28 December 2008

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.


Anonymous Anonymous said...

In my early twenties, I once shared a house with a girl who exhibited these behaviours. After the initial couple of weeks, I thought she was just a little crazy but nothing to get too worried about, but after a couple of months I began to be very worried.

Her behaviour can only be described as that of the flatmate in 'Single White Female'. This young woman took over my life, and got very angry with me if I didn't allow her to continue. In the first few weeks of our house sharing she announced to me that I was her best friend. We were strangers before taking this house together, I only knew her on recommendation from a mutual friend (who also happened to be her counsellor, but that is another story). I told her that she barely knew me, and that I wasn't her 'best friend'. THe reaction was volcanic. From then on, she took over my life, even going so far as to take great pains to get a job where I worked. When I changed employers, she did the same. She was sick and disturbed, but as a twenty something, I didn't think it was all that bad.

I had another friend at the time with BiPolar disorder (she was on meds) who became a christian and decided God had cured her. She stopped the meds, and the bizarre behaviour she visited on everyone was a direct result of believing this lie.

Sometimes I feel like I have a neon sign on my back advertising myself as a friend to all disturbed and abusive people looking for supply.

All of this information helps me to make sense of my past however.

Thanks for these posts.

28 December, 2008 20:07  
Blogger Stormchild said...

Thanks for your comments, Meg - they're always edifying :-).

I tend to be more sympathetic to bipolar sufferers, because a key part of the illness is often a disabling of the person's insight. People think they can 'surf the high' and get enhanced creativity, etc. from their manic phases - or the mania sneaks up on them because they can't recognize the signs once it's in the neighborhood - or the disease persuades them that they don't need their meds.

"An Unquiet Mind" by Kay Redfield Jamison is a very good read; she's bipolar herself, and thus has firsthand knowledge about it.

OTOH, trying to keep up with someone whose insight is disabled and whose disease is in control is utterly impossible - and I don't recommend even considering it as a course of action.

Interesting... your former housemate's stalker-type behavior [following you from workplace to workplace] reminds me of something similar that has happened to me [mildly] and another woman I know [severely] - I called it The Ultimate Hostile Takeover in an earlier blog post.

At the time I saw this as a particularly vicious form of narcissistic predation, essentially 'identity plagiarism'; but you've shone new light on it.

I still think the 'social nasty' version, where X is 'cut dead' while her ideas and concepts are stolen left and right by the very ones cutting her dead, is pure narcissistic/sociopathic predation.

It hadn't occurred to me before, but perhaps the more extreme and prolonged form of this behavior, where someone obsessively copies the clothes, car, doctors, workplace that someone else has, is sometimes the result of borderline 'idealization'.

IOW, sometimes it's an attempt to clone the target's personality because the borderline sufferer doesn't feel that they have any personality of their own [or doesn't like the personality they do have], and thinks a new one can be acquired like a change of clothing.

It's still very unhealthy, though, and it's certainly still predatory, because of course it is a perfect setup.

Once the borderline flips from idealizing to devaluing their target [and they will - this flip also occurs with narcissists], they're perfectly positioned to 'push the target out of the nest' and take over, at least externally, the identity they've copied. And it's absolutely predictable: this is what they'll try to do.

Who needs science fiction? You've lived the real life version of "Invasion of the Body Snatchers".


**facepalm facepalm headdesk headdesk**

28 December, 2008 23:09  
Anonymous Meg said...

I have always been fascinated by human behaviour and looked for patterns and causes in my own life as much as others. Now in my mid-forties, it seems I have been given some insight and hindsight which I lacked in my twenties.

I can put others bizarre behaviour into categories, instead of assuming it was all random and inexplicable, and that is a great comfort to me.

My house-mate had used these tactics with much less success to others, but apparently, despite my protestations, I was a good source of supply. I think it was that in my twenties I was observant, but much more easy-going, and more liable to attach myself to abusive people because of my N family behaviour. I had been trained to be the 'devil's valet' if you like.

My housemate went on to take over the friendships I had formerly had, thinking she was doing me out of a good thing, not realising that I had already outgrown these friendships ahead of her and discarded them based on abusive behaviour. She was inheriting my cast-offs.

THe final insult was when my husband proposed to me and I made the mistake of asking her to be my bridesmaid (I was evidently temporarily insane at the time). She had recently been proposed to by her boyfriend and had declined. As soon as she knew the date of my marriage and had agreed to be a bridesmaid, she decided to get married herself, and fixed the date a month BEFORE my wedding, and asked me to be HER bridesmaid.

Whether she was Borderline or Narcissistic, only an experienced mental health professional could ascertain. I do know she had faced severe trauma as a child (or so her counsellor had told me but I am not sure how much of that is true). So I was always excusing her behaviour because she was the poor victim.

This is off topic, but I would be interested in your thoughts about the victim as blameless heroine. You know, that ability of victims to get to a point where they start to cash in on their status, and refuse to take any accountability for their own behaviour because nothing is any longer their fault.

THey use phrases like...

'You can't pick on me because I have always stood up for the sufferings of others and have suffered greatly myself'

29 December, 2008 18:59  
Blogger Stormchild said...

Good heavenly days, Meg. What you're describing is textbook narcissist-borderline behavior.

-the business of 'taking over' your friends and workplace, and copying your identity otherwise: I have personally tagged this 'psychological cannibalism', and I chose this term very deliberately. Sorry for what follows, but it's necessary to explain what I mean and why the term is so apt.

Literal human cannibalism, when it's actually part of a society's formal practices [as opposed to an act of desperation in time of famine or catastrophe] has tremendous psychological, even spiritual [!] connotations to it. It's the ultimate form of both literally and symbolically defeating an enemy, forever, with permanent foreclosure of any comeback or revenge. While at the same time the cannibal is ***literally*** consuming everything good about the defeated foe - thus doubling the defeat. The cannibal has not merely killed, but absolutely, and intentionally, DEVOURED, the enemy, thus taking everything possible away from them, in the most degrading way the human mind can imagine. Truly evil.

See the parallel? [And we can talk theology, but I think that's best done elsewhere. The negative spiritual aspect to this is huge, and IMO that is not accidental, given that there is such a positive sacred ritual that is - in all respects - its opposite.]

-the business of having to jam her wedding in first, so she got married before you, because you asked her to be a bridesmaid in your wedding: this is classic narcissistic female-vs.-female competition, carried to an insane degree. She had refused her suitor's proposal just prior to learning of your wedding, and then immediately changed her mind and rushed to the altar merely to 'beat you to it'.

You got off lightly, methinks; I'm surprised that she didn't try the other time-honored narcissistic response, i.e., attempting to **ahem** 'divert the attention' of your fiance before your wedding day, then making sure that you found out about it afterwards.

This is classic narcissistic-borderline behavior.

Also classic hostile dependency, at its most extreme.

Don't believe for a moment that this woman ever actually liked you. These are the actions of someone who hates.

And please don't think that I'm making any inferences here about you being unlikeable. Quite the contrary. This type of desperate clinging - while simultaneously inflicting as much damage as possible - usually arises from profound envy. You had what she did not [friends? career? love? mental health?], and she knew it.

I am sorry, I am having trouble moderating my responses here, and I'm showing a definite inclination to bash. I simply haven't put enough emotional distance between myself and this area to be 'detached enough' quite yet.

But the behavior that you have described is so completely abusive that I'm not feeling as guilty about it as I might otherwise.

I have nothing but sympathy for people who have been hideously traumatized, but that sympathy does tend to dry up and blow away rather quickly if I see that traumatic history being used as an excuse to justify 'paying the abuse forward'.

Not every abused person becomes abusive. I know that even the healthiest person may become a bit short-tempered, temporarily, under sufficient adversity. But consistently abusive behavior - abusiveness as a salient personality characteristic - is always, always a choice.

Which, I think, actually answers the question you raise at the end of your most recent post, too. Folks who want to be given a permanent exemption from the normal rules of decent behavior because they have suffered greatly - yet refuse to admit that the suffering they now inflict is just as significant to those they harm - are people who have made a serious moral and ethical choice.

You might be consoled by reading Primo Levi ["The Drowned and The Saved"] or Viktor Frankl ["Man's Search for Meaning"] or Corrie ten Boom ["The Hiding Place'] - I'd suggest Levi if you can only read one of these. These people survived the Holocaust. They know a thing or 6.023 x 10E023* about suffering, and none of them chose to respond by inflicting as much of it as possible in return.
*Avogadro's Number, 602,300,000,000,000,000,000,000. Primo Levi was a chemist... but surviving Auschwitz turned him into a philosopher and psychologist extraordinaire. His book "The Periodic Table" was a bestseller in my youth... may he rest in peace.

30 December, 2008 20:47  

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