Is it BPD

[onlychildmom]

Hi all! My son was told 3 yrs ago by a therapist he had BPD traits. My son is totally sold on this. Me?.... not so much. He had a psychological test and dx was bipolar 2 , which I do not agree with either...... Everything I read about or hear abt BPD is worst than I have ever experienced with him. Are there different degrees of BPD? He has the mood changes and few other traits but he didnt have trauma as a child nor was abandoned.... This is hard to understand......

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Skip]

There is a spectrum with BPD and there are people with BPD-traits (subclinical). Studies suggest that only 1/2 of BPD cases involve some type of childhood emotional trauma.

How would you describe your son? Does he over-emote (highs are really high and his low are really low)? Is he impulsive? Does have problems keeping relationships? Holding jobs for extended periods? Substance abuse?

[CC43]

Hi there Mom,

Indeed BPD behaviors lie on a spectrum, with some diagnosed people seemingly able to live productive lives, and others who are so incapacitated that they can't live as independent adults.  There are also subtypes, like Quiet BPD, Petulant BPD or Impulsive BPD.  To be diagnosed with BPD, a person needs to exhibit a number of behaviors on a persistent basis, but they don't have to exhibit all of the behaviors, just a majority of them.  So for example, self-harm might occur with some people with BPD, and others might exhibit paranoia when highly stressed.  If you read these boards, you'll quickly see that patterns of unstable relationships are at the core of BPD, as many of the stressors that trigger BPD are social ones, and the resultant behaviors typically involve other people, especially loved ones.  Feeling rejected, abandoned, humiliated, inferior, mistreated, abused, disrespected, ignored, unloved--these are the common "triggers."  What's more, the person with BPD tends to be very easily "triggered"--he or she will detect slights where you or I might not perceive any slight at all.  And he or she will tend to ruminate over it, long after a "normal" person would allow such a thing to consume our attention.  A person with BPD often has a very hard time getting over perceived slights, so much so that it can be disruptive to their relationships and life in general.  They have unreasonable demands and expectations about how other people should behave, and yet they seem oblivious to the repercussions of their own behavior.  They seem so fixated on alleviating short-term pain that they completely ignore any long-term consequences.

I've read that many doctors are hesitant to diagnose BPD, because there might be a stigma.  Many will hold off on this diagnosis until the person reaches adulthood, because behaviors could evolve over time.  When I think about BPD, I think less in terms of "personality," and more in terms of BEHAVIORS and coping mechanisms that a person employs when handling stress.  This enables me to dislike some of the behaviors, but not dislike the person.  And the clinically recommended treatment for BPD, which is DBT (Dialectical Behavioral Therapy), focuses on precisely that--behaviors.  It's almost as if a person with BPD needs extra training to learn healthy ways to cope with stress, disappointments and their hypersensitive emotions.  You see, their natural behavioral responses tend to be self-destructive.

I don't think it's necessary for a child to be abused or abandoned (in the conventional sense) to develop BPD, though abuse and abandonment are risk factors.  I have a stepdaughter diagnosed with BPD, and it's hard to argue that her childhood was abusive (even though she insists it was abusive).  It wasn't perfect, but nobody's upbringing is.  She has two siblings who grew up in the same environment, and they don't have BPD.  In my opinion, she's just wired to be hypersensitive.  She is very moody, and she has very low distress tolerance.  I think she has a negative attitude generally.  She was highly supported in the home by her parents, so she seemed to be pretty normal when she was a teen, and she did OK in school.  My opinion is that she was coddled and highly privileged!  But, when she went away to college, and she didn't have a strong familial support system anymore, she fell apart.  She wasn't ready to handle adult-level stressors (academic rigor, complicated social relationships, independent living, roommates, competition, freedom over her schedule), and her resultant self-destructive behavior checked most of the BPD boxes.

There can be many co-existing conditions with BPD.  Anxiety, depression, eating disorders and substance abuse seem to be fairly common, based on what I'm reading on these boards.  The treatments for these conditions can be different than for BPD, and medications can be helpful.  Maybe that could be another reason why you could have doubts about the diagnosis.

I'd ask, do you think that if you accepted the BPD diagnosis, you'd be accepting the notion that you abused your kid?  It's not true that BPD results from abuse in childhood!  However, your kid might insist that he feels that way, and maybe he's just "wired" to perceive "abuse" where others don't.  That is part of BPD.

On these boards, you'll see reminders of the three Cs:  you didn't Cause BPD, you can't Control it, and you can't Cure it.  I guess the gist of this is acceptance.  It's OK that your son has a mental illness--we all have our problems to deal with.  But just because he has a mental illness doesn't mean he can't get treatment and learn to cope with it.  BPD is not an excuse to treat others poorly, or to self-destruct.  He might need extra training and extra patience to learn HEALTHY coping skills, which is exactly what DBT is about.

Look, after watching my stepdaughter battle BPD over several years, I tend to think that she developed a trauma-like response to ordinary stimuli.  By trauma response, I mean a fight or flight response.  Flight looks like avoidance (for example, storming off, blocking you from communications, or holing up in her apartment).  Fight is easy to see--she'll rage and accuse others of all sorts of transgressions, often inventing details that aren't even true.  She'll lash out, sometimes even with physical violence.  Her reactions are over-the-top, not proportional to the situation, and last for an extensive time period.  She'll even fight about trivial things that supposedly happened a decade ago, and she seems unwilling and unable to move on.  Does this sound familiar?  It's classic BPD.  But with extensive therapy and the help of medications (mood stabilizers), she's learning to cope better now.  I wouldn't say that she's "cured," but her self-destructive behavioral tendencies are much diminished now.  She's still moody, and she still perceives slights where you and I wouldn't see any, and she'll still dredge up past grievances as a reaction to current stressors, but the frequency and degree are much more manageable now.  She still hasn't repaired relationships with most of the family, but I'm not losing hope, as she'll build up her self-confidence and maybe eventually find a way to let bygones be bygones.

All my best to you.