Go! To the Border!

Posted on May 6th, 2010 by Clinically Clueless

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May is borderline personality disorder (BPD) awareness month and this is how it is experienced by those with BPD.  This diagnosis is difficult as there is so much stigma attached to it and it takes a real committment and a lot of patience for a therapist to provide services and for the patient to perservere.  Many therapist will not treat those with borderline personality disorder. I am diagnosed with this disorder and it is treatable, but takes a very long time.

The prevalence of BPD is about 2% of the general population. It is seen in 10% of psychiatric outpatients, and 20% of psychiatric inpatients. This disorder is more frequent in females (about 75%) than males. Emotional instability and impulsivity are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this emotional instability and impulsivity persists and intensifies into adulthood; thus they become diagnosed with this disorder. As with other mental disorders, the causes of borderline personality disorder are complex.

The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But, that view doesn’t reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.

Meanwhile, the cause of borderline personality disorder remains under investigation, and there’s no known way to prevent it. Possible causes include:

  • Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
  • Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
  • Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Personality forms during childhood. It’s shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase your risk of developing borderline personality disorder. These include:

  • Hereditary predisposition. You may be at a higher risk if a close family member — a mother, father or sibling — has the disorder.
  • Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
  • Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.

border1Marsha Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak “higher” emotionally on less provocation and take longer coming down. People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings.

I also agree with A.J. Mahari’s theory that compliments Linehan. Mahari states, “It is the core wound of abandonment in those who have been diagnosed with Borderline Personality Disorder (BPD) that is the source of insecure or non-existent attachment that leads to the toxic and unhealthy ruptured relationships that have at their centre emotional enmeshment and an insatiable need for love. These broken relationships, often rupture under the weight of the child-like behaviour and needs of the borderline still searching for the much-needed unconditional acceptance, validation and love of a parent as the result of unmet early childhood developmental needs.

Most, if not all, borderline behaviour is driven directly or indirectly by fear of abandonment and the fear of re-experiencing the intolerable pain of your original core wound of abandonment. What feels like it keeps happening to you, is in fact, a triggered, dissociative, regressed re-experiencing of what initially happened to you in the very early and formative developmental years of your life.”  With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships.

Individuals with BPD seem to have a much higher stigma than individuals with other disorders even within the mental health community and there is debate as to whether or not they are treatable. Many professionals will not treat people with BPD or must limit the number of patients. In order for treatment to be successful, it requires a significant commitment from the therapist and patient. My personal belief is that people with BPD can be treated. I, for one, have been receiving treatment and am near a point where I will no longer meet the criteria.

But, it has been a long time of much tumultuous and extremely painful hard work for both my therapist and I. There were times when I think both of us wanted to quit. Persons with BPD are often described, by the DSM as deliberately manipulative and difficult with extreme inner pain and turmoil, powerlessness and defensive reactions with extremely limited coping and communication skills. My translation, they take tremendous energy, extra attention, consistent limit-setting, terminate treatment prematurely and may return, and have a love/hate relationship with the therapist. But, there is hope.

And, I, for one, am getting there; however, it has taken a very long time and much commitment and painful work. I can see why people “give up” treatment. But, the reward for sticking it out is priceless. Well, really not priceless…therapy and medication is expensive, but that is a whole other issue. Don’t even get me started.

Below is a Polyvore collage that I put together expressing how having a borderline personality disorder sometimes feels for me.  I know the image is difficult to see, but if you click on the link below the picture you will be able to see it more clearly.

Borderline Personality Disorder
Borderline Personality Disorder by ClinicallyClueless on Polyvore.com
The text in this post is an excerpt from my blog Clinically Clueless.  Last year, I wrote a five part series about borderline personality disorder so if you want to see more please go visit my blog and click  on the “Borderline” picture on the left sidebar.  Thoughout the month of May, I will be adding different types of posts related to this disorder, so keep your eye out on my blog.  But, do remember to GO! Smell the Coffee!!
I hope that this gives you a better understanding about borderline personality disorder and breaks some misconceptions.  Any and all questions welcomed.  How does this post effect what you thought or didn’t know?

12 Responses to “Go! To the Border!”

  1. Jim says:

    Hi CC – infomrative as always and tell me – whats the difference between this and Bipolar?

    • Jim,

      Great question as it has been debated whether or not Borderline Personality DO is another type of Bipolar disorder and people are often misdiagnosed which is harmful as the treatment is different. However, Bipolar DO is a mood disorder characterized by a persons moods and Borderline Personality DO is a personality disorder which is thought to be long-turn and untreatable, but symptoms can be managed. Both have mood instability. Bipolar is usually managed well with medications and will usually need to be taken for a life time. Psychotherapy is also helpful Borderline is managed by medications and psychotherapy. However, I have had more years medication free than on medications. Current realistic goal is to eventually be medication free.

      Bipolar DO go from depression to mania (a mood characterized by elation, decreased need for sleep, impulsivity, and an increase in activity). Often, there is not identifying “trigger.”

      However, those with Borderline Personality DO frequently change from being “normal” to feeling extremely distressed in a matter of minutes. There is usually an clearly identifiable “trigger/stressor.” Mood shifts are more short lived and ususally last for a few hours to a day or so. The shifting of moods rarely involve elation or a emotional “high.”

      Sorry to go one, but it really is a complicated issue.

      .-= ClinicallyClueless´s last blog .. =-.

      • Jim says:

        Hey dont apologise for ‘going on’ – thats the idea of your post – its the whole point! Thanks for the clarification and the learning, its appreciated…

        I presume the use of alcohol is banned for people with the disorder of Borderline Personality as it often pushes the traits to the limits…

        • Alcohol isn’t necessarily “banned.” It really depends like all people it is how they are effected. But, two of the criteria for BPD is (1) impulsivity that are self damaging such as reckless driving, spending, sex substance abuse, binge eating,etc.. and (2) recurrent suidical behavior, gestures, or threats, or self-mutilizing behavior. Alcohol may reduce their impulsivity. Also, if they are on medications, they are more than likely the ones that are contraindicated for drinking alcohol.
          .-= ClinicallyClueless´s last blog .. =-.

  2. irishcoffee says:

    Great stuff, CC! I’m particularly interested in the relation of these various “disorders” to childhood. From what you have said about BPD, it seems that under abusive conditions etc. the growing child is not able to properly develop its ego or personality.

    It therefore seems to me that to “overcome” one’s disorder (if we can put it like that), there must be very specific efforts made. These efforts, whatever they would actually entail, would have the effect of creating a hard shell around oneself, a tough exterior / face to the world. At the same time, crucially, there must be a development on the inside, the soft centre, the heart. So the real function of the outer shell is to protect the heart; and when it is ready, courageous enough, it will break open the shell by its own force. So the shell must be strong enough to withstand all the external forces of society. Strengthening one’s external defences, wearing masks, ducking and diving – all these must be fully accepted, if simply because they are necessary to therapy. What is inside (the potential) is a more real reality than what is outside (the actual). I think the biggest obstacle for those with mental illness is actually believing that they can DO SOMETHING to overcome it.

    • Thank you Irish Coffee,

      You are right in relation to therapy in general. My experience is that my trust issues are so significant that it took me about five years to really start “working” the rest was about physically showing up and my therapist just being there with me. Even during a hospitalization seven years into therapy, I still never talked about my constant thoughts of suicide. It does take courage and many terminate impulsively or cannot withstand the emotion. Me I should have, theoretically terminated a long time ago. However, I’ve had the same therapist for 19 years with a five year break. For having seen someone for 19 years is a significant thing for someone with Borderline Personality DO to do. However, I am not a “classic” Borderline.

      What you say about development of one’s ego which is having a sense of self and able to self-comfort and of knowing who they are without someone having to tell them. BPD basis is abandonment usually when they are an infant.

      In my case, I was emotionally abandoned as my parents fought constantly and I was ignored if I was in distress. (This is where the ability to learn that I am worthy of being cared for and how they learn to self comfort.) I also had physical and emotional abuse as an infant. My parent’s divorced when I was very young and my father disappeared. My mother was emotionally and physically unavailable. My family has told me that my grandparents used to get into arguements as I would be crying, but she would leave to go party. She would also ignore my crying and walk right past me. These ages are key in ego strengh development.

      .-= ClinicallyClueless´s last blog .. =-.

    • Often, mental illness is not to overcome it, but learn how to manage the symptoms. But, in managing they definitely need to be an active participant in therapy. For some, they really are not able due to the disease itself to do something except for in rare cases.
      .-= ClinicallyClueless´s last blog .. =-.

  3. irishcoffee says:

    Thanks for sharing. I hesitated when using the term “overcome” in relation to mental illness. Simple understanding, however we might arrive at it, can change everything by itself. If you don’t mind me asking, how do you think about / understand your parents now? I.e. do you blame them or feel sorry for them or are just numb to them? Does your therapist, for example, encourage you to forgive them? Or is that a no-go area?

    • It is okay about the term overcome…it takes time to learn what is correct and PC for the time because it changes and changes according to culture and age. Regarding my father, I’ve pretty much dealth with my feelings about him…basically he just left, but there are consequences for his decisions. Regarding my step-father who was sadistically abusive (see my blog for details), For the last few years, I go from angry to numb to sad. With my mother, I finally felt my rage toward her this past year which also included terror and pain.

      My therapist doesn’t encourage my to forgive them. At this point, it is about accepting the part that is their reponsibility and seeing how it effects me now which is my responsibility to “fix”…sucks.

      I view forgiveness in terms of stages of loss and also that you cannot truly forgive someone if you don’t know what you are forgiving them for which means experiencing and feeling the transgressions against me. Getting past my denial and actually feeling my feelings without self-judgement is the toughest part, but it is only then that I think I or anyone else can forgive someone…they need to own thier thoughts, feelings and experience in order to forgive. I hope that made sense.

      Thanks for your great questions!!

      .-= Clinically Clueless´s last blog .. =-.

      • Ian Baker says:

        as the bloke who ran cobra-kai on karate kid said

        ‘mercy is for the weak’

        forgive no-one

      • irishcoffee says:

        Thanks again CC, it made a lot of sense! And I think you’re already well on the way to great (simple) understanding!! I admire the courage of someone who takes it upon themselves to face up to such trauma. I’m no preacher, but I find awe-inspiring the understanding, courage and compassion shown by Jesus when on the cross was able to proclaim “forgive them; they don’t know what they are doing” !! Talk about justice turned on its head, eh?! Do people really not know they are doing such evil??
        .-= irishcoffee´s last blog ..The Dubai Digital Media Conference 2010 =-.

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