FAQ: How common are personality disorders?

[BPDFamily.com]

  Not sure where to put this, but I thought others might find this interesting.

  Many of us have talked about the fact that the often quoted rate of 2% of the population having BPD seems rather low.  Some experts have acknowledged that there hasn't been enough research and that the figure may actually be higher.

  Well, I have come across some information and did my own computation using some other reported figures.

  I have been reading a book regarding the latest scientific research on ADHD in adults, "ADHD in Adults--What the Science Says" by Russell Barkely, Kevin Murphy and Mariellen Fischer.  It just came out and it documents two studies done on ADHD in adults.  The estimates of adults with ADHD is between 5 and 6% of the population, according to the book.  In addition, they studied some of the other comorbidities that accompany ADHD in adults and within their two samples, between 24 and 29% of adults with ADHD also had Borderline Personality Disorder.

   In reviewing some information from the website of the NEA BPD and a subsequent email to Dr. Robert Friedel (author of "Borderline Personality Demystified" and one of the founders of the aforementioned website), the research indicated that 25% of those with BPD also have ADHD.

  If roughly 25% of adults with ADHD also have BPD, then that would mean between 1.25 and 1.50% of the population have both ADHD and BPD.  And if only 25% of those with BPD have ADHD also, then the total population of individuals with BPD would also be between 5 and 6%.

  Hope I didn't confuse anyone with my computations.  Which figures are the most reliable?  Any comments?

  Abigail

[Abigail]

  Not sure where to put this, but I thought others might find this interesting.

  Many of us have talked about the fact that the often quoted rate of 2% of the population having BPD seems rather low.  Some experts have acknowledged that there hasn't been enough research and that the figure may actually be higher.

  Well, I have come across some information and did my own computation using some other reported figures.

  I have been reading a book regarding the latest scientific research on ADHD in adults, "ADHD in Adults--What the Science Says" by Russell Barkely, Kevin Murphy and Mariellen Fischer.  It just came out and it documents two studies done on ADHD in adults.  The estimates of adults with ADHD is between 5 and 6% of the population, according to the book.  In addition, they studied some of the other comorbidities that accompany ADHD in adults and within their two samples, between 24 and 29% of adults with ADHD also had Borderline Personality Disorder.

   In reviewing some information from the website of the NEA BPD and a subsequent email to Dr. Robert Friedel (author of "Borderline Personality Demystified" and one of the founders of the aforementioned website), the research indicated that 25% of those with BPD also have ADHD.

  If roughly 25% of adults with ADHD also have BPD, then that would mean between 1.25 and 1.50% of the population have both ADHD and BPD.  And if only 25% of those with BPD have ADHD also, then the total population of individuals with BPD would also be between 5 and 6%.

  Hope I didn't confuse anyone with my computations.  Which figures are the most reliable?  Any comments?

  Abigail

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[Skip]

I think your calculations are really interesting, Abigal. Here is the study we are basing the "site" numbers on.
 
Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder.
Bridget F. Grant, PhD, et.al
Journal of Clinical Psychiatry 69:4, April 2008.
See article here
 
The research was conducted by the Laboratory of Epidemiology and Biometry at the National Institute for Health (NIH).
 
34,653 face to face interviews were conducted in 2004 - 2006.
 
Some conclusions are:
 ~ the prevalence of the disorder is  5.9%
 ~ that prevalence in men is the same as women.
 ~ BPD was more prevalent among Native American men, younger and separated/divorced/windowed adults, and lower income and education.
 ~ BPD was less prevalent among Hispanic men and women, and Asian women.
 ~ the study details many other conclusions such as BPD prevalence was greatest among people with bipolar disorder (50%), panic disorder, or drug dependence.  Smokers were also more likely to have BPD.
 ~ 24% had comorbidity with another personality disorder.  The rates of NPD/BPD and ASPD/BPD were higher among women.
 ~ the greatest decline was seen after 44 years old.
 
Respondents were asked a series of questions about how they felt and acted most of their adult life.  They were instructed not to includes symptoms that only occurred when they were depressed, manic, anxious, drinking heavily, using medicines or drugs or physically ill.  They had to agree that there was also some social or occupational dysfunction.
 
This was an epidemiological study, not a clinical study - the diagnosis was determine by answers to survey questions, not a clinical work up.  The population studied was random members in the community - this is not a limited study of people seeking treatment.

[Matt]

I'm not sure what it may mean that the study was based on answers to questions.  On the one hand, I'd say that means many of them may lie and so the study can't be accurate.  But the MMPI-2 has scales to assess the individual's honesty in taking the test, and gives results even if the individual tries to fool it.  (My ex scored very low on the honesty scales but still showed a lot of psychological problems anyway.)

It seems to me that a clinical study would be more effective - something that doesn't rely on the patient to be honest - but I don't know if such a thing exists.  That's one of the challenges:  Only by living with someone and observing their patterns of behavior can you compare it with those characteristic of BPD to draw a conclusion.  I was amazed when our marriage counselor told me my then-wife probably had BPD;  after just a short time she saw it clearly, but couldn't give a formal diagnosis.  I guess that just means she's very perceptive and led the conversation in ways that drew out the information she needed.

[Skip]

... .I'd say that means many of them may lie and so the study can't be accurate.  

Matt, can you elaborate on the practical aspect of your thoughts here.  Are you thinking that 5.9% is too high? too low? that this study meaningless? studies in general are meaningless?  that we should we reference a more trusted source?

This study was conducted by the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA.   It was published in a leading peer review journal, The Journal of Clinical Psychiatry.  The editor is a Professor of Psychiatry, Yale University School of Medicine.

[Matt]

... .I'd say that means many of them may lie and so the study can't be accurate.  

Matt, can you elaborate on the practical aspect of your thoughts here.  Are you thinking that 5.9% is too high? too low? that this study meaningless? studies in general are meaningless?  that we should we reference a more trusted source?

This study was conducted by the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA.   It was published in a leading peer review journal, The Journal of Clinical Psychiatry.  The editor is a Professor of Psychiatry, Yale University School of Medicine.

I'm probably just exposing my own ignorance here.  I don't know the answers to any of those questions, and I certainly don't know if the 5.9% is too high or too low.  The credentials of the researchers are surely impressive, so maybe they know a way to get the truth from people who tend to lie about themselves;  the MMPI is said to be meaningful by somehow discerning the truth within the lies.  At the same time, many of us here have seen credentialed professionals struggle to see the truth when looking closely at a single individual - taking many hours to try to figure it out and not always getting to the truth.  So I don't know if there is a method of getting the truth from a lot of (presumably disordered) individuals through a survey.

I can say from experience that credentialed scientists can use established methods to gather information, but if there is a flaw at the core - such as getting information by asking people who have a motive to lie (or say things that aren't true) - the results of the study may not be meaningful no matter how impressive the credentials of the researchers.

We can also note how this number tends to vary - from what I've read, generally between 1% and 10%, but sometimes even higher - which would suggest that it's not easy to pin it down.

So I guess my short answer would be, I don't know if such a survey is meaningful or not.  My guess is that the only way to understand this would be to put audio/video recording devices in the home.  But that may be ignorance on my part;  I may just not understand the methods being used.

[Unreal]

We can also note how this number tends to vary - from what I've read, generally between 1% and 10%, but sometimes even higher - which would suggest that it's not easy to pin it down.

So I guess my short answer would be, I don't know if such a survey is meaningful or not.  My guess is that the only way to understand this would be to put audio/video recording devices in the home.  But that may be ignorance on my part;  I may just not understand the methods being used.

Confidence intervals.  We'll never pin it down exactly.  Epidemiological research on a large scale presents many challenges.  When you're talking 1000s of participants, it is too expensive to do a full clinical evaluation on everyone.  Who is going to pay for it?  So, they give questionnaires with cheaper personnel and try to extrapolate from that.  The logic is a bit different on a meta-level like this (30,000+ patients).  I haven't read this particular article (no access right now). 

My guess would be that this is a structured interview/survey of some sort that it is probably fairly lengthy (given the topic. . . this wasn't specific to BPD).  They are looking for patterns that are consistent with various disorders.  I think the data are meaningful, but not ideal. 

[G.J.]

I have selected some articles from the National Institute of Mental Health and the American Psychiatric Association.  The statistics seem to vary; however, overwhelmingly - if you take an average of the estimates - the numbers seem to add up to over 20% (1:5) of the population having a diagnosable mental disorder.



According to the National Institute of Mental Health, "An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year."

www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

The article also states:  "About 6 percent, or 1 in 17, suffer from a serious mental illness."  (It didn't specify which were considered serious and which were not.  This article does not include BPD, NPD or AsPD in it's findings.)


A study published in 2004 in the Journal of Clinical Psychiatry summarizes that, "14.8% of Americans (30.8M adults) meet diagnostic criteria for at least one personality disorder."  Not included in this study were BPD, NPD and Schizotypal PD's "due to the large number of symptom items required to diagnose those disorders."  (Also noticeably missing was BiPolar Disorder.)

www.pn.psychiatryonline.org/cgi/content/full/39/17/12

Obsessive Compulsive PD 7.9% (16.4M)

Paranoid PD 4.4% (9.2M)

Antisocial PD (Sociopath) 3.6% (7.6M)

Schizoid PD 3.1% (6.5M)

Avoidant PD 2.4% (4.9M)

Histrionic PD 1.8% (3.8M)

Dependent PD 0.5% (1M)

The US Department of Health also republished this report:  www.nih.gov/news/pr/aug2004/niaaa-02.htm


I'm not entirely sure what "Schizotypal PD" is, and in Googling it, I can't find too much readily available.  So let's just put that aside.  But here are the statistics for the other 3 PD's not included in this report:

Narcissistic PD:

Psychiatric News, published by the American Psychiatric Association, summarizes that, "The lifetime prevalence of narcissistic personality disorder among American adults is 6%."

www.pn.psychiatryonline.org/cgi/content/full/43/15/38

Borderline PD:

I can't find a good NIMH or APA article referencing this, but most sources estimate between 1 - 3%, with most stating 2% or 4M people.

Point of interest, another article states:  "The prevalence of Borderline Personality Disorder is estimated to be about 2% of the general population, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients. In ranges from 30% to 60% among clinical populations with Personality Disorders."

www.borderlinepersonalitytoday.com/main/dsmiv.htm

BiPolar Disorder:

From the same NIMH article listed above, "Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year."


So, adding all of that up:  OCD, Paranoid, AsPD, Schizoid, Avoidant, Histrionic, Dependent = 14.8%  Plus NPD, BPD and BiPolar = 10.6% for a grand total of 25.4% or 1:4 people in the US.  For argument's sake, lets assume those numbers are high, and we subtract 5% off of that total for good measure.  That puts the prevalence of PD's at 1:5 people.  Let's assume that those numbers are WAY off, and we subtract 10% off the total prevalence.  That STILL puts the prevalence of PD's at almost 1:6 people.


Look at this another way... . Personally, I find the Cluster C PD's (BPD, NPD and AsPD) and BiPolar Disorder to be the least readily identifiable of the PD's, and the most destructive to the people that get involved with them.  Just using those numbers:

BPD 2% (1:50)

NPD 6% (1:17)

AsPD 3.6% (1:28)

BiPolar 2.6% (1:38)

That's a total of 14.2% or 1:7 people have a pervasive, mostly incurable, destructive personality disorder, that has been known to wreak havoc in the lives of those around them... . Take it a step further, and let's say that those NPD estimates are off (they seem to vary), and we'll use 2.5% for NPD to keep it amongst the average of the rest.  That still puts the numbers at 10.7% or more than 1:10 people have a destructive PD.

When you think of the BPD estimates of being only 2%, it sounds small.  But not when you consider that's the equivalent of one out of every 50 people in the US - and the majority of them are not in mental institutions.  The scariest to me is the AsPD (Sociopath - no conscience) estimates of 3.6% or one in 28 people in the US.  Granted, many of these people are locked up in prison - but certainly not the majority.  Assuming that a full 1% percentage is locked up (that's a third of all AsPD's and is probably being generous) - that still leaves 1 out of every 38 people you come into contact with having absolutely no conscience, compassion, or sense of responsibility towards any other human on earth.


All of this is just some food for thought the next time you visit a dating website, get on an airplane, go to the mall, or look around your family dinner table.  

[elphaba]

I had seen a report that had claimed the rate of BPD was much higher 1%... .like 5.9%... .from Time Magazine.

www.time.com/time/magazine/article/0,9171,1870491,00.html

A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 18 million Americans — had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD

18 MILLION Americans... .this is only those given a BPD diagnosis... .and if you figure a minimum of 2 people that are directly and significantly impacted by the behaviors of each of those... .that makes 36 million Non's... .in the US alone.  Not to mention the likelyhood of millions more that are undiagnosed.

[Abigail]

THe neaBPD.org reports 1-2% --they usually have the latest information on BPD and articles from the top experts.

[Matt]

This was an epidemiological study, not a clinical study - the diagnosis was determine by patients answers to survey questions, not a clinical work up.

Does anyone know how meaningful such a study is, or if there is a way to make it meaningful?

My ex lies, so anything based on her answers to questions - unless it's something like the MMPI-2, which is designed to see through lies - might be worthless.

[Skip]

It was a study of 43,000 people conducted by the National Institute of Health.   There is a discussion in the paper (se link) regarding the prior (smaller) studies and way they may have arrived at such low figures.

You can direct your questions to:

Bridget F. Grant, Ph.D., Ph.D.,

Laboratory of Epidemiology and Biometry, Room 3077,

Division of Intramural Clinical and Biological Research,

National Institute on Alcohol Abuse and Alcoholism,

National Institutes of Health, M.S. 9304,

5635 Fishers Lane, Bethesda,

MD 20892-9304,

Tel. 301-443-7370,

Fax 301-443-1400,

E-mail, bgrant@willco.niaaa.nih.gov

[ForeverDad]

Bill Eddy is an author, founded or co-founded www.HighConflictInstitute.com and holds seminars in various cities for lawyers, judges and other professionals.  Of course, the focus is on divorces and custody, but it also affects other aspects of conflict and disputes.  He has taped his presentation on Understanding & Managing High Conflict Personalities and has an 8-DVD set of one of his seminars.  It's not cheap but I do feel that as a professional conducting quality seminars, he presents common sense background, insights and suggestions for those in the legal and counseling systems dealing with these "High Conflict Personalities".

I've only started viewing his seminar, but he outlines the various personality disorders and focuses on the acting-out Cluster B PDs (Narcissistic, Borderline, Antisocial and Histrionic).  Everyone fits into one of three groups.

• reasonable persons... .  can settle and resolve their conflicts.



• maladaptive personality traits... .may resolve conflicts with careful management



• personality disorders... .rigid patterns of thinking and behavior, may be unable to resolve conflicts

He notes an NIH study, possibly the one already mentioned here and arrives at the already mentioned nearly 15% approximation.  Then he switched to the courts and noted a survey of over 1100 cases in 2 California counties revealed about 15% of divorce cases are reported as "intense" legal conflict and another 10% as "substantial" legal conflict.  As I recall, he stated something like this... .Is this [percentage] familiar?

In a High Conflict Divorce study of 160 parents by Johnston and Campbell, 2/3 met DSM PD criteria and another 1/4 had traits, which he referred to as the intermediate ones who had maladaptive traits.

In summary, while those with acting-out PDs may comprise only 15%, more or less, of the population, they comprise the majority of high conflict disputes.

[roni-nator]

The statistics I was given in a NAMI class I took was 2% for BPD.  I don't remember what that was based on.

The thing that surprised me from the NAMI class was that they said research had shown that the same percentages of the same mental illnesses showed up in all cultures - even non-industrialized.  I remember that, because I felt so sorry for the people who do not have our understanding having to live with that.  I believe their statistics on all mental disease was about 25% approximately.  Can you imagine living in a culture where there is little to no understanding of what the person is going through.  I guess some of those people were the shamans or mystics of those cultures - the people who saw visions.  But, as I said, that is a guess.  It just makes me realize how lucky we are to have some education to fall back on.

That's about all I have to say on the subject at the moment.  Just needed to put my two percent worth in.

[an0ught]

He notes an NIH study, possibly the one already mentioned here and arrives at the already mentioned nearly 15% approximation.  Then he switched to the courts and noted a survey of over 1100 cases in 2 California counties revealed about 15% of divorce cases are reported as "intense" legal conflict and another 10% as "substantial" legal conflict.  As I recall, he stated something like this... .Is this [percentage] familiar?

In a High Conflict Divorce study of 160 parents by Johnston and Campbell, 2/3 met DSM PD criteria and another 1/4 had traits, which he referred to as the intermediate ones who had maladaptive traits.

In the interest of full disclosure: I don't like the thought of a large percentage of the population being mentally ill, somehow it feels like "normal" is defined too narrow. Warning following is very very very unscientific as the things considered are not independent and one BPD can account for multiple events... .

Does it make sense to look at a population that is at a time of conflict (divorce) during their life? When children are involved even rational people become irrational and are steered by emotions. BPD is not a temporary phenomena and pervasive in a BPDs live. Everyone feels down at times in their life and likely meets depression criteria. Not everyone needs treatment - most illnesses heal themselves.

But let's take the 15% at face value. How much population is that? Only half because the other half won't get divorced so we are at 7.5%. Then only one is BPD and the other is a non so we are at 3.5%. If we then adjust for the divorced BPDs going through more than one divorce (speculation) then we are at 2-3%. This still feels a bit on the high side.

Let us do it the other way round. Assuming 10 sex partners on average per person during their lifetime and making that 10 for BPDs (excluding on-night stands for them). Also assume 5 jobs and some fertility. Then 1% BPDs in the population would affect in a big way 2% (parents) + 1% sibling + 10% partners + 2% children + 5% bosses + 5% subordinates= 25%.

==> We don't need a lot of borderlines to see nons (and indirectly them) everywhere.

Considering the damage a BPD can do if not handled right and the cross section of the population indirectly affected in a big way - awareness has to be build both for the condition as for the tools.

[Iguana]

An article on this site states:

https://bpdfamily.com/bpdresources/nk_a103.htm

"Although definitive data are lacking, it's estimated that 1 percent to 2 percent of American adults have borderline personality disorder (BPD). It occurs in about one in every 33 women, compared with one in every 100 men, and is usually diagnosed in early adulthood."

Looking over the message boards, it seems there are just as many posts about BPD men as women. Is this because women are more likely to seek support and information on sites such as theses?

[Matt]

That may be one factor - who chooses to come here for help.

The article you cite refers to how many men and women are diagnosed with BPD.  That's not quite the same thing as how many men and women have BPD.  Other studies have shown that it's about equal, but women are more likely to be diagnosed than men are;  that is, there are more men who have it but haven't been diagnosed.

One possible reason for that is that when someone enters adulthood and their behavior is no longer excusable - it's not a kid throwing a fit - women are more likely to go toward behavioral health treatment - medication and/or talk-therapy - either because they choose to or because someone else pushes them.  Men are more likely to go into the criminal justice system.  Unfortunately those two systems don't overlap much;  if you are getting help you are less likely to commit serious crimes, and if you are in jail you probably won't get treatment.

So it's a fork in the road - maybe just as many men as women coming to that fork but more men taking the "jail" road and more women taking the "treatment" road.

[DreamGirl]

According to the specific study mentioned in that thread, like Skip reported, the ratio is closer to being equal as far as men and women suffering from the disorder (and would support  the reason there is an equal number of women and men posters in a relationship with a pwBPD on this board).  

So it's a fork in the road - maybe just as many men as women coming to that fork but more men taking the "jail" road and more women taking the "treatment" road.

Gosh, I had never thought of that. It feels a little stereotypical to me (i.e. men don't ask for directions), but I can see where it would make sense. Is there any literature/studies to support that idea?  How can we possibly determine the undiagnosed population?  

I wonder how many of those choosing the "jail" vs. "treatment" route, were in fact chosing the "substance abuse" route and the consequences involving "jail" or perhaps "treatment". There are studies that have shown that nearly 50% - 60% of those diagnosed with BPD have issues with alcohol or other substances, so I'm sure that statistic could overflow to those who are not diagnosed.    

~DreamGirl

[Matt]

Yeah, DG, I think you're right - probably most guys think they're choosing the "drinking" route and then later realize they're on the "drugs" route and then wake up some day in jail.  The signpost doesn't say "Jail this way"... .

The way this has been quantified - I'll try to find links if I can, or maybe somebody else remembers where they are - is two ways.

One method is to survey people who have been diagnosed with BPD and find out how many are men and how many are women.  This is the type of survey Iguana referred to in her original post.  Surveys like this always show way more women diagnosed with BPD than men.  (You could view this as counting the number of people who are traveling on the Treatment Road.)

The other method is to survey a random sample of adults and give them a test to indicate if they have BPD.  Of course, you have to survey a lot of people because only a few % will show positive.  This method shows more nearly equal numbers of men and women with BPD.  (You could view this as counting the number of people who are traveling on the road before it gets to the fork.)

A third type of survey - I'm sure it's been done but I've never read one like this - would be to talk to people who are traveling on the Drugs And Jail Road.  I think it's a safe bet that a lot of them would have BPD (and other problems) but never have been diagnosed.  (I've had the opportunity to talk with many people like this but I haven't read any quantitative studies.)

[roni-nator]

I re-read these this morning, and I want to take a minute to refer back to Skip's message a couple of years ago in which he stated that it was more prevalant among lower income groups.  I wonder if it is a genetic disorder, why would this be?

The reason I ask this is that I've said this to my counselor many times.  Many of you who might remember my posts will remember that I've talked about how being raised by a borderline had opened me up to repeated borderlines in my life, and one of the reasons for that is that I come from a very poor culture - my parents came from illiterate Appalachian American, I was the first generation to learn how to read.  So, other than a boss I had who was BPD (and she may have come from a poor culture - I don't know) most of the borderlines I've met are from the poor roots of my background (even the ones I met out of the mountains and in the inner city when we moved here) or they were in the inner city preying on the vulnerability of the poor.  So, that's why I've met so many of them and been a repeat victim.  But, if it is genetic, then why is it more prevalent among the poor?  To me, that says that it is conditioning.  Any thoughts? 

And, how do those of us who were raised and trying to escape a poor environment become more successful at it when we're surrounded by borderlines?  I don't remember the name of the book, but there was a young man who wrote a book to rebuff the book "Nickled and Dimed" and he was on a news interview telling how he wrote his book to rebuff Nickled and Dimed because he left his culture as a college educated young man who had been raised in a very functional family with good resources and good breeding and took a "common" job and had put $1,500 in the bank in six months and was talking about how if he could do it anyone could do it.  Well, I'm gonna say it quite frankly and if he's offended he can get on this forum and talk to me himself - he is an idiot.  If you are raised very poor you can't be selfish enough to just go out there and think about yourself - what money you are making is helping your family (and not just your kids but your parents and grandparents) and then if there is any left over you put it in the bank.  Plus, you are not as educated (I went to night school for twenty years) and you are not as socially comfortable in upper classes to be able to charm employers and co-workers, and often you have illness in the family such as BPD that needs your attention.  I can't tell you how many sabbaticals I had to take from school to attend to family illnesses or my own health situations.  Therefore, when you are dealing with BPD and need to be considerate of how it is affecting your entire family who lacks resources and still get ahead for yourself and your family.  I finally made it, but the price was great and there must have been a way to do it with a lesser price tag.  And, honestly, some of that price was created by BPDs who came in from better resources to prey on the poor.  So, to some degree BPD's are more in the poor population cuz they can't earn as much money due to their disease, so they end up in the inner city trying to find a kind person (read the book the Framework for Understanding Poverty by Ruby K. Payne and you'll see how the poorer cultures survive by caring for each other and the kindness they offer in times of need, which is real as I've lived it) to prey upon in the hope of having their previous lifestyle given to them by a kind heart, but there are also many there who originated in the poverty and due to the lack of resources they are the responsibility of everyone in the community and that can't be taken lightly.

Thank you.

[Randi Kreger]

Somewhere I had seen a recent study that had claimed the rate of BPD was much higher... .like 5.9%   I posted it on here a while back... .from Time Magazine.www.time.com/time/magazine/article/0,9171,1870491,00.htmlA 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9% — which would translate into 18 million Americans — had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD18 MILLION Americans... .this is only those given a BPD diagnosis... .and if you figure a minimum of 2 people that are directly and significantly impacted by the behaviors of each of those... .that makes 36 million Non's... .in the US alone.  Not to mention the likelyhood of millions more that are undiagnosed.

This is the figure the NEABPD.org is using now.

[MaybeSo]

Many people in our culture today likely have borderline or narcisstic traits to a degree that is less than optimal, and moreso than in past history, from what I can see, our current culture is pretty borderline eg., we are emotionally immature especially as it pertains to ideas about intimate relating.

We live in an instant gratification culture: We are weaned to expect instant and sustained happiness  we put the kids in daycare asap so we can work and be fulfilled and have more stuff,  we feel entitled to great big houses, great big lives, porn star sex, we want to live the life of a 20 year old in our 40's and 50's and this culture spends huge amounts of money on fantasy based pursuits including pornorgraphy, hollywood movies and plastic surgery... .  our idols are caricatures on drama saturated reality TV shows and hollywood movie stars with revolving drama-based relationships... .  we don't connect eye to eye or really even converse anymore, we text or sext or hook-up online like finding a partner and relating is as simple as putting a nickle into the never ending gum-ball machine... .  the list goes on and on.

Both men and women (US) are raised and marinated in this culture of instant gratification; many of us probably do not in FACT meet the clincial criteria for 5 out of 9 symptoms (DSM IV) of a Borderline Personality Disorder, probably many of those we dated and talked about here don't either... .  but please don't be fooled that if you DON'T have a clincial personality disorder that you actually have excellent and flexible adult emotional skills, good boundaries, are able to defer gratification and have grown up, reasonable and healthy expectations about what an intimate relationship provides long-term.  You can fall way far away from an actual clinical personality disorder and STILL be a difficult relating partner long term (traits) and we are all hooking up and dating eachother folks, all of us with our 'traits'... .  we don't need to look any further than in the mirror to see dysfunction... .  especially in today's culture which doens't even PROMOTE healthy adult relating in any meangingful way in mainstream culture... .  why bother when you can become rich AND get your "needs" met instantly with online porn and all the little girls growing up are trying so hard to meet that fantasy standard?  That is not a healthy society for men or women.

We are part of a pretty unhealthy time in our culture overall... .  in my opinion, WE are currently living in a borderline culture.  

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[seeking balance]

According to "I Hate You, Don't Leave Me" (written in the 80's mind you)... .  

"For many, American culture has lost contact with the past and remains unconnected to the future. Our flooding of technical advancement and information requires greater individual commitment to solitary study and practice, thus sacrificing opportunities for socialization. Increasing divorce rates, expanding use of day care, and greater mobility have all contributed to a society that lacks constancy and reliability. Personal, intimate relationships become difficult or even impossible to achieve, and deep-seated loneliness, self-absorption, emptiness, anxiety, depression, and loss of self-esteem ensue." - Page 63

We are a borderline culture in meeting some but not all of the criteria... .  not enough for actual diagnosis.

[Mountaineagle]

In regards of the discussion about modern american culture being more prone to BPD, I would like to add a little of my recent discoveries. I have learned that many of the relationships in my family had some dysfunction going as far back as great grandfather generation, further knowledge is not available. In my culture we have strong connection to the past, so the stories are around. From what I can gather I think BPD problems have existed for a loong time. But time and history has a tendency to just keep the "good" parts. Just feel the tendency in your own self when looking at your relationship and wanting back . I have to make an effort to remember the bad stuff that happened and still it gets  hidden away in my head, can't remember much of the raging fights I had with my ex. As you all know, there are not many people who can relate unless they have been in a BPD or other pd relationship, and also the shame connected to this kind of situation in the past where it was maybe more important to keep the mask, does insure that these kind of stories does not stay around for a long time. When I am done with this I will not speak about this unless I encounter some friend that needs help, and be able to validate him or her. I don't think BPD is limited to culture or modern times. It is just that the past seems so much better because we as people only remember the good bits. 

[MaybeSo]

Mountaineagle,

You make a good point and I do not think our current culture with it's emphasis on adolescence  is the only time in history where a borderline or unhealthy way of thinking was emphasized... .  personality disorders are assumed to have been around for as long as groups of people have been around, some researchers certainly speculate about  times in history that represent particularly unhealthy group psychology or self destructive group think... .  Alexander the Great, the Roman Empire, and Nazi Germany are just a few obvious  examples that come to mind.

[Maryiscontrary]

I see attachment disorganized relational styles everywhere. In the US, there is a collapse of accessibility to job security, food security, housing security, safety security. And since the family is smaller and more scattered, everything above is exasterbated. Hispanic and Asian populations often have more solid family structures, and this may explain the lesser incidence of BPD in these groups.

[heartandwhole]

That may be one factor - who chooses to come here for help.

The article you cite refers to how many men and women are diagnosed with BPD.  That's not quite the same thing as how many men and women have BPD.  Other studies have shown that it's about equal, but women are more likely to be diagnosed than men are;  that is, there are more men who have it but haven't been diagnosed.

One possible reason for that is that when someone enters adulthood and their behavior is no longer excusable - it's not a kid throwing a fit - women are more likely to go toward behavioral health treatment - medication and/or talk-therapy - either because they choose to or because someone else pushes them.  Men are more likely to go into the criminal justice system.  Unfortunately those two systems don't overlap much;  if you are getting help you are less likely to commit serious crimes, and if you are in jail you probably won't get treatment.

So it's a fork in the road - maybe just as many men as women coming to that fork but more men taking the "jail" road and more women taking the "treatment" road.

Here is a recent review of studies that seems to support your ideas, Matt: www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/

"Zanarini et al. examined Axis II comorbidity in patients with BPD according to gender in 1998. According to their findings, the rates of avoidant and dependent personality disorders were similar for both genders. However, men with BPD were significantly more likely to have comorbid paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders. In support of these data, in the previously noted study by Tadic et al. (2009), researchers also found a higher frequency of antisocial personality disorder in men compared with women (57% vs. 26%). Therefore, men with BPD appear to be characterized by antisocial overtones. Again, given the overload of antisocial features in the psychological styling of men with BPD, disposition in the correctional system would be more likely."



It goes on to convey that while the prevalence of BPD is roughly the same in men and women, men often express more "explosive temperaments" and "novelty seeking," whereas women display more "eating, mood, anxiety and posttraumatic stress disorders."  Women are also more likely to seek therapy and pharmaceutical treatments, according to the study.

[gotbushels]

Just an update from what I found.

Re overall incidence.

K&S seems consistent with 6% overall incidence.

They use Grant, Chou, Goldstein's, 2008 results on page 5.

---

Re gender incidence bias.

First, K&S state 3:1 female:male bias.

Not cited but they probably used DSM4.

Second, K&S then go on to say "recent epidemiological research confirms that [BPD] prevalence is similar in both genders, although women enter treatment more frequently."

Pages 16-17.

Not cited. But this is suggested in Grant, Chou, Goldstein's, 2008 results, which K&S used earlier.

There is a partial discussion on the justice system as explanatory for the male-female difference on the same page.

---

K&S = Kreisman&Straus(2010) IHYDLM (Revised ed.) NY, NY: Perigree.

Grant, B. F., Chou, S. P., Goldstein, R. B., et al., 2008

s=34,000

non-clinical survey basis

DSM4 content regarding the gender incidence bias; I'm guessing are clinically based.

[Matt]

I think several researchers in the past have found that women with BPD get treatment, and men with BPD go to jail.

That probably accounts for the different incidence from men to women.

If 6% is based on 3:1 women, that would be 9% among women, 3% among men... .but assuming the other 6% of men are in jail, maybe it's really 9% total.

I've never seen a study that finds without any assumptions - that is, randomly checking a significant number of both men and women - a big gap in incidence.

[Skip]

If 6% is based on 3:1 women... .

The "6% study" is the first to conclude that the disorder is 50%/50%.

Some conclusions are:

~ the prevalence of the disorder is  5.9%

~ that prevalence in men is the same as women.

~ BPD was more prevalent among Native American men... .

[Matt]

If 6% is based on 3:1 women... .

The "6% study" is the first to conclude that the disorder is 50%/50%.

Some conclusions are:

~ the prevalence of the disorder is  5.9%

~ that prevalence in men is the same as women.

~ BPD was more prevalent among Native American men... .

Thanks - I missed that.

The Native American men I know *do* have a lot of substance abuse issues... .but I haven't seen BPDish behavior... .or maybe I'm overlooking it... .