We need to understand the extreme pain of having BPD in order to make sense of why people behave as they do: Dr. Mary Zanarini and colleagues identified “BPD Pain” as involving: “Feeling misunderstood, thinking that no one cares “Feeling about them or that they are overwhelmed, bad, thinking about killing worthless, very themselves, believing they angry, empty, are evil, feeling like a small abandoned, child, and believing they are furious, enraged” damaged.” “the overall ‘amplitude’ of this pain may be a particularly good marker for the borderline diagnosis.” Zanarini, et al. Harv Rev Psychiatry. 1998 Nov-Dec;6(4):201-7.
The American Psychiatric Association’s manual of diagnoses (the DSM IV TR) defines nine BPD symptoms. These symptoms, you’ll note, are also basic human experiences, and so, the disorder is best defined by the severity of symptoms and their duration. “A pervasive pattern of instability of interpersonal relationships, self-image, affects and control over impulses beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following criteria: (5 out of 9)1. Frantic ef forts to avoid real and 5. Recurrent suicidal behavior, gestures or imagined abandonment. threats; or self-mutilating behavior.2. A pattern of unstable and intense 6. Af fective instability due to a marked reactivity of mo od (e.g. intense episodic interpersonal relationships dysphoria, irritability or anxiety usually characterized by alternating between lasting a few hours and rarely more than a extremes of idealization and few days). devaluation 7. Chronic feelings of emptiness.3. Identity disturbance, persistently and markedly unstable self-image or sense of self. 8. Inappropriate, intense anger or lack of control of anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).4. Impulsivity in at least two areas that are potentially self damaging (e.g. substance abuse, sex, binge eating, 9. Transient stress related paranoid ideation or spending, reckless driving). severe dissociative symptoms.” American Psychiatric Association Dialogistic and Statistic Manual IV TR
Additionally, many clinicians cannot see the disorder because they focus on the many “Co-Occuring” diagnosis, as BPD “borders” on and combines with numerous other struggles…. Often, people with BPD will be given other diagnosis and treated specifically for those, but ultimately the core of our suffering is never healed. This can go on for decades, leading to the conclusion that there are people who are untreatable and incurable. When, in fact, they have not received the right education and treatment. PTSD Generalized Anxiety Disorder Is there “Ragaholic” anything I don’t have? Depression Bipolar & Bipolar II Eating Disorders Substance Abuse Obsessive Compulsive Disorder Agoraphobia Kleptomania Co-dependence Sex Addiction I’m certain you don’tPanic Disorder have BPD! Personality Disorder Not Otherwise Specified
Why is BPD called a “Personality” Disorder?Unlike many mood disorders, a personality disorder involves one’s sense of selfand perception of the world. For some of us, our experience of self and other, ourways of behaving and reacting, become harmful and rigid. It takes great courageand insight to go beyond our habitual ways to grasp that our personality might beimpaired. Of course, everyone’s personality is disordered to some extent. But with“Personality Disorder,” it is sever, destructive, incapacitating and often hellish forourselves and those who know us. Personality Development involves the interaction of Biological pre-dispositions (nature) External Environments (nurture) A Personality Disorder occurs when personality traits are inflexible and maladaptive and cause functional impairment or subjective distress.
Common beliefs researchers discovered those with BPD have about themselves and the world, in addition to “dysregulation” I am endangered The world is dangerous and malevolent I am like a small child I am powerless and vulnerable I am uncared for Zanarini, (1988) I am inherently unacceptable Beck and Freeman (1990) These very much contribute to our personality and how we interact with ourselves and the world!
There are recognized biological components to BPD Research shows abnormalities in the neural systems that regulate emotions, impulsivity and thinking Emotions Perception andRegulation is Reasoning disortions impaired Dorsolateral prefrontal systemAmygdala system Impulsivity control problems Anterior Cingulate Orbitomedial Prefrontal Systems The Best and Most Up to Date information on this is found in Valarie Porr’s Book: Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change
People with BPD and those in relationship to them will encounter challenges specific to the disorder For example, intimate and close relationships are triggering to a person with BPDBeing with and needing others brings up: Emotional reactivity Sense of being threatened Paranoia and jealousy (especially perception of betrayal) Dif ficulty negotiating boundaries (taking on others emotions, issues) Heightened sensitivity to judgment and criticism Polarized thinking / perceptions Dif ficulty seeing others’ perspectives Taking desperate actions in order to manage pain of conflicts and to express feelings. We all need to see these behaviors as “maladaptive” rather than “bad”: those with BPD can be triggered constantly by those they are closest to , therefore it may seem impossible to interact with them without getting hurt yourself.
Treatment for Borderline Personality Disorder is now proven effective and available in many places DBT : Dialectical Behavior Therapy (Marsha Linehan, WA) www.behavioraltech.org CBT: Cognitive Therapy (Aaron Beck, PA) www.academyofct.org SFT: Schema-Focsued Therapy (Jeffrey Young, NY) www.schematherapy.com Mentalization (Andrew Bateman and Peter Fonagey, UK) www.menninger.edu TFP: Transference-focused Psychotherapy (Otto Kernberg, NY) www.borderlinedisorders.com STEPPS: Systems Training for Emotional Predictability and Problem Solving (Nancy Blum et al, IO) www.uihealthcare.com/topics/medicaldepartments/psychiatry/stepps/index.html
Dr. Marsha Linehan specifies 4 Stages of Recoveryfrom Borderline Personality Disorder Stage 4: “Incompleteness” Capacity for Joy and Freedom: Love as inter-dependence, internalized mastery, “having Sense of perspective”, self-management, sense of self is evolving. Self Stage 3: “Problems in Everyday Living” Ordinary Happiness and Unhappiness: Rebuilding a life, generalizing skills to Interpersonal relationships and work, involved with life. Stage 2: “Overcoming Quiet Desperation” Emotional Experiencing: Emotional & Dealing with PTSD and trauma, fear of emotions, Cognitive understanding triggers. Stage 1: Severe Behavioral Dyscontrol Behavioral Behavioral Control: Reducing self-harm, addictions, dissociation, rage, suicide attempts, chronic despair.* Adopted from M.M Linehan, 2004
No matter what kind of treatment is done, healing from BPD involves the cultivation of the following qualities for ALL involved Openness: A willingness to Non-judgment: Mindfulness: Not imposing our experience the symptoms Developing awareness of own viewpoint but without shutting down or body, feelings, thoughts, defending ourselves focusing on facts reactions, & surrounding unnecessarily environment Giving the Benefit of the Validation: Doubt: Not jumping to Recognize what conclusions about other each person is people’s behavior saying and experiencing, even if you Curiosity: disagree. Asking “what is going on” rather than makingPausing and imagining judgments and assumptions what others are feeling: Patience: The pause allows us to Allowing ourselves and Hope:respond rather than react others to go through the Believing that recovery process and accept it won’t be on our schedule is possible