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Author Topic: DIAGNOSIS: BPD. What is it? How can I tell?  (Read 6695 times)
sosadandone
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« Reply #25 on: November 02, 2010, 07:24:22 PM »

I read alot of others posts here and many seem to focus only on the on/off or irrasible qualities of their partners. I'm not minimizing anyone else's suffering here but I wonder if some are just too quick to label their partner who may just be somewhat quick tempered. IMHO BPD- as I experienced it with my ex was a severe disorder which had many many facets beyond just someone who gets easily upset. In fact mine seldom got angry. However he did have almost all of the other criteria seen in BPDs. In fact when I once sent him Dr Gunderson's criteria and asked how many of them he had; he answered; "all of them". So I am going to list Gunderson's criteria and ask if you would look at them and see how many your partner really exhibits.

I guess what I am suggesting is that we not be too quick to label someone, especially those we claim to love. Here is the list. How many does your partner really have. Mine had almost all

Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:

Affect

chronic/major depression

helplessness

hopelessness

worthlessness

guilt

anger (including frequent expressions of anger)

anxiety

loneliness

boredom

emptiness

Cognition

odd thinking

unusual perceptions

nondelusional paranoia

quasipsychosis

Impulse action patterns

substance abuse/dependence

sexual deviance

manipulative suicide gestures

other impulsive behaviors

Interpersonal relationships

intolerance of aloneness

abandonment, engulfment, annihilation fears

counterdependency

stormy relationships

manipulativeness

dependency

devaluation

masochism/sadism

demandingness

entitlement

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« Reply #26 on: November 02, 2010, 08:27:16 PM »

Dear sosadandone,

I agree that the problems with some people are much more severe than those of others. I am not familiar with Gunderson's criteria, but the DSM-IV-TR gives nine criteria, not the much more extensive list you gave here. You can be diagnosed by a professional with five. Some of the criteria are more about the pwBPD's inner experience, so if they have not received an official diagnosis, it is their SO, relative, or friend's guess that they are BPD. That's why many people (including myself) designate their problematic person as "uBPD" (undiagnosed BPD).

The way the profession currently defines disorders is using a "categorical" model. Therefore, you can fall into the "category" of a PD or of BPD in particular, yet this says nothing about how severe your problems are. A method of defining disorder according to the severity of dysfunction would be a more "dimensional" model.

It appears that the Gunderson that you reference is attempting to get at the depth and severity of dysfunction in the structured interview you describe.

Depression may be simpler to wrap our heads around when we are talking about categorical vs. dimensional ways of looking at problems. You can meet the criteria for depression with five of the nine criteria for depression --- say, excessive guilt, fatigue, weight loss, insomnia, and depressed mood --- and be SEVERELY impaired (guilt is crippling, you can't get out of bed, you're skin and bones, haven't slept in three weeks, etc.) or MILDLY impaired (unrealistic guilt is uncomfortable, you get to work but aren't as productive, you've lost 10 lbs without trying, sleep 4-5 hours a night, etc.).

I think here at BPDFamily.com we try to support everybody regardless of the level of BPD or even BPD traits in people we are in relationship with.
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« Reply #27 on: December 09, 2010, 09:46:18 AM »

We're used to the DSM criteria for BPD, but i was looking at BPD resources and came across the ICD criteria which i hadn't seen in some time; i felt the differences were interesting and in turn, thought they may be interesting here. My search was sparked by the increase in discussion of the diagnosis itself on the boards (at least, that i've seen) and despite my H not presenting in perhaps the same volatile way as others, he is most definitely BPD. Anyway, i digress, i've lifted this from Wiki but the differences were, i thought, very interesting:

www.en.wikipedia.org/wiki/Borderline_personality_disorder

Excerpt
Diagnostic and Statistical Manual

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[1][14]    A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

       1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

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

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

       4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

       5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

       6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).

       7. Chronic feelings of emptiness

       8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

       9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Excerpt
International Classification of Disease

The World Health Organization's ICD-10 defines a conceptually similar disorder to borderline personality disorder called (F60.3) Emotionally unstable personality disorder. It has two subtypes described below.[26]F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

   1. marked tendency to act unexpectedly and without consideration of the consequences;

   2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;

   3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;

   4. difficulty in maintaining any course of action that offers no immediate reward;

   5. unstable and capricious mood.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

   1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);

   2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;

   3. excessive efforts to avoid abandonment;

   4. recurrent threats or acts of self-harm;

   5. chronic feelings of emptiness.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

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Skip
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« Reply #28 on: May 10, 2011, 09:22:01 AM »

DSM-5 sheds some light...

The DSM-5, due out in 2013, will bring a number of changes to the definition of the personality disorders.  The working group is trying to do away with the complex multiaxial diagnostic approach and to make the personality disorders more discrete (less overlap) - basically the Axes I, II, III will be consolidated to one -- the 10 personality disorders will be reduced to 5 or 6.

But maybe the greatest change for non-professionals like ourselves, is that they are attempting to clearly define the lne between personality disorder and personality style.

Have a look...




The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

Self (impairment in at least 1):

Identity: Experience of oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity for, and ability to regulate, a range of emotional experience.  To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Self-direction: Pursuit of coherent and meaningful short-term and life goals; utilization of constructive and prosocial internal standards of behavior; ability to self-reflect productively.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Interpersonal (impairment in at least 1):

Empathy*: Comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding of the effects of own behavior on others.    To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Intimacy*: Depth and duration of positive connections with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).






Below is the scale for "empathy".  There are four scales in total.

Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing.  Is aware of the effect of own actions on others.

Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.

Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.

Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering.  Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.

Extreme Impairment (4)  Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance).  Social interactions can be confusing and disorienting.





Here is the scale for intimacy.  There are four scales in total

Healthy (0) -Maintains multiple satisfying and enduring relationships in personal and community life. Desires and engages in a number of caring, close and reciprocal relationships. Strives for cooperation and mutual benefit and flexibly responds to a range of others’ ideas, emotions and behaviors.

Mild impairment (1) -Able to establish enduring relationships in personal and community life, with some limitations on degree of depth and satisfaction.Capacity and desire to form intimate and reciprocal relationships, but may be inhibited in meaningful expression and sometimes constrained if intense emotions or conflicts arise. Cooperation may be inhibited by unrealistic standards; somewhat limited in ability to respect or respond to others’ ideas, emotions and behaviors.

Impaired (2) Capacity and desire to form relationships in personal and community life, but connections may be largely superficial. Intimate relationships are largely based on meeting self-regulatory and self-esteem needs, with an unrealistic expectation of being perfectly understood by others. Tends not to view relationships in reciprocal terms, and cooperates predominantly for personal gain.

Very Impaired (3) Some desire to form relationships in community and personal life is present, but capacity for positive and enduring connection is significantly impaired. Relationships are based on a strong belief in the absolute need for the intimate other(s), and/or expectations of abandonment or abuse.  Feelings about intimate involvement with others alternate between fear/rejection and desperate desire for connection. Little mutuality: others are conceptualized primarily in terms of how they affect the self (negatively or positively); cooperative efforts are often disrupted due to the perception of slights from others.

Extreme Impairment (4)  :)esire for affiliation is limited because of profound disinterest or expectation of harm.  Engagement with others is detached, disorganized or consistently negative. Relationships are conceptualized almost exclusively in terms of their ability to provide comfort or inflict pain and suffering. Social/interpersonal behavior is not reciprocal; rather, it seeks fulfillment of basic needs or escape from pain.





The remaining scales are listed here:  dsm5.org/ProposedRevisions.aspx?rid=468
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« Reply #29 on: May 11, 2011, 09:03:31 PM »

Are people with BPD psychotic as well as neurotic...Can someone explain that a little better. I know there are varying degrees of the disorder...does the BPD individul who suffers more psychotic episodes make them extremely disordered?

Thanks
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« Reply #30 on: May 13, 2011, 09:38:20 PM »

Are people with BPD psychotic as well as neurotic...Can someone explain that a little better. I know there are varying degrees of the disorder...does the BPD individul who suffers more psychotic episodes make them extremely disordered?

Thanks

BPD is called "borderline" because in the past it was considered to be on the "borderline" between psychosis and neurosis.  Now the map of mental illnesses has been changed and it's no longer viewed like that, but the name hasn't been changed.

It's a personality disorder and doesn't necessarily involve psychosis.  But about half of those diagnosed with BPD are "co-morbid" - that is, there is more than one problem.  So someone who has BPD could have another problem, including maybe a type of psychosis.
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« Reply #31 on: September 14, 2011, 04:08:32 PM »

As Skip mentions, everyone has personality 'style'. A style is not a disorder. A style is still flexible and adaptable.  A disorder is not.

If you look at the DSM criteria for BPD there is nothing new under the sun. It is describing human behavior.  However, when it becomes pervasive, rigid and all encompassing...throughout life...(not situational)...not a style...then you have a personality disorder.

A pw a personality disorder is like a person who has only 4-5 tools that they use for every single purpose under the sun as they go through life. Often, it will seem more or less appropriate, because it's a tool other people use from time to time also. Nothing wrong with a hammer, for example.  But that's all they have, just 4-5 tools, to use with for every purpose.

A person with a personality style, as we all have...can pull from hundreds of thousands of various tools depending on what they come across each day.  A person with a personality style is flexible, adaptable, can get into a problem, but can pull out  variety of 'tools' flexibily so as to adapt to whatever is in front of them...to help solve the problem and move on. This is done usually w/out lots of fanfare or drama...we just live out lives.

A personality disordered person will pull out a hammer...and be fine, until they pull out the hammer to use for something completely inappropriate for the task at hand.  Then it gets noticed...then problems start. It gets noticed, and a lot of drama ensues.

People w/ personality styles have a certain amount of drama, and ups and downs, in life, too.  But for a pwBPD...drama follows them around like that kid in the peanuts cartoon that has a cloud of dirt/dust billowing around him at all times.  It is a wholly different feel.  

There is a big difference between a 'style', regressed behavior during a midlife crises, and a personality disorder.  

Having said that...culturally, I really do worry sometimes that as a whole we are moving more toward a cult of personality that embraces and even  worships immature 'child-like' behaviors and in essence we are creating a personality disordered culture... meaning, as a culture, it has become more acceptable to lack empathy, look and act young all the time, be selfish and self absorbed, have your cake and eat it to, enjoy getting over and one-upping others,  have to get all your childish "id" needs met instantly,  feel entitled,  absolutely no deferred gratification (eg., total and instant access to drugs, porn, instant contact w/ the mother ship at all times, shallow communication all the time w/ little or no depth etc.), we don't want to raise our own kids, everything that takes time and patience is downplayed as just a pain in the ass, we want to feel 'good all the time' and if we don't it someone's fault...we are in a way...becoming a very childish " borderline" society.  But that is just my humble, worried opinon.  



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« Reply #32 on: January 29, 2012, 07:39:57 PM »

I have been reviewing several online resources about some of the co-morbid features of BPD, including alcoholism.  What I have found is that those suffering from alcoholism per se, whether they are ACOA or not, is the striking similarity of symptoms to those discussed on this board, including some used in the DSM used to classify someone as having BPD:

Black-white thinking

Relationship difficulties, barriers to intimacy

Child-like reasoning/thinking

Low self-esteem; poor sense of self

Fear of abandonment

Hypersensitivity to criticism

Are there an traits that are unique to BPD?  it has started to make me wonder whether the DSM threshold for BP diagnosis (5/9 critera) may be a bit loose.

Seeking comments...thank you in advance.
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« Reply #33 on: January 30, 2012, 12:54:45 AM »

Hi search4peace, I agree, and have also noticed before that long term heavy alcoholism can probably result in a BPD diagnose based on the criteria. I am not a psychologist, but I think that for a diagnose in this case, one needs to look a bit beyond the criteria. BPD is an attachment disorder, so I think you need to look specifically at the intimate r/ss and its developments. Next to that, although less clear cut, the lack of self-identity for a pwBPD tend to display itself in particular ways. For example, changing looks often, inconsistent opinions etc. There are some specific BPD traits, although they are not necessary for the official diagnose and are not necessarily found with every pwBPD. That's why a proper diagnose should only be done by a trained specialist.

It's the chicken and the egg story really, and most therapists IMO will advice to first beat alcoholism, before looking further.
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« Reply #34 on: March 14, 2012, 04:56:35 PM »

Just read this thread, my concern would be the inability to properly diagnose a non-cooperative patient. In a case like my ex, a highly intelligent, high functioning person, she knows what answers to give in order to avoid a diagnosis. However, if you were to ask about her behavior to someone like me who really knows her, the diagnosis would be very clear. She is only honest when she feels it will give her the biggest payoff. All other times she is extremely secretive and dishonest, probably because she knows that there is something fundamentally wrong with her, although she would never admit it to someone else.
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« Reply #35 on: March 14, 2012, 05:28:54 PM »

Just read this thread, my concern would be the inability to properly diagnose a non-cooperative patient. In a case like my ex, a highly intelligent, high functioning person, she knows what answers to give in order to avoid a diagnosis. However, if you were to ask about her behavior to someone like me who really knows her, the diagnosis would be very clear. She is only honest when she feels it will give her the biggest payoff. All other times she is extremely secretive and dishonest, probably because she knows that there is something fundamentally wrong with her, although she would never admit it to someone else.

My wife and I both took the MMPI-2 (Minnesota Multiphasic Personality Index) during our Custody Evaluation.  What you are saying here, Bent, is exactly what I asked my lawyer:  "How can the test tell if she's lying?"  My lawyer told me not to worry, it could tell.

Sure enough, the test not only indicated "multiple psychological disorders" (and I think the details that the psychologist saw gave him the information he needed to say what those are), it also indicated that she had "presented falsely" (that is, lied).

Later I learned how this works.  There are about 500 items in the test - you rank each statement from "Very true" to "Very false" or something like that.  The test has been given to a lot of people, including many who had already been diagnosed with various disorders.  By studying all the data, researchers have been able to determine what patterns of responses indicate which disorders, and also which patterns indicate that somebody is trying to fool the test.

With so many items in the test, they have lots of ways to cross-check, so no one answer makes a big difference.  And they keep adding all our tests to their data base, so it keeps getting more accurate.

What you want to do is make sure that any diagnosis (or non-diagnosis) is based on objective testing, not just a professional's subjective opinion.  A professional might be able to tell if someone is faking, or maybe not - too much risk.  Using an objective test like the MMPI-2 reduces that risk.
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This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board.

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« Reply #36 on: August 28, 2012, 07:22:56 AM »

When I first came here I was against any type of labeling.  After all, Im not qualified to judge.  And if I was being labeled - especially by someone not qualified - I wouldnt like it all that much.  (the old... 'do onto others' rule)

But then it was pointed out to be that some type of characterization was useful to determine 'whether to prescribe antibiotics or flintstones'.  That is, we still need to analyze whats going on in order to increase our chances of helping the situation.

But to a large extent, that is as far as its useful (to me, in the context of this forum).  Because pretty much EVERYONE here has our own stuff that contributes to the relationship.  And that, coupled with the fact that there is a mix of items to consider (some may have problems in one area but not another), and with the relative severity (its a continuum, from those needing institutional help to those that are just strong personality traits) - each situation is pretty unique.

Devil is in the details so to speak.  And for difficult situations we recommend direct intervention (and T for both sides involved).  

Then even if not fully a disorder - that doesnt mean the personality style isnt a difficult one.  And the same tools of looking at ourselves and making change in our own behavior first - are STILL very helpful, and relevant.  And many many of these tools cross more than one PD type, so again the general good advice holds.

If we want to take this a step further - our own personal growth, and learning, is just part of the lesson being taught here.  And if we dont learn from it - dont worry, we will get that lesson all over again at some future point in life.

So for me - as a practical matter - I dont get too hung up on labeling.  Im more interested in the pragmatic:  "So, what are YOU going to do to change YOUR behavior to improve your life for the better?"    
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« Reply #37 on: September 03, 2012, 11:27:16 PM »

I too am not too hung up on accurate diagnoses, partner was recently diagnosed BPD with alcohol/medication abuse issues. Years ago she was diagnosed OCD, with anxiety and panic disorders and severe depression.

Whatever the diagnosis is makes no real difference to me. Her behaviour is in line with much that is described on this site and the tools provided work to help manage it. She will decide for herself what she wants to believe her condition to be, to be officially diagnosed BPD and recommended DBT makes no real difference as she wont accept it nor enter the treatment. Thus obtaining official diagnosis serves no more purpose than validating my own thoughts on the matter.

She is low functioning and admits to mental illness, is on a disability pension as a result of it, and in fact wears it as an excuse to do as she pleases at times. She still insists on the version that suits her purposes best. After all anyone who suggests something that she does'nt like is incompetent, right?

So I just use the tools that seem to work best, or try to. Many of these tools are not disorder or individual specific
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« Reply #38 on: October 23, 2012, 04:00:04 PM »

Finally an answer.  For six years I've been ok dealing with ADHD and cyclothymia, even some addictions, but there's always been those underlying issues that nothing else, no diagnosis has been able to encompass.  My husband is borderline and we finally have a diagnosis in the right direction.  His psychiatrist mentioned it right off the bat and his psychologist put a name to it: narcissistic pd. But I know it goes much deeper than that.  My life, OUR life has BPD written all over it.

Thank you for the video, Skip.  I'll take this to counseling.
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« Reply #39 on: October 23, 2012, 04:51:46 PM »

NPD (narcissistic personality disorder) and BPD are two closely-related but different disorders.  Someone could have both.
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« Reply #40 on: November 21, 2012, 11:50:54 AM »

Here is something that I posted in another thread that I think would be informational here, as well:

Traits vs Disorder: BPD is a disorder rated by dysfunction.  When a person is high functioning (opposite of dysfunction) it means less severe.  Most people we describe as "high functioning" are not clinical BPD - rather they have personality disorder traits or BPD traits or other issues - all of which are enough to contribute to a very difficult relationship.

Recycling is something we both do and are equally responsible for.  Many people contact there exs for various reasons after a breakup.  Most of these contacts are not related to rekindling the relationship - however some are.  From studies done here, we are as likely to contact or exs as they are to contact us - and we are as likely to try and rekindle as they are.

BPD - NPD - ASPD Comorbidity Extremely rare and not really indicated in this list below.  BPD traits alone are enough to make this hard. And remember, the level of our pain we feel is not related to the severity of their disorder - it is is related to our ability to cope.

Denial Someone with a subclinical traits oif BPD will much less suspect BPD than someone with severe BPD who is dysfunctional and can't hold a job, is suicidal, etc.  Subclinical traits of BPD are technically not BPD so the denial is more or less accurate.  The person still has serious issues.

Everyone - including all of us - tends to not suspect mental health issues (denial) until there is an emotional crisis.  Many of us will learn from this experience that we too have been in denial of our own issues - like abandonment issues or codependency or etc.  Hopefully we will o more to face them than our partners.

Here is a good link to help out with Facts.  These breakups are really painful.  Stay with the facts, they will help you heal faster and better.

https://bpdfamily.com/message_board/index.php?board=45.0;sort=views;desc

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« Reply #41 on: November 21, 2012, 05:28:54 PM »

W2K--

That's very informative. I suppose I saw "high/low functioning" as whether they could stay out of jail or not. Some dysfunctional people are better at evading consequences than others. not sure what this would be called.
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« Reply #42 on: January 20, 2013, 07:46:01 PM »

Thanks for the info. I also had high and low functioning confused...  
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« Reply #43 on: February 28, 2013, 02:57:45 AM »

I realize that each situation of BPD is different and that most people would believe that Low Functioning BPD is by far the worst, but from what I have seen is that most of the Higher Functioning BPD's refuse to admit they even have a problem, that it is everyone else's fault, and are able to appear somewhat normal to others that they don't see on a daily basis.  My experience with Low Functioning BPD's is very limited, but at least they admit they have a problem and are trying to seek some type of treatment usually.  I believe it is a fine line between some low and high functioning BPDs, it is amazing to me that the high functioning ones I have experienced are able to keep their job and somehow have been able to avoid getting themselves into a lot of serious trouble.  I'd be interested to hear what others have to say.  Thanks all of your responses. 
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« Reply #44 on: February 28, 2013, 05:47:28 PM »

I realize that each situation of BPD is different and that most people would believe that Low Functioning BPD is by far the worst, but from what I have seen is that most of the Higher Functioning BPD's refuse to admit they even have a problem, that it is everyone else's fault, and are able to appear somewhat normal to others that they don't see on a daily basis.  My experience with Low Functioning BPD's is very limited, but at least they admit they have a problem and are trying to seek some type of treatment usually.  I believe it is a fine line between some low and high functioning BPDs, it is amazing to me that the high functioning ones I have experienced are able to keep their job and somehow have been able to avoid getting themselves into a lot of serious trouble.  I'd be interested to hear what others have to say.  Thanks all of your responses. 

My ex is high functioning.  She has been diagnosed with "multiple psychological disorders" including BPD.  And yes, I worked with her for many years, and in a structured environment, she does very well.  It's in the home that she can't act right all the time, especially under stress.
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« Reply #45 on: April 20, 2013, 10:39:18 AM »

I realize that there are many, many different types and subtypes and categories (& subcategories) of BPD/ERD/narcissism etc. (high functioning, low functioning, social avoidance, overly social types, etc

Where does one get a list of all these different types anyway?

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« Reply #46 on: April 20, 2013, 05:41:54 PM »

Where did you get the information re there being over 200 different types of BPD? As far as I am aware, BPD is BPD - there are no 'types' per se (at least clinically speaking). ERD and narcissism are not the same as BPD, they are separate disorders which may coexist in the same individual, but they are distinct diagnoses. High vs low functioning just describes where on the spectrum a person with BPD falls - i.e. how severe their symptoms/traits are. Social avoidance vs being over social - again, this is not a sub-category of BPD but is either a feature of that individual's core personality or, if problematic, a separately diagnosed disorder.

Comorbidity is high with BPD, i.e. many people diagnosed with BPD will also have other disorders at the same time. This complicates diagnosis and treatment but it does not change the nature of BPD itself.

If you have other information, I would be all ears - trying to learn as much as possible here! Smiling (click to insert in post)
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« Reply #47 on: April 20, 2013, 08:25:34 PM »

For me I guess I was just trying to understand the high and low functioning of BPD; I see that mentioned a lot on the boards.  I am dealing with someone who is undiagnosed, so I am learning all on my own. 
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« Reply #48 on: June 19, 2013, 07:45:46 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 BPs

1.   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 Characteristics

Many 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 #49 on: June 20, 2013, 02:26:20 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.  :)r. 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.

 

Abigail

I could not agree more with Abigail's closing remark.

Ian
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