Backing Up: Borderline Basics

Having described in some detail what borderline PD 'feels like' to me, I want to provide a more academic description of the condition.

This page on this site gives a very clearcut and accurate 'official' description of this disorder. A brief excerpt follows.

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a serious psychiatric illness. The diagnosis encompasses patients with a pervasive pattern of affective instability, severe difficulties in interpersonal relationships, problems with behavioral or impulse control  (including suicidal behaviors), and disrupted cognitive processes. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. The estimated prevalence of BPD in the general adult population is about 2%, mostly affecting young women. It has also been estimated that 11% of outpatients and 20% of psychiatric inpatients presenting for treatment meet the criteria for the disorder.

What are the symptoms of BPD?

1. Frantic efforts to avoid real or imagined abandonment.

2. 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. spending, sex, substance abuse, reckless driving, binge eating).

5. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood.

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms. (DSM IV)

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change of plans.

Distortions in thinking and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone by acting out; i.e. impulsive behavior or suicide attempts.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

You can see how the behavior patterns captured in the previous two posts resemble borderline PD.

In my own discussion of BPD on this blog, I am well aware that my tone is somewhat ambivalent - in fact, this is one reason I've postponed discussion of this subject. I myself do not feel sufficiently detached to be a wholly reliable 'guide' in this area. However, I know that this is a problem shared by many seasoned health care professionals and practicing therapists.

And there is good reason for it. It is very, very difficult to maintain a healthy detachment when dealing with a friend, colleague, classmate or loved one who suffers from this disorder, because this disorder 'takes hostages'. Everyone within a specific radius of a BPD sufferer also suffers, in one way or another, from BPD. Even trained and seasoned therapists can find working with a BPD sufferer extremely challenging. It can call on all the emotional reserves a person can bring to bear.

I would also like to add that it can be difficult at times even for a trained, professional observer to distinguish BPD from other disorders, especially bipolar disorder and alcohol or substance abuse. "Nobody's Girl" could, possibly, be either bipolar or addicted, based on the behaviors described [see earlier post]. She could also be borderline plus bipolar, or borderline plus alcoholic / drug addicted. I've described elsewhere how alcoholism, in particular, imitates personality disorders, and can occur concurrently with them.

One way to determine how much dysfunction arises from addiction, bipolar, or a similar condition - vs. borderline PD - is to 'reduce the number of variables' by successfully treating the other underlying condition[s]. This is quite a challenge; it's time-consuming, requires the full cooperation of the person involved, and is thus certainly not a simple step to take. If, when this is successfully managed, borderline type behavior persists, then one can be reasonably confident about its origins.

Another way to estimate, at least, whether borderline PD is present is to consider how 'flamboyantly destructive' the person's episodes of acting out are [see previous post] and how punitive their intentions seem to be at the time. You'll note from the list of characteristics/behaviors above that, while terrified of abandonment, borderline sufferers also experience intense, inappropriate rage, and can even, briefly, appear psychotic under stress [the list does not mention that this stress is fairly often self-produced; it does not take long to realize this in real life].

If you see frequent, punitive outbursts of rage, not associated with 'using' alcohol or drugs [!], and especially if the person in question seems to 'lock on' to an idea that is totally at odds with reality as a way of justifying punitive rage, it is very likely indeed that you are dealing with borderline PD. Bipolar sufferers, and people with addictions, are not, invariably, punitive. Borderline sufferers, in contrast, will almost always react punitively to stress or disappointment, real or perceived, with an intensity that is far out of proportion to the magnitude of the 'offense'.

Having said this, I must again emphasize: I am still struggling with my own ambivalence about this condition. While I feel genuine sorrow for the people who suffer from it - because Borderline PD doesn't 'just grow'; it's a response to early, almost un-survivable trauma - I also understand the frustration and exhaustion, and general sense of helplessness, that friends, colleagues, loved ones, and therapists can experience when dealing with the behavioral manifestations of this disorder.

It is said that 'old age is not for sissies'. I would add to that, that 'close relationship with BPD sufferers is best managed by the strongest, bravest, and healthiest among us, ideally with external resources that match their internal resources.'

In my own experience, I've found that I simply cannot cope with the disorder in anything but the mildest form; for me, the only way to win is not to play. I find the inevitable punitive, abusive behavior to be more than I am willing to accept. This, I emphasize again, is my response, and my solution, and must be seen and understood as such.

For I also know that others, both professionals and non-professionals, manage to maintain productive relationships with actively, acutely suffering borderlines. And I know that the condition can be treatable. Therefore I know that there are heroes living among us, and by that I mean both those who suffer and sincerely seek relief from this condition, and those who remain staunchly alongside them all the way.