FAQ: Is BPD a spectrum disorder? Can there be "BPD lites"?

[BPDFamily.com]

Here is a question for everyone:

What really is the difference between high functioning BPD's and low functioning BPD's?

Just when I think my ex is low functioning, her games seem to be played like an intelligent person would play.

Is there such thing as a middle functioning BPD?

Kind of like a mixture of both?

pizaluvr

[pizaluvr]

Here is a question for everyone:

What really is the difference between high functioning BPD's and low functioning BPD's?

Just when I think my ex is low functioning, her games seem to be played like an intelligent person would play.

Is there such thing as a middle functioning BPD?

Kind of like a mixture of both?

pizaluvr

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[PamelaMc]

As relates to my DH's uBPDx (aka The Terrorist), I would say from "outward" appearances, she is high functioning.  Peel back the layers of the onion, and I'm surprised she makes it to work each day.  I think the fact that the BPD is not incarcerated or hospitalized means they are "functioning".  I think the common vein is that they all have very low functioning interpersonal relationships.

[EyesWideOpen]

My uBPDNPDh is high-functioning.  His drive for recognition and perfection won't let him just sit around, though when the weekends come around he usually doesn't accomplish much at all.  He gives all of his energy to his job, and leaves nothing for his family.  When he comes home, he shuts down.  His father taught him good work ethics through intimidation and competition, so whatever job he has, he does it with gusto, trying to outperform his coworkers.  He usually succeeds, and every time he gets promoted, he gets all stressed out about trying to prove himself again, and the family suffers his wrath.  All the while, he is complaining about how everyone is trying to screw him, and how noone appreciates his hard work.

His work ethic and his job and career choice are a major problem with our marriage.  He is all blue collar, and is jealous of the white collar, because they have better working conditions, but he won't make the time to study something else, like internet businesses.  He says he's getting too old to physically work so hard, yet doesn't feel like he's done a good job unless he gets dirty.  He's a manager/salesman/tree worker, so he manages the crews and paperwork, gives the estimates and sells the jobs and climbs and cuts the hardest trees or picks up the slack when his crews get behind.  He works so hard because he doesn't know any other way to do it, but he won't honestly try to learn any other way to do it.  He'll read this or that article or book half-heartedly, and a little bit of the advice works, but again his attempt at changing his ways is feeble, and he's complaining the whole time about how I'm not helping him do his job.  He contradicts himself all of the time, back and forth, even in the same conversation.  He's jealous of my job (I work from home), and puts me down about it, then he'll praise me for it, saying I'm doing a great job.

It is literally driving me nuts.

[JoannaK]

I don't know if there is any accepted distinction in the mental health community.  Usually "low functioning" (in any situation, not just BPD) refers to someone who can't hold a job, support themselves, or even take care of themselves, someone hospitalized or frequently hospitalized, someone with frequent brushes with the legal system.

High-func types can go low-func, and vice versa.  The level of function is not set in stone.

[PDQuick]

My understanding was that High Functioning meant they were able to conceal their sickness in front of most everyone. They show it to those at home, or in very personal relationships. As far as Low functioning, it is more obvious to everyone.

[pizaluvr]

Thanks for the input guys!

Joanna,

I asked this question because my ex does such a good job pretending that she is innocent in all of this.  She isn't a very bright person, and it is so hard for me to believe that she could pull this off without anyone else figuring her out.

That is the crazy part, or the part that makes me look crazy when I talk about what she did to me. People are perplexed because she is so quiet and controlled around other people.

Can they hide this that well?

Can a low functioning borderline hide it better than a high functioning borderline?

I'm at the point that I believe she is so good at hiding it, she hides it from herself.

She complains constantly about being broke, she doesn't drive (doesn't even have her license), her apartment needs to be condemned.

Low or high?

pizaluvr   

[ian]

Low functioning BPDs are the ones who can't hide it, and have serious impairments to most aspects of their lives. Alot of the time they do more drastic things like cutting, suicide threats and attempts. They more obviously fit the stereotyped image of a mentally ill person.

High functioning BPDs are the ones that you have to get fairly close to realize something is wrong. They seems like great people to everyone else, do well in school and in work and can be quite social and even popular.

IMO high functioners tend to be more angry because of the denial and blame necessary to compartmentalize their personality so that most of their freinds don't suspect. They tend to lash out at people they are close to because they need to externalize their problems more. Low functioners seem to self-inflict more and have obvious self-hatred problems. They are not as able to compartmentalize and fake it as well.

[pizaluvr]

Ian,

Thanks for the feedback. 

I think my ex may have been (and still is), very depressed. 

When I got involved with her I thought I could rid her of her depression by loving her.

She didn't do well in school, and she isn't popular or well liked.

She pretty much just exists.

I'm thinking maybe she is somewhere on the low end of a high functioning borderline.

I get very confused by her behavior.  I'm trying to educate myself to protect myself.

pizaluvr

[JoannaK]

It's not a conscious act, pizaluvr.  That's the hard thing to understand.  She really feels differently with a lover than at work... .or with more casual friends.  The intimacy brings out different behaviors.

[LAPDR]

JoannaK;

I agree, mine was very intellegent and highly functional in her work life and around friends and family, I believe this took a lot of energy for her to project this. At home she could swing from hi to low and back at given notice. At times it was scarey. At home she didn't feel as insecure the when she was outside where she had to prove she was better than she thought she was and hide who she really was. At home she felt venurable.

lapdr

[pizaluvr]

Joanna,

I thought about the fact that this isn't a conscious effort.  You sure are right that it is very hard to understand. 

You mentioned your ex was BPD lite.  I'm sure that was more difficult than the obvious.  I guess it's all difficult at different levels.

Thanks for your advice.

Lapdr,

I guess my ex is as functional as she can be in the workplace.  I think Joanna made sense when she mentioned that it is because they act differently with people they are intimate with.

I have always been involved with people that are for the most part, emotionally healthy.  My ex has major issues from her childhood that she refuses to face, yet she takes it out on the people who love her most.

Thanks for the input.

Eyes Wide,

It does drive us nuts doesn't it?

It's almost as if they know they have to act around others because they don't know them very well and their cover will be blown.

When they get close to someone, they idealize them, they cling to them, confuse the hell out of them, and then leave them.

I guess this is their idea of love.

pizaluvr

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GENERAL ANNOUNCEMENT 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).

[PDQuick]

It seems to be my observation that the illness increases latterally with the closness of the subject at hand. People at work are expedable, therefore, will not trigger the fear of abandonment. A lover is wanted, needed, and loved, but unfortunately, the fear of abandonment is especially strong, and the behavior catapults from the first sign of intimate feelings.

[JoannaK]

Just another comment...   I don't think there is a big black line separating high-func from low-func.  I think it is a matter of degree... .a continuum.

[Stepmom04]

She isn't a very bright person, and it is so hard for me to believe that she could pull this off without anyone else figuring her out.

That is the crazy part, or the part that makes me look crazy when I talk about what she did to me. People are perplexed because she is so quiet and controlled around other people.

Can they hide this that well?

I have thought about this a lot over the last 3 years.  How can someone who is obviously so crazy, convince others she is so "normal", and oftentimes an overachiever, super volunteer, sweet mother who has been wronged by the system?  Our BPD is high functioning, and does relatively well in society.  She has her missteps but if you don't know what to look for, which the casual onlooker wouldn't, you'd dismiss her screwups as minimal.  The outsider doesn't see the whole picture.  Also, and I think this is a big part of it... .Most of us nons and those in society get to a certain age or point in your life where you become generally honest and assume that others are honest too.  For most of us it happens during our late adolescent years.  No need to feel like you need to show off for your friends or distort the truth to gain allies.  Unfortunately, the casual observer or coworker may just assume that the BPD is honest like most of us.  It would never occur to them that the BPD will lie when the truth works just as well.  Their facade could easily be missed by someone who doesn't see them in pressure situations.  From the research I have done, it seems like BPD's lack a real sense of self, and truly don't know who "they" are.  Because of this, they create a personality that suits their needs for the moment.  If that means being the perky coworker, or mom who joins the PTA, Coalition Against Underage Drinking, Healthy Schools Taskforce, Bible school teacher, or volunteer "counselor" at our Women's Resource Center, then that is the role they assume.  All of these roles give our BPD a sense of self, without them she'd crater.  I'd be willing to bet that none of these places know of the felony forgery conviction, neglect charge, or drug history.  It really is sad if you think about it.  Now I have no pity for our BPD because of the absolute havoc she has created in our lives, but it would have to be a devistating way to live. 

Sm04

[LAPDR]

My BPDxw was very functional and intelligent, at work she assumed all the other women were her friends and thought that her views were theirs. Lots of lies were told about me, lots of her fantasy behavior with boyfriends was shared with some of them too. What she didn’t realize was that some of her friends had common friends of mine. I or my children would receive anonymous calls from women and I would hear things through the grapevine also. Some of her co-workers didn’t approve of her behavior outside of work but she persisted in believe everybody was her trusted friend. When confronted with information I had she would explode and rant and rave that her friends supported her and would never tell stories about her. She was so desperate for approval she would take boyfriends around to her friend’s homes and show him off as her new prize. I believe she never was welcome back at some of those homes again. She lived in a fantasy land and pulled all the strings she could to make it perfect, even at her own expense of thinking that everything she did was what all her friends did and it was OK. I believe she was very disappointed later.

lapdr

[pizaluvr]

Step,

I wish I could accept the fact that her behavior is because of the disorder.

I would probably be much further in my recovery from this experience if I could just accept that.

The strange thing is, my ex doesn't have any humanitarian qualities about her.

She just sits around and feels sorry for herself.

The act she puts on at work is one of innocence and sweetness.  This is the same girl that physically threatened me, called me horrible names, and threatened to kill me.

You make a lot of sense regarding the honesty issue.  I am a very honest person.  Throughout my relationship with her, I was very honest.  I felt like I should have lied sometimes.  I was honest and she thought I was lying.

I guess if I lied, she would think I was telling the truth?

I'm starting to feel sympathy for her, it is a horrible way to live, but does she even realize that?

pizaluvr




Lapdr,

You mentioned she told lies about you.  Do you think she truly believed that you did these things that she lied about?

I really am beginning to believe that they believe our truth is our lies which becomes their truth.

God thats confusing!

But so are they.

Thanks for the input.

pizaluvr

 

[RTTCB]

Hi Piza,

When I first met my friend she seemed "relatively" normal - but then I used to just pass through the country I am now currently living in on 1-2 week visits.

Over time I did sense that there were things that were not right, but once again there was not enough emotional involvement at that stage for me to really see the worst - and i'd never come across anyone with BPD before.

In the workplace she was regarded as a a bubbly attractive girl.

Then there was a trigger that caused her to basically have a melt down.

She rapidly went downhill, lost her job, started self harming, the alcohol and drug abuse magnified. Now she is visibly regarded as a person with serious issues.

She had always had a problem with alcohol, and since i've been living here permanently I have discovered that behind closed doors she was a nightmare to her Ex. But her Ex is what held it all together, and very few others witnessed the BPD behaviours. And while she was with this person she was able to hold down a job and keep the alcohol and drugs to a manageable level.

I agree with what has been said here about low and high functioning - I do believe they can move back and forth between the two.

But to me low functioning is someone who is incapable of taking care of themselves, holding down a job - well basically functioning in society.

Regards,

RTTCB.

[kellaroo]

Hello all... .its been a bit since I have posted and the reason being , things are going fairly smoothly and life is busy but good.

I have through the years heard lots about high vs low functioning BPDs.

For the 10 years I was with my exh I would say he was high funcitoning.   From a distance others might find him to be a bully arrogant tough guy.   In the relationship he was a hurt little boy that took offense to everything and felt the world was against him.

the last year or two we were together , things got worse.   Increase in jealousy, paranoia, more drug use, more drinking, more controlling, more abusive.

When we split... .he went psycotic.  I dont mean that lightly.  I had no idea who he was.   More drugs, harder drugs, suicidal, homicidal, bizarre tatoos of death, off work almost a year on mental leave, followed me, threatened me , didnt see the kids etc etc.

He has always been in victim mode... .but nothing like he was for about 2 years.

The follwoing couple of years, he was less crazy per se but still all about poor him.   Twisted conversations, contstant battles, he went through 4 lawyers, threatened court everyother month, sued me once but dropped.  So still not normal but not psycotic.

a year and ahalf ago, my daughter stopped seeing him after she ended up in emerg with panic attacks post visits with dad.   she thinks he is crazy.  he told her about almost murdering someone.   He blamed me.  He sued me.  he was the victim... .again.

The last 6 months, he seems calmer.   He still snaps on a dime if given the opportunity.   He cries quite easily.   He gets angry quite easily.  But with minimal contact its been bearable.   He is more polite and tries to be cooperative.  He is dropping all court issues and dropping trying to force daughter to visit him.

I guess what I am wondering is ... .have many of you had this experience.

I know he is not a healthy well man or anything... .he will always be that poor hurt little victim boy... .but have any of you experienced them becoming high functioning after hitting rock bottom?

[JoannaK]

Kell, mine was never as low-functioning as yours, but he did go through some very hard times right before and after we separated.  He was drinking a lot, got fired and then not working, moving from place to place.  But he kept looking for work, and finally, through a friend, he got a job in Florida.  So he had to move to take the job, but it was a good job and he was reasonably paid.  Now, a few years later, he is again doing well.  He and his new wife bought a house, TV, car, etc. etc.  Of course, I don't live with him anymore, but I think he's doing much, much better.

[dramacat]

Color me confused.

My upbdw meets 7 of the 9 DSM-IV criteria *some* of the time.  Our couples T (who is also my individual T) has never used the term BPD in our conversations, but he seems to agree that she has it.  At the same time, I don't know what to believe.  I read about the things that other folks' BPD SOs have done, and my wife comes nowhere close.  She is not physically abusive, she has never cheated on me, she doesn't concoct elaborate lies, she isn't jealous, she doesn't spy on me (she has read my email a couple of times, though).  It just seems like I have it easy.  Plus, for the past couple of weeks, she has been incredibly high-functioning - pleasant to be around, fun and caring to be with, making progress on job and grad school apps, making an effort to share in household tasks.

I feel so mind-effed... .Less than a month ago she was crying hysterically and accusing me of not caring about her feelings, called me mean and insensitive, slept for 18 hours a day, raged about perceived slights from people she barely knew, dissociated due to overstimulation, had odd paranoid ideation, etc etc.  I know BPD cycles and moods can shift quickly and unpredictably.  I have been working through Stop Walking on Eggshells and have been learning a lot about BPD.  Sometimes, though, it feels like maybe I'm completely wrong.  Maybe I am pathologizing something that isn't there.

I guess the question is, "Are there degrees of BPD?"  Can someone be "kind of" borderline?  Have other folks gone through similar questioning?  If so - what did you do to help yourself gain perspective on the situation and gauge whether or not your perceptions are valid/grounded in reality?

[paul16]

I have found that the behavior comes and goes. Could be periods of days or weeks where none of the nine DSM-IV criteria are met. I used the criteria on an "if ever" basis and seven of the nine had been present at some point.

What makes it so frustrating is that there is no way to predict when or where the behavior will taking place so sometimes it feels like your SO is a ticking time bomb that could explode at any time.

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GENERAL ANNOUNCEMENT 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).

[Up and Down]

Yes I believe all of the cluster B personality disorders are on  a scale. Its not an on off thing but the traits are there to varying degrees. I agree with the ticking time bomb, since you don't know whats going to set them off... .you end up thinking and re-thining what to say so you don't set them off... .hence the walking on eggshells. It sucks because when its good it can be truley great but when its bad it can be horrible.

[tengu]

I was seeing a consoler for a while. I started talking to him about BPD, asking him what he knew of it. He hands me a book, I forget the name, but it was written for therapists treating BPD's. He wrote the book, and turns out is a fairly big reference for consolers on BPD, lecturing etc. As we talked, one question I asked was what if someone only has 4, not 5 of the required items to be BPD, but the 4 they have are highly intense? His reply was he doesn't go by that much except for insurance, he looks at the behavior.

He further went on to state that we all have BPD traits, particularly when stressed. He told me these are defense mechenisims. The big difference between "normal" people and BPD's is while a normal person may veer into BPD land, it's often due to a real stressful event, and usually short lasting. The BPD on the other hand lives in BPD world, and ocassionaly veers into our "normal" world (maybe the nice side we see and crave?). Their BPD behaviors are often triggered from imagined events.

That said, I have first hand experiance with 2 uBPD's. The first, my mother who raised me alone. She was a total basket case. She spent 3-4 years at least in bed and on welfare - I guess depression. She'd yell and scream at my sister and I so bad that when I went to boot camp, I thought I was on vacation. She'd beat us with what ever was at hand, wooden sandals, extension cords. She was arrested at least 6-8 times that I know of for shoplifting. This happened two or three times with me, and I think twice with my sister. She ruined every life she touched. People would be taken by her, offer hel for this poor down and out woman. One family allowed her and my sister to move in after I left. After a few months she started stealing from them - mostly stuff they'd have gladly given her if she'd have asked. She gets paranoid about getting caught and takes off leaving them to wonder what happend. She cancelled people electric, phone, car insurance. She'd call child services and say they were beating thier kids. If she was mad at a guy for some reason and he was married, she'd call (if she could get the number) his house, get the wife and ask for him, but in such a way as to arouse suspision - basically make it seem like they were dating. She held a few decent jobs, but never long and never without constant conflict. Most of my childhood she cleaned houses, waitress or bar tender.

My W is much higher functioning, though she has never had much of a track record with jobs. I think the longest was a year. While my mother abused prescription diet pills, my stbex rarely drinks more than a glass of wine. My ex does not ruin lives the way my mother did, she is more inward acting, and only directed at me and the kids to a lesser and different degree. My wife tends to keep everyone else just far enough away that they can not see her true face.

[LEO]

 I am copying my own thread here but this is something that has had me thinking daily on and gets to the heart of the matter Low -vs- High Functioning BPs

What’s the Differences? What is the difference between "high functioning" and "low functioning" BPs? For instance, someone said cutting indicated low functioning. What about job instability, raging, or promiscuity, for examples?

While those with BPD come in all ’shades’, there are two extremes of the continuum, which are often designated ’low functioning’ or ’high functioning’. Disclaimer: The management states: Please know that the following information is to be taken as general information only and not an indictment of any of the professions listed. ;-)

Indicators of low functioning BPD: cutting and other self mutilation, excessive risk taking, which may include numerous and near fatal traffic accidents, extreme addictions, and sex addiction (for example getting caught by police on several occasions in public places, promiscuity at an early age), heavy duty involvement with psychiatric institutions and frequent hospitalization, successive non completed suicide attempts, inability to maintain employment, extreme instability in personal relationships, assaulting others, beginning pre-puberty or early adolescence and often early and prolonged involvement with criminal justice system and prisons. Most of the children seen in group homes and psychiatric institution with a history of the above, including cutting and self mutilation are female more often than male and may have a diagnosis of one of the personality disorders.

Raging appears to be a behavior of all those with BPD traits, all across the continuum. The intensity may vary some, but it is a constant. It may be more problematic with low functioning, as they have less inhibition control and are more prone to rage in public and in front of many witnesses. Both low and high functioning borderlines can be extremely physically dangerous, even if they have not acted out in this way before.

High functioning are the ones who "fool everyone" into thinking that they are ’Mr. or Ms. Wonderful’, and reserve the extreme BPD behaviors for their partners or children. On the surface they appear to function well in the majority of areas their lives. They are frequently psychiatrists, social workers, clinical therapists, or otherwise involved in the caring industry. A second sub-set do very well in the military/prison system or customs where they are in control of those around them, in positions like: military officers, police officers, prison guards or customs officers.

These careers can and often do offer lots of rewards and reinforcement for black and white thinking, splitting, and an excessive need for power and control over others. The criminal or the speeder is the ’bad guy’ and they (BPD) are therefore ’the good guy’. What they do is ’right’, therefore they are ’good people’. These professions offer lots of positive reinforcement for BPD behaviors and patterns as well as places for excessive control over others to be tacitly or actively rewarded.

High functioning may rage only in front of their significant other. In fact many keep it so well hidden that Non’s are not believed when they tell friends and family what is happening. Job instability may or may not be present in high functioning, but is usually found in low functioning. Those who are high functioning may choose professions where their behavior will be rewarded or seen as ’normal’ in the context of that profession. They mask their problems better, and are very good a moving from place to place in a ’logical’ or ’justified’ manner.

If the BP in your life fools everyone but you and maybe one or two others, they are usually high functioning. Those who are truly low functioning are obviously very disturbed and families get a lot more support from their communities than those who are high functioning. There is some debate among many therapists that high and low are actually two separate illnesses, linked by similarities of behaviors and attitudes.

The new version of the DSM may vary the ’label’ towards another framework called ’dyslymbia’, which presupposes that BPD is caused by a combination of life trauma along with a predisposed or genetic lack of some neurotransmitters (such as serotonin) within the brain. The word is still out on which way that one will go. I’m not all that much up on this new information yet, and doing more research for yourself is advised.

Hope this is of help.

Respectfully

Deedee

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[discohornet]

So what was your question again? It sounds like you almost answered it there.

In my personal, uneducated opinion, the difference between low and high functioning borderline is a matter of survival tactics. Both extremes suffer from a lack of clear self and an inability to regulate their emotions. The coping mechanisms they develop through life is what determines the difference in my opinion. Some are more socially acceptable, easier to hide and are acted out on others rather than the self.

Why cut yourself, for instance, when the 'real' problem is everyone else (highly developed projection)? Instead rage out at them and you release that emotion without having to look like you are weak or vulnerable (narcissism).

It could also very easily be a difference in their nervous system. The lower functioning may have an even more dysfunctional emotional center whereas the high functioning have a smaller degree of impairment. Look at the difference between problem drinkers and alcoholics (AA would say they're all alcoholics, but dance with me for a minute). You have one person who drinks four or five beers a night but still holds down a job and makes enough to keep the family fed, but is most likely emotionally unavailable and a burden on the family unit. But then you have the all out alcoholic who binges for days at a time, can't hold a job and is always in and out of hospitals for alcohol poisoning. The difference could be their brains. Their genetic predispositions really. How does one person dabble in drugs for a period of their life and then walk away whereas someone else does a line of coke and then ends up living on the streets? It usually comes down to genetic predisposition. 

It could also be learned. If the bp has a parent or other role model that "successfully" deals with their own frustration in a certain way then perhaps that person learns from their model.

I think the most disturbing thing I've learned since studying BPD is that the successful treatment of the disorder usually occurs with the lower functioning. And essentially it helps them to be higher functioning. For higher functioning borderlines, they have already acquired "successful" ways of dealing with their inner turmoil AND they usually have enablers in their life who help keep everything together, so why would they think they have a problem?

It could also be the age in which the trauma occurred and it could also have to do with how many other resources they had available. Perhaps the father was a rager but the mother protected the child. I hear of stories of dysfunctional families that still hold it all together for appearances. Then I hear about children who raised themselves because their parents were crack addicts. Two completely different environments.

[LEO]

In My case her role model was her father a high functioning BPD,every sunday calls for twenty some years he coached her in how to deal with people,Me included.It was successful careerer wise .but it was using people as stepping stones .a high functioning mentoring a high functioning. but time seems to have caught up with both,both leaving there family's at the same age.both advertising for friends (swingers as soon as they were out of the door,both leaving there spouses broke as they controlled the money.both picking favorite children and cast aways,painted black.with a low functioning the powers that be and friends see clearly what is going on ,with high functioning you are made to look like the one with the problem,how ever time catches up with them xBPD is not functioning career wise as she was.but the ability to distort the facts is still intact.i have searched for the crystal ball to tell me where its headed for the sons sake as well as mine.the best i can come up with is looking at her father who evolved to a paranoid schizophrenic with a hermit life.he too was violent behind closed doors but very articulate to outsiders,As she is.personally Im glad to be out but it will be 37 months today my youngest turns 18,the damage to him in the last again 37 months has been catastrophic.considering genetics and a witch mother intentionally out to destroy him the son I raised. while the son she raised is being mentored as she was ,history repeats itself?

[LAPDR]

Leo - her father sounds very NPD, controlling with high opitions and hard to please. That was a big issue for my ex for she was always looking for approval from him but had a love / hate relationship with him and probably still does. Creates a very difficult childhood to grow up in.

[GameGirl]

Look at the difference between problem drinkers and alcoholics (AA would say they're all alcoholics, but dance with me for a minute). You have one person who drinks four or five beers a night but still holds down a job and makes enough to keep the family fed, but is most likely emotionally unavailable and a burden on the family unit. But then you have the all out alcoholic who binges for days at a time, can't hold a job and is always in and out of hospitals for alcohol poisoning.

Actually, the AA big book makes very specific distinctions between the heavy drinker and the alcoholic.  Also, AA never diagnoses anyone with alcoholism.  That decision is left to the member.

Also, the ability to function has nothing to do with being an alcoholic or not.  I think that is a fallacy.  The question really is - can you stop, can you stay stopped, and is alcohol use making your life unmanageable.

I was an A student, held a job and was a full blown alcoholic at 23 years old.  For me saying "Hey I can function" was a huge denial mechanism.

[JoannaK]

Unlike many physical ailments, many mental health disorders, particularly personality disorders, seem to include many conditional statements in the DSM. 

A quote from Wikipedia about the definition of "personality disorder": 

Personality disorders are defined by the American Psychiatric Association (APA) as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". [1] These patterns, as noted, are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e., the patterns are consistent with the ego integrity of the individual), and therefore, perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to late adolescence and the beginning of adulthood, and, in rare instances, childhood. [1]

O.K... .   "deviates markedly"  "inflexible and pervasive".  Seems simple enough...   someone can't be diagnosed with a personality disorder unless their behavior and inner experience is "deviating markedly" and the patterns are "inflexible and pervasive".  But what about a person whose behavior "deviates pretty much" (but not "markedly" and someone with "pretty inflexible" patterns of thoughts, feelings, and behaviors?  First of all, who defines the difference between "deviates markedly" and "deviates pretty much" or "deviates somewhat"?  Then, a person whose behavior deviates "pretty much" is more than likely still going to cause his family/partner quite a bit of misery, even if he/she isn't as off-the-wall as a really difficult, diagnosable personality disordered person.   

Borderline personality disorder is not a cut-and-dried disorder.  Let's look at just a few of the traits according to the DSM:

   1. Frantic efforts to avoid real or imagined abandonment.

What's "frantic"?  There is no common definition of "frantic"... and what about someone who was frantic last year but is no longer frantic? 

    2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

How unstable?  What is unstable?  Changing partners every two weeks?  Fighting once a month?  Going back and forth between two partners for a month or two?  A year or two?  Over ten years?   What exactly does this "extreme" mean?   

   3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

How marked and persistent and unstable does ones self-image have to be before it is considered "markedly and persistently unstable" according to the DSM?

And ... .  what if the person had these traits in the past but things are better now?  How much better and for how long?

It seems pretty obvious that it is tough to figure out who is or isn't BPD in many situations.  And it is an easy diagnosis to be challenged in a court of law particularly in areas of custody evaluations.  I think this is why it is rare that a custody evaluator will call a parent on having a personality disorder.  It's not a black/white thing.  It's not like a diagnosis of cancer... .you have it or you don't.  Some forms of cancer have precancerous states... .  If you have a pre-cancerous growth on your skin, for instance, the question is whether or not it should be treated, how aggressively, or whether it should be watched and how frequently evaluated.  But BPD "traits" are more like that, but, unlike the precancerous skin lesion, they will probably not develop into more "advanced" BPD.  But who knows?  Under extreme stress all kinds of difficult behaviors pop out.  But then they aren't "pervasive" and "consistent". 

I'd like to see some research or studies on this, but, yes, leet (who asked about this), my own personal feeling is that these are spectrum disorders and there is a tremendous variability among/between people who evidence various degrees of BPD traits.

[Shadow722]

JoannaK,

Now that is an interesting analysis.  And I have had many of the same questions myself, but you put it so clearly.  I regret that I do not have an answer to your questions,  but I'm just chock full half arsed unproveable theories.

I do agree with your premise for "BPD Lite". Is not High Functioning synonymous with BPD Lite? Or is it something else?  I'm not really sure myself.  But my experience and reading tells me that Full Blown BPD, ie: low functioning, is more observable.  I believe that these individuals are crying  out for help, and help they need for their condition and unhappiness is palpable.

BDP Lites ( or High F's if they are the same), are a horse of a different color.  They do not appear unhappy and miserable. Far from it, they appear happy and well adjusted.  That is because they have always found an outlet for their unhappiness.  The NON.  The NON caused them to be unhappy; the NON took advantage of them;  they are the victim, the NON was/is the abuser.

In their world, they have nothing to be sorry for;  nothing to apologize for; no regrets and no remorse.  Whatever misery happened in their life, it was caused by the NON, not them, never them.

They just chose poorly.  Next time they will chose better.  And when unhappiness strikes them again, they will have a new NON to blame, because "they" just chose poorly.  Rinse, latter and repeat.

Interesting though.  Wish we had more data and less supposition.

Thanks,

Shadow