-- Borderline Personality Disorder

Introduction and preliminary information

Introduction & disclaimer
This is my little catechism (= information provided in a question - and - answer format) on Borderline Personality Disorder. I have tried to provide information which I find useful and which I didn't find anywhere else, or at least not in concise form. Please note that this document represents my personal opinion to the best of my limited knowledge, and is therefore not meant to be authoritative -- I encourage you to actively seek further information.

Briefly, what is BPD?
Although difficult to define concisely: it is a serious mental illness that causes a complex pattern of generally idiosyncratic and destructive behaviour of the patient against him- / herself as well as against close friends and family.

What exactly is BPD? What does the "borderline" in BPD mean?
Though not overly descriptive of the illness, it means "on the border between neurotic and psychotic"; in other words, even though it is a very destructive illness, sufferers can appear to be deceptively functional.
It wasn't meant to mean "bordering on other mental illnesses", even though that's how BPD is often perceived, sort of a fuzzy mix of several mental problems.

What's a personality disorder?
Since there is no exact definition of personality, there can be no exact definition of a disturbed personality. It's a handy blanket term for a whole raft of mental illnesses, more descriptive than scientific.
The widely recognized though not-so-handy definition would be "inflexible and maladaptive patterns of behavior".
"Recognized" personality disorders include: avoidant, dissociative, antisocial, histrionic, sociopathic, schizoid, schizotypal, and of course borderline. The existance of some of these is under heated debate, as well as whether severe criminal behaviour is rooted in personality disorder.

What do "neurotic" and "psychotic" mean?
To put it very informally, "neurotic" describes a mental affliction that leaves the sufferer fairly functional (i. e. capable of getting on with his or her life), whereas "psychotic" describes a more serious illness. Keep in mind that these are colloquial, not scientific, terms.
Another informal explanation: "neurotic" means "not quite as bad as a psychosis"; "psychotic" means "far more serious than a mere neurosis".

How do BPs behave? I have read that BPD only ever co-exists with other mental illnesses, that there is no "pure" BPD.
In my mind BPD is a pattern of behaviours, so as long as we are talking about the pattern there is "pure BPD"; but when we are talking about the symptoms it appears to be a strange mixture of mental illnesses and reckless behaviour.

What isn't BPD?
One popular misunderstanding of BPD is to mistake it for its symptoms. Idiosyncratic teenager behaviour (getting piercings and tatoos, sitting in a dark and musty room listening to Kurt Cobain and Judas Priest all day), for example, isn't BPD -- it's fairly normal for teenagers to behave that way. Self - mutilating behaviour (slashing one's under arms or burning skin with cigarettes) can be a symptom for BPD, but they do not constitute the illness -- BPs may not exhibit this sort of behaviour, and people who do might not be BPs.
BPD is a pervasive, degenerative and permanent pattern of generally destructive behaviour which takes the form of acting in (self - injuring) and acting out (hurting close friends and family).
It is distinct from ... Can BPD be treated with medication?
BPD itself -- no. But medications can be useful in taking the edge off the illness. Here is some information I found on the internet:
Medications are often successfully used to help people with BPD by reducing depression, dampening their emotional ups and downs, and putting the brakes on excessive impulsivity. According to Larry J. Siever (1997) antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Tegretol may be helpful for controlling excessive anger and irritability.

What other mental disorders can appear similar to BPD?
BPD generally causes a wide array of symptoms, so obviously there are many similarities to other mental illnesses. In fact, in my experience, BPs often have a history of being unsuccessfully treated for other mental problems; for example, the BP went through an anorexic phase and was treated for eating disorder; then the BP stopped the anorexic behaviour and acquired a similarily erratic behaviour, which is again treated unsuccessfully. In such a case, after the diagnosis of BPD has finally been made, the patient is often very weary to engage in yet another form of therapy. What is the DSM-IV Definition of BPD?
Note: DSM = Diagnostic And Statistical Manual of the American Psychiatric Association; the "psychiatrist's bible" that lists all "recognized" mental illnesses and conditions.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and 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-mutilating behavior covered in (5).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
  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). Note: Do not include suicidal or self-mutilating behavior covered in (5).
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  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, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

General BPD information and some frequently asked questions

A brief history of the term BPD
As far as I know the term "Borderline Personality" was first coined by a certain Kernberg in the late 1960ies (he spoke of a group of patients characterized by a "borderline personality organization" of their personalities). Before that, Hoch and Polatin had already used the name "pseudoneurotic schizophrenia" in 1949. Earlier than that, it is probably fair to say that the illness had not been recognized at all.

How come so much more women than men (about 75 versus 25 percent) have BPD?
I would speculate that men are more likely to act out and come into conflict with society: "women go to therapy, men go to jail". It could also be that society deems agressive behaviour to be more acceptable in men than in women.

What causes BPD?
The experts say that it has probably to do with neurochemistry, and that it is caused by biological factors and / or upbringing. In other words: they don't bloody know.
A more elaborate version of this admission of ignorance: The causes of BPD are unclear, although psychological and biological factors may be involved. Originally thought to "border on" schizophrenia, BPD now appears to be more related to serious depressive illness. In some cases, neurological or attention-deficit disorders play a role. Biological problems may cause mood instability and lack of impulse control, which in turn may contribute to troubled relationships. Difficulties in psychological development during childhood, perhaps associated with neglect, abuse, or inconsistent parenting, may create identity and personality problems. More research is needed to clarify the psychological and/or biological factors causing BPD.
My personal theory is that BPs feel abnormally (they don't feel anything in situations they should, or their feelings are unduly strong) because of a neurobiological defect, and they don't learn to adapt and cope from their family, leading to a pattern of destructive behaviour and desperation.

I have heard that BPD is caused by sexual abuse during childhood.
This is a myth, but with some truth to it: there is one statistic that suggests that about 75% of a BPD sample group have been abused as children. Personally, I don't really see a stringent connection.

Is BPD the same as slashing your arms (and similar self - mutilating behaviour)?
This is one of the more "spectacular" and publicised aspects of BPD. It is typical of BPD, but by no means a prerequisite.

I know someone who behaves BPD - like, but it seems to be less serious (less intense or persistent).
If you have problems dealing with this person, you might want to try out the communication strategies that are recommended for BPs, and see if they work for you. Knowing about BPD is of course very useful in case the condition becomes worse.

Can BPD be treated through Freudian psycho - analysis?
In my opinion, psychoanalysis (or psychodynamic analysis) is maybe philosophically or historically interesting but scientifically worthless, and should not be practised any more. The "talking cure" itself may be helpful to many people, but most of Freud's concepts are bogus in the light of modern day.
Instead, cognitive therapies and DBT seem to be the way to go.

Non - BPs, or how to deal with the BP in your life

What are the characteristics of a non - BP?
This list was written by a non - BP and posted on the internet -- food for thought.
  1. Desire to make others happy even at our own expense (co-dependency).
  2. Not looking after our own needs.
  3. Excessive flexibility.
  4. A feeling we have to do better, and our best is never enough (perfectionism).
  5. An inability to focus on ourselves and a tendency to be too easily led into focusing (unhealthily) on our BP. (It's easier to think about other people's problems than my own.)
  6. Lack of clear boundaries (other people wouldn't tolerate the raging).
  7. A feeling we always know better (enough to drive even the sanest into a BP rage).
  8. An intensity/devotion to commitment and fidelity ... Intransigent hope coupled to expectation that we *must* be able to effect something positive to improve the circumstances.
  9. Willingness to interpret the slightest "improvement" as undeniable progress.
  10. Willingness to abandon ourselves, with determination to not "abandon" another and the inability to recognize that this solves nothing except to continue the self-devaluation that began the spiral --only now, it is cloaked in a definition of humanity.
  11. Poor self-image/out of focus or simply self-hatred.
  12. Nothing I do is good enough/ the need to be criticized.
  13. Justify my existence by doing for others.
  14. Need to be controlled/unable to trust in self-direction.
  15. Irrational loyalty to others -- willingness to abandon self but not others.
  16. Inability to recognize our own hurt feelings when emotional injured.
  17. The ability to make an instant assessment but to delay action (deer-in-the-headlights syndrome).
  18. The ability to delay gratification, even forever.
  19. Long-suffering, martyrdom - nobody else could stand this, but I can and I do.
  20. The ability to co-operate but not to delegate.
  21. The initial ability to see the forest through the trees but eventually the inability to escape the jungle.
  22. An inability to allow people to fail or suffer.
  23. The tendency to feel responsible for others at the expense of being responsible for ourselves.
  24. Unsure about our own value and dependent on the other person's opinion.
  25. Willing to jump through burning hoops while bending over backwards, way out of your way, in order to win back the approval of someone who once appeared to approve; willingness to keep trying no matter what.
  26. Excessive conscientiousness.
  27. Willing to appear "too good for this world" - with good intentions, optimism, a forgiving nature, we advertise unconditional love, offer a place where a BP can feel warm and secure - for a while.
  28. Belief that I am the only salvation for the "poor" BP in my life if he/she would believe in me, we would both find true happiness.
  29. Drawn to drama, passion and fairy tales; belief in a soul mate and happily ever after.
  30. If I "saved" this person, he/she would be eternally obligated and grateful to me - read: would never leave me; abandonment issues of my own.
  31. Low self-confidence, meaning that I think that I do not deserve anything better than what I'm getting.
In other words: they are a bunch bleeding heart tree huggers.
The above list seems to me rather cynical, blaming the people who have to deal with a tremendously difficult situation.

All there is to know for the aspiring BPD - insider

Here is some BPD vernacular, so that you are hip to the lingo. What is meant by "stop sponging and start mirroring"?
When you are communicating with a BP, it is generally a good idea to maintain a non - aggressive, non - accusatory, understanding and even overly gentle attitude. Basically, this creates the basis for communication, because otherwise the BP will just shut down and become aggressive.
Once you are at a stage when the atmosphere has become relatively calm and composed, this is when the "stop sponging and start mirroring" act comes in.
So far you are holding your breath, trying to stear clear of confrontation, appeasing (sponging). Mirroring means: reflect the BPs statements back to the BP (for example by summing up what they have said), delineate the different positions, and point out what part of the problem lies with the BP, without becoming accusatory.
It's certainly easier said than done!

What's PUVAS?
This is an acronym describing a communication strategy for non - BPs to deal with BPs, propagated by the authors of the book "Stop Walking On Eggshells"; PUV describes the behaviour of the non - BP towards the BP, AS the behaviour for the non - BP towards him/herself; together, it stands for ...
P ... ay attention
U ... nderstand fully = ask them to be specific, make sure that there are no misperceptions
V ... validate the BPs emotions
A ... ssert yourself with "my reality statement"
S ... hift responsibility for the BPs feelings back to the BP

What is DEAR?
Another acronym, this time describing how to communicate with a BP, developed by Marsha Linehan as part of her Dialectical Behaviour Therapy (DBT). It stands for ...
D ... escribe
E ... xpress
A ... ssert
R ... einforce

BPs In The Public Eye

I have heard that actress Angelina Jolie is BP.
The basis of this is that she starred in the movie "Girl, Interrupted" as an alleged sociopath (for which she received Best Supporting Actress Academy Award ("Oscar")), alongside Wynona Rider who played a character who was supposed to be a borderline patient. Also Jolie has said in interviews that she used to mutilate herself (i. e. cut her arm), and that she carries a drop of her husband's blood encased in a pendant.
Personally I think that this is a lot of media hogwash, that according to the available information Angelina Jolie definitely isn't BP. It's a good example though of how psychological catchwords are inappropriately used by the media.

I have heard that Diana Spencer (the Princess Of Wales, "Lady Di") was BPD.
In my opinion this is highly speculative, solely based on the fact that she once mentioned self - injuring behaviour (slashing her arms) in an interview, and that she generally behaved somewhat outrageously (which might well be normal for someone in her position).
My personal opinion is that, based on the available information, Diana Spencer did not suffer from BPD.

I have heard that the fictional character Alex Forrest, played by Glenn Close in the 1987 movie "Fatal Attraction" is supposed to represent a BP.
The basis for this is that AF is shown to behave aggressively against herself as well as her lover, and that she seems to have a problem with interpersonal boundaries. However, to me she is very far removed from a "real life" BP -- maybe she was just angry.

Comment on supposed BPs in the media
It is of course tempting to speculate about people in the public eye, and be it just to give you the comforting feeling that might have it made, but hey, they've got problems just like me and you. But it generally seems to lead to misinformation, especially with BPD. I would generally advise to refrain from making these speculations.

I am looking for an newsgroup on the internet usenet on BPD.
In my experience, most of the discussion is taking place on website forums and through mailing lists, rather than through the usenet.

Some links ...

This site is a listed member of the Borderline Personality Disorder Webring.
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