Borderline Personality Disorder
January 30, 2009 1:20 PM   Subscribe

"Borderline individuals are the psychological equivalent of third-degree burn patients." They have no emotional skin. Even the slightest touch can create immense suffering. The extreme oversensitivity and tendency to demonize/deify others may be due to faulty neural circuits or even genetic predisposition (but some debate this). Pharmacotherapy remains challenging. And those afflicted continue to fight stigma. "We have largely ignored this problem."
posted by terranova (51 comments total) 57 users marked this as a favorite
Wipe them out. All of them.

[/sarcasm], obviously.
posted by Ryvar at 1:24 PM on January 30, 2009

My second (ex) wife shows all the classic signs of BPD. It's ben intensifying over the years, and she's the last person on earth who wants to hear she needs help. It's really tough when people come crying to you for help, then leave screaming obscenities because you offered it. Ugh. If we didn't have a daughter in common, I would have long since severed contact.

Thnaks for thee reading material -- it might do me some good, at least.
posted by Devils Rancher at 1:26 PM on January 30, 2009 [4 favorites]

"Thanks for the." I type "thnaks" on five out of six tries. Weirdest persistent typo. Bring on the edit window. Once you're done huffing servers around, that is.
posted by Devils Rancher at 1:27 PM on January 30, 2009

They should steer clear of MetaTalk.
posted by dawson at 1:30 PM on January 30, 2009 [2 favorites]

Related: a previous Metafilter discussion of BDP.
posted by jchgf at 1:44 PM on January 30, 2009 [4 favorites]

Maintaining a romantic relationship or a post-facto friendship with someone with BPD is difficult in the extreme. My sympathies and sincere best wishes to you, Devils Rancher - there's not a lot of clear, effective help to be had, as the problem appears to be rooted in the victim's neurotopology, rather than their neurochemistry.

Unfortunately, for this reason it seems likely that any treatment will always involve radical personality alteration - the 'cure' is basically rewrite of identity so thorough that I'm always left wondering how it is fundamentally ethically different from killing the victim.

"The problem is simply who you are and we are doing away with that."
posted by Ryvar at 1:44 PM on January 30, 2009 [3 favorites]

They should steer clear of MetaTalk.

I would recommend avoiding the internet altogether, aside from maybe Cute Overload.
posted by The Card Cheat at 1:45 PM on January 30, 2009

btw, I wasn't trying to be flippant re a serious mental sickness here, just, you know, taking the piss.
posted by dawson at 1:49 PM on January 30, 2009

I've been friends with BPD people before, or at least people who exhibit the symptoms. It was nearly impossible to remain on good terms with them, and I can't imagine that anyone who hasn't heard of BPD could even begin to tolerate that kind of behavior. From the outside, it really just comes across as being a complete self-obsessed douchebag. It's a really difficult thing for people to understand, and certainly to live with. I often have ambivalent feelings about psychotherapy, but people really need it in my opinion, if for no other reason than simply because they need to know how to explain to other people why there's so much friction in their personal relationships.
posted by shmegegge at 1:59 PM on January 30, 2009

but people suffering from BPD really need it...
posted by shmegegge at 2:00 PM on January 30, 2009

To be fair, I would think that the rapidly rising rate of BPD diagnoses has a lot to do with the heavy pressure to prescribe atypical antipsychotics. When they fall out of patent, I'm sure they will become far less popular - just as the SSRIs did.
posted by mek at 2:06 PM on January 30, 2009 [1 favorite]

I actually had a "sitting bolt upright in bed at 2am" moment the other night when it sunk in that my tendency toward conflict avoidance, which has in the past verged on passive-aggression, is almost certainly there because it's been a superbly effective coping-with-BPD-loved-ones strategy.

It's sad to have decided that avoidance is the better strategy. The people I'm thinking of are clever, funny, passionate and talented. In fact, that's pretty much the whole problem right there. If they were just assholes without redeeming traits, it'd be so much easier to disregard the irregular streams of deliberate abuse, thus avoiding the fustercluck that is a relationship with them.
posted by Coyote Crossing at 2:07 PM on January 30, 2009 [3 favorites]

The comments here are an excellent discussion on issues surrounding antipsychotics and the diagnosing of BPD: cliffs notes version is that BPD diagnoses were largely avoided for reasons of stigma until 2008, where there was a strong push to correctly diagnose. The rise of atypical antipsychotics is related, naturally.
posted by mek at 2:12 PM on January 30, 2009 [1 favorite]

To be fair, I would think that the rapidly rising rate of BPD diagnoses has a lot to do with the heavy pressure to prescribe atypical antipsychotics. When they fall out of patent, I'm sure they will become far less popular - just as the SSRIs did.

What? Typically I see people diagnosed with BPD when all medications fail to produce any response. That's kinda one of the signs. Maybe I'm wrong but I was not aware of atypicals being used for personality disorders. The problem I see is misdiagnosis as Bipolar disorder and then treatment with atypicals.

Another sign is that when normally caring mental health professionals start to run away screaming when they see you coming. 20% of your patients, 80% of your time...

Gotta go, someone with BPD waiting for me...
posted by threeturtles at 2:20 PM on January 30, 2009 [2 favorites]

Another sign is that when normally caring mental health professionals start to run away screaming when they see you coming. 20% of your patients, 80% of your time

Yeah, this is a tough one. People with BPD can be great in so many ways, and everyone with mental illness deserves compassion. And yet... if a friend met someone with BPD and was considering a romantic relationship I would advise them to run the fuck away at full speed. And that's sad. But nobody deserves the kind of crap you usually get when you're around someone with BPD for extended periods.
posted by Justinian at 2:28 PM on January 30, 2009 [11 favorites]

Hasn't the push for atypical antypsychotic use diminished at all in the past few years, after concerns about their role in the onset of diabetes?

My understanding is that, at least in terms of bipolar disorder, the atypicals were originally welcomed as a miraculous alternative to the toxicity of lithium—until it became apparent that they carried their own set of health issues.
posted by evidenceofabsence at 2:37 PM on January 30, 2009

Some doctors think my mom is borderline. Some diagnose her with bipolar, which is so grossly an under-diagnosis that it'd be funny if it wasn't so horrifically sad.

I want to love my mom, and if she was just angry or volatile I think I could still give it a shot, but she needs me to a degree I can't provide for her. And to draw me in, she doesn't have any sense of boundaries or appropriateness, often making sexual comments about my body because I guess she thinks that's how people show they love each other. She was an addict most of my early life, and after my dad overdosed and died he became a very important part of her story. Before he died we didn't see him much, but afterward he was magic. Everything he did and was became special and romantic. My parents do look suspiciously similar but she started saying that they also had birth marks in the same spot, and that I did as well. That it was all destiny and Jesus-like. It didn't help that he struck a very romantic figure as well, in overblown 70's snapshots with long gold-blonde hair.

Her parents are Jewish but I see nothing in her early life drawing her to religion, mainly to substances. In her later years she became clean and started moving heavily toward religion, often she'd express jealousy that I went to yeshivas while she was sent to public school. Lately, I've gleaned from my siblings that she's been going to church and talking a lot about Jesus.

She's had a tremendous amount of plastic surgery. Her self-esteem problems are something I can relate to, as I was raised by her parents, my grandparents. And I know that as mean as they were to me they were actually older and quite softened, having been much more cruel to her as a child. And as a child I was often told how ugly my feet were, how big my nose was, how fat I was getting, how stupid and useless I was. I can only imagine the degree of scorn and hatred showered on her. By her parents. I know that's why she thinks complimenting my body is part of showing me love, because she knows that's the opposite of Bad, which is to have your body remarked on negatively.

In the early 2000s I tried to have a relationship with her again. My own life wasn't going terribly well and I was very hopeful that I could enjoy the love and support of a parent. But wow, it didn't quite go like that. I ended up having to take care of her during one of her bigger plastic surgeries, hiding and doling out the opiates, as requested by her, so that she wouldn't become addicted. She'd purposefully disobey doctor's orders to stay in bed and not move around a lot just so, I believe, I would have to spend more time doting on her. Those episodes could get kind of ugly, but things got really ugly when she basically stole my car and then charged me thousands of dollars to ship it back to where I lived.

When I really and finally severed ties with her was when she asked my opinion about whether she should cheat on my step-father. I, of course, said "Uh, no, that's a really terrible idea." But she did it anyway and in such a dramatic manner as to move in the children of her brand new lover, forcing my young siblings into a shared bedroom so some guy she was fucking's kids could live in her house.

After that, I was done. I felt bad for abandoning my siblings at such an awful time for them, but my life was pretty shit too and being around her was magnifying that by a lot.

She has a great sense of the absurd and is really funny. But she makes being alive really hard to deal with.

She used to call my grandmother's place of employment and make unfounded claims about her behavior on the job, and did the same to her sister as well. Don't get me wrong, my grandmother is no saint, but all her vices are saved for the home life, at work she's always been a good and honest worker. I wish I could say my mom was a teenager when she did that, but in fact I was a teenager when she did that. I didn't understand at the time that she was literally and actively trying to ruin my grandmother's life. When I think about it now, it blows my mind. Who would do that?, I think. My mom would.

Yikes, didn't intend to say all that. But thanks, it was cathartic.
posted by birdie birdington at 2:46 PM on January 30, 2009 [24 favorites]

Ignored? I was under the impression that BPD received the most attention of all the personality disorders, and I know it's the only one with an empirically-proven treatment. Dialectical Behavior Therapy, a fairly recent therapeutic innovation, is considered ground-breaking in its efficacy in treating BPD.

Rather than the more theoretical models like client-centered therapy or psychodynamism, DBT follows Cognitive-Behavior Therapy by resting on an empirically-tested foundation. But it goes beyond the points where CBT failed. CBT's major shortcoming arose from focusing too much on either emotionally validating the patient without encouraging behavioral change, or pushing for behavioral change without emotional validation. DBT, which does both, has been proven more effective than any other therapeutic model in treating BRD.

It's been shown to reduce parasuicidal behaviors, reduced rates of treatment drop-out, lead to fewer days of inpatient treatment being needed, and produce a more significant improvement in patient affect.

DBT is, in my opinion, a better attempt to avoid putting the cart before the horse in the course of treatment by progressing through a series of stages organized according to therapeutic priority. By first focusing on behaviors that present the biggest obstacles to progress in therapy, DBT's structure helps it to be effective even in the face of symptoms that interfere with participation in treatment.

BPD is a horrible problem, both for the patient and for those around them. But I disagree that it's being ignored now, or that it has been in the recent past. It's true that its resistance to pharmacological treatment means that it's not on the cutting edge of developing medicine, since Big Pharmacy is pushing other methods of treatment out of the profession, but the same can be said for any other personality disorder. In fact, I'd say there's more hope for BPD than ASPD, NPD, HPD, or schizoid/schizotypal, since there's an empirically proven treatment for BPD.
posted by Law Talkin' Guy at 2:49 PM on January 30, 2009 [11 favorites]

it's a horrendous condition. a close friend developed it. it's one of those conditions that makes it hard for the person to get the help they need. and they manage to alienate almost everyone around them. after a while only the docs will talk to them.
posted by cogneuro at 2:59 PM on January 30, 2009 [4 favorites]

My sister, an LCSW, thinks our mother is borderline.

My sister hasn't talked to my mother for more than 20 years.
posted by Joe Beese at 3:47 PM on January 30, 2009 [1 favorite]

Do they have a bingo card on livejournal?
posted by Artw at 3:50 PM on January 30, 2009

I called my shrink when I read this article. My multitude of meds are doing nothing much and I was afraid this was me and I would never get better and she would also come to hate me. I barely got out, "So, I was wondering if I might have Border...." when she interrupted and said, "Oh my God, did you read that Time magazine article? Total garbage." She was angry -- the first time I'd ever heard her angry. So I guessed I was not the only patient to call about it. I don't know if I have BPD but I kind of want to have a nice, neat, wrapped-up package to describe the all the crazy stuff. It's exhausting.
posted by bluemoonegg at 4:08 PM on January 30, 2009 [7 favorites]

I have a friend who is there such a thing as self-treatment? She has no insurance but has some awareness of her behavior. I suspect self-help books are of little use but thought teaching her some zen might work.
posted by snap_dragon at 4:09 PM on January 30, 2009

If you can teach zen.
posted by snap_dragon at 4:09 PM on January 30, 2009

I don't know if I have BPD but I kind of want to have a nice, neat, wrapped-up package to describe the all the crazy stuff.

That's the problem. Most people's problems don't fit these nice, neatly wrapped packages.

Another problem is that some less-competent therapists use this package as shorthand for "pain-in-the-ass patient."
posted by jason's_planet at 4:23 PM on January 30, 2009 [2 favorites]

I imagine that I'm going to react to this the same way that I did to learning about Asperger's, which is to say that I'll spend several months misdiagnosing it in various people that I know, and eventually coming to the conclusion that they're not sick, just assholes.
posted by Parasite Unseen at 4:54 PM on January 30, 2009 [1 favorite]

I know this isn't the first BPD post on the blue, but I felt like I finally ought to chime in. Today in fact is my last day working as a computer programmer in Dr. Linehan's research lab here at the University of Washington, the Behavioral Research and Therapy Clinics and with her training and research arms Behavioral Technology. Having Time come through for the photoshoot was kind of a trip. I've been here for the past seven years and I can honestly say that I believe we have done some first-class research with an extremely difficult population. Extremely difficult in the sense that they often end up in jail, deceased, or do things like bring weapons to their treatment sessions. Good luck trying to plan a study protocol around them, and doubly so if you're the guy (me) trying to build a computer system to put all their data in neat little rows for analysis. Law Talkin' Guy is correct that today, thanks to the work done to develop an empirically proven treatment the chances have greatly improved of a severe BPD individual getting effective treatment and living a normal life, but the work's not done yet, and it isn't easy.

Unfortunately, right now the mental health research community is facing a double crisis. Even a well-established lab like ours is finding it more and more difficult to secure research funding from NIMH, NIDA and other sources. The chances of other labs working on less-proven grounds trying to develop their own empirical treatments for different disorders seem even slimmer. Meanwhile, the community mental health programs nationwide that need training in proven treatments remain underfunded and unable to take advantage of the research work that we're doing. I was amazed to find out that, at least in Washington State, there was no requirement for research-tested treatments for those undergoing mandatory treatment programs. Even worse, we have worked with the folks down at Ft. Lewis and discovered that soldiers with BPD are being put in a double-bind, since being diagnosed with BPD would eject them from the main support network most of them have.

We have been doing the best with what we can, however, and working on both developing better tools and influencing policy where possible. Recently we have been working with FMRIs to demonstrate that 'talk therapy' can affect neurological response, along with a number of other psycho-physiological measures including heart-rate monitoring and skin conductance. We are trying to push forward the notion that treatment should be based in empirical evidence, that it should be repeatable and verifiable - and that proper diagnosis is a component of that. We're also working on figuring out how the components of DBT and the symptoms of BPD interoperate so that we can improve our own outcomes. The PhDs and graduate students are working incredibly hard to develop a treatment that we can show really helps real people.

If you or someone you know has BPD, keep hope - there exists a treatment. If you're looking for ways to help the cause of mental health, even a little bit can go a long way in your local community. Take a shift at a suicide hotline. Lobby your local politicians to increase funding and to support funding for scientifically-validated treatments. Write a letter to your federal representatives asking for increased research funding and funding for development of new non-drug treatments and programs for their certification and accreditation. If you want to support the research here directly, we're always looking for people to help or even small amounts of funding. I'm sure other labs developing new treatments are the same way.

I've been fortunate to work with some exceptionally gifted young researchers and I have high hopes (if they can be funded!) for the future of BPD research and the application of DBT or related treatments to other disorders (Eunice Chen at Chicago is using it for eating disorders, Melanie Harned here is evaluating it for PTSD, we've also looked at heroin addiction). While I'm sad to be leaving the University, I still believe that the ethic of service to the ignored and untreated and the dedication to evidence-based treatment I saw here will stick with me for the rest of my life.
posted by lantius at 5:06 PM on January 30, 2009 [45 favorites]

Well, damn, lantius, that should be sidebarred.
posted by billysumday at 5:22 PM on January 30, 2009 [1 favorite]

When they fall out of patent, I'm sure they will become far less popular - just as the SSRIs did.

Links please?
posted by TheOnlyCoolTim at 5:25 PM on January 30, 2009

Thank you for your comment, lantius.
posted by ltracey at 7:34 PM on January 30, 2009

"Borderline individuals are the psychological equivalent of third-degree burn patients."

Technically, I think it should be second-degree-- third-degree burns the nerves out, so there is no pain.

Pedantic, I know.

Anyway, I used to be like this. I do not know how I grew out of it, or whether it was chemical or environmental (likely a combination of both). I'm certainly glad I am not like that anymore. I have a pretty thick skin now.
posted by exlotuseater at 7:36 PM on January 30, 2009 [1 favorite]

I have a younger friend I've been in contact with for about a decade who has a kind of reactive arthritis-- in his case an auto-immune disorder-- and who has also been diagnosed by a psychiatrist as suffering from BPD; I've personally seen him (many times) display and heard him describe behavior which meets No.s 2, 3, 5, 6, 7, 8 & 9 of the nine diagnostic criteria listed in the DSM-IV-TR, any five of which are required for a diagnosis.

The really peculiar thing is, his episodes of BPD have been perfectly correlated in time and severity with his reactive arthritis, except that the arthritis preceded the BPD by at least a few hours. I would say the BPD following the arthritis clearly and vividly embodied the last four of the nine criteria:

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, worthlessness.
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

most markedly 9.

So I think my friend's BPD is due to an auto-immune attack on his brain secondary to his arthritis.

I looked for some indication auto-immunity might be involved in BPD more generally, and so far I find only one suggestive, but very far from conclusive item. The atypical anti-psychotics which have had some success in treating BPD, such as clozapine, are often profoundly toxic to some cell populations of the immune system. Clozapine,

The first of the atypical antipsychotics to be developed, it was first introduced in Europe in 1971, but was voluntarily withdrawn by the manufacturer in 1975 after it was shown to cause agranulocytosis that led to death in some clozapine-treated patients.


from the Greek, meaning without; granulocyte, a particular kind of cell; osis, from the Greek, meaning condition [esp. disorder]) is an acute condition involving a severe and dangerous leukopenia particularly of neutrophils causing a neutropenia in the circulating blood.[1][2]

Concentrations of granulocytes (a class that includes neutrophils, basophils, and eosinophils) can often drop to below 500 cells/mm³ of blood), less than one-sixth of the reference value of 3-10 x 103 cells/mm³.

posted by jamjam at 8:58 PM on January 30, 2009 [4 favorites]

Ooops. BPD, clozapine.
posted by jamjam at 9:02 PM on January 30, 2009

One of the things that to my displeasure is not often mentioned in the professional and journalistic analyses is the extent to which the "conditions" are a matter of relationships, not simply individuals. The situations of course made more complex because individuals naturally engage in those contexts that allow them to repeat existing behaviors, for better or worse. But that doesn't mean the others who are involved with the "BP" people don't have their own inverse-mirror role. In one sense, my argument is the old Freudian one, that of transference and countertransference, but honestly I don't like the "victim" and "savior" aspect of that tradition as it existed or exists. We're left with my distaste for the projection of a systematic condition onto an individual. Medicate half the "problem". I'm not saying there's necessarily a black and white better solution; just for the third time, stating my distaste for an aspect of how these things currently get billed.
posted by peter_meta_kbd at 9:02 PM on January 30, 2009 [1 favorite]

So I think my friend's BPD is due to an auto-immune attack on his brain secondary to his arthritis.

Sorry to burst your bubble a bit, but autoimmune conditions are often aggravated by stress. I think it's way more likely that the causality is BPD episode -> stress -> autoimmune problems rather than autoimmune problems -> BPD.
posted by TheOnlyCoolTim at 9:26 PM on January 30, 2009 [1 favorite]

My only run in with someone with BPD was my junior year in college. Junior year was our big sister year (women's college) where we mentored the incoming freshmen. My friend and I were kind of a gruesome twosome that year and attained a weird popularity among the freshmen, attracting Jen.

Jen was smart. Scarily so. And in an intelligent artsy way that was highly attractive. We really wanted to be friends with her, and Jen really needed us to be friends with her. I cannot explain just how strange it all way, except to say it was almost like we were in a courtship with her. But being in our early twenties and not at all worldly, we didn't understand something was really wrong. We just thought she was slightly weird because all artsy, smart people were.

Then one day we decided to stop by her dorm room unannounced to see if she wanted to head off campus with us to the local dinner. My friend knocked and the door sort of stuttered open. Jen wasn't inside and .... Christ, my heart just started pounding things about it. The curtains had been ripped off the window and were slouched in a pile just under the sill. It was the first thing I saw because it was right across from the door. I thought is was so strange because who rips the curtains off the window, because then everyone can see in when you're on the ground floor. Then I realized the beds were completely bare, no sheets or even the plastic liner they're wrapped in before we show up on moving day. Then the floor, wow. Over turned plants, papers, books, pens, rotting food, clothes, lightbulbs, and just squalor spread across the floor. All the shelves were bare. Then in the corner her desk stood neat as a pin and set out like it was a photo taken for a magazine.

My friend and I stood there shaking and then slowly backed out and closed the door. We headed back to her room and shared a bottle of vodka and a gallon of OJ. Then we didn't talk about it.

About a week later Jen left school and we were told she was feeling ill. She called and invited us to visit and my friend thought we should go. I got the impression Jen had been calling her, begging. We showed up and her mother was confused as to why we were there. Jen told her we were her ride. Turns out she had made us her drivers to her psyche appointment. My friend and I hung around outside the doc's office talking about how Jen had a crush on my friend and my friend was afraid Jen was going to kill herself since my friend wasn't gay. Jen came out and told us she was BPD. It was the first I had ever heard the diagnosis.

We dropped her off. She never came back to school. About three weeks after that my friend and I got fancy embossed invitations to a party to celebrate the beheading of Ann Boylen.

We never went.

I have no idea what happened to Jen.
posted by FunkyHelix at 10:42 PM on January 30, 2009 [6 favorites]

Many of the folks I see in my walk-in center are BPD or at least exhibit the traits for this. Many of them will "do the work" and are keenly aware of their symptomology. It can be depressing for the counselor, aggravating with the level of manipulation of the situation, self, and treatment. All but a slim majority are "gamey" and hijack the sessions.

What has really injected this disorder into my life however is the 14 y.o. boy who now calls me dad, of whom I've become a co-custodian. He has severe Bipolar, the type which if under treated has been shown to lead to BPD, Psychotic Disorder, and other fates. I obviously can't be therapeutically objective with him... I'm the closest thing to a dad he's ever known. Yet I see the treatments, the therapy, less-than-effective mediation cocktails, and a series of terrible familial declines creating an opportunity for a lasting personality disorder, versus the incredible intellectual ability, the creativity, the compassion (damn near Buddha-like sometimes), and the glow which attracts sympathetic adults to him as moths to a flame.

When I tuck him in (at 14, he still loves that), I see this sweet, loving face... yet I know he has run a terrifying gauntlet of abuse, poverty, and seeing things he cannot ever un-see which has scarred him forever. So many of the clinicians I work with deeply discount the potential of kids like him. He wants to be a geologist or an engineer. They'll say people like him are lucky to ever be anything ever greater than a stockboy. This is because they are so accustomed to the "average" outcomes of the disease, of the people who in a 50 minute session vomit their desperation all over the nice carpet and are the drama teams of the trailer parks. I can understand their pessimism, yet, there's this boy who can design paper airplanes which fly fifty feet, who can draw a bluejay from memory with perfect detail, who calls me dad.

Even if he were to fully convert into BPD or other like diagnoses, I can't allow myself to believe he will be among the sad, medicated, "problematic" classes. I'll fight as hard as I can for him to be that geologist, even as I've lost all of my so called clinical objectivity.

sorry for the rant, just had to get that out.
posted by moonbird at 11:50 PM on January 30, 2009 [10 favorites]

Interesting disorder. The high-sensitivity idea is right on. I recently had to terminate a years-long friendship with someone who probably suffers from this. One month she'd exchange a hundred text messages with me and want to hang out constantly, declaring me one of her closest friends. The next month she'd freak out about the slightest perceived (illusory) insult and fly into a rage. After awhile it wasn't worth it. It was exhausting dealing with her, constantly defending my actions, feelings like I was always apologizing for everything I did and said around her.

One of the most bizarre situations I ever witnessed was when she, her two boyfriends (polyamorous), and I were all hanging out one night. Time and again, she complained that one or the other of the boyfriends were slighting her in some way. Both of them would apologize profously for the smallest things, lavishing attention on her. It was strange, and scary, how they held up this fragile ego for her. I think ultimately she became angry with me over time because I refused to engage in this kind of apologetic, bend-over-backwards-for-her type of behavior. Hmm, makes me wonder how closely aligned BPD is with narcissistic personality disorder. I've known narcissists whose egos were highly sensitive too.

Anyway, it was too bad, because she was a highly intelligent and interesting person, but yeah, I didn't need to be treated like that.
posted by wastelands at 12:46 AM on January 31, 2009

My older sister has BPD. After years of treatments, and apparent mis-classifications as things like bi-polar, she is no better off than when she was 5. She is now 30, on the streets, and scrounging cash from passers-by for drugs. Heroin and meth are her most frequent medications.

Every few months we hear from her. Usually she has some medical complication, and needs our help. We constantly get calls from collection companies for her unpaid ER bills. Often she appeals to my grandparents by claiming to have found God, then stealing from them and disappearing again, likely for more drugs. Every few days her daughters, who are in my parents' charge, will ask about her. They're too young to understand anything more than the pain of dashed hopes and dreams. The younger was even born deformed because my sister felt drugs were more important than a healthy pregnancy. When she's old enough to realize what her mother has done, the emotional scarring will last as long as the physical.

Everybody in the world appears as nothing more than a resource to her. She complains that nobody ever trusts her, and gets hypersensitive when we point out that she has done nothing to earn and everything to betray trust for 25 years. It's always about the next chance, not the previous uncountable ones, and she inevitably lives up to her pattern.
posted by mystyk at 1:17 AM on January 31, 2009

I believe my mother may have been a BPD sufferer. She died in 1976 in a car accident that almost killed me too (Pinto + alcohol + telephone pole = dead mother). She had spent time off-and-on in mental institutions, where they diagnosed her as 'manic-depressive', sometimes just 'depression'. My siblings (all older and out of the house and on their own) and my grandparents tried to hide from me the fact that my mother was involuntarily committed, but I was a smart kid and figured it out anyway. The problem when it's your mother and your father is out of the picture is that if you're a child, what can you do? You're basically trapped; there's just no way out. I spent years watching my mother slowly devolve from a decent mother into an alcohol and downer addicted person, just a shell of her former self.

If only she had listened to me. When I was 9, my mother married a young black man, 20 years her junior. I told her not to do it, not because I'm racist, but because I felt 'bad vibes' coming from the guy. Sometimes children see deeper into peoples' souls than adults do. As it turned out, he was a mean drunk, and almost killed her one night with a severe beating. I stabbed him that night and he broke my collarbone. He never hit me again, because the next morning, when he awoke from his hangover, I told him, "If you ever hit me again, I will wait until you are unconscious from alcohol and then I will kill you in your sleep." I assume he saw that I was not kidding, because he never hit me again.

The day my mother died, I spent the day watching her drink a case of beer and two bottles of wine with my brother-in-law. When it was time to leave, I begged her not to drive. I begged my sister to drive us, but she was too busy, as she had a night out with friends scheduled. (I didn't speak to her for more than 10 years because of that.) On the drive home, I begged my mother to pull over because she was clearly too drunk to drive. When she refused, I climbed in the back and hunkered down into a fear-ridden ball on the floor. 60 seconds later, she veered off the road and slammed into a telephone pole, dying instantly. Looking at the car, I was amazed that I survived.

Personality disorder, BPD, manic-depressive -- I don't know what afflicted my mother. They didn't have all these terms back then. Whatever it was, she suffered, and so did I.
posted by jamstigator at 3:58 AM on January 31, 2009 [6 favorites]

"He has severe Bipolar, the type which if under treated has been shown to lead to BPD, Psychotic Disorder, and other fates."

I'm curious where you read this, as I haven't heard of this concept.

Also, nobody seems to be mentioning Schema Therapy. I don't know much about it, but have heard enough to know that it, along with DBT, is used to treat not only Borderline but other difficult problems that are not helped with the traditional approaches.
posted by Defenestrator at 4:17 AM on January 31, 2009

Hi mystyk. You wrote, "When she's old enough to realize what her mother has done, the emotional scarring will last as long as the physical." Don't forget that the oyster forms a pearl around a grain of sand.
posted by peter_meta_kbd at 9:03 AM on January 31, 2009

Oh wow. Did not see this post and thread on BPD until late last night. Any thread with people talking about BPD always has the most poignant, heartrending comments.

God, jamstigator, I'm so utterly sorry for what you had to endure and impressed you were able to stand up for your needs with that guy who beat your momster. It's astonishing you are alive. As I've said to other numerous MeFites, who have written me privately about their having survived an Axis II Cluster B parent, it really is a miracle you are alive, here, functioning at all. Many, many do not make it either out of childhood or long into their adulthood.

People who are Axis II Cluster B disordered (NPD, BPD, ASPD and HPD) all have, imo, homicidal ideation and project death onto those closest to them, who often have repeated narrow escapes with death or become risk junkies.

Please accept my loving good wishes for your recovery process and congratulations on your being alive. I wish you a good, healthy life.

lantius, it's awesome you worked on this research. I love your comment and am intensely curious about what were some of the things you discovered or observed were discovered in those years.

Society NEEDS to know about these disorders, to study them, learn about them, watch out for people in power with them, protect the children of parents with these disorders, educate employers about their employees with these disorders.

Statistics: 9.1 percent of the USA population has a personality disorder. "Two previous smaller surveys have estimated the percentage between 9.0% and 15.7%", which I think is more realistic.

I wrote extensively about BPD issues in the other long thread, which covered a number of facets of the disorder.
posted by nickyskye at 11:46 AM on January 31, 2009 [2 favorites]

I dated a girl with BPD briefly (a few weeks). It was a fucking roller coaster, and I'm glad I extracted myself when I did.
posted by empath at 12:18 PM on January 31, 2009

BPD is a lousy term. It's inaccurate. It shouldn't be used in the DSM or anywhere. It's a backward, ignorant and unscientific use of language. The border between neurosis and psychosis? Say wha? That could be said of all the personality disorders. BPD as a diagnosis is used to cover too wide a range of issues.

There is no blanket treatment for BPD, no one pill or even several pills that do it all, no one or several therapies are THE fix. The science/medical community hates that. And, imo, for good reason. It would be like trying to find a pill or a treatment for somebody who said they had pain. Like WHAT pain? WHERE is it? Simply "pain" isn't going to work as a term to treat a medical problem. For the science and psychotherapy communities to do their best with BPD I believe the term needs to be broken into smaller, more precise sections.

Certain doctors, scientists or therapists have, imo, gifts in particular areas. If BPD were divided into more workable components, I believe those, who are able, could more successfully treat aspects of the illness.

As it is now, there is, imo, a large majority of workable/treatable BPD and a certain percent of unworkable, intractable BPD. Even in the intractable BPD, there are issues included that are treatable to one extent or another, such as depression, anxiety, compulsivity, addiction. On the dark end of the continuum, there are issues included in the BPD diagnosis that are, as yet, untreatable, such as pathological narcissism.

Off the cuff, these are some of the elements of BPD:
ptsd, inability to sustain object constancy, depression, anxiety, various substance addictions, emotional volatility, rageaholism, mood swings, social inability, dependence on "romance" or enmeshment with another, usually Axis II Cluster B person (particularly NPD and ASPD), boundary issues, promiscuity, seductiveness, manipulativeness, narcissism, black-and-white thinking/splitting, malice, drama and intrigue addiction, deprivation addiction, eating disorders, the need for self-mutilation, approach-avoidance issues, projective identification, deceptiveness/pathological lying, stalking, reckless endangerment of their own and others' lives, violence, kleptomania, compulsive rumination.

The immediate, medication and/or 12-step treatable aspects of BPD are: addiction, depression, anxiety, compulsivity.

One of the main issues at the core of BPD is PTSD and that issue is itself a complex one.

People with chronic or complex PTSD often behave in the same way as BPDs: Emotional volatility, depression, mood swings, bouts of rageaholism, high anxiety, intrusive memories, compulsive rumination among them.

A soldier returning from war, a battered wife, an incest survivor all can have PTSD to one degree or another, treatable with very different types of talk therapy, behavior modification and different meds. A PTSDed soldier, for example might not, in general, be benefited by blaming as part of the talk therapy. However, the battered wife and the incest survivor would, as a way of establishing a sense of safety and boundaries. A PTSDed soldier might cope in an ill way by compulsively rehashing the fear of the past. The battered wife might cope in an ill way by denying the fear of the past. So the recovery journey, although all suffering with PTSD, would be quite different.

So there is the PTSD that is part of the core of BPD, which is what created the inner architecture of the illness. This is the PTSD arising out of the trauma the person survived in their childhood that was not abated by loving kindness from any other source.

I disagree with the idea that fobbing off a kid to emotionally unavailable nannies is not abuse. Just because it is not violent and the kid is fed, has toys, is medically healthy, does not mean repeated neglect is not deeply damaging neglect. It may be done simply because the mother wants to go to whatever, not out of deliberate malice, but repeated neglect of infants, toddlers and children leaves profound, usually irrevocable scars. So does suffocating children with over control, "spoiling" with too many things as a surrogate for authentic, emotionally balanced loving.

For an infant and toddler, the process of learning connecting and individuating is an essential one. If it is done badly, incompetently, it leaves terrible scars. For life.

Then there is PTSD which brings about BPD traits but is not BPD. That PTSD, imo, is quite treatable. All children of a parent who has an Axis II Cluster B disorder, will have, imo, some BPD traits at some time in their life. Part of this is the "fleas" of having grown up with a disordered parent and being around bad behavior, not knowing how to express anger, displeasure, sadness or grief in responsible, healthy ways. Those unwell behaviors can be deconstructed and healthier emotional/psychological/social skills learned over time. I think adult children of the Axis II Cluster Bs need to heal both their inner child, learn to reparent their core wounds and their inner adult, so they learn to have good out in the world social skills.

Most teens of either gender have lots of BPD traits for a while, including emotional volatility, manipulativeness, narcissism, promiscuity, seductiveness and recklessness.

Another core issue with BPDs is lack of sustainable object constancy. Object constancy is a major perceptual event in an infant and toddler's life. Having felt cared for by a loving primary caretaker, usually a parent, the infant is able to internalize that external love. What is external is now held inside, a perceptual object of memory and inner emotional architecture. My silly name for this is "love battery". Children who are healthily loved have a well charged love battery, which goes with them into the world and which they can depend on in times of stress. It's constant.

A child who was repeatedly neglected, traumatized or abused may have a badly charged battery and come to chronically, pathologically depend on others to feel charged enough to function. Because the person may not find others who offer that sense of constant charge (mothering), an addiction may be used as a substitute, which worsens the situation badly. Or there is tremendous fear that, even if a person is found, that they might be abandoning.

This object constancy issue is, imo, the hardest one for therapists to handle because it is one of the most draining and leads most to empathy burnout. This is where the gifted therapists come into play. Some are able to teach deep object constancy with great patience. But this is an uncommon gift and hard to find. This why, imo, online support communities for people with BPD may be one of the most healing resources for people with this core issue. The web is always there, 24/7/365.

Object constancy issues for BPDs on the low end of the continuum can be treated with many varieties of talk therapy, which may heal some badly charged "batteries" and teach the wounded person to charge their own battery, to reparent themselves, to soothe their wounds without substances or serotonin binges, to find a way to achieve some workable amount of healthy autonomy.

Then there is the behavior mod of DBT. the great thing about behavior mod is that having a healthier external life takes off a huge amount of stress. The relationship between the person offering the DBT and the patient creates a health parent-child dynamic that can be internalized. If a person with BPD traits can stop staying addictively in an enmeshment with an emotional abuser, can stop their substance abuse, stop their self destructive habits like self-mutilation or eating disorders for example, a huge amount of the distress in their lives is lifted.

Once the mayhem in their lives is somewhat quietened, there is more of a chance to work on core PTSD and object constancy issues.
posted by nickyskye at 12:46 PM on January 31, 2009 [11 favorites]

On the dark end of the continuum, is what I think of as "real BPD", as opposed to the treatable aspects caused by PTSD and object constancy issues. Real BPD is, imo, the actual personality disorder - not just treatable issues- and should not be called BPD at all. This destructive personality disorder is all pervasive, rigid, unhealable. I don't know what it should be called. "Real BPD" and HPD (Histrionic Personality Disorder) should probably, imo, be one disorder, not separate. Or one disorder with subtypes.

The abiding issue with this type is DRAMARAMA and routine havoc, chronic messes with intense spikes of fear, dread. This type of BPDed person is always getting into monster dramaramas, epic messes with adrenaline roller coasters. They are around or in car wrecks, sexual abuse scenarios of all kinds, fights of all kinds, screaming matches of all kinds, near murders, every kind of drug and legal fiasco. People with "real BPD" enmesh with sociopaths, malignant narcissists. The external behavior may be modified temporarily but the core issues are too deep, "real" BPD, like NPD or ASPD is not treatable.

In reorganizing/tweaking the latest edition of the DSM, which offers the labels for disorders so that the insurance companies can be permitted to reimburse the doctors/pharmacies for the meds or the treatment, I'd like to suggest the following. The default condition of all the Axis II Cluster B disorders is, imo, pathological narcissism. That is, imo, the basic issue, which has a continuum, a range. Pathological narcissism manifests in a variety of "styles", examples might be:
NPD+dramarama=BPD and/or HPD.
NPD+violence = violent ASPD
NPD+money and influence = politicians and CEOs (just kidding but not), non-violent ASPD
cold cerebral NPD = Aspergery types of NPD, eg Einstein, Bill Gates
hot cerebral NPD = creative intellect types, eg Picasso
somatic NPD = sexual predator, body builder types, eg Schwarzenegger.
posted by nickyskye at 12:46 PM on January 31, 2009 [6 favorites]

jam jam, your comment is intriguing. I put together some links that might be of use to you and your friend: Dr. Sarah Myhill re treating autoimmune illness l she has an online diagnosing site l What Types of Doctors Treat Autoimmune Diseases? l Judith Lee Nelson, MD. Both Dr. Myhill and Dr. Nelson might offer you, if you asked them, an opinion on your friend's situation. At the very least it might prompt them to think about it and maybe along their medical way to come across an answer.

I suspect you are onto something significant there because people who have survived longterm abuse by a person with BPD or any of the other Axis II Cluster Bs (BPD, NPD, ASPD, HPD) often suffer from autoimmune illness. The stress and elevated cortisol levels induce a cascade of issues.
posted by nickyskye at 12:47 PM on January 31, 2009 [1 favorite]

The thing with the Axis II Cluster Bs is that they are context dependent disorders. The people with them do not lead quiet lives of misery, they savage those around them, in particular their children, their spouses, their siblings, their co-workers, their neighbors, their lovers. For every person with an Axis II Cluster B, there are hundreds, thousands, millions, even tens of millions of people left damaged in their wake, verbally abused, emotionally abused, sexually abused, psychologically abused, spiritually abused, financially abused, politically abused, stalked, libeled, slandered, harassed, bullied, intimidated and traumatised.

With the massive speed/meth addiction happening, at least 1.5 million addicted crystal meth users in the United States, social workers need to learn the difference between meth induced BPD traits and actual BPD.

New names for BPD are ERD and EDD.

Out of the FOG forum.

Radio Lab: Into the Brain of a Liar.

Personality Disorders: The Controllers, Abusers, Manipulators and Users in Relationships byJoseph M Carver, Ph.D., Clinical Psychologist.
posted by nickyskye at 12:55 PM on January 31, 2009 [2 favorites]

What's the best community of recovery and good life practice for bpd sufferers?
posted by By The Grace of God at 3:21 PM on January 31, 2009

(i mean on the internets, that is!)
posted by By The Grace of God at 3:35 PM on January 31, 2009

Hi By The Grace of God, there are many aspects to the BPDed person, as I said above. With that in mind, here are some possibly useful links, hope they're helpful:

First, an excellent, wise article, Support Groups for Borderline Personality Disorder by Patty Fleener M.S.W.

BPD Central. BP links on that site.

Online Support for Those with BPD

About Borderline Personality Disorder forum

Top » Personality » Support Groups

BPD Today

borderline · Support Group for those Dx'ed with BPD

ABC article on the trust game.

BPD Resource Center.

DBT Resources: Clinical Resource Directory

If the person who suffers from BPD traits is a survivor of childhood sexual/physical abuse or negect, support groups for that of many kinds.

Adult children of alcoholics recovery. Other dysfunctional family survivor issues.

Al-Anon, for those working on not getting into, not being addicted to or enabling relationships with abusers.
posted by nickyskye at 4:32 PM on January 31, 2009 [5 favorites]

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