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Author Topic: BPD: What is it? How can I tell?  (Read 92644 times)
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« on: October 01, 2007, 06:51:24 AM »

It is a significant challenge to determine if someone in your life has Borderline Personality Disorder or any personality disorder. We often do not have a formal diagnosis to rely upon.  

The American Psychiatric Association cautions us against using the DSM criteria for making amateur "cookbook" diagnoses as they are often inaccurate. For our own sake and for the sake of others,  we want to be responsible and constructive in assessing the mental health of others in our life.  First and foremost, these designations were created to help people and families, not label and blame.

When we encounter high conflict and destructive relationship behaviors in others, our first priority could be to triage our situation. Write down the difficult behaviors that we have observed.

  • If any are dangerous (e.g., domestic violence, suicidal ideation, or criminal) or fatal to the relationship (e.g., serial adultery, ruinousness spending), it makes sense to immediately start planning for safety.

  • For all the others, we should do everything we can to reduce the conflict in the immediate term. This may not be not easy for us.  It usually involves giving in to the other person and providing them space and listening to/validating them. At the same time, we should force ourselves to step back from the conflict and process the hurt or resentment that we are feeling.  This requires a great deal of maturity.  We have tools for neutralizing the situation (stop the bleeding) and we have tools for taking a step backward (rebalancing ourselves). As difficult as it may be, starting here is usually in the best interest of ourselves and our children.

Once the situation is defused as best it can be, we can then start investigating what is going on so that we can make informed decisions.  When we encounter high conflict people with destructive relationship behaviors it is important for us to know that the problems can be caused by a large range of things from immaturity,  short term mental illness (e.g. depression), substance induced illness (e.g. alcoholism), a mood disorder (e.g., bipolar), an anxiety disorder (e.g. PTSD), a personality disorder (e.g., BPD, NPD), or even a learning disability (e.g. Aspergers) and "any combination of the above" (i.e., co-morbidity). It will likely take some digging to sort it out.

The behaviors exhibited during a relationship for all of these afflictions can look somewhat alike but the driving forces and the implications can be very different.  For example, was that lying predatory (as in ASPD), ego driven (as in NPD), defensive (as in BPD), a result of being out of control (as in alcoholism), or ineptitude (as in Aspergers).  Was it situational, episodic (bipolar), or has it been chronic. Yes, all lying is bad, but the prognosis for the future is not that same in all situations. For example, depression and bipolar disorder (mood disorders) are very responsive to drug therapy -- substance abuse often requires intervention and inpatient detoxification -- personality disorders require multi-year re-learning therapies (e.g. DBT, Schema) --  Aspergers is often considered a long term disability.  Chronic bad behavior and situational bad behavior are very different.

It is probably best to resist the temptation to immediately latch onto one of the personality disorder symptoms lists as the magic formula. Doing this may make the situation appear more hopeless and more one-sided than it actually is, and it may send us in a wrong or unhealthy direction.  

Getting back to the subject in the title "What is BPD?" -- personality disorders, per se', are lifelong afflictions -- anyone can act "borderline" in a particular situation. To be a PD, symptoms must have been present for an extended period of time, be inflexible and pervasive, and not a result of alcohol or drugs or another psychiatric disorder -- the history of symptoms should be traceable 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.

"Present for an extended period of time" doesn't mean constantly and obviously present.  Many people with this disorder, especially as they get older, learn to adapt and control or isolate the worst of the disordered actions except when stress pushes them past their ability to control and manage.  This is why the disorder is more visible to the family and close friends. "Present for an extended period of time" means that there have been indications of the disorder at different times dating all the way back to the teen years.

It is also worth noting that personality disorders are spectrum disorders - meaning that there is a broad range of severity.  At the lower end, it is not necessarily a personality disorder at all - people can have personality style like a BPD or NPD.  Surely you know someone that is pretty narcissistic, but not mentally ill.  People with BPD can range all the way from "very sensitive with somewhat nonconstructive ways of coping and avoiding hurt" (BPD personailty style) all the way to social dysfunction (e.g., unable to hold a job) and potentially life threatening behavior (e.g. severe BPD).

Whether it is BPD or BPD personalty style, Bipolar Disorder, or simple depression, etc, you are welcomed and encouraged to work with the members here at bpdfamily.

A high conflict, emotionally abusive parent, child, relationship partner or spouse, regardless of the causation, is a challenge and we need to take appropriate steps for our own wellbeing and that of our family.  And hopefully you want to learn how to rise above and manage your interface with the difficult person in a constructive, mature and healthy way.  It's our very next step to a constructive, mature and healthy future for ourselves.

Tall order, I know.  I had a loved one with this disorder, too.  



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: October 01, 2007, 06:53:04 AM »

Below are characterization of the disorder by the American Psychiatric Association, the National Institute of Health, and The Mayo Clinic.

The American Psychiatric Association

Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A very important part if that is they must have impaired functionality.  Without that, we are pretty much talking about a borderline personality style - a difficult but not pathological condition that is more responsive to therapy than than a "personality disorder".

A topline summary of the DSM 5 definition (due to be published in March 2013)  is:

1. Impairments* Impairments in self functioning AND impairments in interpersonal functioning (*important)

2. Negative Affectivity, characterized by:

  • Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

  • Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

  • Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

  • Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

3. Disinhibition, characterized by:

  • Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

  • Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

4. Hostility:  Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

The complete DSM-5 definition is located here: DSM 5

National Institute of Health

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The Mayo Clinic

People with BPD often have an unstable sense of who they are. That is, their self-image or sense of self often rapidly changes. They typically view themselves as evil or bad, and sometimes they may feel as if they don't exist at all. This unstable self-image can lead to frequent changes in jobs, friendships, goals, values and gender identity.

Relationships are usually in turmoil. People with BPD often experience a love-hate relationship with others. They may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even misunderstandings. This is because people with the disorder have difficulty accepting gray areas — things are either black or white. For instance, in the eyes of a person with BPD, someone is either good or evil. And that same person may be good one day and evil the next.

In addition, people with BPD often engage in impulsive and risky behavior. This behavior often winds up hurting them, whether emotionally, financially or physically. For instance, they may drive recklessly, engage in unsafe sex, take illicit drugs or go on spending or gambling sprees. People with BPD also often engage in suicidal behavior or deliberately injure themselves for emotional relief.

Other signs and symptoms of borderline personality disorder may include:

* Strong emotions that wax and wane frequently

* Intense but short episodes of anxiety or depression

* Inappropriate anger, sometimes escalating into physical confrontations

* Difficulty controlling emotions or impulses

* Fear of being alone


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« Reply #2 on: October 01, 2007, 07:32:49 AM »

These are concepts from my most recent book, The Essential Family Guide.  These are not clinical concepts reported in any study or professional organization, rather my take on things.Types of pwBPDs: ~Lower Functioning~Higher Functioning (Invisible)Lower-Functioning These are the classic border¬line patients who result in the statistics you read about in chapter 1. Here are some characteristics of lower-¬functioning conventional BPs: 1.   They cope with pain mostly through self-¬destructive behaviors such as self-¬injury and suicidality. The term for this is acting in. 2.   They acknowledge they have problems and seek help from the mental health system, often desperately. Some are hospitalized for their own safety.3.   They have a difficult time with daily functioning and may even be on government disability. This is called low functioning.4.   If they have overlapping, or co-¬occurring, disorders, such as an eating disorder or substance abuse, the disorder is severe enough to require professional treatment.5.   Family members’ greatest challenges include finding appropriate treatment, handling crises (especially suicide attempts), feelings of guilt, and the financial burden of treatment. Parents fear their child won’t be able to live independently. Because lower-¬functioning conventional BPs seek mental health services, unlike the higher-¬functioning invisible BPs we’ll talk about next, they are subjects of research studies about BPD, including those about treatment. Higher Functioning Invisible BPs1.   They strongly disavow having any problems, even tiny ones. Relationship difficulties, they say, are everyone else’s fault. If family members suggest they may have BPD, they almost always accuse the other person of having it instead. 2.   They refuse to seek help unless someone threatens to end the relationship. If they do go to counseling, they usually don’t intend to work on their own issues. In couples therapy, their goal is often to convince the therapist that they are being victimized.3.   They cope with their pain by raging outward, blaming and accusing family members for real or imagined problems. 4.   They hide their low self-¬esteem behind a brash, confident pose that masks their inner turmoil. They usually function quite well at work and only display aggressive behavior toward those close to them. Family members say these people bring to mind Dr. Jekyll and Mr. Hyde. 5.   If they also have other mental disorders, they’re ones that also allow for high functioning, such as narcissistic personality disorder (NPD).6.   Family members’ greatest challenges include coping with verbal, emotional, and sometimes physical abuse; trying to convince the BP to get treatment; worrying about the effects of BPD behaviors on their other children; quietly losing their confidence and self-¬esteem; and trying—¬and failing—¬to set limits. BPDs with Overlapping CharacteristicsMany BPs possess characteristics of both lower-¬functioning conventional BPs and higher--functioning invisible BPs. Author Rachel Reiland is typical of a BP with overlapping characteristics. When she insinuated she was going to shoot herself, her psychiatrist admitted her to a psychiatric hospital. Yet she held a job as a full-¬time mother and was active in church. Although she acted out toward her husband and psychiatrist, she was able to appear nondisordered toward most people outside her family.
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« Reply #3 on: October 01, 2007, 01:33:07 PM »

Skip, very good overview and perspective.  Randi, I generally agree with your analysis of high functioning, however, the concept of a severity scale that Skip writes about makes more sense than just high functioning/low functioning.

I agree that this disorder is less likely to be diagnosed when it is on the lower end of the severity scale.  My husband had seen 5 psychiatrists and yet he was never diagnosed.  He also wasn't likely to provide any therapist or professional with an accurate life history in one or two sessions. And due to privacy laws, its easy to block interviews with family members who could shed some light on the "reality" on the home front. The closest they came was a diagnosis of depression and some "anger management problems".  There's a difference between having a temper problem and raging over insignificant events.  

I often wonder what the statistics would be if these less severe pwBPD's were included in the statistics.  I know way too many people who have signs of having the disorder from the descriptions I've heard and the behavior I've observed.   I know at least 10 who are diagnosed (several of whom I had a part in getting them to the right professional who diagnosed them) and another 15 who fit some of the criteria, and another 12 who I suspect but I don't know enough about them or their situation.  And I am not in the mental health field.

We were fortunate to find a doctor, Leland Heller, who truly understood the disorder and was able to diagnose it in a lot of high functioning individuals.  He has developed a treatment plan that works and he is truly unique.  My husband's BPD is controlled with the proper combination of medication and through following his doctor's instructions.  Dr. Heller is a family practitioner, not a mental health professional.

Therapists need to be better trained to recognize BPD traits in less severe individuals.  Unfortunately, they are looking for textbook examples of a female who self-injures and is low-functioning.  And wherever possible, talk to those closest to the patient to get a better understanding of what is going on.


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« Reply #4 on: October 02, 2007, 09:57:36 PM »

How do you tell if someone has the disorder?

I think you first must consider your own tendencies.  For example, are you someone who thinks they see people with personality disorders EVERYWHERE  (If so, maybe you'll want to be careful to be sure that you aren't interpreting one bad situation as a pervasive condition) ?  Or, are you someone who tends to allow many people into your life that are struggling to function at a basic level (Maybe you struggle to see the difference between normal and abnormal behaviors - you might tend to overlook giant red flags)?  If you know your own vulnerabilities, you have a better shot at asking the right kinds of questions, mitigating your own thinking.

When I was a kid, I was surrounded by people who had thoughts and behaviors that would be considered "personality-disordered".  The way the adults in my life thought about, experienced, and reacted to the world was markedly different than one might expect from the culture and environment.  Thus, as I approached adulthood, my "normal meter" was broken.  I simply couldn't tell what thoughts and behaviors would fall into or out of the range of normal.  So, for me, I had to learn to be MORE discerning about abhorrent behaviors/thinking/emotional reactivity.  I had to re-guage my normal meter.  I learned to tell by reading criteria, and talking about it with others, and reading more and more and more, and watching people outside my family, and asking more questions to people I trusted as mentors.  I learned to understand what it really looked like to have an unstable sense of self, to have mood lability, to conceptualize what splitting was.  I had seen it my whole life - but reading the words didn't connect to the experience I'd had.  I had to make the connection.

Another thought relates to discerning reactive behaviors to the syndrome of BPD.  Most people have, at one time or another in their life, had behaviors that were emotionally reactive, impulsive, self degrading, lacking stability in thought of self.  To see this behavior in another does not indicate BPD.  What indicates BPD is to see the criteria pervasively in that person's life, across many circumstances, and over a significant period of time.

To view another person as having a personality disorder is to see a serious and persistent mental health condition; it seems to make sense to bounce questions and thoughts off those who are experienced, knowing from where you come.  It seems asking a lot of questions (like - what else could this be?) is an important part of the process, and having objective, educated mentors to help is advisable.


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« Reply #5 on: November 09, 2007, 09:46:04 AM »

I think it is very challenging. I'm seeing many people with undiagnosed spouses/exs/parents on this site.  I'm one of those (my ex is not officially diagnosed).  The important thing to realize with mental illness is that the DSM is not a cookbook.  At any given time, someone may have many or all of the symptoms of an active disorder, or several disorders but really be suffering from another syndrome, another etiology, or nothing.  Many disorders can look like BPD.  BPD, itself, is a controversial diagnosis in the field.  Many of the leading personality researchers have rec'd it be excluded from the next DSM.  I look at the DSM as a descriptive system.  The core features of a disorder can be found and understood far better in reading journal articles than they can be in a surfacey examination of DSM symptoms.  The situation is far more complicated, diagnostically, than checking off five symptoms.  It is a fairly common opinion to argue for a dimensional approach to personality disorder diagnosis.  Most of these behaviors occur on a continuum.  They are not generally dichotomous.   

I think that the presence of personality traits such as splitting and raging are enough (for example) that it is really not of concern what you may call the problem.  It needs to be dealt with and understood.
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« Reply #6 on: May 21, 2008, 03:45:09 PM »

Getting a basic understanding of personality disorders (and mood disorders, and anxiety disorders) greatly helped me understand the difficult relationship I was in.  It sent me on a journey that helped me see that our problems had roots in issues that long preceded our relationship.  I discovered her life-long patterns after talking to a family member and asking the right questions. I made important decisions based on them.  

Later, I came to realize that some of the situational stuff was more a contributing factor than I had thought.  That was a learning experience for me.  

And, still later I realized that I too, had some baggage to work on.  I now have, hopefully, greater self-awareness and a more mature understanding of relationships. smiley

It all took time to understand. A lot of time. And what I initially thought was Borderline Personality Disorder was probably more like borderline personality style - not the clinical manifestation of the disorder (BPD) but the traits on a sub-clinical basis.  There is a difference between having borderline tendencies (borderline personality style)  or narcissistic tendencies (narcissistic personality style) and actually having the disorder.

This all paired up disastrously with a situation we eventually found ourselves in (a suicide in her family) and my own weaknesses.

Why was it so hard to understand if some one has this disorder?

1) The diagnostic process is complex. First the person has to qualify as have sufficient impairment to be considered a personality disorder (there are 5 point scales for this).  They they have to qualify for a type (there are 5 point scales for this, too.)

2) Many of the symptoms for BPD and other personality disorders are the also seen in depression, bipolar disorder and other mood disorders, anxiety disorders (e.g., PSTD), substance abuse, and even Aspergers syndrome.

3) 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.

4) Analyzing a relationship conflict when you are one of the involved parties is tough. Everything you see is through the eyes your own biases (and lack of professional training is challenging). It's much easier to see dysfunction in others and harder to see our own or how we are contributing to the overall dynamics.  If the relationship conflict is driving us to do things we don't normally do - how much of that is happening of the other side.

5) Many of us are dealing with people tendencies, the so called high functioning or invisible BPD, rather than the disorder so it is not as obvious.  There is little consolation with "tendencies" as pw BPD tendencies  can be very hurtful and very destructive.  The one upside is that they are likely to be more responsive to therapy than someone with a full disorder.

It's a journey of discovery... every answer tends to open another door to more questions.


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« Reply #7 on: June 24, 2008, 09:24:34 PM »

I do have to second Skip's comments above...  

It isn't cut and dried, and transient symptoms can make it difficult to determine if your loved one suffers from a borderline personality disorder.  But, if you or your children are being abused, picked on, subject to fairly continuous criticisms or complaints, if life with the person is either a roller coaster (highs and lows) or increasingly unpleasant, you need to look carefully at personality disorders as a possible cause.

Here is a video that Skip developed with the staff that may help in understanding BPD:



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« Reply #8 on: May 07, 2009, 08:12:14 PM »

Does anyone have any information on the Personality Disorder Belief Questionnaire and how it works?

Thanks in advance

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« Reply #9 on: May 08, 2009, 08:16:31 AM »

The Personality Disorder Beliefs Questionnaire (PDBQ)

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors, 1999

A. Arntz, R. Dietzel and L. Dreessen in

This questionnaire provides 6 sets of 20 "Assumptions" held by those suffering from the various personality disorders.

The following 20 "beliefs" have been the most commonly associated with those diagnosed with BPD:

1. I will always be alone.

2. There is no one who really cares about me, who will be available to help me, and whom I can fall back on.

3. If others really get to know me, they will find me rejectable and will not be able to love me; and they will leave me.

4. I can't manage by myself, I need someone I can fall back on.

5. I have to adapt my needs to other people's wishes, otherwise they will leave me or attack me.

6. I have no control of myself.

7. I can't discipline myself.

8. I don't really know what I want.

9. I need to have complete control of my feelings otherwise things go completely wrong.

10. I am an evil person and I need to be punished for it.

11. If someone fails to keep a promise, that person can no longer be trusted.

12. I will never get what I want.

13. If I trust someone, I run a great risk of getting hurt or disappointed.

14. My feelings and opinions are unfounded.

15. If you comply with someone's request, you run the risk of losing yourself.

16. If you refuse someone's request, you run the risk of losing that person.

17. Other people are evil and abuse you.

18. I'm powerless and vulnerable and I can't protect myself.

19. If other people really get to know me they will find me rejectable.

20. Other people are not willing or helpful.

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