DIAGNOSIS: BPD. What is it? How can I tell?

[BPDFamily.com]

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.

[Matt]

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.

[GENERAL ANNOUNCEMENT]

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).

[MaybeSo]

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.  

[search4peace]

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.

[Willy]

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.

[BentNotBroken]

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.

[Matt]

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.

[yeeter]

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?"    

[waverider]

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

[kellens]

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.

[Matt]

NPD (narcissistic personality disorder) and BPD are two closely-related but different disorders.  Someone could have both.

[Want2know]

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

[GENERAL ANNOUNCEMENT]

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).

[doubleAries]

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.

[Cantor]

Thanks for the info. I also had high and low functioning confused...  

[ScotisGone74]

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. 

[Matt]

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.

[ogopogodude]

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?

[arabella]

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!

[changingme]

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. 

[mamastired]

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.

[Oldsoldier2411]

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

[Reg]

Hi,

I was wondering if there is some logic behind high and low functioning BPD.

My ex partner was high functioning even perfectionistic in her work.  I've seen other high functioning ones becoming low functioning ones due to alcohol abuse.  But I've also seen some high functioning ones drinking only at home or elsewhere when they are not at work.  Most curious !  As if they manage to make a boundary on that matter for themselves.

I was wondering how many can relate to this :

The high functioning ones I know, all had the example of parents who were actually very hard working and had very little time for their child or children.  This may have triggered the borderline at a young age as weel of course.

Could this high functioning have anything to do with the example they got at home ?

Reg

[musicfan42]

Hi Reg,

I think that everyone is influenced by their parents' values-everyone..not just borderlines. I notice that I'm becoming more like my parents the older I get..picking up both their good and bad habits. There is that phrase "the apple doesn't fall from the tree" for a reason.

You're right-high functioning alcoholics do set a boundary of sorts with themselves. They think "oh I'm not as bad as a chronic alcoholic because I don't drink all the time/I only drink at home/I only drink after a stressful day at work". Drinking to alleviate stress is a big issue with them... it's the ultimate excuse.

You mention that high-functioning alcoholics can become low-functioning-that tends to happen in the later stages of their alcoholism.

I think there are some parents that prioritize work so much because they want their children to be financially independent as adults. They may think "yes I'm working very hard now but that's only to pay for my child's good education etc". So sometimes the emotional neglect aspect isn't deliberate..it may be borne out of good intentions. These type of parents may not have the communication skills needed to emotionally care for a child either-they may be of the attitude that "children should be seen and not be heard". Parenting styles have changed so much recently-it's all about children's self-esteem, thoughts and feelings etc whereas before it was much more about survival..ensuring that the child was able to fend for itself basically.

[lovespopcorns78]

HI  well my mom was BPD a widow, she never touched alchohol or drugs of any kind, I was emotionally and physically abused by her, I am high functioning with some BPD traits they are related to the trauma I lived in growing up as a small child, living in fear of not knowing what she was going to do to me next , low self worth, the need to be accepted by others at any cost, shame, I believe to cope as a child to survive since no one was there to protect me, I became an expert at hiding all these symptoms to survive, push things way down deep no one would have imagined but another trauma in my life brought these more to the for front so I am just beginning my journey I have a great T who really knows my history and he put the pieces together,and I finally understand why I think and do the things I do so I do believe everyone has different reasons for how they internalize lifes experience but yes I have succesful career long marriage and amazing kids but internally struggling  all my life, its the only thing I know, it keeps one yet alone in there shame i dont want anyone to think I cant handle life so thats how someone can be high functioning at least in my case...

[maxen]

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.

one of the searing things about my disaster is that my stbxw's actions have been exculpated. in other words, that her immaturity, her lack of empathy, her selfishness, her entitlement, her other-blaming, things mentioned above, have been found excuses for. "there's two sides to every pancake" i was told; "the marriage wasn't working" too: so deceit, infidelity and adultery are to be "understood", but have no moral content. facing one's patterns, facing the effects of behaviors on others?

[modafinilguy]

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.

What is often overlooking is that dual diagnosis situation can exist, and this is quite common with BPD.

I don't have the citation, but I read from an authoritative source, but 25% of BPD have ADHD, but in this case it is typically over looked.

cyclothymia- never given it much credibility, from anything I have experienced.

However I mean I could help I am pretty good with ADHD, if you are interested PM, I can send you a pretty good list to identify if ADHD may ALSO be present.

Maybe its just BPD, but if the person ALSO has ADHD, the best outcome will be obtained from the dual treatment of both disorders. Primarily DBT therapy for the BPD, but you want a good therapist, many are close minded to this, but it is accepted in the higher reaches of psychiatric academia to be a legitimate thing to treat BOTH disorders when they co-exist.

Some therapist are like "OMG! But the psycho-stimulants for ADHD, very bad if a person with BPD decided to over dose on them", true yes, but there are ways to manage risks to a degree.

Typically I mean in ADHD + BPD, I read typical treatment, is psycho-stimulant (gold standard for ADHD treatment, but some other treatments do exist) + low dose neuroleptic. Low dose neuroleptics (antipsychotics), do not be scared off, nothing to do with psychosis. Most atypical antipsychotics are KNOWN to have antidepressant effects in low doses. Low doses atypical AP's are probably the most credible medical treatment for BPD (medication wise), and in conjunction with the psycho-stimulant are supposed to stop the psychostimulant possibly interfering with BPD symptoms, while it is improving the ADHD ones!

Not saying this person has ADHD, also, but honestly you WANT this to be correct. I have read authoritative literature on this, and all my experience suggests if they truly meet the criteria for BOTH, then dual treatment will produce the best outcome.

It should be noted that ADHD, has been long known to be common in BPD childhood backgrounds. ADHD may actually predispose a person to BPD, theoretically the idea would be in a traumatic, unstable, or invalidating early life / childhood environment.

There are reasonable non-stimulant options available.

Just trying to help, ADHD + BPD, one of my main interest areas But if it is just BPD, well that knowledge should be a great tool, and even comfort to you!

[modafinilguy]

 In one study, 38% of participants with BPD met the criteria for a diagnosis of ADHD

That is quoted from wikipedia, here is the abstract to the study, doesn't contain sample size though

www.ncbi.nlm.nih.gov/pubmed/21158602

Well that all I can find at the moment (very, very tired).

It is an issue often overlooked.

If a person VERY well meets the ADHD diagnosis for adults (it is important to understand certain symptoms such as blatant hyperactivity are not as pronounced in adults with ADHD as children, the landscape changes somewhat in symptoms from child to adult).

In adults with both ADHD + BPD, impulsive would be expected to be especially pronounced.

Such a person would tend towards messiness and disorganization, misplacing things constantly, careless errors and rushing tasks the require "focus" (even cleaning etc), they may come across as somewhat sloppy in their efforts with doing many tasks, well there is a lot more but I am off.

Especially if a person is NOT prone to panic attacks or SEVERE anxiety, and has both disorders (and has healthy heart etc), ADHD treatment could produce profound benefits in conjunction with BPD treatment. I have directly witnessed this. However do NOT take psychostimulants if you have ever been addicted to misusing stimulants like cocaine or methamphetamine.

Indeed a person with severe ADHD (I am that), who had BPD, and has not the ADHD treated, may not focus and participate well in therapy due to their poor ability to maintain focus and interest on such things (very similar).

Bye

[Vanityvanity]

Just a note re diagnosis. I myself am autistic (or have Asperger's Syndrome, depending on your preferred term). I suspect it long before I was formally diagnosed. One psychiatrist who saw me for five minutes said I couldn't have Asperger's, as he'd be able to tell - just by looking, I suppose. Years later, a therapist diagnosed me as having traits of it, though she said she thought I didn't, at first, because I read novels, and "people with Asperger's never read fiction" (big myth that). Then the year before last, at the age of 49, I saw an expert in autism at the local university. He saw me for an hour, did some obvious tests, did some covert observations (ie judging my behaviour when I didn't realise he was doing so) and said Yes, I do have Asperger's. So you see diagnosis for many conditions is very patchy, especially if they have only been recognised for a relatively short time.

[pessim-optimist]

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).

The idea of 200 different "types" of BPD comes from the current clinical diagnostic criteria. There are 9 different criteria, and to meet a diagnosis of BPD a person has to meet at least 5 out of the 9. It doesn't say which 5. It could also be 6, 7, 8, or all 9. When you calculate that mathematically, there are around 200 different possible combinations coming from these criteria.

I personally would not call it "types", but given the different combinations of symptoms, and also the different severity of each of the symptoms that a person can experience, it gives you an idea of just how unique each person w/BPD can be - and that does not count in the uniqueness of their non-disordered part of their personality.

On the other hand, there are certain similarities between pwBPD that are not expressed by the current DSM criteria, and that is partly the reason why the professional community is trying to rework those.

[Panda39]

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

There might be common impairments but an alcoholic can stop drinking and much of the impairment stops too...  unfortunately not so easy with BPD

[LoveLove]

Can anyone tell me if/what the difference is between Borderline Personality Disorder and Borderline Personality Style?

I can't say that my ex has been diagnosed with BPD (no contact per his therapist)...  but I want to know if there is a difference in "symptoms" with the above and if the person is going therapy, can they truly be helped?