it is definately because they have lost contact with reality. So by defination, they are psychotic.

[Abigail]

  Quoting from the book "Biological Unhappiness" by Dr. Leland Heller regarding BPD:
     "Psychosis is a temporary loss of accurate reality perception.  Psychosis usually develops in borderlines from mild to moderate stress, dysphoria, fear of abandonment and emotional pain.  BPD psychosis can be brought on by drugs, especially alcohol and marijuana.  A prominent expert on the BPD wrote that only borderlines become psychotic from marijuana."  (that does not mean they will definitely become psychotic on marijuana but they can become so)

     "Psychosis is a state of reality perception--it is not a person.  You are not "a psychotic," however you can become psychotic.  Psychosis is the last "line of defense" when overwhelming stress and/or pain are present.  Borderlines are NOT psychotic--but often become so."

  Abigail

[paul16]

     "Psychosis is a state of reality perception--it is not a person.  You are not "a psychotic," however you can become psychotic.

If someone suffering from bpd loses touch with reality then they become psychotic. So the original question on this thread would have to be answered that they are on the border of psychosis.

[geroldmodel]

So the original question on this thread would have to be answered that they are on the border of psychosis.

...and modern psychiatry has left that idea 30 years ago...

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation.

Aapel view of Schizophrenia and Borderline Personality Disorder
Here is our feeling.
What is schizophrenia ?
A mental illness where the individual has psychotic symptom, when he "loses touch with reality"

What is a delusional Disorder ?
A mental illness where the individual has psychotic symptom with false belief. The subject is resistant to every argument: It is then impossible to think logically with him / her, even confronted with tangible proofs, he or she continue to firmly maintain it.

Are BPD, schizophrenia and delusional disorder 3 entities ?
Obviously yes

Do some BPD people have psychotics symptom ?
It is possible but not necessary.  In case of BPD it is probably better to speak about dissociation and not about "real" psychotic symptom. The Dsm criteria of BPD talk about "severe dissociative symptoms" and not about psychotic symptom.

An empirical study of psychosis in borderline personality disorder
HG Pope Jr, JM Jonas, JI Hudson, BM Cohen and M Tohen


To assess the nature and prevalence of psychotic symptoms in borderline personality disorder, the authors reviewed the cases of 33 patients meeting DSM-III criteria for borderline personality disorder, using both "narrow" and "broad" definitions of psychosis. Only eight patients displayed psychotic symptoms meeting the "narrow" DSM-III definition; in all of these cases, the symptoms appeared to be attributable to either severe drug abuse or major affective disorder, present simultaneously with borderline personality disorder. The remaining patients displayed only "broadly defined" psychotic symptoms or symptoms that appeared to be under voluntary control. These findings weigh AGAINST the assumption that borderline personality disorder lies "on the border" of classical psychotic disorders.

[geroldmodel]

This is hellishly complicated.

I agree.

Samuell, you describe BPDs as having a state of "normal" behaviour & a state of "extreme behaviour".
These behaviour states are very obvious when you are living with a BPD and I very much agree that the term "borderline" sticks from this view...

But over the years I came to learn that EXTERNAL behaviour is only the tip of the iceberg of the CONSTANT INTERNAL turmoil...
and "normal" behaviour does not equal "normal" emotions...
From this point of view BPD cannot be seen as "borderline" between two states, but as a permanent unstable state.

 

[Samuell]

geroldmodel, you are probably right about the internal turmoil. I try to move on from wondering what went on in her head - trying to understand that was pointless. Sometimes she even knew her thinking was twisted but had to act on it anyway.

You are right to say that they are permanently unstable. But in terms of what affects the outside world and nons in particular is the behaviour and language. That is what is on the borderline - acting and talking crazy then acting and talking sane then back to crazy again.

Once upon a time I wanted so badly to see what went on in her head so that I could try to help. I genuinely believe I got a glipse of it just once - a flash in her eyes and she said somthing like "you can see me." I will never forget it and for that brief moment I was there. It was hell and I never want to see it again.

Sam

[geroldmodel]

There is a debate as to whether BPD should be renamed. The term "borderline" started in clinical use in the 1930s, originating in the idea (now out of favor) of some patients being on the "borderline" between neurosis and psychosis. BPD only became an official Axis II (personality) diagnosis in 1980 with the publication of DSM-III.[35]

From Wikipedia on BPD

[Bellamina]

It is my personal experience that when my husband is in a full rage he is psychotic. He blacks out and loses all sense of time and place. It seems like he becomes that robot in the Looney Toon cartoons that Elmer Fudd bought that he could program to kill Bugs Bunny. He literally has a one track mind and the only message he is getting is KILL!
 
In another event he may become paranoid which is usually triggered by an argument he and I are having and I make a remark about leaving. He goes into full paranoid mode at that point and will physically detain me and has even hurt me to prevent me from leaving.

If for some reason he is unable to obtain his medications he will have auditory hallucinations. A year ago or less we could not afford his meds and he was without them for a month. He told me that he was hearing things and voices that he knew were not real. I'm not 100% that he was being truthful or just making up some of it but I took him seriously. He has no memory of it now. After him being medicated for a year that was one of the most difficult months we have both been through and I never want that to happen again! For the first time in our relationship I was frightened and I came within seconds of dialing 911 and having him baker acted that month.

My husband is currently medicated but if I push him too far he will still flip into one of these behaviors. He has ran the full gamut I believe between psychosis, paranoia, dissociative disorder and so on. It is just my opinion but I think instead of BPD being one or another mental illness it is in fact a mix of all of them. We have BPD's who have Narcissistic issues, psychotic behaviors, paranoid behaviors and so on. Maybe BPD is just the combination of them all or some. Maybe what we think is co-morbidity such as BP with BPD is truly just a form of BPD itself. I dunno just my thoughts.