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Borderline Bill
November 13, 2010 6:50 AM   Subscribe

A cartoon dog explains Borderline Personality Disorder and how it affects day to day life.

Courtesy of Ofir Sasson, an Israeli Animator. Previously on BPD.
posted by Lord_Pall (58 comments total) 32 users marked this as a favorite

 
The 256 combinations of symptoms that can lead to a diagnosis is something that is very wrong with the current criteria. There are a few that are really necessary for the diagnosis to have any meaning; the DSM casts too wide a net.

I should also note that Borderline Personality disorder is TREATABLE. People do get better. Lots of them. It's not a death- or permanently-crazy sentence, not at all.

The thing with the basketball hoop cracked me up, so, although I watched it without sound, A+
posted by the young rope-rider at 7:05 AM on November 13, 2010 [3 favorites]


Damn. I was hoping he was going to be a Borderline Collie.
posted by pracowity at 7:05 AM on November 13, 2010 [33 favorites]


I should also note that Borderline Personality disorder is TREATABLE. People do get better. Lots of them. It's not a death- or permanently-crazy sentence, not at all.

That gives me some hope for American politics.
posted by clarknova at 7:11 AM on November 13, 2010 [2 favorites]


Fine. Now I'm looking for a cartoon explaining the Seminars of Jacques Lacan.
posted by nicolin at 7:11 AM on November 13, 2010 [2 favorites]


Wow, that's awesome! And the credits say Ofir Sasson also performed the piano on the soundtrack. Quite a multitalented person, then, Ofir Sasson -- pianist, animator, etc...
posted by koeselitz at 7:18 AM on November 13, 2010 [2 favorites]


The 256 combinations of symptoms that can lead to a diagnosis is something that is very wrong with the current criteria. There are a few that are really necessary for the diagnosis to have any meaning; the DSM casts too wide a net.

I should also note that Borderline Personality disorder is TREATABLE. People do get better. Lots of them. It's not a death- or permanently-crazy sentence, not at all.


This. When I was diagnosed a few years ago, I had the impression that it was incurable. If you look at the slew of askme questions involving a loved-one with BPD, the majority of responders will say "run now, run fast, it doesn't get any better". Boy am I glad my now-husband didn't read those threads and give up on me right there- I almost did, but luckily the responses to my askme were a little more hopeful/dismissive of my diagnosis.

Turns out my BPD symptoms were just a subset of my long-term (10+ year) depression and anxiety. I had a small amount of psychotherapy (5 sessions over the course of two months) and 6 months of Wellbutrin. Guess what? I no longer fit any of the criteria laid out in the DSM regarding BPD.

I feel like a new person. I feel like myself.
posted by sunshinesky at 7:22 AM on November 13, 2010 [22 favorites]


I thought the "kicking the ball away" sequence toward the end was meant to be symbolic of the fact that the disorder is treatable and improvement is possible. Was I reading too much into that?
posted by Gator at 7:24 AM on November 13, 2010


Please note that this cartoon is American - labeling people with personality disorders is a much more controversial field in the UK. Unfortunately I don't know any more than that, but later on when my girlfriend gets home then I'm going to show her the little vid and ask her what she thinks (she is a psychiatric nurse).
brb :)
posted by Monkeymoo at 7:45 AM on November 13, 2010 [1 favorite]


Please note that this cartoon is American

No, the artist is Israeli.
posted by ValkoSipuliSuola at 7:48 AM on November 13, 2010


Someone else has my borderline personality book (grr) but I recommend it wholeheartedly for an overview of various treatments and controversies about diagnosis.

It's by Joel Paris, an MD from McGill.

But yes--it is treatable.

There is a huge stigma against BPD, even among mental health practitioners, which is too bad.

Even shrinks tend to be like OMG BPD RUUNNNNN which is silly.
posted by the young rope-rider at 7:56 AM on November 13, 2010 [1 favorite]


Fine. Now I'm looking for a cartoon explaining the Seminars of Jacques Lacan.

I'm ashamed to admit how much this book helped me during my first year of grad school.
posted by bibliowench at 8:01 AM on November 13, 2010 [1 favorite]


BPD is an easy term to throw around. I grew up with a sister who may have been diagnosed with this as much as anything else, and she finally received medical/pharma treatment for bipolar, which I believe has been tremendously helpful. (according to my mother's reports and what I can see wrt her relationship with her husband over the past 16 years.) She was only diagnosed at age 30 but true difference didn't really happen until her son was born just 5 years ago. I have no relationship with her left now but for a call exchanged on birthdays, and skulking around my parents home avoiding altercations if we both happen to be visiting their country of residence around the same time.

Do we ever really know what is and what isn't when we throw these diagnoses and labels around?

Boy am I glad my now-husband didn't read those threads and give up on me right there- I almost did, but luckily the responses to my askme were a little more hopeful/dismissive of my diagnosis.

There's an edge I believe, between teh genuine sociopath/malicious/abusive persona and the very real suffering of people unable to control their brain chemistry or life history and its impact. Self awareness and acknowledgment is the one critical way to evaluate whether to run or stay. The danger is in denial that any problems exist or a trivialization of concerns, whether one's own or the others. (That is, do you share a perception of reality with the other people in your world?) Other clues are signs of compassion, how far one's own ego drives one's actions over foresight or thoughtful actions, one's impact on others and finally, and most importantly respect. Clear boundaries must then be negotiated in interpersonal relationships, with deal breakers clearly identified. Mutual trust building is essential to this process. The biggest change I saw in my sister after her son was born was in her ability to control her impulsive responses and reactions with regard to him, to rein it back. He has never faced or seen what I grew up with. So, the control ability is there as is the ability to choose one's response. Imho, only.
posted by The Lady is a designer at 8:03 AM on November 13, 2010


Monkeymoo: “Please note that this cartoon is American - labeling people with personality disorders is a much more controversial field in the UK. Unfortunately I don't know any more than that, but later on when my girlfriend gets home then I'm going to show her the little vid and ask her what she thinks (she is a psychiatric nurse).”

I'm just a layman, not a psychiatrist, so what I know is limited, but as far as my knowledge of the subject goes: there is some controversy surrounding this, but it is not an American/UK division. (As some have noted, the artist behind this cartoon says he lives in Israel.) Also, please note that the controversy is not regarding whether Borderline Personality Disorder exists, or is an actual disorder – it's about whether the name is appropriate, given that it doesn't really describe the disorder at all. The difficulty arises largely because Borderline Personality Disorder seems to be a quite misunderstood in the popular mind; I'm constantly hearing people saying "oh, he's a bit Borderline" or "she seems BPD" when it's clear those people don't really have a grasp of what the disorder actually is. So, at least with BPD, it's an issue of semantics, not an issue of the actual nature of the illness. There is in fact a strong campaign which is trying to change the name of the disorder in the forthcoming DSM-5. (In a sense you may be right – most Americans are probably far too quick to label people as having personality disorders – but that's not really an issue of psychiatry, and moreover this educational video is probably a good thing on that count.)
posted by koeselitz at 8:14 AM on November 13, 2010


moreover this educational video is probably a good thing on that count.

Yes, it was eye opening, in retrospect, for what that knowledge may be worth to me after all these decades - there was much of what I saw in my sister (and we were forced to share a room, as someone who prefers to avoid conflict, I had nowhere to hide).
posted by The Lady is a designer at 8:35 AM on November 13, 2010 [1 favorite]


I really loved the video and thank you for posting. Like others, I had assumed that BPD was untreatable. Like others, somebody I love exhibits many symptoms of BPD. I have wanted an approach that was something other than run far away for a long time. This helps me both maintain my love for my person and my hope that things will get better for her.
posted by angrycat at 8:48 AM on November 13, 2010 [1 favorite]


Nice cartoon. I liked how the BPD dog seemed fleshed out, as far as BPD-suffering dogs go.
posted by Sticherbeast at 8:49 AM on November 13, 2010


i thought it was odd that the narration said that BPD was largely female, yet the dog was male?

especially since there may be a closely related, largely male and somewhat more socially acceptable "Raging Asshole Disorder."
posted by ennui.bz at 9:02 AM on November 13, 2010 [1 favorite]


i thought it was odd that the narration said that BPD was largely female, yet the dog was male?

The artist is male and I'm assuming he suffers from BPD, which is why he made the short.
posted by ValkoSipuliSuola at 9:14 AM on November 13, 2010 [1 favorite]


The character appears to be one that Ofir Sasson has used before: see Wolf and Sheep, which uses the same animated dog/wolf/canidoid.

Yup, it's definitely troubled animated canid day on Metafilter.
posted by hackwolf at 9:17 AM on November 13, 2010 [1 favorite]


I'm not sure how silly the impulse to get the fuck away from BPD people is, even amongst mental health professionals. There is stigmatizing, and then there is not wanting to deal with the exhausting toxic explosiveness of the disorder. I worked as a shelter worker in Vancouver's DTES for several years, and I'll take a violent crack addict over the guilt trips of a Borderline person any day. There were only a few people who bore the diagnosis (rightly or wrongly I'm not qualified to say) who used our services, but they drained an disproportionate amount of time and energy. I don't blame them by any means, but neither do I blame someone for being spooked by the diagnosis.
posted by Roachbeard at 9:21 AM on November 13, 2010 [7 favorites]


The 256 combinations of symptoms that can lead to a diagnosis is something that is very wrong with the current criteria. There are a few that are really necessary for the diagnosis to have any meaning; the DSM casts too wide a net.

Not necessarily. It isn't clear that everything can be defined in terms of essential characteristics. Wittgenstein's famous example was family resemblance. Your uncle and brother share the same nose, you and your mother have the same eyes, your uncle and your mother have the same chin, and so on, such that there is no feature all family members share.
posted by Marty Marx at 9:27 AM on November 13, 2010


Yup, it's definitely troubled animated canid day on Metafilter.
posted by hackwolf at 12:17 PM on November 13 [+] [!]


Epony...oh, wait, we're not allowed to do that anymore, right?
posted by Gator at 9:29 AM on November 13, 2010


Monkeymoo: "Labeling people with personality disorders is a much more controversial field in the UK."

Much as with Metric, the majority of the world outside the US Does Things Differently. There, BPD is known as the more semantically justifiable Emotionally Unstable Personality Disorder (types Impulsive or Borderline).

I've personally seen far too many people labelled as Bipolar Types 1 and 2 (or even Schizoaffective or full-on Schizphrenics) who are in fact BPDers with a little sustained anxiety/PTSD component. They are treated (badly) with almost exactly the wrong sort of meds and no DBT-ish therapy.
posted by meehawl at 9:33 AM on November 13, 2010 [2 favorites]


I'm not sure how silly the impulse to get the fuck away from BPD people is, even amongst mental health professionals. There is stigmatizing, and then there is not wanting to deal with the exhausting toxic explosiveness of the disorder.

Yeah.

I lived with somebody for a little over two years who has BPD, the very bad kind that nickyskye talks about here. It was impossible for her to get help; anybody, including doctors, who suggested that she was not OK became labeled as "out to get her" and a liar, and did not know what they were talking about.

I cannot even begin to document the atrocities that she caused.

I last saw her in court, when I got a restraining order against her.

People like her are capable of doing unspeakably fucked up, harmful things to anybody close to them. The scariest part of it, to me, is that when she wasn't ruining everything she touched, she seemed like a perfectly normal, nice person. I ran the fuck away from that, and if I didn't, there'd be a good chance I'd have ended up dead or falsely imprisoned. I'd encourage anybody else to do the same.
posted by Threeway Handshake at 9:43 AM on November 13, 2010 [10 favorites]


meehawl: “Much as with Metric, the majority of the world outside the US Does Things Differently.”

Well, like I said, it's just as likely as not that that'll change in the next few years. And it was only a few years ago that the WHO called it BPD, too. This is just something that's changing at the moment, and I think it's a good change.
posted by koeselitz at 9:53 AM on November 13, 2010


The term "Borderline" is a vestige of early psychoanalytic theory in which the so-called personality disorder was seen as the line separating neuroses from psychoses. Most of the associated theory is now considered obsolete but the name remains.
posted by Obscure Reference at 9:57 AM on November 13, 2010 [1 favorite]


"I'm not sure how silly the impulse to get the fuck away from BPD people is, even amongst mental health professionals. There is stigmatizing, and then there is not wanting to deal with the exhausting toxic explosiveness of the disorder. I worked as a shelter worker in Vancouver's DTES for several years, "

I hear this a lot from people who work with the most extreme forms of the disorder. The vast majority of people who would be in shelters are going to be those who are the worst off.

There is another issue, which is that some forms of support seem to make the disorder worse, but that starts to get really technical.
posted by the young rope-rider at 10:33 AM on November 13, 2010 [2 favorites]


"It was impossible for her to get help; anybody, including doctors, who suggested that she was not OK became labeled as "out to get her" and a liar, and did not know what they were talking about. "

Again, this is a very extreme form of the disorder. The vast majority of people with borderline disorder are highly troubled by their inability to maintain relationships (among other issues) and they seek psychiatric help.

Obviously, if someone is destructive, unpleasant, or disregards your boundaries repeatedly, then yes, avoid them. And if you're a layperson, then fine.

However, it's inappropriate for mental health personnel to be spooked by a relatively common (and, again, treatable) disorder. They should know how to handle it, just like they should know how to handle bipolar disorder, major depression, OCD, addiction...
posted by the young rope-rider at 10:37 AM on November 13, 2010 [2 favorites]


However, it's inappropriate for mental health personnel to be spooked by a relatively common (and, again, treatable) disorder. They should know how to handle it, just like they should know how to handle bipolar disorder, major depression, OCD, addiction...

Yes, but I don't think that the video with the cute dog was made for mental health professionals.
posted by Threeway Handshake at 10:40 AM on November 13, 2010 [1 favorite]


Yup, it's definitely troubled animated canid day on Metafilter.

Strangely, all of them seem to be about my mom!
posted by katillathehun at 10:50 AM on November 13, 2010 [5 favorites]


The 256 combinations of symptoms that can lead to a diagnosis is something that is very wrong with the current criteria.

I don't think anyone would argue that flu is a made up disease but I can come up with five common symptoms, of which a flu sufferer might only have two or three. That's more than fifty combinations of symptoms for something that can be well explained at the molecular level.

To be fair, "Patient has an elevated body temperature." is a lot more objective than "Patient makes frantic efforts to avoid real or imagined abandonment." but really, it's impressive that people working within the scope of human thought and behavior" can narrow things down to 256 symptom combinations.

Not that any of this is going to stop me from razzing my biologists friends.
posted by Kid Charlemagne at 11:53 AM on November 13, 2010 [1 favorite]


(I'm paraphrasing one of the top BPD researchers.)

When the criteria is too broad (which it is) it makes it much harder to do good research.

Someone who doesn't have any suicidal ideation is not the right person to put in a trial for a treatment that is designed to reduce suicidal ideation, even though they're both "borderline" according to the DSM.

Nor is a treatment that was developed for people with one set of symptoms appropriate for someone who has none of those symptoms.

It's not a theoretical issue, but a practical one.
posted by the young rope-rider at 12:19 PM on November 13, 2010 [1 favorite]


I have several family members with (diagnosed) BPD, and I wouldn't blame people for running, either. There is undoubtedly a big difference when people want to try to ameliorate their symptoms, but living with two people who had it and refused to be treated is as close as I ever want to be to living in hell.
posted by winna at 12:50 PM on November 13, 2010 [3 favorites]


Interesting cartoon, but some of the text was difficult to read, even when played back at half speed. Seems a little more time spent cleaning up the presentation might make for a better viewing experience.
posted by 2N2222 at 1:14 PM on November 13, 2010 [1 favorite]


After a trip to the emergency (incredibly bad suicidal thoughts) and a hellish boring four days in the hospital I was misdiagnosed with BPD. It turned out to be a reaction to my medication and a worsening of my major depression. However, it took me a year or so to recover from even having the label spoken to me.

My mistake was actually looking on the internet and seeing horror story after horror story about people with the disorder (on metafilter too). I so didn't want to be like that I went the opposite way and even though I was in therapy I never brought it up as I didn't want to appear to be denying the diagnosis as everyone says that BPDers do that. I was afraid to counter anything my therapist said or started to question every emotion I had. Constantly wondering if I was manipulating people when I cried or laughed. It was hellish.

It wasn't until I got to the point where I was having psychological testing to see if there was anything missed before I got electroshock therapy that it came out to the new therapist. We talked it over, she did some testing, looked through my chart and told me that everyone has borderline traits but that I didn't qualify. Soon as that happened a year long hellish battle was over.

I guess I just wish people wouldn't always be quick to tell their bad BPD stories even though they exist. Everyone just seems to assume that people know it is treatable or that there are mild forms of it but when you search for information and people are tend to do when diagnosed with anything all you find are scary stories telling you that you will never be loved again, or find a mate, or that everyone around you is afraid of you.
posted by kanata at 3:04 PM on November 13, 2010 [9 favorites]


I'm glad the video said BPDers can be good with babies. I am and I absolutely adore them. There is at least 1 person who knows my diagnosis who does not trust me with her child, and it really hurts me. Because I would never, never, NEVER hurt a child. Mental illness =/= automatic danger to children.

I also no longer meet the diagnostic criteria.

Threeway Handshake: "People like her"

Not all people with BPD are People Like Her.
posted by IndigoRain at 4:03 PM on November 13, 2010 [5 favorites]


I'd say I probably have this but 1) I'm a mental disorder hypochondriac and 2) I'd worry it would seem guilt-trippy
posted by tehloki at 4:15 PM on November 13, 2010


Fine. Now I'm looking for a cartoon explaining the Seminars of Jacques Lacan.

Try this.
posted by clarknova at 4:48 PM on November 13, 2010


Not all people with BPD are People Like Her.

To be fair, he did say that she was afflicted with the "very bad kind". I totally understand where you're coming from, since that bit put me off at first too.

Sadly most people won't qualify their statements like that. We all just get lumped in together, and it's rather insulting! Obviously, since it stung a bit even with the qualification.
posted by sunshinesky at 8:53 PM on November 13, 2010


Not all people with BPD are People Like Her.

I made it very clear that she is of the "untreatable kind." And that is why I said "people like her" and not "everybody with BPD."
posted by Threeway Handshake at 9:02 PM on November 13, 2010


Thank you for the post Lord_Pall. I almost always enjoy it when there is a psychology topic here on the blue and, because of my personal interest in personality disorders, particularly when there is a post in this area of psychology.

I didn't really get a lot out of this video though as I don't think it adequately described either what it's like inside the mind of a person with BPD, nor what it's like for the people around the person with BPD. But I like the idea of this video a lot, enjoyed the artwork of the animation itself, and hope there are more animated films along these lines, better done, depicting what it's like inside the mind of a person with a personality disorder. And films created by those who are around the person with BPD, what they experience.

As I've discussed in the past on the blue, I think BPD is a very inadequate and inaccurate term and really shouldn't be in the DSM at all.

Among the issues not brought up in this brief video, that I think are common or typical of the issues faced by people with BPD, are: that BPDed people self-mutilate, sometimes to extremes; that people with BPD may have dissociation as a coping mechanism for stress; that being promiscuous -sexual glutting- or having no sex -sexual anorexia- can be a typical way for BPDs to try not to feel abandonment; that people with BPD have many issues to do with punishment and vindictiveness, what has been called the talionic impulse; that people with BPD often have many other issues at the same time, like over-spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating; that BPDs are often deceitful.

In the video it is incorrect that BPD is a disorder "affecting 2 percent of adults Mostly young women". Young women - and most Western teenagers- have BPD traits during their teen years, particularly emotional volatility and impulsiveness. But having a handful of traits for a few years does not mean it's a full blown personality disorder. An Axis II Cluster B personality disorder - like BPD- is basically set in place for life by age 6. Some aspects of the disorder may be treated but the core issues -particularly the narcissism- are rigid, all pervasive and lasting throughout life. The video would be more correct if it said BPD traits are more common in young women.

Because so many people in power or celebrity suffer with one of the Axis II Cluster B (NPD, BPD, ASPD, HPD) disorders, I think the world needs to know about these personality disorders.

Even if this interesting, short video isn't as informative as I'd like it to be, I'm still glad it was made and hope it inspires others to create more animated films about psychology.
posted by nickyskye at 9:22 PM on November 13, 2010 [1 favorite]


PS for nicolin, Lacan for Beginners comic.
posted by nickyskye at 9:24 PM on November 13, 2010


nickyskye, the information you're putting out there is, while well-intentioned, inaccurate.

--The core issues are, indeed, treatable and do not last throughout life for many people with BPD.

--The personality disorders that you list do not exist in any scientifically notable way; only BPD and schizoid personality disorder are consistently diagnosable (to simplify, it means that different clinicians using different tools come to the same diagnosis).

--Bad people do exist; however, labeling them with the same terminology that is used to identify disorders so that they may be treated is not appropriate, nor is it helpful for those who suffer from BPD and constantly read misinformation about it

The way that the diagnosis falls largely on young women is an especial cruelty. Want to get a diagnosis of BPD? Go to a psychiatrist and tell them that you were abused as a child (particularly sexually abused), have never had a stable romantic relationship, and overeat/undereat/sleep with too many people/sleep with no one.

Then, go google "borderline personality disorder" and look at the multitude of bad information out there that tells you that you're a horrible person, no one wants to be around you, and that you'll never get better.

Even if someone does have borderline personality disorder--it's not okay to classify them as inherently evil because they share the same label as someone else.
posted by the young rope-rider at 5:06 AM on November 14, 2010 [1 favorite]


Upon thinking about it a little harder -- neither one of us is wrong, we're just butting against the difference between a largely unscientific and colloquial use of the term "borderline personality" and the scientific, relatively obscure use of the same term.

That is majorly the fault of psychologists, who have mushed about unscientifically for so long (and yet claimed so much authority over the human mind).

Problem comes when people are given life/death sentences based on pseudoscience.
posted by the young rope-rider at 5:36 AM on November 14, 2010


Disagreeing strongly with your opinions the young rope-rider. My info on this topic is not merely well intentioned, it is thoroughly researched and I can back up what I've said with science based documentation.

While I feel compassion for those who suffer from an Axix II Cluster B personality disorder, I know that people with these disorders create tremendous suffering and misery in the world around them, not just temporarily but over an entire lifetime. There is a wake of agony that people with an Axis II Cluster B disorder leave behind them, decades, if not generations, of suffering, messes, confusion and costly chaos.

People with an Axis II Cluster B disorder suffer. But they create a LOT of suffering in those around them.

The problem with BPD as a diagnosis based on the present DSM criteria is that it has been used to casually label anything from self-mutilation to symptoms of PTSD. It's routinely called a "trash basket diagnosis" by professionals because of its inaccuracy. In order to be an effective diagnostic tool, the DSM must change both the BPD label and the traits so it is more accurate and practically useful.

A personality disorder is defined as inflexible. "Persons affected by these disorders have rigid personality traits and coping styles that they are unable to adapt to changing situations and that impair their social and/or occupational functioning."

Certain traits of BPD may be treatable, the depression for example, but what makes it a personality disorder, not just a trait, is that BPD consists of a group of traits that are pervasive, rigid and lasting over a lifetime.

You said: --The personality disorders that you list do not exist in any scientifically notable way; only BPD and schizoid personality disorder are consistently diagnosable (to simplify, it means that different clinicians using different tools come to the same diagnosis).

What are you talking about? What you are saying is grossly incorrect. Narcissistic Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder and Histrionic Personality Disorder are clinical diagnoses and are consistently diagnosable.

You said: Bad people do exist; however, labeling them with the same terminology that is used to identify disorders so that they may be treated is not appropriate, nor is it helpful for those who suffer from BPD and constantly read misinformation about it.

It is appropriate, legally, socially and psychologically. Who are these "bad people"? And why are they labeled bad? It's because they repeatedly hurt other people, especially those nearest them with malice, manipulation, deception and violence. People with BPD are not considered "bad" if they only suffer from depression, self harm, were "abused as a child (particularly sexually abused), have never had a stable romantic relationship, and overeat/undereat/sleep with too many people/sleep with no one". People with BPD are considered bad people for the harm they do to others.

One of the uses of the DSM is labeling people who have been taken to court because of criminal activity that they have committed. This is particularly true of the Axis II Cluster B personality disorders and in the case of BPD, the legal issue that is most common is stalking and harassment.

Psychology is not a pseudoscience. It's the science of mind and behavior. Like most areas of science there is a lot more to be discovered and developed.
posted by nickyskye at 10:24 AM on November 14, 2010 [2 favorites]


Aw. It's sad that in the video, the caption "And [they] can be very kind" is accompanied by an image of the little dog asleep. "They can be very kind...in their sleep!"
posted by limeonaire at 1:47 PM on November 14, 2010 [2 favorites]


One hundred borderline patients from a general hospital population were followed for a mean of 15 years. Seventy-five percent were no longer diagnosable as borderline.

75%. That's one of multiple journal articles that I can cite about treatment of borderline personality disorder.

The biggest risk with BPD is not that it will never get better, but that patients with BPD will commit suicide. One of the biggest issues in terms of resource use is inpatient treatment for suicidality when outpatient treatment is actually linked with better outcomes. Anyway.
posted by the young rope-rider at 5:48 PM on November 14, 2010 [1 favorite]


nickyskye: "I know that people with these disorders create tremendous suffering and misery in the world around them, not just temporarily but over an entire lifetime. There is a wake of agony that people with an Axis II Cluster B disorder leave behind them, decades, if not generations, of suffering, messes, confusion and costly chaos.

People with an Axis II Cluster B disorder suffer. But they create a LOT of suffering in those around them
"

I have a hell of a lot of friends and family who would disagree with you. Even when I was at my worst (and yes I did hurt a few people, emotionally), I still had positive traits.

SOME people with Axis 2 disorders might create tremendous suffering and misery. But not all of them. It's very unfair to paint them all with the same brush. There is hope for everyone.
posted by IndigoRain at 11:32 PM on November 14, 2010


I still had positive traits

I believe you. Perhaps you do not have what I consider "real BPD".

People with Axis II Cluster B personality disorders typically have amazing qualities, sometimes dazzling ones, such as their business savvy, creativity, exceptional communication skills, scholarly abilities, detail oriented perception, talent, gifted memory among many others.

These disorders are on a continuum, from 'garden variety' to intense and are typically co-morbid with other issues. In my experience, when a person with an Axis II Cluster B personality disorder has schizoid or "secret schizoid" traits, living alone most of the time, they cause the least suffering in the lives of those around because they have very limited close contact.

I sincerely wish you, your family and friends healthy relationships.
posted by nickyskye at 8:19 AM on November 15, 2010


Here's the thing: you are using the term one way and other people do not use it the same way. Most notably, the way you use it is not the same way that the community of researchers and clinicians who study and treat borderline personality disorder use it.

You can consider BPD whatever you'd like but it's not accurate to say that you are basing that on any kind of scientific evidence. If I'm missing some, let me know.

As it is, it seems that you have a very set (and relatively personal) idea of what "real BPD" is and you're perfectly willing to throw everyone else who is diagnosed with it into the exact same category and say that they'll never get better. If there is a range from garden-variety to severe BPD then what is to be gained with demonizing all of them? And yes, that is what you are doing.

The stigma against people with borderline personality disorder is already extreme, even among mental health professionals, and you are not helping by spreading misinformation.

People with BPD do tend to avoid intimate (most easily defined as living with a partner) relationships more than people without the diagnosis, but it would be wrong to say that these are schizoid traits. It seems that they would be more aptly described as people avoiding situations and relationships that trigger the worst aspects of their illness.

There is also no indication that this avoidance of intimate relationships includes avoidance of all relationships (as in schizoid personality disorder).
posted by the young rope-rider at 9:10 AM on November 15, 2010 [1 favorite]


No, the young rope-rider, I do use the term BPD as it has been documented by psychologists, eg the many comments of mine in this thread or this one and make an effort to be meticulous about that. It is my opinion that the DSM criteria for BPD needs to be amended. I read and heard many psychologists are of the same opinion. There is a lot of controversy about the diagnosis.

The BPD is not a label, it's a diagnosis. And it seems there are many opinions about its origins and treatment, including that it's a type of epilepsy.

I never said all BPDs have schizoid traits but those who do have co-morbid schizoid traits are less likely to hurt people because they have less close contact with people.

I can understand that if you are a therapist treating people with BPD it is your professional role to offer a holding environment, one of sympathy and support to those with BPD. I wish you the best in your work.

My perspective about the Axis II Cluster B personality disorders is biased towards offering information to those people who have survived abuse by those with these disorders, not towards treating traits of those with these personality disorders. My focus is not on treating BPD but on offering support to those who have been in a destructive enmeshment with a person who has an Axis II Cluster B disorder.
posted by nickyskye at 9:56 AM on November 15, 2010


nickyskye, I feel like I'm not communicating my point very well, so apologies in advance for that. I think that we might be talking past each other because, as I mentioned above, I think that there is a fundamental difference in the terminology we're using. I've been very "I'm right, you're wrong" about it so apologies for that as well. I don't think it's that simple at all.


Focusing on the non-curable nature of the disorder might be helpful in the extreme for people who are, for whatever reason, sticking around and taking abuse in the hope that things will get better. I appreciate that. I also appreciate that a diagnosis sometimes gives people an excuse to stay with someone in a deeply dysfunctional relationship.

I hope that I have made it absolutely clear that anyone who has any kind of abusive person in their life should feel perfectly free to disengage, avoid, or otherwise GTFO. Even if they're not abusive--there's no need to stay in any kind of relationship with someone who sucks. They don't have to wait for a diagnosis. There doesn't even have to be a diagnosis.

The thing is, though, that you can't say that BPD = abusive. (If I've misread you on this, apologies).
You are making a lot of statements which I'm sure are accurate about a subset of people with BPD, but which are not accurate about everyone who is reasonably diagnosed with it.
Plenty of non-abusive, kind people who are distressed by their inability to function in relationships are diagnosed with BPD by trained researchers and clinicians. Those people are treatable. They don't necessarily wreak havoc over multiple generations. They might even have some high-quality relationships.

You think that BPD as its generally used as a diagnosis is too broad (we agree on this) but you want to shrink the criteria to a very severe form of the illness that is incurable, or label it something else. I don't think that would necessarily be valuable for research or treatment.

I do value research and treatment very highly; the people who are around those with BPD benefit when they are treated. The people who care for them benefit. Society at large benefits. It's not a matter of choosing one or the other (the person with BPD or the victims of abusive people who have BPD).

I should also mention that I am the child of two people who were significantly fucked up and abusive (although I wouldn't call it a personality disorder, their patterns of abuse are persistent throughout their interpersonal relationships). My father's mother was hospitalized repeatedly with something that was either BPD or similar, until her early death from possible suicide. I lived with someone for 4.5 years who was abusive and had issues with rage and splitting (a completely terrifying combination).

So I don't look at it from a perspective that is all about the person with BPD. I certainly have empathy for people who are victims of abuse. I am one. A lot of people with BPD are victims of abuse as well.

I do try to extend my empathy and knowledge to benefit people who are suffering from a real, distressing, and treatable mental illness. It's a perspective that is largely missing from the broader dialogue about BPD.
posted by the young rope-rider at 10:49 AM on November 15, 2010 [1 favorite]


I am the child of two people who were significantly fucked up and abusive ...I lived with someone for 4.5 years who was abusive and had issues with rage and splitting (a completely terrifying combination).

So sorry you had to endure such suffering as a child and then, understandably after downloading that socio-emotional template, went onto staying in an abusive enmeshment as an adult. Glad you detached and wishing you well on your recovery journey.

The thing is, though, that you can't say that BPD = abusive.

Disagreeing with you there. A person who has been diagnosed with BPD may not be an abuser but BPD by its very definition in the DSM is a disorder that would create the experience of being abused by the other - non-BPD- person in the relationship. If a non-BPD person is in a relationship with a person diagnosed as BPD with 5 of the following traits, that non-BPd person is in an enmeshment that is chaotic, frantic, a roller coaster of emotional volatility, impulsivity, unstability ie being emotionally abused and on the receiving end of rage, capriciousness, threats of suicide, emotional manipulation, dissociation:

BPD is by its definition: A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

posted by nickyskye at 3:56 PM on November 15, 2010


I don't see that a person with BPD must be an abuser. I don't think I abused anyone, but then again I may not have what you consider "real BPD" but just have part of the broader category of the disorder. (I am not being critical or sarcastic in my statement, I'm just repeating how I think you say you understand the disorder.)

This is not directed at you nickyskye, or anyone else, but in general, I know that a lot of people who have had an experience with a (real?) BPD person in the past are very angry and hostile towards anyone else that has it. There's a forum, I believe called the Nook, for non-BPDs and they are extremely hostile to anyone with BPD, fearing "we" will invade "their safe zone." Just saying you have BPD makes them immediately demonize you.
posted by IndigoRain at 7:40 PM on November 15, 2010


the young rope-rider: "One hundred borderline patients from a general hospital population were followed for a mean of 15 years. Seventy-five percent were no longer diagnosable as borderline."

Suicide mortality was 8.5%. That's a large survivor bias. Recent work with combined meds and DBT for BPDers can get the remission rate up to the 86% range. The interesting question is whether treating the refractory cases with impulse-retarding drugs such as Lithium or Clozapine could make a dent in the high suicide mortality, possibly within specific sub-groups. How to identify them? That's where a lot of work is going on.

nickyskye: "I do use the term BPD as it has been documented by psychologists ... It is my opinion that the DSM criteria for BPD needs to be amended. I read and heard many psychologists are of the same opinion"

That would be difficult considering BPD is a medical diagnosis documented by psychiatrists, and the American Psychiatric Association writes the DSM. The American Psychological Association writes the Publication Manual for the "APA Style".
posted by meehawl at 8:14 PM on November 15, 2010


Thanks for the correction meehawl. From what I've read, the term Borderline Personality Disorder actually originated in 1938 by a psychoanalyst, named Adolph Stern.
posted by nickyskye at 12:03 AM on November 16, 2010


nickyskye: "The term Borderline Personality Disorder actually originated in 1938 by a psychoanalyst, named Adolph Stern"

Yes, Stern was a psychologist trained as a psychoanalyst and attached the "borderline" name in his paper, Psychoanalytic Investigation of and Therapy in the Border Line Group of Neuroses, presenting the (incorrect) theory that it was a sub-type of schizophrenia. However, as he notes early on, the characteristics of the disorder (affective instability, mood reactivity, interpersonal oscillations, paranoia, impulsivity, self-harm) had long been noted to run together. There was a growing consensus by the end of the 19th century that personality disorders could group into clusters and had a natural life cycle and progression,and psychiatrist Emil Kraepelin, the originator of the basic taxonomy of psychiatric diagnosis and opponent of a non-biological basis for psychiatric illnesses, even accepted and described quite elegantly the personality-based borderline pathology as an entity distinct from the periodic mania or the progressive dementia praecox (schizophrenia) near the end of his life in the mid-1920s.
posted by meehawl at 8:04 PM on November 16, 2010


brief, transient, and reversible psychotic ("quasi-psychotic") experiences are a characteristic of the lives of many patients with borderline disorder led to the inclusion of transient paranoid ideation and severe dissociative symptoms among the nine criteria for borderline personality disorder in DSM-IV.

As Michael Stone (11) has pointed out, estimates of the prevalence of borderline personality disorder in the United States are in the range of 2.5%–3.0%—about the size of the population of Denmark or Sweden.
posted by nickyskye at 6:23 AM on November 17, 2010


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