FAQ: Is a personality disorder a mental illness or a character flaw?

[BPDFamily.com]

In terms of the discussion on whether abuse must be present to have BPD or diagnosed with BPD, the answer is no.I think the anti-Axis ll people are out in full force as they write the latest incarnation of the DSM. The NEA-BPD has been lobbying, I bet--I KNOW TARA-APD has been lobbing since I wrote SWOE in 1997. I wouldn't be surprised if it changes, but I wouldn't be surprised if it didn't. I not sure if emotional dysregulation disorder is the substitute, but knowing the influence that DBT and Marsha Linehan, has I wouldn't be surprised.What would shock me is if they put it under an Axis 1 diagnosis, bipolar. In terms of is BPD a mental illness, I don't think there's any question here. The American Psychiatric Association says so; unless you're a person who think the DSM is a lot of hooey (and they have a sizable contingent since it's written by consensus, not science, really) you have to go with that. Some insurance pays for it. NAMI advocates for it. The NIMH funds a ton of research (search for BPD in PubMed and you'll get a zillion results). If it's not a metal illness, then I'm a bowl of spaghetti. And I don't like Italian food. Randi Kreger Author, "The Essential Family Guide to Borderline Personality Disorder "

[Randi Kreger]

In terms of the discussion on whether abuse must be present to have BPD or diagnosed with BPD, the answer is no.I think the anti-Axis ll people are out in full force as they write the latest incarnation of the DSM. The NEA-BPD has been lobbying, I bet--I KNOW TARA-APD has been lobbing since I wrote SWOE in 1997. I wouldn't be surprised if it changes, but I wouldn't be surprised if it didn't. I not sure if emotional dysregulation disorder is the substitute, but knowing the influence that DBT and Marsha Linehan, has I wouldn't be surprised.What would shock me is if they put it under an Axis 1 diagnosis, bipolar. In terms of is BPD a mental illness, I don't think there's any question here. The American Psychiatric Association says so; unless you're a person who think the DSM is a lot of hooey (and they have a sizable contingent since it's written by consensus, not science, really) you have to go with that. Some insurance pays for it. NAMI advocates for it. The NIMH funds a ton of research (search for BPD in PubMed and you'll get a zillion results). If it's not a metal illness, then I'm a bowl of spaghetti. And I don't like Italian food. Randi Kreger Author, "The Essential Family Guide to Borderline Personality Disorder "

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[mleigh]

Even as a psychotherapist, I was not aware of that research. That makes so much sense!

Yes BPD is a mental illness. It is in the DSM IV (the "Bible" of mental disorders for us therapists). BPDs do not have the same ability to emotionally regulate that non BPs do. My fiance is a BP and he tells me during his "normal" states that he does not understand why, when he becomes triggered, he literally can not control his rage. You are right. There is no rationalizing with them at that point. It is just impossible. They have to deescalate in whatever way works for them in order to get to a point where rational thought replaces "fight or flight" instincts. Only at that point can they learn healthy coping skills for those times when they are triggered. BPD is biological and environmental and is usually triggered by trauma.

[oceanheart]

Well guess what BPD is real, its organic and more importantly it is not their fault. My ex doesnt want to be crazy. He doesnt want to need meds or alcohol or another woman to make him feel good enough to just get thru the day

I don't want to be crazy, so I've spent the past five years since my breakdown and diagnosis of BPD changing the way I was taught - from a difficult childhood and from an inborn sensitivity - to respond to the world. Since puberty I've known something was "wrong" with me, I just didn't know what.

BPD is not my fault.

but, . . .

We are not responsible for how we came to be who we are as adults.

But as adults we are responsible for whom we have become and for everything we say and do.

Do nurturing, re-parenting, supportive relationships help a person with BPD get better? My belief is yes, because I've had that personal experience. My grandmother, my two older male best friends, and my dog all helped me become human. Really.

But I must qualify that I believe an intimate relationship with a sexual partner is not conducive to growth for someone with BPD. Partly because so many pwBPD have sexual abuse histories, partly because BPD is an attachment disorder and normal intimacy is disturbed, partly because the "non" is way too close and most likely have their own unhealthy issues, to a degree. All those things create a barrier to helping, which is why people with BPD need a competent Therapist, medication to help regulate the underlying mood disturbances, supportive and platonic friendships, an ability to break through denial, and a strong desire to get better.

Our intimate partners do us no good in sticking around putting up with our abuse. Healing comes when we learn that despite the hell we may be going through, we have no right to bring our loved ones down into that hell with us. It isn't abandonment to leave someone with BPD - it's loving them and letting them go and being good to oneself and refusing to be a martyr and letting the person get the help they need on their own, which I believe is the only way they'll be able to affect a real, lasting change.

But that's just imo   

[francienolan]

Our intimate partners do us no good in sticking around putting up with our abuse. Healing comes when we learn that despite the hell we may be going through, we have no right to bring our loved ones down into that hell with us. It isn't abandonment to leave someone with BPD - it's loving them and letting them go and being good to oneself and refusing to be a martyr and letting the person get the help they need on their own, which I believe is the only way they'll be able to affect a real, lasting change.

Thank you for writing this. I think a lot of us need to hear it.

[oceanheart]

Feel the need to give a bit of a disclaimer here  There are many "flavors" of BPD and I happen to be more of the "in-acting, quiet" type. My point is that I certainly can't speak for everyone with BPD - poster child I ain't! - and there are many folks on this board whose SO/loved one has narcissistic/antisocial PD traits, which makes it waaaaaay different (the lack of true empathy being key). So take my opinion with salt-flavored grains, certainly!

Even given that, tho, I do believe and have witnessed healing and change in other pwBPD, but I can't speak for them and can only speak for myself. It is one of my core beliefs that just like folks with substance abuse issues, the pwBPD has to WANT to change and perhaps "hit bottom" just like an alcoholic/drug user must, to get help. That's what helped snap me out of my ingrained patterns, including some denial of my problems.

The thing I see in sosadandone and other non's posts that I can understand on an emotional level (remember, I've been a non, too), but which I think speaks of perhaps an unhealthy dynamic is viewing the pwBPD as a child. Emotionally are we? Hell ya. But we are adults and the only way to "get to normal" is to require of us to start acting that way. We do a disservice to those we love when we don't let them reap the consequences of their actions. How many of us ever change unless some big consequence happens? That's just human nature to a degree. And pwBPD have a higher degree of growing-up and falling-down and getting-back-up to do than others, since we weren't taught certain skills in childhood, or we're so obsessed with getting fundamental needs met that were never, sadly, met that we excuse our childish behavior because of it. Spoiling a dog does it no good. Spoiling a child does it no good. Spoiling an emotional child does it no good... .

sorry for the rant . . . just wanted to be clear on some things, because these are important issues, these are people's lives and happiness and real pain. It is possible, useful, and supportive to detach, with love. Taking care of yourself and your emotions and your health really is one of the most helpful and loving things you can do for someone in your life who has BPD. Yes, it hurts so bad to see them hurting. Yes, we want to help. No, we can't really help them as much as we want. Help yourself first, for yourself.

[oceanheart]

Overcoming the need to fix

Eliminating caretaker behavior

Eliminating overdependence

Letting go of the "uncontrollables and unchangables"

Developing Detachment

[anker]

I would like to interject that even if someone IS mentally ill, they still have the right to end a relationship. To not be right for you.

To act as if the illness is the only problem in a relationship that ended... .is dangerously like denial of that.

[PDQuick]

This is an interesting topic, and the diversity of it allows us to really learn a lot about dynamics of these relationships, and most importantly, about ourselves.

In the relationship I had, and the aftermath, I remember having these same thoughts that Sosadandone has here. I struggled between what I saw in her behavior, and what I deemed as personally right, in my own mind. I also loved her enough to want to be the savior, and rectify things so that the opportunity came that we all could live in peace, harmony, love, and happiness. It is a fine and noble goal indeed.

Humanity has many truths. The very first truth is that from the day we are born, we all are entitled to free will. Society and culture has brought upon us laws that govern what consequences are to be held for those who flex their free will to the point of effecting others lives. These laws are known as consequences for actions. Some are actually governed, and upheld by municipalities, some are state, some are federal. Some are are more spiritual in nature, and are left to higher powers to sort out, after our lives have been lost. Some are moral in nature, and leave it to others that are in our lives to be the judge and jury. These situations being dealt with in this thread are in that morality context.

In most situations dealing with a love bond between a disordered person, and the ones that love them, (nons) there aren't any laws broken. There are no immediate consequences for the actions taken out of one's own free will. The "abuse" and "injustice" of these situations are completely left up to the people in the dynamics of the relationship. We tend to be our own bailiff's, judges, juries, and wardens.

The problem that arises, is that because of free will, the trials are being held in two totally separate courts. One trial is held in the disordered court, and the other is being held in the nons court. Both of those courts are being represented in this thread. Both are right in, and of, themselves, due to the laws of free will.

The disordered person has the right to live, love, and persue life the way they see fit, unless breaking the laws of the land, written by their corresponding municipalities. Although it may be deemed immoral by those surrounding them, the choice is still their own. The consequences are different, because the actions interfere with others free will.

The non has the same rights. The problem occurs when the non tries to alter the thoughts and actions of the disordered person, based on the nons desire to have something changed. We each have our own journey in life, dependant only on what we can do, have, understand, and accomplish. Our own desires should not override some elses desires. We cant want something for someone that doesn't want the same thing. It goes hand in hand with the saying, we cant change someone, only they can.

Where we get into trouble is when we think that we have the right to alter someone elses free will. If we believe they should change, and they dont feel the need, we are left with two options. Abandon the situation, and leave the other person to live their life as they see fit, or stay and try to alter them, to fit our desires for them. Most, if not all of us, have chosen the latter and have learned that it is the art on enabling. Simply by staying, and continuing to support the person in the dysfuntion, is nothing short of condoning it, and thus, giving the signal that the treatment is ok. Further trying to control the situation is viewed as dysfunctional and manipulative, giving off the perception of disrespect, and non-acceptance. This deepens the dysfunction, and the fight for what each believes is an acceptable life to lead, based upon our own free will.

There is another saying that has offered a new meaning to me post relationship. The saying is "If you love somebody, set them free." What it means to me now is, if I love someone, and I believe their free will is immoral, I set them free, because only in the loss of someone important, can lessons be learned, and the chance of change happen. It isn't a sure bet, but if everyone dropped my ex at the first sign of dysfunction, her desire to be loved would over take her desire to manipulate, and control, and she would change her ways. There would be a priority shift, and only in that, would the light be seen. I stayed and tried to change her for 13 years, but I never took myself from her. I allowed her to concrete herself in her own ways, because there were no consequences for her actions. Sure, I complained and wanted different, but I never showed her that people cannot be treated like that, and stick around. I showed her the exact oppostite. I taught her to treat me any way she saw fit, and that I would still be there. Hardly fodder for changing someone.


Sosadandone, I know where you are at, and I know that you are still in the grieving process. It is ok to want a happy life for yourself, and your loved one. You will eventually turn your focus within, and try to control only what you can, and have the ultimate free will to control. It will be then, that the healing will begin. I hope it comes quickly for you.

[C2]

PDQ, I thought your view was particularly well articulated. I wonder, though, about your theory that if a BP is left enough times for dysfunctional behavior he or she would choose love over manipulation and use free will to change. I think somehow the hardwiring of the BP acquired during childhood makes it virtually impossible for them to exercise healthy free will for any significant length of time.

It also gets into metaphysical debates about free will across the course of a lifetime vs. fated events. Is it the BP's destiny in life to be disordered? As nons with different brain wiring, do we have a better chance to change and start exercising free will when we "see the light?" Can a BP ever really see the light? Would that paradigm shift have to have occurred during childhood for them?

Of course, no one really has any answers for these questions--I'm just musing about something that loops around in my brain a lot. I think one's spiritual and religious beliefs come into play here, too. If we believe we only have one life on this earth, there may be more pressure to see change as a possibility during that one lifetime. If we believe that we reincarnate and have many lives on earth, there may be a tendency to think of BPD as a karmic destiny or life lesson only for this lifetime, and once the lesson is learned, the soul returns to learn new lessons. I fall into the latter camp, but maybe that's just because it makes it easier to accept any number of tough life lessons, knowing that we all get another chance to do it better some other time.

[exfundamentalist]

I think a lack of good parenting skills definitely plays a part. I think the inablity or refusal of the parents to communicate with each other and the kids in a kind and loving way is enough to mess with any kids mind in such a fashion that damages them for life. Verbal abuse is a horrible thing, especially when it is a small child who is receiving the verbal abuse!

When parents lack character and their kids do not learn character, it is not a good situation. This only adds to the complication if the parents are verbal abusive as well as lack character, work ethic, or hygene.

Poor communication skills can cause many angery moments.

I think these things (poor parenting skills, lack of character, and poor communication skills) all play a part in a person becoming a "borderline".

[Skip]

Personality disorder is not an easy concept to grasp.

I saw an FBI behavioral analyst speaking about ASPD.  He said that they are not without knowledge of what is right or wrong - it's that the don't possess the ability to care or fully feel the ramifications.  And ASPD kills someone, they know it is wrong, but they feel not a whole lot different than we do if we run a red light at 3 AM.

Do all of the "BPD's" referred to on this site have BPD.  No, not by a long shot.  Many have BPD traits or are temporarily acting BPD (situational) or are just just people from a world with poor role models and poor treatment.

I think the most important point about labeling someone as pwBPD or uBPD is that it gives us an understand of what is going on - and it gives us tools for managing the relationship and for making decisions.

Without the "BPD" label, many of us would just believe that the criticism and bad behavior toward us is justified. If we are able to see BPD, or BPD traits, it's starts to suggest that we not take everything so literally or personally.  This is really huge step toward dealing with our own struggles and hurts.

We are also able to start to understand the prognosis.  Without the BPD label, many of use mike think the situation is justified by some circumstances - and removing the circumstances would solve or reduce the problem.

And lastly, with the BPD label, we learn that there are certain ways to communicate that are more effective or that defuse the day to day exchanges with the difficult person.

[Steph]

 There have been studies that show, physically, that people with BPD process emotions from an atypical spot of the brain... they simply process them differently and they lack the ability to not feel them severely.

Yep, its a mental illness and classified as an axis 2 in the mental helth profession. Its not a charactor flaw, or a weakness or lack of mothering... tho a nasty childhood can turn the switch that will get it fired up.

It also has treatment available, as well, which helps retrain the brain to process emotions in healthy ways. It can take years,and it works.

[LOAnnie]

I don't see any difference between a person admitting they have a diagnosis of BPD and admitting that they have a diagnosis of myopia, or of bipolar disorder, or of dyslexia, or of depression.   Its something you're saddled with, whether you are born with it or acquire it, makes no difference to me.   Its dealing with it and accepting it and managing it in real time, in the present, that is the issue.

The FBI guy you watched in the documentary was probably referring to the fact that those with personality disorder are considered to be "legally sane," and responsible for their behaviors, so those with pd can be convicted of crimes and go to prison for it.  Its those who do not know the difference between right and wrong (those who are having a break with reality, like schizophrenics) who are considered "legally insane" and are not sent to prison but are sent to mental institutions instead if they are convicted of crimes or are diagnosed as being a danger to themselves or to others.  

But I see no problem, or, I see no bad thing about "labeling" a person with a mental disorder.  A true mental disorder like schizophrenia is not a "character flaw", its a mental illness and the individual who has it was born that way, its not their fault.  Personalty Disorder is, at the moment, a gray area.  It is considered to be a mental illness, yet at the same time the individual who has a personalty disorder is also considered to be connected with reality and considered to have control over his or her behaviors, so the law considers those with pd to be "legally sane" and responsible for their behaviors and able to be tried in open court and held accountable for their actions.

Me personally, I'm not sure that personality disordered individuals should be considered '"legally sane."  I think that those with BPD are all too frequently not connected with reality at all, and I believe that during these psychotic episodes the person with BPD inflicts profound and long-term damage on their children.

So, I'm in the camp that believes that Personality Disorder needs to be reclassified as a more severe mental illness due to organic brain dysfunction so that those who have it can receive very intense drug treatment and talk therapy for it, and so that their children can be removed from their care for the children's safety.   That part is very important.  Children are not left in the care of paranoid schizophrenics, and I think that children should not be left in the care of those with personality disorder for the same reason.  

The safety of children should take precedence over the rights of their adult parents or caregivers, in my opinion. Children's needs and safety should always come first.

-LOAnnie

Personality disorder is not an easy concept to grasp.

I saw an FBI behavioral analyst speaking about ASPD.  He said that they are not without knowledge of what is right or wrong - it's that the don't possess the ability to care or fully feel the ramifications.  And ASPD kills someone, they know it is wrong, but they feel not a whole lot different than we do if we run a red light at 3 AM.

Do all of the "BPD's" referred to on this site have BPD.  No, not by a long shot.  Many have BPD traits or are temporarily acting BPD (situational) or are just just people from a world with poor role models and poor treatment.

I think the most important point about labeling someone as pwBPD or uBPD is that it gives us an understand of what is going on - and it gives us tools for managing the relationship and for making decisions.

Without the "BPD" label, many of us would just believe that the criticism and bad behavior toward us is justified. If we are able to see BPD, or BPD traits, it's starts to suggest that we not take everything so literally or personally.  This is really huge step toward dealing with our own struggles and hurts.

We are also able to start to understand the prognosis.  Without the BPD label, many of use mike think the situation is justified by some circumstances - and removing the circumstances would solve or reduce the problem.

And lastly, with the BPD label, we learn that there are certain ways to communicate that are more effective or that defuse the day to day exchanges with the difficult person.

[Skip]

So, I'm in the camp that believes that Personality Disorder needs to be reclassified as a more severe mental illness due to organic brain dysfunction so that those who have it can receive very intense drug treatment and talk therapy for it, and so that their children can be removed from their care for the children's safety.  

Maybe you can share more details about this camp or advocacy?  There DSM 5 proposals are currently being discussed and I have not yet seen any recommendations along the lines of what you mention.

I believe that there are 4 issues in your recommendation and it may help to separate them.

Legal insanity is not a medical term, it's a legal term. Since the 1980's the requirements for legal insanity have become more limiting (fewer people qualify).  The M'Naghten Rule basically say a person was not legally insane unless he is "incapable of appreciating his surroundings" because of a powerful mental delusion.

Insanity doesn’t imply anything about the nature of the underlying disorder or treatment. Just about any major psychiatric disorder—a psychotic disorder (e.g., schizophrenia), a mood disorder (e.g., major depression), an anxiety disorder (e.g., PTSD), or a dissociative disorder (e.g., DID)—could be used as the basis for an insanity defense.

Custody Currently, a diagnosis of schizophrenia or other mental illness do not result in automatic loss of child custody.  The major reason states take away custody from parents with mental illness is the severity of the symptoms and the absence of other competent adults in the home.  Mental disability alone is insufficient to establish parental unfitness, it's the manifestations  in a particular person, such as disorientation, hallucinations, psychosis that are necessary to demonstrate parental unfitness.  A controlled schizophrenic in a stable home setting would not likely lose their children.

Statistics show that custody is being taken away from an unfit parents with greater frequency. Some feel it needs to happen even more.

Treatment mental illnesses  are not classified on a scale of "severe and non severe".  Within a mental illness, there are often a spectrum of the severity.  And moving the disorder from one place in the DSM to another wouldn't change treatment or access to treatment "so that those who have it can receive very intense drug treatment and talk therapy for it.  

Do you have any references about work being done with BPD and  "intensive drug therapy" - which refers to significantly higher than the normal dose levels.  I'm sure many would be interested in reading about this.

Civil Liberties  You've suggested in other threads that you would like the States to take children away from BPD parents... .and your feelings based on your experience are understandable.  But current civil liberty laws and practices would prevent such a sweeping initiative (taking children away from + 6% of all mothers) from happening.  Having BPD or BiPolar disorder or being suspected of having these disorder does not result in the automatic forfeiture of parental rights.

[Randi Kreger]

My question is:IS this behaviour really a Mental Illness or just character flaws, or lack of good parenting of values, or anger management issues, petty or superficial or wrong thinking, or deficiency in cognition ... .are some of us (on some lists) too quick to label normal ups/downs, disagreements, or even some upsets or conflicts in a marr/rel as BPD... .? [small (non-physical) fights & arguments are normal, o/w it is not a normal rel]! Mental Illness implies somewhat psychotic or non reality or simply paranoia type of mindset... .too harsh a term?... .whereas - what we see in BPD is more about extreme sensitivity about rejection (aren't we all, non-BP's also, a little afraid of being rejected?) OR ... .Anger Management (A/M) issues, OR few character flaws to "lie" or misrepresent, ... .and we all ( non-BP's and/or "normal" perceive things differently  (basic Pysch 101 course tells us that),... .so are we too eager s/t on some posts to label such thinking or behaviour as MI?

The issue here is, I think, the definition of mental illness. It is a stigmatized term and does not necessarily have anything to do with a break from reality. It includes depression, eating disorders, substance abuse, etc. etc. etc. Yes, PDs are a mental illness. The "character flaw" thing was thrown out decades ago. Randi KregerAuthor, The Essential Family Guide to Borderline Personality Disorder

[oceanheart]

Maybe there's a difference in the level of suffering between BPDs who mostly act in with self-destructive behaviors, and BPDs who have a lot of narcissistic traits and act out toward other people?

Do people with strong narcissistic traits, or with NPD/ASPD suffer in the same way "normal" people suffer? NPD seems to include some dysfunction of the physical emotional system. For example, this abstract about an article on predatory agression:

In the study of aggression, psychopathy represents a disorder that is of particular interest because it often involves aggression which is premeditated, emotionless, and instrumental in nature; this is especially true for more serious types of offenses. Such instrumental aggression is aimed at achieving a goal (e.g., to obtain resources such as money, or to gain status).

Unlike the primarily reactive aggression observed in other disorders, psychopaths appear to engage in aggressive acts for the purpose of benefiting themselves. This is especially interesting in light of arguments that psychopathy may represent an alternative life-history strategy that is evolutionarily adaptive; behaviors such as aggression, risk-taking, manipulation, and promiscuous sexual behavior observed in psychopathy may be means by which psychopaths gain advantage over others.

Recent neurobiological research supports the idea that abnormalities in brain regions key to emotion and morality may allow psychopaths to pursue such a strategy—psychopaths may not experience the social emotions such as empathy, guilt, and remorse that typically discourage instrumentally aggressive acts, and may even experience pleasure when committing these acts.

Findings from brain imaging studies of psychopaths may have important implications for the law.

I can't of course say your mother had sociopathy or whatever. But from the little I've read, she was exceedingly cruel, and she sounds very NPD-ish. On a personal level, I saw a big difference in the suffering between a bf of mine who I believed had BPD and one who I believed was very narcissistic - the former was like a wounded bear, lashing out because it was in pain and the latter was like a crocodile, cold and calculating. The difference in their ability to feel empathy and compassion for other people was marked, the bf with NPD being one of the most vicious people I've ever met - towards everyone. He thought girls who got raped on dates in college deserved it (and didn't deserve therapy) because they put themselves in that position in the first place, they shouldn't have been so dumb... .

The bf with NPD was always in control: he responded to events in ways that would benefit himself, the bf with BPD was never in control: he reacted and often caused worse problems for himself. I think there is a big difference between the "black holes" at the center of the BPD universe vs NPD universe... .

[LOAnnie]

Currently the website of NIMH says, "Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. "  

Your situation echos my mother's: she is the only individual in her entire family of origin with personality disorder.   However, neither my sister nor I wound up with BPD, although we were psychologically injured by her out of control mood swings, abusive rages, unrealistic expectations and perfectionism.

So, IF BPD is genetically linked, then possibly the genes that convey it are recessive genes, and it takes the right (or wrong) spin of the genetic roulette wheel to turn up those particular sets of recessive gene pairs.  A very simplified example:  two brown-eyed parents have a one in four chance at each conception of producing a blue-eyed child if each parent carries the recessive blue-eyed gene.  That would explain how two parents who do not have personality disorder themselves could produce a child with personality disorder IF (LOTS OF IFS) they both carry the recessive gene(s) for it.  Theoretically.  

That is so very encouraging that you have self-awareness and can control your behaviors, and you have the empathy to realize that extreme reactions and behaviors on your part would not be healthy for your child to experience.  You are taking personal responsibility for your behaviors.   See, to me, that would seem to indicate that you do not actually have borderline pd.  Instead, perhaps you only have somehow acquired BPD "flea" behaviors.  Or perhaps you have a few of the BPD diagnostic criteria traits but not enough of them to be full-blown BPD... .sort of "BPD lite."

In any case, as far as your little boy is concerned, perhaps the section of this forum for the parents of children with BPD would have some more knowledgeable help and advice for you.

I've read that dialectical behavioral therapy really helps with BPD behaviors; maybe you can look into db therapy for him.

best of luck with that, you sound like a good and caring mom.

-LOAnnie

[bpdfriend]

It's not a "behaviour" though, it's a whole slew of behaviours and traits that keep recurring... .that they can't escape in spite of the destruction and havoc they cause.

You point out that all people suffer "a little" from rejection anxiety. That's the point. The anxieties that BPDs suffer from are shared by most of us... .the difference is that in BPDs their emotions and anxieties are inflated beyond our imagination.

Have you ever known someone with BPD? Don't mean to sound flippant, but having known someone there's really no question in my mind that it's a real mental illness, and a very serious one.

[kathj]

I believe behavioral scientists made some headway toward an answer to this question in 2008.

People with borderline personality disorder suffer from an inability to understand the actions of others. They frequently have unstable relationships, fly into rages inappropriately, or become depressed and cannot trust the actions and motives of other people.

"This may be the first time a physical signature for a personality disorder has been identified," said Dr. P. Read Montague, professor of neuroscience at Baylor College of Medicine and director of the BCM Brown Foundation Human Neuroimaging Laboratory.

"For the first time, to my knowledge, we have a specific brain association for people with a personality disorder," said Dr. Stuart Yudofsky, chair of the Menninger Department of Psychiatry and Behavioral Sciences at BCM. "It's new and different because it's not a lesion (or injury to the brain) but it is a difference in perceiving information that comes from an interaction." That is the area where people with borderline personality disorder have the most problem.

"It's important that this biological signature has been identified," said King-Casas. "It's not just a matter of bad attitudes or a lack of will."

www.bcm.edu/news/packages/trust.cfm

This post is very interesting, as it clarifies that it is the way that people with BPD perceive as the issue, I have found this to be true in my relationshp with my husband, however, as he experienced a trauma in his childhood, and by his own admittance cannot trust anyone and constantly struggles with his identity, almost as though he does not have one and does things that he percieves will be accepting to me. It is possible that his perception is now 'perceived' through the previous trauma, maybe the trauma is what triggered this?

[oceanheart]

Coming from a staNPDoint of recovery from BPD . . . I'm starting to believe it's both. If it didn't have anything to do with "character" (although that's judgmental and I prefer "personality", then how could I have changed so much from 5 years ago when I got my diagnosis and decided to better my life?

But perhaps I was one of the lucky ones in that my underlying mental illness wasn't as severe as others', and neither was my childhood homelife.

I know much of my recovery has been finding ways to modulate/moderate a seemingly inborn sensitive temperament. I'm wired differently than most people I know and I still suffer from bouts of depression. I handle the symptoms differently now than I did when I was "full-blown" BPD, but the intensity of the emotions has lessened. Whether that's just a natural maturing process or what, I don't know. I think part of it is that I've re-trained my brain somewhat. I'm not always successful (I started smoking again to help with a recent stressful period), but I have more options and coping mechanisms that help me be the real me, sans BPD.

[C12P21]

It is a completely rational choice on their parts to not go to therapy, for the cost of exposure is far greater than the cost of just discarding  their loving and devoted abusee of the moment and just finding another hostage

Although I understand  your point... the use of the word rational is questionable. A person suffering from a disorder hasn't the ability of rationality. Is it rational to continue to sabatoge those around you... or yourself?

[Auspicious]

It's possible for perceptions to be distorted, so that the actions taking in response to those perceptions are, in a sense, "rational", given the distorted perceptions.

[tuli]

This is not an illness like schizophrenia - neither extreme genetic sensitivity nor being invalidated as a child adds up to cognitive impairment in a medical sense.  It's a toxic brew, to be sure, but this is a psychological condition, not a brain impairment.  

[rosannadanna]

Tuli,

You might find these helpful:

www.nimh.nih.gov/science-news/2008/borderline-personality-disorder-brain-differences-related-to-disruptions-in-cooperation-in-relationships.shtml

www.sciencedirect.com/science/article/pii/S0165032798001049

www.sciencedirect.com/science/article/pii/S0006322301010757

www.sciencedaily.com/releases/2007/12/071221094757.htm

Any long-term emotional dysfunction creates changes in the brain.Also, according to Wikipedia, 25% of people with BPD don't have a history of abuse or neglect and because someone with a BPD parent is six times more likely to have BPD, it is thought to have a strong genetic link.  Of course there is the nature vs. nurture argument, but what about families with multiply siblings and only one develops BPD?  Again, very suggestive of genetics.

Unfortunately, even with all the tons of research out there indicating that BPD is a more severe, biologically rooted psychiatric d/o like schizophrenia, the powers that be let it stay a personality d/o in the upcoming DSM-V.

[Auspicious]

This is not an illness like schizophrenia - neither extreme genetic sensitivity nor being invalidated as a child adds up to cognitive impairment in a medical sense.  It's a toxic brew, to be sure, but this is a psychological condition, not a brain impairment.   

Whatever you choose to call it, there is a great deal of impaired, distorted thinking involved. Emotional reasoning, black and white thinking, periods of dissociation (for some). Unrealistic idealization, unrealistic devaluation.

I think it is actually helpful to use some analogies to schizophrenia, because of how illustrative it is.

For example, it is just as pointless and inflammatory to try to argue someone with BPD out of their distorted thinking, as it is to try to argue someone with schizophrenia out of their hallucinations or delusions. It's just not as blatantly obvious how pointless it is, since the nature of the distortions is different.

[tuli]

www.nimh.nih.gov/science-news/2008/borderline-personality-disorder-brain-differences-related-to-disruptions-in-cooperation-in-relationships.shtml

www.sciencedirect.com/science/article/pii/S0165032798001049

www.sciencedirect.com/science/article/pii/S0006322301010757

www.sciencedaily.com/releases/2007/12/071221094757.htm

Thank you for these links.

I agree completely that genetic is an integral part of borderline and without it you don't have borderline.  A lot of the borderline condition cannot be fixed.  They can never live a normal life.  But the parts that can be changed relatively quickly with either behavior modification (like DBT) or neurolinguistic programming (PTSD work) would not be considered genetic.  Emotional dysregulation is genetic to some extent, but more as a predisposition to or a tendency or a weakness.

This is easy to prove anecdotally.  Many nons experience the borderline in highly dysregulated rage in the home, but when the phone rings or the doorbell rings, the borderline can transition instantaneously to calm and loving emotional states and transition back into the rage as soon as the door closes.  Also many recovering low-functioning borderlines in the recovery forums will admit to being able to plan their rage attacks or ride them consciously to their advantage.  

Much of what is reported firsthand from borderlines contradicts the present understanding by the medical community.  

This is very understandable as it as a very rapidly changing field, and really amazing progress is being made in what borderline is about at a very fast rate.  But I feel it is important for nons to remember that the borderline can heal the parts that hurt their partners the most.

[GreenMango]

There's a quite a variety of research areas in respect to BPD.  There are several facets to the disorder including mood lability/affect and behavior in addition to cognitive functioning.  Cognitive functioning is one facet of the disorder where members see a marked difference in thinking patterns.  The other areas of mood/affect and behavior are not to be discounted as major contributing factors in the expression of the disorder.  Research in impaired cognitive functioning is fairly young and could vary by test sample size and other factors including severity of  the illness among participants

Some clinical info on cognitive impairments include the following:

The Psychiatric Clinics of North America2004 Mar;27(1):67-82, viii-ix.

Neuropsychological impairment in borderline personality disorder.

Monarch ES, Saykin AJ, Flashman LA.

Source

The Virtual Reality Treatment Center, 154 Waterman Street, Providence, RI 02906, USA. elenamonarch@yahoo.com

Abstract

In spite of accumulating evidence from neurological, neuroimaging, neuropsychological, and, more recently, developmental studies, borderline personality disorder (BPD) is not considered routinely a neurocognitive disorder. A review of the neuropsychological literature shows that the preponderance of BPD studies failed to examine a broad range of cognitive domains and, in particular, have not adequately evaluated attention. Nevertheless, most neuropsychological studies suggest that these patients' cognitive skills are compromised. The authors administered a neuropsychological battery designed to evaluate nine cognitive domains in twelve female inpatients diagnosed with BPD. Relative to a healthy normative group, inpatients with BPD were impaired in seven cognitive domains, with attention-vigilance and verbal learning and memory most pronounced. Neuropsychological performance was significantly related to degree of psychopathology. The authors recommend that clinicians routinely screen BPD patients for cognitive dysfunction and highlight the roles that this important knowledge can have in treatment.

PMID: 15062631 [PubMed - indexed for MEDLINE]

Development and Psychopathology. 2005 Fall;17(4):1173-96.

Neurocognitive impairment as a moderator in the development of borderline personality disorder.

Judd PH.

Source

University of California, San Diego, Department of Psychiatry, Outpatient Psychiatric Services, 92103, USA. pjudd@ucsd.edu

Abstract

Borderline personality disorder (BPD) is characterized by a pervasive instability of interpersonal relationships, affects, self-image, marked impulsivity, dissociation, and paranoia. The cognitive dimension of the disorder has received relatively little attention and is poorly understood. This paper proposes that neurocognitive impairment is a key moderator in the development of BPD and elaborates a possible pathway for the expression of the cognitive domain. Neurocognitive impairment is hypothesized to moderate the relationship between caretaking and insecure disorganized attachment and pathological dissociation in the formation of the disorder contributing to impaired metacognition and a range of cognitive difficulties. The empirical evidence from studies of cognitive processes, brain function, attachment, and dissociation that support this theory are reviewed and discussed. Areas for future research that might verify or refute this theory are suggested.

PMID: 16613436 [PubMed - indexed for MEDLINE]

Psychiatry Research. 2005 Dec 15;137(3):191-202. Epub 2005 Nov 17.

The neuropsychology of borderline personality disorder: a meta-analysis and review.

Ruocco AC.

Source: Department of Psychology, Drexel University, 245 N. 15th Street, Mail Stop 626, Philadelphia, PA 19102-1192, USA. acr32@drexel.edu

Abstract

The neuropsychological profile of borderline personality disorder (BPD) is unclear.  Past investigations have produced seemingly inconsistent results of precisely what neuropsychological deficits characterize the patient with BPD.  A meta-analysis of 10 studies was conducted comparing BPD and healthy comparison groups on select neuropsychological measures comprising six domains of functioning: attention, cognitive flexibility, learning and memory, planning, speeded processing, and visuospatial abilities.  BPD participants performed more poorly than controls across all neuropsychological domains, with mean effect sizes (Cohen’s d) ranging from -.29 for cognitive flexibility to -1.43 for planning.  The results suggest that persons with BPD perform more poorly than healthy comparison groups in multiple neurocognitive domains and that these deficits may be more strongly lateralized to the right hemisphere.  Although neuropsychological testing appears to be sensitive to the neurocognitive deficits of BPD, the clinical utility of these results is limited.  Implications of these findings for future neurocognitive investigations of BPD are discussed.

Development and Psychopathology 20 (2008), 341–368, Copyright 2008 Cambridge University Press

A neurocognitive model of borderline personality disorder: Effects of childhood sexual abuse and relationship to adult social attachment disturbance

MICHAEL J. MINZENBERG, JOHN H. POOLE, AND SOPHIA VINOGRADOV

University of California, Sacramento;

University of California, San Francisco; and

San Francisco Veterans Affairs Medical Center

Abstract

Borderline personality disorder (BPD) is a paradigmatic disorder of adult attachment, with high rates of antecedent

childhood maltreatment. The neurocognitive correlates of both attachment disturbance and maltreatment are both

presently unknown in BPD. This study evaluated whether dimensional adult attachment disturbance in BPD is related to

specific neurocognitive deficits, and whether childhood maltreatment is related to these dysfunctions. An outpatient BPD

group (n ¼ 43) performed nearly 1 SD below a control group (n ¼ 26) on short-term recall, executive, and intelligence

functions. These deficits were not affected by emotionally charged stimuli. In the BPD group, impaired recall was related

to attachment–anxiety, whereas executive dysfunction was related to attachment–avoidance. Abuse history was correlated

significantly with executive dysfunction and at a trend level with impaired recall. Neurocognitive deficits and abuse

history exhibited both independent and interactive effects on adult attachment disturbance. These results suggest that

(a) BPD patients’ reactivity in attachment relationships is related to temporal–limbic dysfunction, irrespective of the

emotional content of stimuli, (b) BPD patients’ avoidance within attachment relationships may be a relational strategy to

compensate for the emotional consequences of frontal-executive dysregulation, and (c) childhood abuse may contribute to

these neurocognitive deficits but may also exert effects on adult attachment disturbance that is both independent and

interacting with neurocognitive dysfunction.

[qcarolr]

Here is an article from January 2013:

www.sciencedaily.com/releases/2013/01/130115101427.htm

The most hopeful thing for me is the reference to the goal of all this research - to find better treatments for the ones we love that so struggle with BPD. Plus ways that I can develop my own knowledge to be in a more therapeutic relationship with my BPDDD26 hoping to trigger her ability to become more and more reflective and more open to doing therapy.

The hardest part for me is the economics of treatment - lots of money. lots of time (1-3 years investment in regularly participated in  treatment), and enough well-trained professionals and supervisors/support peers to meet the needs of this 1% - 2% of our population suffering with BPD.

It will take a community effort to see large scale change in all mental illness -- reduction of stigma and discriminatoin, shifting of funding for research and treatment, support for the caregivers willing to continue being invovled with their family and friends with BPD.

I have been struggling (big words, lots of distractions citing references, lots of information to absorb) to read a recently published book that focuses on the 'lack of sense of self' criteria in BPD as primary - the emotinal dysregulation as secondary - and all from a CNS point of view. (Central Nervous System). ":)issociation Model of BPD" by Russell Meares. He also offers a new protocal for therapy that focuses on  restoring 'self' in his book "BPD and the Conversation Model".  His work really parallels the skills that are working in my home to make things better (and my D26 refuses therapy - it is too unsafe yet for her, IMHO). These include Validation, values-based boundaries that take care of my and my home, Radical Acceptance, mindfulness... .    By living these principles to the best of my ability I am seeing imporvements in all my relatiionships, even with my DD.

I am very passinate about the validity of the brain based research and look forward to changes in treatments. Now to find the resources to make them availavble to the broader population - patients, family/friend, community (neighborhood, schools,... .  )

qcr  

[Somewhere]

I used to think it was a controlled thing, but I am no longer clear on who is controlling the controls.  In our house the switches are harsh enough to have names (the kids and I named them) for the persona(s).  Mrs. Somewhere's voice, affect, stance, and even clothes change to match them.  She even has blanks about what she has said between them.

There is some excellent "wetware" brain research cited in this outstanding thread.  We (Mrs. Somewhere, that is) has an open offer for "free" (research) fMRI Brain Scans due to her eating disorder(s) and history of other related behaviors.

After the University figured out we have some knowledge of the topic, they have agreed to do wider area scans and adjust the protocols to catch more areas and behaviors.  Basically anything we ask for.  Mrs. Somewhere is none-too-happy about any of it.

I am reluctant to get involved due to boundary and family issues, but at this point I mostly want to help our 8 year old son, who has some early markers of BPD.  Great kid, kind, very (very, very) smart -- but has total dyregulation from time-to-time.  So I am looking at getting back into this field (EE, used to do Neural Implant studies), just to try to make help available for him, when and if the time comes.

[Somewhere]

Here is an article from January 2013:

www.sciencedaily.com/releases/2013/01/130115101427.htm

The most hopeful thing for me is the reference to the goal of all this research - to find better treatments for the ones we love that so struggle with BPD. Plus ways that I can develop my own knowledge to be in a more therapeutic relationship with my BPDDD26 hoping to trigger her ability to become more and more reflective and more open to doing therapy.

The hardest part for me is the economics of treatment - lots of money. lots of time (1-3 years investment in regularly participated in  treatment), and enough well-trained professionals and supervisors/support peers to meet the needs of this 1% - 2% of our population suffering with BPD.

It will take a community effort to see large scale change in all mental illness -- reduction of stigma and discriminatoin, shifting of funding for research and treatment, support for the caregivers willing to continue being invovled with their family and friends with BPD.

I have been struggling (big words, lots of distractions citing references, lots of information to absorb) to read a recently published book that focuses on the 'lack of sense of self' criteria in BPD as primary - the emotinal dysregulation as secondary - and all from a CNS point of view. (Central Nervous System). ":)issociation Model of BPD" by Russell Meares. He also offers a new protocal for therapy that focuses on  restoring 'self' in his book "BPD and the Conversation Model".  His work really parallels the skills that are working in my home to make things better (and my D26 refuses therapy - it is too unsafe yet for her, IMHO). These include Validation, values-based boundaries that take care of my and my home, Radical Acceptance, mindfulness... .      By living these principles to the best of my ability I am seeing imporvements in all my relatiionships, even with my DD.

I am very passinate about the validity of the brain based research and look forward to changes in treatments. Now to find the resources to make them availavble to the broader population - patients, family/friend, community (neighborhood, schools,... .    )

qcr  

You are quite a Mom.  Super Job.

Agree on the wetware research and you seem to have a Very Good Understanding.  From some other end with Autism Study, I am almost expecting to see this become the other end of the same problem.  (Autism being hypo-connected, hypo-activity and BPD being hyper-connected, hyper-activity).

Unfortunately, you are also about a decade (or more) ahead of much of the would-be treatment community.  Or I guess I should say treatment industry.

There is a lot of stopped-learning-once-started practice folks who have absolutely no knowledge of these aspects of the topics, but continue to hack along on what they "learned" 20 or 30 years ago in school.