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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and Dissociative Identity Disorder  (Read 16033 times)
almostknowhoiam
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« on: March 17, 2008, 11:04:18 PM »

Does anyone know the difference?
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« Reply #1 on: March 18, 2008, 01:10:44 PM »

Split personality is a highly dissociative disorder where the entire personality changes to another personality. It is like several people inhabiting one body.

Borderline is a one fractured personality.
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Skip
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« Reply #2 on: June 25, 2008, 04:33:31 PM »

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong illness was diagnosed or whether there are comorbid (multiple) personality disorders at play. Bipolar and Major Depressive Disorder, for example, are far more responsive to pharmaceutical therapy than Borderline Personality or Aspergers Syndrome.

~ If you are trying to get along better with your wife, it's not as important to precisely analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic/developmental (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity of BPD with another personality disorder was very high at 74% (77% for men, 72% for women).  In the study, the comorbidity of BPD with mood disorders was also very high at 75% as was anxiety disorders at 74%. This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.

More info

In a small 2003 study by Drs. Vedat Sar, and Turgut Kundakci (MD), two hundred and forty (240) consecutive patients who presented to a university outpatient psychiatry unit were screened. Twenty-five (25; 10.4%) of the participants tested positive for BPD and 33 participants (13.8%) tested positive for dissociative disorder in the final evaluation. Sixteen participants or 64.0% with BPD also tested positive for a dissociative disorder (i.e., dissociative amnesia, dissociative identity disorder, dissociative fugue, depersonalization disorder). The findings demonstrate that a significant part of psychiatric outpatients who fit the criteria of BPD have a DSM-IV dissociative disorder on Axis I. The presence of dissociative symptoms as a part of BPD could lead to overlooking the possibility of a co-occurring dissociative disorder.

Source: The Axis-I Dissociative Disorder Comorbidity of Borderline Personality Disorder Among Psychiatric Outpatients

Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control


  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.


  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.


  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   Smiling (click to insert in post)  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.


  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 


I hope this helps keep it in perspective.   Smiling (click to insert in post)

Skippy




DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions...

Personality Disorders

Borderline and Paranoid Personality Disorder

Borderline and Schzoid/Schizotypal Personality Disorder

Borderline and Antisocial Personality Disorder

Borderline and Histrionic Personality Disorder

Borderline and Narcissistic Personality Disorder

Borderline and Avoidant Personality Disorder

Borderline and Dependent Personality Disorder

Borderline and Obsessive Compulsive Personality Disorder

Borderline and Depressive Personality Disorder

Borderline and Passive Aggressive Personality Disorder

Borderline and Sadistic Personality Disorder

Borderline and Self Defeating Personality Disorder

Other

Borderline PD and Alcohol Dependence

Borderline PD and Aspergers

Borderline PD and Attention Deficit Hyperactivity Disorder

Borderline PD and BiPolar Disorder

Borderline PD and Dissociative Identity Disorder

Borderline PD and P.T.S.D.

Borderline PD and Reactive Attachment Disorder (RAD)
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peacebaby
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« Reply #3 on: June 25, 2008, 05:43:52 PM »

Here's my take... Horrible childhood abuse tends to create mental illness, especially with family histories of drug/alcohol addiction or mental illness. Sometimes kids make it through basically sane. But most do not, and most when they are enduring the abuse, must dissociate to survive it. I think there are a lot of variables involved, and this early dissociation can continue to be used as a coping mechanism and potentially morph into DID (dissociative identity disorder) or BPD. Or other mental illnesses.

My dBPDso has the Jekyll and Hyde thing - most of the time she's sweet and child-like, thoughtful and generous and accepting and loving. And then when she dissociates so badly that she has a full psychotic break, her face literally gets darker, her eyes deeper and scary, and her voice changes, the way she speaks is different. The nice, self-effacing person is replaced by an abusive b_tch. I know it's her, it's not a different personality--it's part of her personality that only wakes up when the working part of her brain is triggered in particular ways and stops working right.

My partner remembers everything that happens during these times. She says it's like a dream where she's watching herself from above, unable to control herself, unable to really feel that it's her doing the things she's doing.

Sometimes she fears that it is DID, most of the time she says she knows it's not. (She knows what's going on. She has all 9 diagnostic criteria of BPD, plus PTSD, PMDD, and panic attacks. But not the symptoms of DID.

Like DID, though, BPD is often developed during childhood abuse as protection. The horrors are too great for the little mind to cope with, and cause it to split, to separate the awful things into compartments in a way that allows a part of the mind to remain sane--as opposed to someone who becomes full-time psychotic. So in that way, the diseases have similarities--DID creates different personalities to handle various and/or triggering things, while BPD creates different behaviors to handle triggering situations and emotions. Point is, there's a vulnerable person that's protected by a tougher personality (DID) or an a$$hole persona (BPD).

I don't know a ton about DID, and I base my opinions on BPD on my readings and my experiences with my partner.  BPD has lots of other criteria, the DID-like aspects are only a part of this disorder, and I imagine that DID has lots of stuff BPD doesn't have, like there are a bunch of different personalities that handle different situations and they all have different names--note the name of the disease was changed from "personality" to "identity" implying that those with DID do have these separate identities with different conciousnesses and experiences.

And again, this is my theory for those who got these diseases as a partial result of childhood abuse. I know that they can develop without the abuse, but I don't know how that works.

Peacebaby

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Gagrl
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« Reply #4 on: June 26, 2008, 10:37:59 AM »

My husband's ex-wife would dissociate to violence or near-violence but swear later that she did not do it, say it, or remember it.  This included telling him that if he ever left her, she would burn down the house with the children in it.

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« Reply #5 on: June 26, 2008, 10:49:04 AM »

Just for the record, here's the intro to DID from Wikipedia:

Dissociative Identity Disorder, as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), is a psychiatric diagnosis that describes a condition in which a single person displays multiple distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment.[1] The diagnosis requires that at least two personalities routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be due to substance abuse or medical condition. Earlier versions of the DSM named the condition multiple personality disorder (MPD) and the term is still used by the ICD-10. There is controversy around the existence, possible causes, appearance across cultures, and epidemiology of the condition

www.en.wikipedia.org/wiki/Dissociative_identity_disorder

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Bitdawg

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« Reply #6 on: July 24, 2008, 06:04:16 PM »

I truely beleive there is a connection between the BPD and MPD. Prior to leaving a 20 year relationship with a BPD, the last year and a half I keep a journal of all her chaotic and bizarre moments, which I recorded her behaviours, anger outbursts, rages, ect... I journaled and audio recorded these occurances for court proceedings, per my lawyer, because children were involved.  In a nine month period, I recorded 56 pages of arguements and 40 hours of audio.  Referring to Hurricanes, these arguements were Category 4 and 5 range.  My BPD wife, after a cool down period and when asked, did not remember one single incident.  When asked in court about these arguements, she stated se could not remember, when certain arguements and the issues of those arguements were brought up, she stated they did not happen.

The strange and awe inspiring part of the arguements I still have trouble with, is she looked directly over the top of my head while raging frantically, her face white as a ghost, not bulging red like one would think and her eyes were glassed over.   
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« Reply #7 on: July 24, 2008, 09:27:47 PM »

I do believe there is similarity between DID and any of the other dissociative disorders, including BPD and even severe depression. The difference is that in someone with full blown DID, the dissociation is much more severe and dramatic. Whereas someone with BPD has the classic "Jekyll and Hyde" dynamic, someone with DID is literally harboring different people within themselves. Each of the dissociated parts has a different name, different abilities (including being able to speak languages the other alters cannot), and different relationships with the outside world of which the other "alters" are usually totally ignorant. Someone with DID might be named Jane on her birth certificate, but at work she is known as Mary because that is the alter who got the job. She might lose the job because Denise, a three year old alter, comes on the scene one day and bursts into tears in the middle of an important meeting. Typically, in someone with DID there is one core alter who has all the dirt about all the others. Getting this alter to participate fully in therapy is usually required to achieve any sort of effective treatment.

Though there is some debate as to whether or not DID had its glory day as the "mental illness du jour" in the mid eighties and is nowhere near as prevalent as once was thought. Recent revelations that the two most famous media portrayals of DID, "Sybil" and "The Minds of Billy Milligan," were both fabricated didn't help on the credibility front either.

BTW, it is commonly believed that people who end up having DID suffer the worst kind of ritualistic abuse, such as Satanic cults, etc. It takes a LOT of very intense, very evil and prolonged abuse to produce DID, from what I understand.

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« Reply #8 on: July 24, 2008, 10:16:02 PM »

I did a research paper for first yr college english course on MPD in mid 90's.  It was very difficult to find info on the subject.  Cult, the info you just provided on MPD is how I understood the mental illness.  The one thing that has always stuck in my mind about the dissociation and going into other personalities are the headaches they get as they are about to go into another personality.  Therapist in fact go by the headache before change in personality as an indication that they may be MPD.  My exBPD had headaches (migraines) frequently.

I'm definitely with you Bitdawg!
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moscowpurple
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« Reply #9 on: September 22, 2008, 03:46:18 PM »

Hi,

I am a new member but have been involved with someone who has BPD and DID. 

My experience and understanding is that the two conditions are often comorbid or co-exist. 

My BPD person experienced terrible childhood abuse and still dissociates to this day when under any kind of stress.  I think it makes the experience for the non even harder because not only do you get the classic BPD push pull, etc but also the fragmentation of DID.
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