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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: DIFFERENCES|COMORBIDITY: Borderline and Antisocial Personality Disorder  (Read 31792 times)
Abigail
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« on: September 27, 2007, 03:38:24 PM »

Just read a fact sheet from NAMI that said the comorbidity of BPD with ASPD and with NPD is common. It still seems strange to me to have both BPD and ASPD but I guess it does happen.

 

Abigail
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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).

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« Reply #1 on: September 27, 2007, 03:45:20 PM »

Perspective and context.   smiley

When asking differential questions about personality disorders or multiple personality disoredrs, it is important to ask yourself why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong personality disorder was diagnosed or whether there are comorbid (multiple) personality disorders at play.

~ If you are trying to get along better with your wife, it's not as important to pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's helps to know that the distinctions have, historically,  are not all that neat and tidy. In a 2008 study sing the DSM-IV criteria, co-morbidity with another personality disorder was very high at 74% (77% for men, 72% for women). This is one reason why there is controversy around the DSM-IV classifications of Personality Disorders - there is so much overlap it is confusing even to professionals.  In 2013, the DSM will redefine these disorders and people that do not neatly fall into one of 6 types/patterns, will be classified as Personality Disorder Trait Specified (with a trait profile based on the following criteria)

Under the Old DSM-IV Classifications





Comorbid w/BPD--------------

Paranoid

Schizoid

Schizotypal

Antisocial

Histrionic

Narcissistic

Avoidant

Dependent

OCD

More info
Men-----------

17%

11%

39%

19%

10%

47%

11%

2%

22%
Women-------

25%

14%

35%

9%

10%

32%

16%

4%

24%


Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control


  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.


  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.


  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game.  


I hope this helps keep it in perspective.   smiley

Skippy




Additional discussions...

Personality Disorders

Borderline and Paranoid Personality Disorder

Borderline and Schzoid/Schizotypal Personality Disorder

Borderline and Histrionic Personality Disorder

Borderline and Narcissistic Personality Disorder

Borderline and Avoidant Personality Disorder

Borderline and Dependent Personality Disorder

Borderline and Obsessive Compulsive Personality Disorder

Borderline and Depressive Personality Disorder

Borderline and Passive Aggressive Personality Disorder

Borderline and Sadistic Personality Disorder

Borderline and Self Defeating Personality Disorder

Other

Borderline PD and Alcohol Dependence

Borderline PD and Aspergers

Borderline PD and Attention Deficit Hyperactivity Disorder

Borderline PD and BiPolar Disorder

Borderline PD and Dissociative Identity Disorder

Borderline PD and P.T.S.D.

Borderline PD and Reactive Attachment Disorder (RAD)
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RCA212
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« Reply #2 on: August 29, 2011, 08:10:49 AM »

I don't know much, so I was hoping that some of the more educated people on this board could shed some light on this - are BPD behavior and Sociopathic behavior similar at all?  What are the similarities and differences?  What specifically sets the two apart?  Can one person exhibit both? 
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Auspicious
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« Reply #3 on: August 29, 2011, 08:39:54 AM »

I don't know much, so I was hoping that some of the more educated people on this board could shed some light on this - are BPD behavior and Sociopathic behavior similar at all?  What are the similarities and differences?  What specifically sets the two apart?  Can one person exhibit both?  

By sociopathy, do you mean ASPD?

I would suggest looking at the descriptions and diagnostic criteria for both BPD and ASPD, to shed some light on your question. For now, I'll just borrow the shortest descriptions that I can crib from wikipedia wink

ASPD:

Antisocial personality disorder (ASPD) is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition (DSM-IV-TR), as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."

BPD:

Borderline personality disorder (BPD) is a personality disorder described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the disorder often manifests itself in idealization and devaluation episodes, as well as chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.

In my completely unprofessional opinion, BPD can periodically mimic ASPD, in some ways, for some individuals. I think at those times the person with BPD can be so wrapped up in their own pain and distress that they temporarily cannot consider the rights of other people.
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Beach_Babe
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« Reply #4 on: September 26, 2011, 04:59:09 AM »

Article taken from  www.sociopathicstyle.com/

1. GLIB and SUPERFICIAL CHARM -- the tendency to be smooth, engaging, charming, slick, and verbally facile. Sociopathic charm is not in the least shy, self-conscious, or afraid to say anything. A sociopath never gets tongue-tied. They have freed themselves from the social conventions about taking turns in talking, for example.

2. GRANDIOSE SELF-WORTH -- a grossly inflated view of one's abilities and self-worth, self-assured, opinionated, cocky, a braggart. Sociopaths are arrogant people who believe they are superior human beings.

3. NEED FOR STIMULATION or PRONENESS TO BOREDOM -- an excessive need for novel, thrilling, and exciting stimulation; taking chances and doing things that are risky. Sociopaths often have low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time, for example, or to finish tasks that they consider dull or routine.

4. PATHOLOGICAL LYING -- can be moderate or high; in moderate form, they will be shrewd, crafty, cunning, sly, and clever; in extreme form, they will be deceptive, deceitful, underhanded, unscrupulous, manipulative, and dishonest.

5. CONNING AND MANIPULATIVENESS - the use of deceit and deception to cheat, con, or defraud others for personal gain; distinguished from Item #4 in the degree to which exploitation and callous ruthlessness is present, as reflected in a lack of concern for the feelings and suffering of one's victims.

6. LACK OF REMORSE OR GUILT -- a lack of feelings or concern for the losses, pain, and suffering of victims; a tendency to be unconcerned, dispassionate, coldhearted, and un empathic. This item is usually demonstrated by a disdain for one's victims.

7. SHALLOW AFFECT -- emotional poverty or a limited range or depth of feelings; interpersonal coldness in spite of signs of open gregariousness.

8. CALLOUSNESS and LACK OF EMPATHY -- a lack of feelings toward people in general; cold, contemptuous, inconsiderate, and tactless.

9. PARASITIC LIFESTYLE -- an intentional, manipulative, selfish, and exploitative financial dependence on others as reflected in a lack of motivation, low self-discipline, and inability to begin or complete responsibilities.

10. POOR BEHAVIORAL CONTROLS -- expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper; acting hastily.

11. PROMISCUOUS SEXUAL BEHAVIOR -- a variety of brief, superficial relations, numerous affairs, and an indiscriminate selection of sexual partners; the maintenance of several relationships at the same time; a history of attempts to sexually coerce others into sexual activity or taking great pride at discussing sexual exploits or conquests.

12. EARLY BEHAVIOR PROBLEMS -- a variety of behaviors prior to age 13, including lying, theft, cheating, vandalism, bullying, sexual activity, fire-setting, glue-sniffing, alcohol use, and running away from home.

13. LACK OF REALISTIC, LONG-TERM GOALS -- an inability or persistent failure to develop and execute long-term plans and goals; a nomadic existence, aimless, lacking direction in life.

14. IMPULSIVITY -- the occurrence of behaviors that are unpremeditated and lack reflection or planning; inability to resist temptation, frustrations, and urges; a lack of deliberation without considering the consequences; foolhardy, rash, unpredictable, erratic, and reckless.

15. IRRESPONSIBILITY -- repeated failure to fulfill or honor obligations and commitments; such as not paying bills, defaulting on loans, performing sloppy work, being absent or late to work, failing to honor contractual agreements.

16. FAILURE TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS -- a failure to accept responsibility for one's actions reflected in low conscientiousness, an absence of dutifulness, antagonistic manipulation, denial of responsibility, and an effort to manipulate others through this denial.

17. MANY SHORT-TERM MARITAL RELATIONSHIPS -- a lack of commitment to a long-term relationship reflected in inconsistent, undependable, and unreliable commitments in life, including marital.

18. JUVENILE DELINQUENCY -- behavior problems between the ages of 13-18; mostly behaviors that are crimes or clearly involve aspects of antagonism, exploitation, aggression, manipulation, or a callous, ruthless tough-mindedness.

19. REVOCATION OF CONDITION RELEASE -- a revocation of probation or other conditional release due to technical violations, such as carelessness, low deliberation, or failing to appear.

20. CRIMINAL VERSATILITY -- a diversity of types of criminal offenses, regardless if the person has been arrested or convicted for them; taking great pride at getting away with crimes.

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Willy
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« Reply #5 on: September 26, 2011, 05:22:27 AM »

A read a bit about it, but didn't find anywhere a good desciption of the difference between a psychopath and a sociopath. Does anybody have this info, or are the two terms more or less synonyms now?

Is a psycho more the planner and the socio more the impulsive one?
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Beach_Babe
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« Reply #6 on: September 26, 2011, 03:03:07 PM »

From what I understand a psychopath is more genetically bred (nature), whereas a sociopathic development is due to environmental factors (nuture). I know they say BPD and ASPD cant exist together (as, technically they are opposites ASPDs lacking emotion and BPDs feeling it in extremes) however,  I beg to differ. My pwBPD was TEXTBOOK low functioning borderline, but at the same time much she genuinely enjoyed hurting people.
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Willy
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« Reply #7 on: September 26, 2011, 03:35:36 PM »

I know they say BPD and ASPD cant exist together (as, technically they are opposites ASPDs lacking emotion and BPDs feeling it in extremes) however,  I beg to differ

Yes, I have seen both too. The hypersensitivity and a complete lack of emotion. She could be like an insecure 'innocent' child and the next second as cold as ice and mean. Was the first a mask or another personality? I think the child was a part of her, but also a way of getting sympathy and a learned way of disguising her dark side. She could enjoy putting other people down, she had fantasies torturing people (yet had strong submissive BDSM tendencies) and had no respect whatsoever for other peoples property.
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« Reply #8 on: September 26, 2011, 10:46:39 PM »

While I believe their is much overlapping between personality disorders and also since personality is fluid not static, that there are overlapping symptoms in Pds, I also think there's a big distinction between someone who is antisocial and someone who is BPd.  Sometimes people have the same symptom, say promiscuous sexual behavior, but the reasons behind the symptom can be very different.  I think the things underlying sociopathy are quite different than BPD.  BPDs have different defense mechanisms at work and different physiological happenings.  If I recall this correctly, aspd types have an underactive amygdala while BPDs have an overactive amygdala.

Unfortunately, I dated someone who showed typical symptomology of being antisocial, yet I found that relationship to be far less damaging than when I've dealt with BPDs.  I also found him to have a very different type of personality than pwBPD I've known.  He lacked the emotional turmoil of a BPD.  He was more calculating, not at all insecure, and while I've been on the receiving end of a lack of empathy from BPDs, the antisocial guy lacked empathy and a conscious on a whole different level.    B/c my experiences with BPDs have been so hurtful, it's easy for me to feel like they are horrible and lack all emapthy, but I have to admit they have more capability to feel and care than antisocials, I believe. 
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« Reply #9 on: December 03, 2011, 05:19:50 PM »

Sociopaths charm.  Only people with a pleasurable ego are interested in charming ... putting forth a fantastic image...marking themselves as great. The "charmee" is then always put in a lower position in status. Charm is essentially a lie. And it's usually used to pull a fast one.

The Borderline isn't as self-assured.  Borderlines do not charm- they MIRROR. Because of this, they are often confused when mirroring is not enough- and the partner demands the real self to emerge. As the partner gets pulled into a persecutory role, the Borderline frantically back pedals and projects persecution to get out of the snafu. It is at that time that they show to you how they were treated as children, with victimization, persecution and rescuing behavior all on a transference triangle and projected outwardly as if to hurt and maim.  But it's unconscious behavior that is from a distorted perception or belief rather than an outright con.

If they mirror the right people, the counter-transference can be life affirming for them as a bondage persecution- but it's not done in order to get away with bad behavior like the Sociopath- it's done to prove themselves correct about their earliest and most primitive thoughts of bondage.

The partner of the Borderline often misunderstands and casts the Borderline in an anti-social (Sociopathic) role- as this is the easiest and simplest solution to split a person from good to bad and protect the Ego. In a protective ego split, the Borderline is justifiably evil- and has done horrible things on purpose- because deep down, they are bad people- flawed and evil.  But this is purely a defense mechanism of the partner.

When we judge Borderline behavior based on our own projected concept of good- and Borderline disorder usurps our concept of good, we take back the good- and put bad in it's place and it is this defense mechanism that allows us to remain safe by splitting the other party into bad.


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