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Author Topic: Are There Moderate Cases of BPD?  (Read 635 times)
Oh Brother

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« on: July 26, 2021, 10:21:12 PM »

Hello BPD Family,

First-time poster here.  Apologies if this has already been discussed.

I'm wondering if BPD cases occur in different strengths.  Much of what I read about BPD / HCP applies to my sister, but some doesn't.

For example her splitting isn't targeted at a single person in alternating fashion.  Instead she tends to idealize our father, and revile our mother, all the time.  Nor is a strong fear of abandonment readily apparent in her (though I suspect she would be very afraid of our father abandoning her).  Also her rages are definitely noticeable, in terms of what she communicates to family members, but don't go to the extent of destroying physical objects.

So I'm wondering in my mind whether she meets the diagnostic criteria for BPD.

Thanks in advance for any wisdom you can share.
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kells76
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« Reply #1 on: July 26, 2021, 10:32:25 PM »

Great question, Oh Brother, and welcome -- glad you found the site.

A short answer, which you might already agree with, is that even if a person doesn't have an "official" diagnosis of BPD, they can still be incredibly challenging to deal with and deeply hurtful people.

For example, my husband's kids' mom has never (that I'm aware of) received a diagnosis. Yet she exhibits blame, abdication of responsibility, reckless spending, unstable sense of self, "cold" rage, monologues, never seeming "present", parentifying one kid as the "golden child" and alternately scapegoating and doting on the other. Oh and yeah unstable patterns of relationships, but over months/years versus days/weeks.

I'm wondering if you're concerned that if she doesn't "actually" meet the diagnostic criteria, then "it doesn't count" or "she doesn't really have it" or "maybe she had something else" ...?

One thought to ponder is -- often, diagnoses are made so that professionals can treat the person in a targeted and effective manner. In a way, we laypeople have the freedom to not diagnose! We are allowed to say "you know what, diagnosis or not, doesn't matter, because her behaviors are incredibly high conflict and extremely challenging, and I need help dealing with her".

Sometimes we also hope that if a person got diagnosed, they'd finally see the light and start to change in a healthy way.

Oh Brother, does any of that ring true for you?
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Oh Brother

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« Reply #2 on: July 26, 2021, 11:17:41 PM »

Thank you kells76 for the reply.

I guess mostly I'm searching for a fitting explanation for my sister's behavior, and therefore some fitting advice on how to deal with it (frankly).

Many passages in Stop Walking on Eggshells (3rd ed.) describe my sister very well.  She doesn't accept accountability for her actions.  She projects.  She blames others for her plight.  She has to be right regardless of cost.  She twists what people say.  She manipulates.  She threatens suicide (coercive control).  She damages relationships.  She can't keep a job.  She's not financially self-sufficient.  She can't properly care for a residence or an automobile.  She is unable to regulate her emotions.  She's confessed feelings of inadequacy.  She plays the victim.  She increases the scope of arguments and never lets them die.  She doesn't apologize.

If I was confident that a diagnosis of BPD would fit my sister, then I would know what literature to read about how to deal with her.
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Notwendy
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« Reply #3 on: July 27, 2021, 06:37:00 AM »

BPD is a spectrum so a mild form if it is possible. While such an individual may not meet diagnostic criteria, a relationship with them can still be challenging. Think of it as two different goals. A professional needs the diagnosis to direct a treatment plan. Being in some form of relationship with a person with BPD- we need to deal with the behaviors and we need to learn some relationship skills.

Several diagnoses can have some overlapping behaviors. As lay people, we don't need to be focused on the label. But we deal with the behaviors. Learning the relationship skills on this board can help us to deal with the behaviors ( regardless of if we have a diagnosis to work with).

Many people with BPD get diagnosed with other labels such as anxiety or depression.

If the material you are reading seems to fit your sister, and it helps you to deal with her behaviors, then it's valuable to you.
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Oh Brother

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« Reply #4 on: July 27, 2021, 12:32:52 PM »

Thank you Notwendy for replying.

Ultimately I would like to see my sister get qualified professional help for her conditions, and begin healing herself and her relationships in our family if possible.  It's up to the mental health profession to diagnose and treat her correctly - but even the advice in Stop Walking On Eggshells about selecting a therapist assumes the patient suffers from BPD, so I'd like to have confidence that my layman's suspicion is reasonable.

By the DSM-5 and ICD-10 criteria, I believe she exhibits enough of the features of the disorder to be diagnosed with it.

It's true that the advice in the BPD literature is helpful regardless of whether she is officially diagnosed.  This past weekend I set a limit with my sister regarding her rages, without formlly knowing that's what I'd done, because I hadn't read Stop Walking On Eggshells yet (or found this site as a result).

It's also true that my sister has been diagnosed with other conditions and behaviors, by her own reporting: major depressive disorder, panic disorder without agoraphobia, eating disorders as a young woman (she's now 59), and hoarding.  I also suspect she suffers from vulnerable narcissism.

If ever she enters treatment with a qualified professional, I would be interested to know what her diagnoses would be, and whether my suspicions are accurate.

Meanwhile I'm left to deal with the behaviors.  Chapter 8 of Stop Walking On Eggshells is particularly applicable to my sister's case.  Because of that, and the relationship damage she has caused in my family, I've already begun a conditional-contact approach.
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Notwendy
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« Reply #5 on: July 28, 2021, 06:47:53 AM »

I understand that you wish for her to get professional help. I think that's a common wish for many of us here. If this were to happen for your sister- it would be between her and the professional and making the diagnosis would be up to the person treating them.

While there is help available for BPD and the possibility of improvement, this requires the desire of the pwBPD to want the help and to work honestly with the professional. BPD is a tough situation to work with due to the tendency of the pwBPD to project and deny their issues and blame others for them.

In the case of my mother, she's elderly now and no therapy has worked for her. She does see a therapist but spins the story so much, I don't think the therapist can get a clear picture of what is going on. My mother meets every criteria but due to HIPPA laws, the therapist can not speak to me to get another view of the picture.

While I have known for a while that my mother fits the picture of BPD, I have not been able to know if she's ever been diagnosed, even though she has a long psychiatric history. However, now that she's elderly and has home health care, she has consented for them to speak to me, and they have confirmed the diagnosis. So even if a professional knows the diagnosis, my BPD mother still won't accept that she has a part in the relationship issues, and so won't work on her part in that.

Yes, diagnosis or not, we can't assume that the pwBPD wants the professional help that we would want for them, or has the capacity to work with a  therapist. . That is up to them, not us. My advice to you is to deal with the behaviors, not the label, as pwBPD are still considered accountable for them. Yes, we can have empathy for them having to deal with a difficult mental condition, but also have boundaries.
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Oh Brother

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« Reply #6 on: July 29, 2021, 12:10:30 PM »

Thank you so much Notwendy, I completely empathize.  And I'm very sorry about your situation with your mother.

You totally nailed it with "While there is help available for BPD and the possibility of improvement, this requires the desire of the pwBPD to want the help and to work honestly with the professional. BPD is a tough situation to work with due to the tendency of the pwBPD to project and deny their issues and blame others for them."

And with "She does see a therapist but spins the story so much, I don't think the therapist can get a clear picture of what is going on."

And with "still won't accept that she has a part in the relationship issues, and so won't work on her part in that."

And with "we can't assume that the pwBPD wants the professional help that we would want for them, or has the capacity to work with a  therapist."

I really appreciate you sharing those thoughts.  And I appreciate your advice.

Unfortunately in my case my sister's raging behavior is really escalated right now.  She was triggered about a week ago by a medical diagnosis for our father that I think really feels scary and threatening to her (when he eventually dies, I think she will have a very strong feeling of abandonment).  I set a boundary with her last weekend about what would happen if she directed more rage at me, and now I have to enforce it because she did.
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« Reply #7 on: July 31, 2021, 11:07:56 PM »

What specifically, is her raging behavior that you are struggling with?

You mentioned it in so many words,  that the tools are helpful to deal with difficult people. Truthfully, most of the people we deal with are likely "sub-clinical." That doesn't mean that we don't belong here, or that this community isn't the place to be, nor that the tools and info aren't useful. Just the opposite.

My ex is "BPD-lite" Likely. We also have the same Health Maintenance Organization (health provider, for those outside of the USA). A therapist told me that it was their policy not to officially Dx BPD. Kaiser. My ex shared with me that her T told her long ago that she could benefit from mood stabilizers, but my ex refuses (scared). She's officially Dx'd with Depression and Anxiety.

My mother was given a roundabout Dx of BPD by her therapist. My mom was smart enough to pick up on that and told me years later.

It's tough if your personality may be more calm, staid, and logical when confronted by someone who has issues controlling their emotions.

Have you had a chance to look at the tools here (at the top of the board in the pinned topics)?
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Oh Brother

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« Reply #8 on: August 03, 2021, 02:52:24 PM »

Hello Turkish, thanks for chiming in.

My sister's raging behavior that affects me most frequently is harassment, as defined by my state's statutes: "A person commits harassment if, with intent to harass, annoy, or alarm another person, he or she: ... Repeatedly insults, taunts, challenges, or makes communications in offensively coarse language to another in a manner likely to provoke a violent or disorderly response."

This constitutes domestic abuse per my state's statutes: "'Domestic abuse' means any act, attempted act, or threatened act of violence, stalking, harassment, or coercion that is committed by any person against another person to whom the actor is currently or was formerly related ... 'coercion' includes compelling a person by force, threat of force, or intimidation to engage in conduct from which the person has the right or privilege to abstain, or to abstain from conduct in which the person has a right or privilege to engage."

Her harassment usually occurs in written form, either by email or by letter delivered through postal service or left at a relative's house for me to pick up.

Another example of her raging behavior that affects me most severely is defamation: she has repeatedly committed libel against me by writing untrue things about me to my family (and admitting slander by claiming in writing to have told the same untrue things to family members).

Last but not least is frequent mention of suicide - basically suicide threats.  As time has passed I've increasingly viewed these as a form of coercion.  She basically threatened our mother this year that if our mother made a certain decision with respect to estate planning, she would kill herself.  That's not necessarily a raging behavior, but I believe it to be part of her mental condition (see Chapter 8 of Stop Walking on Eggshells).  It meets the definition of coercion in my state's domestic abuse statute: compelling a person by intimidation.

Indeed my personality is more calm, staid, and logical - the polar opposite of my sister's highly emotional, high-conflict personality.  I learned several years ago that attempting to interact with her on the assumption that she's rational is just plain futile.  A non-starter.

I have not yet explored the tools on the menu bar atop this website - thanks for the tip.  But I have read the suggestions in Stop Walking on Eggshells.  Before trying those tools I must first recover some compassion after my sister's most vicious harassment against me to date, which occurred last week.  Today I actually sought a restraining order against her; I'll start a new thread on that.

Cheers.
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