dBPD who is worried she actually may be female presentation of ASPD; help?

[PearlsBefore]

I have a female dBPD who certainly fits all the standard criteria for BPD (self-harm, violence to others, false suicides, chaotic relationships, fractured self-image) but because she has a relative who has been misdiagnosed, and another relative who has 5+ mental health comorbidities...this particular person is concerned that she's either been misdiagnosed and is actually ASPD but nobody recognizes it because she's (a) female, and it is realistically still a gendered diagnosis, and (b) has seen experts in BPD who say it's BPD...but they may have a confirmation bias to assume she fits their specialty.

I tend to assume the BPD diagnosis is correct (she met the famed Johns Hopkins specialist, you probably know who I mean, who agreed it was BPD) - but I do understand her concerns. Because of the high number of BPD relatives in my life, I'm "something of an amateur expert" myself on BPD...but again, that means I'll have the same confirmation bias to jump to BPD rather than ASPD in my personal opinion (she has asked).

So one of her favorite examples of "not BPD" is that there was a college friend who was religious fundie, a virgin, drop-dead gorgeous...and so this dBPD deliberately set about to convince her to sleep with a guy...then again, then again, misrepresented sex parties to her as innocent just hoping to corrupt her, etc...until the religious girl's reputation was ruined. Years later, she says she recognizes how that was bad, but that her only motivation was that the girl had been "turning more heads" than she was. So I agree it doesn't sound like classic BPD tones underlying that (jealousy and amorality aren't really keystones from what I know) - and it "sounds anti-social" except it doesn't really fit into the classic definitions I read of ASPD either...but that might just be because they/I am not taking into account the gender difference at play.

Anyways, looking at online resources for ASPD, there seems to be wide consensus that it's often misdiagnosed as BPD and almost exclusively in females (and conversely almost exclusively male BPDs getting misdiagnosed as ASPD). But then...there's not really any great resources on what female-specific ASPD looks like?

I can find a couple of scholarly articles talking about sex differences in ASPD (or BPD, or Schizophrenia, they all have gender differences) - but they're not giving me a "layman's" grasp of the difference, especially contrasted to how does female-ASPD differ from BPD, rather than how it differs from ASPD.

Does anyone have any resources, anecdoctal tales or similar experiences with trying to differentiate between female-ASPD and BPD?

[beatricex]

hi Pearlsbefore,
I'm assuming ASPD is Antisocial personality disorder.  I personally don't know anyone diagnosed with anything.  In my somewhat small, but mentally ill family and now married into family, we have mental illness but no one is sophisticated enough to have a "therapist" (sounds cool only if you are way progressive) except me! And there is way too much narcissism going around for them to admit any fault anyway.

Sorry I cannot help.

It is probably a great question tho.

b

 

[Notwendy]

We aren't professionals and I can't recall exact sources but I have looked into this because I wondered if my BPD mother is also ASPD.

What I found is that these are spectrum disorders that can have some overlap. So a person with any of these can range from mild to severe and have aspects of another PD. I guess the main diagnosis is made on the characteristics that are most predominant.

Some believe that ASPD is at the most severe end of NPD. Also ASPD is on a spectrum. I did read a book called "The Sociopath Next Door" which describes the more "ordinary" acts rather than the more dramatic ones that we assume someone with ASPD would do.

Both pwBPD and pwASPD can do hurtful things to others but I think a difference is the thinking behind it. A pwBPD can act out when they believe they are in victim mode " they hurt me so I am going to hurt them back".

For ASPD it's not from victim perspective. I have read they don't experience empathy. They deliberately hurt others as some way to actually have a feeling about others and they somehow feel satisfaction when they do.

However, I also think a pwBPD also can deliberately hurt someone else, but I think this is driven by their own internal turmoil. I don't think a pwASPD experiences that the same way.

Of course the two PD's can overlap with traits of both. I think it would take a very skilled therapist to determine what category a person would fit best. But actually the main issue is the behaviors and the issues they cause to themselves and others and how to best address that.

I have seen my mother do very hurtful things- mostly driven by her own perspective of feeling like a victim. I think she is mainly BPD. However she has aspects of NPD and is extremely manipulative. She also lies- so much that I can not tell if what she says to me is true or not. What made me look into ASPD as a possibility is that, sometimes she lies and manipulates for no reason, and seems to enjoy doing it. She seems to have no concern about the harm this does to her relationship with others. She lies to me often and if I fall for it, I can see her smirk with satisfaction.

However, she is not a criminal. She's the typical "next door" type who mainly causes hurt to the people around her. She also does very nice things for people too which makes deciding if she is actually ASPD or not very difficult.

So back to your friend- that was an awful thing to do to that friend. The friend was clearly naive about the sexual world and your friend took advantage of that and manipulated her. My thoughts on this are- this is out of the range of what I see as BPD harmful behavior as it seems to be plotted, and carried out methodically. The kinds of things I see my mother do from the BPD perspective is- trash or ruin my valued possession, tell lies about me-- to "hurt back". Usually she's in the moment, acting out of rage or dysregulation, it's not a carefully thought out plan.

Her lying to people about me is a search for validation. She has to put me down to others to get them to console and side with her. I don't think it's a thought out plan to hurt me, but a way for her to make herself feel better.

Your friend acted out of jealousy, but to me, a BPD person would impulsively lie to others that this friend was "sleeping around" rather than go through the steps she took to manipulate this naive young woman to ignore her own values. To me, that would take some time and some work to carry that out, and when my mother is doing hurful things in revenge, she's not that clear or methodical about it, it's more impulsive.

But I think it would take a very skilled therapist to figure out what is going on with your friend.

Just my 2cents here.

[Methuen]

The thing that strikes me as odd about this is that she is diagnosed in the first place, and secondly and more importantly, arguing or at least participating in dialogue about her diagnosis.  I’m trying to wrap my head around that.  My mom has refused to see a “counsellor” her entire life, and when she was younger would bristle at the suggestion. Instead of seeing it as helpful, she only viewed it as my dad suggesting there was something wrong with her.  He was actually trying to support her and their relationship because he loved her.  Most of the stories I’ve read on here seem to line up with that to some degree, but maybe thats my own confirmation bias.  I’ve  only been on this site 1 1/2 yrs, but this is the first time I can recollect encountering this. Interesting that she is engaged  in this discussion at all, instead of in denial.   Does she like the attention brought on by this distinction?

[Notwendy]

Methuen,

You bring up a good point as my BPD mother would not have accepted the diagnosis either. We could not even suggest it. The only reason she is diagnosed now is because she is elderly and has home health care/social worker visits and they have been around her long enough to be able to see what is going on with her.

However, this person is not accepting the diagnosis but it also proposing another one, to me, one that is socially stigmatizing. However, from what I have read, sociopaths are  self aware, maybe they don't mind it, I don't know. PwBPD don't accept the diagnosis due to shame, denial, projection. Not sure someone with ASPD experiences shame for things they have done.

[Methuen]

NotWendy,

PwBPD don't accept the diagnosis due to shame, denial, projection.

This fits my understanding of BPD too. It is remarkable to me that Pearlsbefore's pwBPD is firstly acknowledging the BPD diagnosis, but then also rationally arguing for ASPD due to gender biases.  That just sounds unbelievably rational for a pwBPD, in my experience. This an intriguing thread.

[PearlsBefore]

>>Both pwBPD and pwASPD can do hurtful things to others but I think a difference is the thinking behind it. A pwBPD can act out when they believe they are in victim mode " they hurt me so I am going to hurt them back". For ASPD it's not from victim perspective.

That's a very helpful summary, you're right - I hadn't really thought of it from that perspective - nor had I considered the fact "Yeah, wouldn't it be easier to just lie and SAY your friend is a slut?" (I don't really invest time in that stuff, somebody tells it to me and I'm just wide-eyed "...okay...wow"). Although it's possible hurting the friend was done out of a place of victimhood herself, being "ignored" or possibly having had childhood trauma or something. I think I'm desperately out of my league here. (Though I did read that "Sociopath Next Door" book many years ago, or possibly just started it)

For those asking about the dBPD acknowledging she is dBPD, while she does deny the diagnosis when necessary (she was recently in court, big surprise, right?), she has told at  least four relatives that she has it (and only one of them knew about the diagnosis beforehand, the other three she told them herself). It could be related to the fact she is studying psychology in college, or it could be related to a desire to shift the blame for "being a bad person" onto a diagnosis...or it could just be a very self-aware person, I'm not really sure. I suppose the final possibility could be that she really doesn't have BPD, as she suggests, but has something else such as ASPD and that's why she's uncharacteristically willing to say it's BPD.

Her aged mother has some high-functioning low-level disorders such as GAD, but never heard anything suggestive of self-harm or suicide attempts ala BPD. I believe the dBPD that is the subject of this post was "the angel child" anyways, not "the devil child" - and if Lawson is to be believed, it is typically the child that is demonized by a BPD mother who inherits the BPD.

But she's got a whole library of books on BPD, she's loaned me a few of them over the years - and the histrionics/suicides/cutting fit BPD much better than ASPD. I guess ultimately I'm probably hampered because I want to believe personality disorders are wholly psychiatric and quantifiable, not psychological, because it would make the world simpler.

Appreciate all the answers, culled a couple useful tidbits there to chew on. Definitely a weird case - someone can be "Textbook X...but not really X, it's actually Y+Z looking like X".

[Notwendy]

Also there can be overlap. Some people have more than one diagnosis. Again, how someone arrives at that would take a trained therapist. I think the main diagnosis is the one that predominates, accounts for most of the symptoms.

So for instance, my mother is BPD. Most of her behaviors fit the description of BPD. However, she also has characteristics of NPD and ASPD. Still, out of the 3 possibilities, BPD is the best fit.

[Harri]

Great discussion!

I just want to add that there are many many people with the diagnosis of BPD  who accept it and are working on improving things for themselves.  Many are very happy to finally have an answer for why they have the difficulties they have.  We don't often hear about them here on PSI which makes sense when you think about the nature of this board. 

Not all BPDs are the same.  Many do not rage for example.  Many do have self awareness, at least after a dysregulation.  There are something like 257 possible combinations of the diagnostic criteria so what we experience individually or even here as a group is not the full picture.