Back to Main Page

CHARACTERISTICS OF BORDERLINE PERSONALITY DISORDER
                       
         (ACCORDING TO DSM-IV)   Updated 3-6-14

"They (Borderlines) have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat."   Shari Roan

"We are not responsible for how we came to be who we are as adults.  But as adults we are responsible for whom we have become and for everything we say and do."   
from BPDRecovery website

Jerold Kriesman and Hal Straus refer to borderline personality disorder as 'emotional hemophilia; [a borderline] lacks the clotting mechanism needed to moderate his spurts of feeling. Stimulate a passion, and the borderline emotionally bleeds to death.'

TOPICS on this page
Long-Term Borderline   (8-15-12)
Co-dependency & BPD  (4-11-12)    long article, but it is the best I've seen on the topic
Erotic Transference      (2-3-12)
Emotional Anaphylactic Shock   (7-20-11)
History of BPD   (6-9-11)
Boredom     (6-9-11)
Cheat Sheet: BPD for Dummies  
Story about a relationship with a Borderline female
DSM-IV criteria

Affect, Cognition, Impulse, Interpersonal
What is Impulsivity?
Rejection & Hostility 
(2-2-13)
Mood Instability
Identity Disturbance
Unstable Relationships
Anger
Suicide    Why Suicide?   Severe Suicide Warnings:  3-6-14
A Borderline's
Sudden Suicide
  (
7
-4-11)
DBT Treatment Reduces
Suicide Rates  
3-17-13
Self-Injurious Behavior
Abandonment

Results of the author's test results from similiarminds.com    (this was an eye-opener)

 

Personality Disorder Test Results
Paranoid |||||||||||||||||||| 86%
Schizoid |||||| 26%
Schizotypal |||||||||||||||| 62%
Antisocial |||||||||||||||| 62%
Borderline |||||||||||||||||| 74%
Histrionic |||||| 30%
Narcissistic |||| 18%
Avoidant |||||||||||||| 54%
Dependent |||||| 26%
Obsessive-Compulsive |||||||||||||||||| 78%
Take Free Personality Disorder Test
Personality Test by SimilarMinds.com


 

Borderline personality disorder ‘not linked to psychosis transition’ 
Published on August 7, 2012   By Mark Cowen, Senior MedWire Reporter 

The presence of borderline personality disorder (BPD) is not associated with an increased risk for transition to full-blown psychosis in ultra-high risk (UHR) patients, research shows. 

The authors found that there was no significant difference in 24-month psychotic outcomes between UHR patients with and without BPD. 

"Clinicians working in UHR clinics have often seen Axis II features as co-morbidity, rather than risk or protective factors per se. This is in contrast to Axis I disorders, such as depression, that have often been implicated in increasing the risk for transition to psychosis in the UHR group," comment Andrew Thompson (Centre for Youth Mental Health, Parkville, Victoria, Australia) and team. 

"Our findings support this distinction but we do not suggest that BPD pathology should be ignored as a clinical problem in its own right," they add.

The researchers studied 96 patients deemed to be at UHR for psychosis due to the presence of attenuated psychotic symptoms within the previous 12 months, a history of brief self-limited psychotic symptoms in the previous 12 months, or a genetic vulnerability to psychotic disorder with either schizotypal personality disorder or family history of psychotic disorder in a first-degree relative. 

Of these, 48 developed full-blown psychosis over a follow-up period of 24 months, with no significant difference among the groups regarding at-risk criteria met, or functioning level at baseline. 

Overall, 14.6% of the participants met DSM-IV criteria for BPD at baseline. 

The researchers found that there was no significant difference between patients who did and did not develop full-blown psychosis regarding the presence of baseline BPD rates. 

There were also no significant differences between the groups regarding the number of BPD traits. 

"It appears that UHR patients with concurrent BPD pathology experience similar psychotic outcomes to those without BPD pathology, at least over the short term," conclude Thompson and team. 

Licensed from Medwire news with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

Codependency and Borderline Personality Disorder       March 26, 2012
(
from downwardspiralintothevortex.com Blog  by "Haven") 

“I can’t live without him.” “Everything will be ok as long as she loves me.” “I must do everything I can do make sure that he’s happy {and therefore associate me with being happy}”

Sound familiar?  

I’ve been talking about relationships a lot lately so I thought I’d touch on a couple things that are not uncommon with Borderline Personality Disorder: Codependency and Counter-Dependency.  

I am not {generally} codependent so I’m relying on my research here. I am counter-dependent. They’re definitely both worth looking at.  

When everything you do, when everything you think about saying {or not}, when everything you feel, is dependent on someone else, it’s a problem. It’s codependent.  

Codependent behaviors, thoughts and feelings go beyond normal kinds of self-sacrificing or caretaking. People who are codependent often take on the role as a martyr; they constantly put other's needs before their own and in doing so forget to take care of themselves. This creates a sense that they are "needed"; they cannot stand the thought of being alone and no one needing them. Codependent people are constantly in search of acceptance. When it comes to arguments, codependent people also tend to set themselves up as the "victim". When they do stand up for themselves, they feel guilty. 

Codependency is an addiction. An addiction to people. Often very specific people. Codependency is a behavioural and psychological condition in which a person sacrifices his/her own wants and needs in favour of someone else’s wants and needs in order to maintain an unhealthy relationship. Codependency is probably related to the intense fear and frantic efforts to avoid abandonment common in BPD. 

Codependency is a dysfunctional relationship with the self. It involves habitual behaviors that are ultimately self-destructive.  Having some symptoms or periods of codependency are actually pretty common for most people. But in order to be considered a true codependent, like any disorder, it is something that must persist for an extended period of time and disrupt your life in an unhealthy way.   

So what’s the difference between depending on someone and being codependent on someone? In a healthy relationship a person can recognize when they need help or assistance in life. Having someone you trust and can turn to for occasional assistance or help when you need it, but otherwise being able to manage your life and support your own self esteem on your own, is a healthy level of dependence. To be codependent is to forget that your life and self-esteem will go on without the love and support of the person you are counting on. Everything in your world, your happiness, yourself worth, depends on the thoughts, opinions, and emotional integrity of the person that you are focused on.  

A codependent Borderline lacks a true self-perception. Their identity is dependent on the people around them. Who they are is determined by the perception of someone else.  

There is a hidden motive in the actions of those that are codependent. One so sneaky that the person themselves are usually unaware of it. Like many aspects of BPD, it’s a motivation of selfishness. When someone is lost in a world of codependence, sacrificing every waking moment to ensure the happiness of those around them, the real underlying, subconscious motivation isn’t because they altruistically want the world to be happy. No, it’s because they want to be loved and appreciated. Everything they do stems from the motivation of wanting to receive: receive love, receive validation, receive self-worth, receive, receive, receive.

To be fair, most people do this to some extent. We do things because ultimately it is to our benefit to do them. It’s that nature of the beast of humanity. For a codependent relationship though it’s so prevalent in the person’s life that it utterly disrupts their ability to live in a healthy way.  

On the surface they appear to be the pinnacle of giving, caring, and nurturing, and indeed all those actions are, they often give of themselves to a fault… but it’s at the expense of what they really need, which is acceptance by themselves. Everything they do is to gain validation from an outside source. 

Someone who is codependent will often bear the burdens of the person they are dependent on. Their mind will be consumed with thoughts of how to provide happiness for someone else. Their happiness, their feelings will in fact, be determined on whether or not something they do is able to create happiness in another. Relief comes from seeing relief in another. Self-worth comes from the recognition in another that what they did made their life better in some small way. This is where I have found myself being codependent before.

The ironic thing is that because someone who is codependent is so absorbed in being accepted by another, they are actually incapable of being accepted by another because they aren’t providing anything real for another person to accept. They’re giving and giving and giving, but they’re giving things that they think another person wants, not things that they actually are.  

How can you feel secure in the love of another human being when ultimately you can’t believe that they love you for who you are… Because all you’ve shown them is what you can do for them and not who you can be with them? It’s an innate contradiction that someone who is codependent may never see. They give things, they give actions, they give relief of responsibility, but what they aren’t giving is the one thing they really need to give in order to form a true bond… themselves. But since their own identity is based on the perception of the person they’re trying to please it becomes a self-fulfilling cycle of sadness, self-doubt, and resentment.  

Also ironically, is that the actions of a codependent often contribute to their partner being selfish and self-serving instead of appreciative and nurturing, which is what they want. When everything you do is focused on another person, naturally their focus is going to turn more and more towards themselves as well. The codependent may subconsciously condition their partner to also believe that everything that is done should be done for them, which contributes to their partner ignoring the needs of the codependent, and makes the codependent redouble their efforts to gain attention and favor, leading to the partner becoming more self-involved…. Can you see where this is going? It doesn’t help cultivate a healthy relationship at all. All it does is cultivate an environment where nothing is ever enough and the codependent person will continue to lose themselves to a cycle that they can never find the security they need.

How can you tell if you are codependent? There are many, many symptoms of codependency. I didn’t come up with this list, in fact I found the write up for most of this here. I will take a look at how I think these things line up with my life though. So let’s take a look at some of them shall we:

Symptoms:

Care taking: the codependent individual feels responsible for other people. S/He feels anxious and even guilty when another has a problem. S/He feels compelled to help that person solve their problem. S/He anticipates the other's needs and feels angry when his help is not effective or rebuffed. At the same time, the codependent feels slighted that others won't help her/him out when s/he needs help. However, this same individual who is constantly doing way too much for others, and not getting "any" help from anyone, will usually answer when asked what is wrong or what do you need, responds, "Oh, nothing." The codependent minimizes his/her own worth. The codependent is his/her own worst enemy.

I can definitely see myself having a lot of these codependent care taking traits. Wouldn’t you feel slighted if you helped someone out constantly and they didn’t reciprocate at all?

The codependent is over committed, harried, pressured, feels safe when giving, but insecure when someone gives to him/her, goes out of her/his way to help others, and believes deep inside that other people are responsible for the way they are and will blame others for the "spot" they are in. Others make them feel the way they feel, they are victimized, angry, unappreciated, and used. Others are driving them crazy.

Over committed, harried, pressured, feels safe when giving: Check. I’m not at all insecure when people give something to me. In fact I usually keep these things around me to help with my lack of object constancy. I do feel weird when someone goes out of their way for me, but I think that’s more because I’m so unused to it and also detached from my emotions that I don’t always know how to respond properly. ::laughs:: Believes deep inside…. No no, I believe right up on the surface there that most people are responsible for the “spot” they’re in. I can absolutely recognize and accept when people have been truly taken advantage of and given a bum lot in life, but ultimately we are responsible for our own lives, choices, and actions. I may have been born and abused into this slew of mental health disaster, but it’s my responsibility to do something about it.   Others are driving me crazy. Hah! True.

Low Self Worth: codependents tend to come from troubled, dysfunctional families, and will deny this to the very end. They blame themselves for their family's shortcomings. They blame themselves for everything. They pick on themselves constantly: not intelligent enough, not pretty enough, not smart enough, not athletic enough, not good enough. But if another criticizes them, boy do they get defensive and angry, not to mention self-righteous. Don't try to give a codependent a compliment; they reject all compliments and praise, even though they get depressed from lack of compliments and praise. They feel "different" from the rest of the world. They reject themselves, but fear rejection. Everything is taken personally, they love being the victim (though will deny it with their last breath). They have been victims of sexual, physical, or emotional abuse, abandonment, neglect, and/or alcoholism. They feel like victims, carry lots of guilt and shame, and think their lives are not worth living. They should have done this, should have done that. They "should" themselves to death. Codependents say, "Why me?" on the outside, and know "why me" on the inside. While trying to prove to others that they are good enough, to themselves they feel worthless and empty.

My self-worth fluxuates with my mood or to be perfectly honest, my body image. My self-worth is entirely dependent on how I perceive myself and this ties in immensely to my dysmorphic issues and my personal accomplishments. Whether anyone else recognizes what I do or not does not raise or lower my self worth. In fact, having my achievements recognized often makes me feel awkward because I don’t want the attention. I am very hard on myself, I do put myself down, but this is due to my perfectionistic nature. Criticisms will make me spin down emotionally because it is a recognition that someone else has seen my flaws. I raise and lower my self-worth. I can usually take compliments. Compliments from women I take sincerely. Compliments from men that I’m involved with I take sincerely (especially if we’re already sleeping together because it’s not like they have to butter me up to get what they want now). Compliments from men I am not close to or strangers, does make me question their motives. Big time. This has been proven to be an issue though and I don’t know if it’s just me being paranoid or me being justified. Maybe a bit of both, but it doesn’t mean that I’m wrong to question peoples motives. I do feel “different” from the rest of my world, but I actually am different than most people I know. Life is definitely worth living even if it sucks sometimes. I do “should” myself to death sometimes but I do this regardless of whether something is just for me or not. “Why me?”…if I know it on the inside than that’s all there is to it.

Repression: most codependents repress their own needs, their own desires. They are afraid to let themselves be who they are and often appear rigid and controlled. They repress all thoughts of self-worth out of their awareness and they are full of guilt. Codependents cannot have fun.

I definitely repress my own needs and desires in order to take care of those around me first, but that falls into the care-taking category. If it’s just me on my own I don’t do this. If I need something I definitely go ahead and take care of whatever it is. Growing up and until a year or two ago I felt guilty about getting myself anything that I desired, but I’ve pretty well taken care of that at this point. I can definitely have fun too.

Obsessive Compulsive Disorder: codependents worry. They worry about the slightest and silliest things (True): they worry that people are talking about them (False); they worry that people are not talking about them (False); they lose sleep over little things (True); they check up on others (Rarely); they try to catch people in the act (Only if I know I’m being used, manipulated, taken advantage of or plotted against. i.e. Evil-Ex); they never find any answers (False), they focus on other's problems (True); they spend money compulsively (I make some compulsive decisions but only if all my bills and responsibilities are taken care of first); eat or drink compulsively (True) ; and wonder why they have no energy and why they never get anything done (I get so much done it’s ridiculous).

My OCD tendencies have nothing to do with codependency and everything with needing structure and control in my life. I’m not even sure how most of these things qualify as OCD.

Controlling Behaviors: codependents try to control events and people through helplessness, guilt, coercion, threats, advice-giving, manipulation, or domination. They are afraid to let people be who they are or let events happen naturally. They've lived in so many situations in which they had no control (abuse, alcoholism, etc) that they now try to control everything and get frustrated and angry when they cannot. They end up feeling controlled by events. They feel controlled by others. They resist change as if change were a contagion.

This is one thing I’m pretty happy to say that I don’t do. When I was younger and Acted Out I definitely had more manipulative tendencies that I would consider controlling behavior. After Evil-Ex though, I learned to let go. With him I definitely felt the need to control a lot of things, but he was actually working to make my life spin out of control. I don’t hold onto things as hard anymore. I do resist change. Change is hard. Especially when it comes fast it can destabilize me, but I don’t know if that is codependent so much as normal. The most zen of Buddhist monks will never have a problem with change, but everyone gets thrown for a loop when things change unexpectedly. I used to fight change tooth and nail. I’ve learned to adapt and move with change as much as I can though. The only person I am compulsive about controlling, is myself. No matter how you look at it, this just isn't going to work.

Denial: codependents ignore problems or pretend they do not exist. They pretend things are not as bad as they are; they tell themselves it will get better; they stay busy to avoid thinking about things; they get confused, sick, depressed and visit doctors for a prescription. Many are workaholics. They lie to themselves and others. They believe their lies. And most of all, codependents will leave a healthy situation (by lying to themselves that it was an unhealthy situation) and get back into an unhealthy situation; though for the most part, most codependents either never leave an unhealthy situation/relationship, or they go from one unhealthy situation/relationship to another.

Denial is one place I’ve struggled with, but it’s always been a wanting to believe something even though I knew it to be otherwise. Even when I was with Evil-Ex I knew the truth of my situation, but my emotions were in such complete opposition that I couldn’t reconcile the two. That’s what made it more maddening for me. I saw the reality but felt a different way. I’m very good at seeing what is actually going on. Making a decision in opposition to my emotions though can be difficult for me. There were times I wanted to believe his lies, but I didn’t actually believe his lies.

Dependency: codependents do not feel happy or content with themselves. They look to others to supply them their happiness or their needs. They are threatened by the loss of anything or any person that provides them with their happiness.

They do NOT love themselves. They did not feel loved by their parents. They equate love with pain and believe others are never, ever there for them. They need people more than they want them; their lives revolve around someone else's life; they tolerate abuse; feel trapped; leave one bad relationship and jump into another bad relationship. They wonder if they will ever find true love. And if they do find true love, they will leave that and find a loveless relationship because deep inside (often beneath consciousness) they feel unworthy of love.

Hm. I don’t expect or think anyone else can make me happy. I do know that I am happier when I am with people I care about and enjoy the company of. Left alone for long periods of time (days, weeks, months) I do sink into a depression greater than usual. To me this doesn’t seem unreasonable though. Who wants to be forever alone? Some people I’m sure, but that strikes me as more unnatural. I think I’m more concerned with being alone, than being happy.

I do equate love with pain, but every experience of romantic love I’ve had has actually caused me deep and intense pain. This is a result of experience, not unfounded fear. I actually do not tend to jump from one bad relationship to another. This constant dating and always having a new partner is relatively odd for me. Traditionally I will end a relationship and stop dating for 6-8 months so I can get my head back on straight. With only a couple exceptions the people I choose to date are generally very good people. Then again, those don’t seem to be the ones I form intense attachments to, do they.

Poor Communication Skills: codependents blame, threaten, coerce, beg, bribe, and advise others. They don't mean what they say and don't say what they mean. They don't take themselves seriously and expect others to do the same. They avoid getting to the point, asking indirectly for attention by sighing, crying, or moping around. They say everything is their fault. They say nothing is their fault. They can't get to the point, and if pressed, they're not sure what the point really is. They believe their opinions do not matter and have difficulties asserting their rights or expressing honest emotions, openly and appropriately. They apologize for bothering people.

I’m getting better at communicating my needs though in the past I was very, very bad at stating anything that was going on with me internally. I do often feel guilty for expressing what is on my mind though I don’t believe things are my fault when they actually aren’t. I’m also absolutely ok with acknowledging when I have screwed up and taking the blame for something I’ve done… once I recognize that I screwed up. It’s so tricky. For a long time I blamed myself for the abuse I took in my relationship with Evil-Ex because I felt responsible for staying in that relationships. To an extent I still feel that is my fault even though the abuse didn’t end once I stopped the relationship. I thought it was my fault. In reality though, I didn’t ask for the abuse, he had no right to treat me that way. It was his fault for being a monster. Tricky tricky tricky.

Poor Boundaries: codependents say they won't tolerate something from anyone, and then engage themselves in exactly that. Then they gradually increase their tolerance levels till they can tolerate most anything others do to them. They allow others to hurt them, over and over and over again. They stay in bad relationships for all the wrong reasons: to fix the other; for the kids (like kids need to grow up in a loveless relationship); because things will get better; and worst of all: because they feel they deserve to live in hell. They complain and blame but far too many never get away from their abuser. Then they finally get angry and become totally intolerant and the cycle begins all over again.

I’m definitely guilty of saying I won’t tolerate something but then allowing it to happen. However, this is conditional. If it’s someone that I’ve already fallen in love with and have emotions that are beyond my ability to control than this becomes a possibility. If it’s not someone that I’ve fallen for and do not have a deep attachment to, then I won’t tolerate shit and I can put up reasonable boundaries. I don’t have any of these reasons though. If I stay with someone that is hurtful it’s because I love them, not because I believe I don’t deserve to be happy. This may still be an expression of codependency, b/c the thought of losing someone I’m so attached to is beyond painful. However once I reach my limit, I’m done. For good.

Lack of Trust: codependents do not trust themselves, their feelings, their decisions, other people, or even God. And then, right out of the blue, they'll trust someone who is totally untrustworthy.

I don’t trust people for good reason. I don’t trust myself because I tend to be impulsive and I make poor emotional choices. However! I do trust some people that have most definitely earned my trust, like Roommate or my sister. One thing I’ve never done is trust someone that is totally untrustworthy. I may interact with them, I may want to trust them, but I won’t actually trust them.

Sexual Problems: codependents go through cycles in the bedroom. They are caretakers there too. They have sex when they don't want to or withdraw sex to punish their partner. They try to have sex when they are hurt or angry, and refuse to enjoy it. They withdraw emotionally from their partner, feel revulsion toward their partner, and don't want to talk about it. They reduce sex to a technical act, wonder why they don't enjoy it; lose interest; make up reasons to abstain, wish their partner would die, go away, or guess what is wrong with them; they have strong sexual fantasies about others and consider having affairs.

I can definitely see myself being a caretaker here. I never say ‘no’ to sexual anything even when I’m tired or uncomfortable (if it’s with someone that I’m already established with! I don’t sleep with random people). Though to be fair I do actually enjoy it and I think using sex or denying sex as a weapon or punishment is just wrong. Idk, I have very few sexual boundaries because I really do enjoy a lot of things in regards to sex. It’s something to enjoy and have fun with. When my boundaries were violated I did learn to talk about it and set solid boundaries!

General: codependents can be extremely responsible or irresponsible, they become martyrs, sacrificing their own happiness. They find it difficult to be happy, feel close to others, or have fun and be spontaneous. They are passive aggressive, feeling passive, hurt, helpless yet violent and angry. They laugh when they want to cry. They are ashamed of their families, of their relationships. They cover up, lie, and protect their family from their problems. They don't seek help because they don't feel the problem is all that bad. And then they wonder why the problems never go away.

In general I can see much of this as true for me. I’m not usually ashamed of my family or relationships (unless cognitively I know the relationship is very unhealthy and yet I’m still emotionally attached). When it comes to my problems, I definitely feel shame when I am not able to take care of something on my own and will not ask for help if I can avoid it. I don’t want others to see me struggle. I think there is an important distinction in this statement. That being “To protect their family”…. I may cover up and lie about having problems, but it’s not to protect others, it’s to protect myself.

I would think that someone who is codependent would feel helpless, feel that they needed someone else to rely on in order to fix their problems. Maybe that’s wrong though. Maybe someone that is codependent is so worried about people thinking they will be too much trouble if they have any problems that they must hide them. What do you think?

Over-responsibility – is taking responsibility for someone else’s problems. A person who is over-responsible will blame themselves for the actions, feelings, and thoughts of others. This can make them a victim of the problems other people have regardless of whether or not those problems have anything to do with them.

No. I often feel guilty if I can’t help enough but I don’t usually feel responsible for other people’s problems.

Resentment and self-pity often accompany co-dependence. When you do so much for other people (whether voluntarily or involuntarily), it’s easy to feel unappreciated, resentful, and self-pitying when you do not receive acknowledgement for the things you do.

I don’t know folks. I recognize a lot of these traits in myself, but I don’t know if I necessarily attribute all these things to codependency. A lot of them come from issues that I have that are completely separate from having anything to do with relationships. Or they’re a product of abuse. That’s the problem with self-diagnosis. You can go through a checklist and see that you match certain things, but if the context of those symptoms isn’t right then you may be attaching to a false label.

Top

Borderline Personality Disorder: Erotic Transference   By Sonia Neale  

Ahh, the Erotic Transference!  The question is do we want to have sex with our therapist because of a deep-seated oedipal complex, primary attachment gone tragically awry, a pre-verbal object relationship that cannot be unified or do we simply want to shag an attractive, empathic person who sets our genitals on fire? 

Much psychological literature is written by Sheldon Cooper types (The Big Bang Theory) who are socially autistic or have Asperger’s syndrome and are desperately trying to quantify the unquantifiable by using terms such as “erotic transference” instead of “lust or love” because by using wholly scientific terms it distances themselves from their own primal and lustful urges.  That is why Amy Farrah Fowler (Sheldon’s girlfriend) cannot understand these sinful longings she gets when she is around men.  It greatly distresses and frustrates her. 

Admitting you have sexual feelings for your therapist to your therapist can create shame and disgust. We are all sexual beings, it’s how we relate beneath the superficial veneer of expected manners and mores of society. 

Civilization as we know it would break down if we all gave in to our primal urges, so we stifle them down until we get into an intimate relationship with someone. Unfortunately that someone can be a professional business person in the form of a clinical psychologist rather than a hot guy/girl at a nightclub where both parties know that the end result of the night in question can end up with a roll in the hay.  That is not an expected outcome of the therapeutic relationship, yet the feelings can be there –  from both sides of the couch, the other side of which is known as erotic counter-transference. 

Just because you want to have sex does not mean you should have sex, but does acknowledging these feelings help the situation any?  Is it the man or woman of the therapist that turns you on, or is it the warm intimate association of sharing secrets in a cozy, isolated office? 

If you saw your therapist at the beach in a pair of baggy bathers or sitting at the pokies in the local casino, or face down in the frozen chip department at the local supermarket would that not shatter your illusion that they are some sort of Greek God sent down from Mount Olympus just to save you from yourself? 

Many if not most therapists are very uncomfortable with their client’s “erotic transference” and find it difficult to talk to them about.  This is understandable.  People with Borderline Personality Disorder with serious boundary issues and greatly heightened emotions and high sensitivity tend to fall in love easily with anyone who shows them small tender mercies.  I know this equation so intimately. 

My therapist gave me space and time to explore these feelings and never made me feel ashamed of them.  I just had to own them knowing she did not feel the same way.  She made that crystal clear in a sensitive, caring manner.  Thank God she did.  I am a better person for her boundaries and ability to enable me to take responsibility for my feelings and deal with them without involving her.  It was a long and messy process but one that clarified our relationship, gave it a framework and created guidelines for healing and moving on so I could live my life fully. 

Dealing with this is something that desperately needs to be addressed in the training process of future therapists. 

Sonia Neale started therapy writing for post-natal-depression and anxiety. Fifteen years later she is the author of two books, The Bad Mother’s Revenge and Death by Teenager, both published by ABC Books/Harper Collins. She lives in Western Australia, is married with three teenagers, has a certificate in Psychoanalytic Psychotherapy and is studying for a psychology/counseling degree. She is not yet a psychotherapist, and has deferred her academic studies in order to pursue a Certificate IV in Mental Health. She currently works as a facilitator in the mental health field. Her website address is www.sonianeale.com.


Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance              By Sonia Neale

Sometimes, the smallest things in life can cause the greatest pain and physical reaction.  A bee’s sting is almost invisible to the naked eye and yet can easily kill someone when they have an allergic reaction.  A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.” 

When a person has a life-threatening reaction to the poison from a bee sting, an ambulance is called and the person is taken to hospital where they receive treatment for their illness as well as respect and dignity but when someone suffering an emotional reaction to life circumstances presents at emergency, they are sometimes treated with rejection, intolerance and disdain.  People can die from a bee sting and Borderlines can “die” from their own personal rage and self-hatred.  If you present at emergency with a swollen face and throat unable to breathe with all your body organs shutting down, is some doctor or nurse going to say, “OMG, it’s a tiny bee sting, how bad can that be, look at you, get over yourself,” like they sometimes do when Borderlines present at hospital with similar symptoms. 

Yet both types of people are in much pain and danger.  One is considered entirely physical and the other is considered entirely emotional.  Or is it entirely emotional?  When a sensitive person with a history of trauma has an emotional “bee-sting” reaction to someone’s criticism there is a definite physical reaction. 

Borderlines tend to be hypervigilant, which means they live with permanent muscle tension and a certain excess of adrenaline pumping round their system at any given time.  So when criticism hits, the body goes into an emotional anaphylactic state where cortisol floods the brain and body system and a type of blackout occurs where nothing anyone says or does registers.  Your body has gone into “shock.”  When I used to get into such a state someone could have cut my arm off and I would not have noticed. 

Things are said during this time that are simply appalling.  I have used language I would not use in normal everyday life.  I have said things that are deeply hurtful and as my husband has said, “you can mend a vase but the cracks are always there for those to see.” My therapist says it is best to repair those cracks with gold. Her favorite quote, by Barbara Bloom is “When the Japanese mend broken objects they aggrandize the damage by filling the cracks with gold, because they believe that when something’s suffered damage and has a history it becomes more beautiful.”  I prefer her take on this matter. 

Therapy has taught me that my perception of events and criticism is usually erroneous.  Even if people are critical and disrespectful, it is about them and not me.  If my ideas get criticized it is not because I am a loser and I deserve to die, it is because we both have a different belief system and ways of handling situations.  There is no right or wrong, just opinions. 

I have criticized my therapist on many occasions including recently when she raised her colleagues’ fees in the light of almost certain public benefit cuts.  Her reply was that her practice survived before the benefits were given and hopefully will survive after the benefits are cut.  She raised her fees because she valued herself and her colleagues.  She did not feel the need to get upset or question herself or her actions because she believed that what she was doing was the right thing to do. 

It is this sort of self-valuing that is empowering to people like myself who always feel others are more valuable and powerful than I will ever be.  When we assert ourselves and say, “No, I don’t like that because….” we can start to realize that it is ok not to people-please all the time.  I said no to unpaid overtime because I value myself as a worker otherwise I will feel undervalued and get resentful.  Like my therapist I am worth it. 

Mindfulness and radical acceptance of people and situations as in Dialectical Behavior Therapy is the key to, well, if not happiness, then a more content and peaceful self.  It is the road to what Abraham Maslow calls self-actualization – autonomy, independence, few but deep friendships, a philosophical sense of humor, resistance to outside pressures and transcendence of the environment.  These are the things I strive for and have spent much time in therapy trying to get a good grasp of. 

A great book, which promotes self-actualization that I am reading at the moment, is “The Art of Happiness” by the Dalai Lama.  While I may not quite reach the emotional plateaus that His Holiness is capable of, I can certainly learn how best to inoculate myself when swarms of emotionally stinging bees are trying to infiltrate my brain and body system.

Top


1-10-2011




Top


Borderline Personality Disorder Diagnosis:  DSM-IV Diagnostic Criteria

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 points 1-9.  The link of "Video" takes you to a video, all made by the same BPD patient.   She explains the criterion in a very straightforward manner.  I recommend viewing them.  For Recklessness, see  #4 Impulsivity "link".

1)   Frantic efforts to avoid real or imagined abandonment. (Excludes #5) Video

2)  A pattern of unstable and intense interpersonal relationships characterized by  alternating between  extremes of idealization and devaluation.  Video

3)   Identity disturbance:  markedly and persistently unstable self-image or sense of self.  Video

4)   Impulsivity in at least two areas that are potentially self-damaging e.g., spending, sex, substance abuse, reckless driving, binge eating.   (Excludes #5)  Video

5)   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.  Video   Why is suicidality so common in Borderlines?

6)   Affective [mood] instability Video

7)   Chronic feelings of emptiness. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are.  Video

8)   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).  Video

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

  • Feeling that others are picking on you or are trying to cause you harm.
  • Having a feeling that people or things are "unreal" or experiencing episodes of feeling "zoned out" or "numb."
  • Feeling emotionally dead inside.  Video

Top

Important Considerations about Borderline Personality Disorder

1)   The 5 of 9 criteria needed to diagnose the disorder may be present in a large number of different combinations. This results in the fact that the disorder often presents quite differently from one person to another, thus making accurate diagnosis somewhat confusing to a clinician not skilled in the area.

2)  BPD rarely stands alone.  There is high co-occurrence with other disorders.

3)  BPD affects between 1 - 4% of the population.  The highest estimation, 2 %, approximates the number of persons diagnosed with schizophrenia and bipolar disorder.

4)   Estimates are 10% of outpatients and 20% of inpatients who present for treatment have BPD

5)  More females are diagnosed with BPD than males; reportedly by a ratio of about 3-to-1, though some suspect that males are under-diagnosed.

6)   75 %of patients self-injure.

7)   Approximately 10% of individuals with BPD complete suicide attempts.

8)  A chronic disorder that is resistant to change, we now know that BPD has a good prognosis when treated properly.  Such treatment usually consists of medications, psychotherapy and educational and support groups.

9)  In many patients with BPD, medications have been shown to be very helpful in reducing the severity of symptoms and enabling effective psychotherapy to occur.  Medications are also often essential in the proper treatment of disorders that commonly co-occur with BPD.

10) There are a growing number of psychotherapeutic approaches specifically developed for people with BPD

Top

 

THE ABOVE INFORMATION EXPLAINED IN MEDICAL TERMINOLOGY

Affect

  • chronic/major depression
  • helplessness
  • hopelessness
  • worthlessness
  • guilt
  • anger (including frequent expressions of anger)
  • anxiety
  • loneliness
  • boredom
  • emptiness

Cognition

  • odd thinking
  • unusual perceptions
  • non-delusional paranoia
  • quasi-psychosis

Impulse action patterns

  • substance abuse/dependence
  • sexual deviance
  • manipulative suicide gestures
  • other impulsive behaviors

Interpersonal relationships

  • intolerance of aloneness
  • abandonment, engulfment, annihilation fears
  • counter-dependency
  • stormy relationships
  • manipulativeness
  • dependency
  • devaluation
  • masochism/sadism
  • demandingness
  • entitlement

    Top

Doesn't sound good, does it?
 

IMPULSIVITY    

Are you someone who tends to take action without thinking through the consequences? Do hasty decisions often get you into trouble? Do you often act based on your feelings in the moment rather than on a long-term plan? You may be struggling with impulsive behavior, one of the symptoms of BPD.

Impulsivity can be a very troubling aspect of BPD. Impulsive behavior can lead to problems with relationships, physical health, and finances, as well as legal issues. Learning more about impulsive behavior and treatments that target it can help reduce the impact of impulsivity in your life.

What is Impulsivity?

Impulsivity is a tendency to act quickly without thinking about the consequences of your actions. Impulsive behavior usually occurs in reaction to some event that has caused you to have some kind of emotional response.

For example, imagine you are waiting in line at the bank and someone cuts in front of you. If you were to act on an impulse, you might immediately behave aggressively toward that person (e.g., yelling, or even becoming violent), without thinking about the consequence of this kind of behavior (e.g., being escorted out of the bank or even arrested).

It is important to note that occasional impulsive behavior is not necessarily indicative of a diagnosis of BPD. Everyone acts impulsively from time to time. Only when this type of behavior becomes either frequent or serious (e.g., dangerous), is it considered problematic.

What are Some Examples of Impulsive Behaviors?

Some examples of impulsive behaviors include:

  • Going on spending sprees
  • Driving recklessly
  • Promiscuous sex
  • Binge eating
  • Yelling, shouting, or screaming at others
  • Threatening to harm others
  • Destroying property
  • Shoplifting
  • Getting in physical fights with people

Can Impulsivity Be Treated?

Yes. Many treatments for BPD have components that target impulsivity. For example, Dialectical Behavior Therapy (DBT) focuses on building skills that will help you to reduce your impulsive behaviors.

Mindfulness, which is a skill taught in DBT, can help you to stay more aware of your actions so that you can take time to consider consequences. Mindfulness can help you to make healthier decisions about how to respond to events around you.

Medications may also help with impulsivity, but are probably most effective when used in conjunction with psychotherapy.

If you are struggling with impulsivity, learn more about treatments for BPD that may help you get impulsive behavior under control.
by Kristalyn Salters-Pedneault, PhD


Top

 
HISTORY OF BPD

The symptoms of Borderline Personality Disorder have been noted and recorded from the earliest times. The presence of impulsive anger, melancholy, and mania has been described from as far back as 800 c.e. Following the suppression of the concept during the Middle Ages (due in part to the conflict it created with ecclesiastical teachings), more serious acknowledgement of its existence begins in the mid-17th century. By the late 1930s, the first clinical analysis of the disorder appears, however lack of specific definitions and terminology hindered studies as the term “borderline” became a catchall term applied to a number of conditions.

By the late 1970s, efforts were made to create a standardized model of BPD, and by 1980 it was recognized as a personality disorder in the DSM-III, with the current terminology established by the APA.

Top


AFFECTIVE MOOD INSTABILITY

The two hallmark psychobiologic vulnerabilities or temperamental predispositions are affective instability and impulse aggression. The individual with BPD is exquisitely affectively sensitive to environmental shifts, particularly in their interpersonal sphere, so that they react with feelings of, for example, rage and despair and separation, humiliation and fury at a setback at work, etc.

It is likely that this highly sensitive affective thermostat is present from a very early age and may apparently have genetic as well as early environmental antecedents.  This affective sensitivity during the course of early development may prove a challenge to the successful mastery of the developmental tasks of childhood and adolescence. For example, an infant who is very sensitive to separation or bodily pain may cry more frequently and be more difficult to soothe when mother or other caretaker leaves, the baby may cry loudly and persistently.  

For a depressed or affectively sensitive parent, such a child can present a particularly formidable challenge. As the child grows older, these crying spells may turn into temper tantrums. For even the most empathic parent, there may be a temptation to respond to these tantrums with either excessive indulgence or at other times inattention of neglect. For the child, these inconsistent responses may constitute a sort of "intermittent reinforcement" making their temper tantrums more likely.   The temper tantrums may be the antecedents to affective storms that we may see in the borderline patient during adulthood when threatened with a potential loss of a relationship or feelings of abandonment.  by Larry J. Siever, M.D.

Top

 
IDENTITY DISTURBANCE   

"There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.
by John M. Grohol, Psy.D.


Top

 
UNSTABLE & INTENSE RELATIONSHIPS 

"People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficient supports or as cruelly punitive. Such shifts other reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected."    by John M. Grohol, Psy.D.

Top

 

UNDERSTANDING BORDERLINE ANGER

What is Borderline Anger and How is it Treated? 

Intense, inappropriate anger is one of the most troubling symptoms of borderline personality disorder (BPD). It is so intense that it is often referred to as “borderline rage.” While anger is a key feature of BPD, very little is known about why people with BPD experience anger differently than other people or even how this experience is different. New research, however, is shedding light on the nature of borderline rage.

What is Borderline Anger?

Borderline anger is more than just a standard emotional reaction. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), anger in BPD is described as “inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights).”

Clinically, anger in BPD is called “inappropriate,” because the level of anger seems to be more intense than is warranted by the situation or event that triggered it. For example, a person with BPD may react to an event that may seem small or unimportant to someone else (e.g., a misunderstanding) with very strong feelings of anger and unhealthy expressions of anger (e.g., yelling, being sarcastic or becoming physically violent).

Research on Borderline Anger

While borderline anger has long been a topic of debate and speculation among BPD specialists, it has only recently become a topic of careful research. Researchers are now examining how borderline anger is different than normal anger and why it occurs. For example, researchers are now trying to understand whether it is that people with BPD are more easily angered, have more intense anger responses or have more prolonged anger responses than people without BPD (or whether it is some combination of these factors).

For example, a recent study examined anger in people with BPD compared to people without BPD (healthy controls) in response to an anger-producing story. This study found that people with BPD reported the same level of anger as the healthy controls in response to the story, but that the healthy controls reported that their anger decreased more quickly over time than the people with BPD reported. So it may not be that people with BPD have a stronger anger reaction, but that their anger has a much longer duration than other people experience.

Research in this area is very preliminary, and much more work is needed to fully understand how and why people with BPD experience borderline anger.

How Is Borderline Anger Treated?

Psychotherapy
Most psychotherapies for BPD target the strong anger responses that people with BPD report and exhibit. For example, in dialectical behavior therapy (DBT), patients are taught skills to help them better manage their anger and decrease angry outbursts. Other types of psychotherapy for BPD, including schema focused therapy, transference focused therapy and mentalization based therapy, target anger as well.

Medications
While there are no medications for BPD that are currently FDA approved to treat the disorder, there are some that have been shown to reduce anger in BPD. BPD medications, however, are probably most effective when used in conjunction with psychotherapy. 
by Kristalyn Salters-Pedneault, PhD

Top

 
SUICIDE: A PERSPECTIVE BEYOND TIME & SPACE  by Dr. Judith Orloff
    
(5-31-10)

Top


SUICIDE AND SUICIDAL IDEATIONS  Why?    (6-4-10)
from website bpdinsideout.com by AJ Mahari

Suicide: Have you attempted suicide? Why or why not? Do you have suicidal ideations? Often, or once in awhile? Under what circumstances in your life do you find that you get suicidal/or ideations?

Once I was as close as one can get to suicide without actually doing it, and I went to the hospital instead tho I don't really know why. I often have suicidal ideations. When something significant goes wrong, I think that I just don't want to live thru the pain, and that the rest of my life will be just periods of pain and no happiness, so I should die now to avoid it. This is always caused by feelings of loneliness or abandonment or having no hope for the future or that I'll never change who I am and that I am worthless.    anon.

--------------------------------------------------------------------------------

When I was in my late 20's and 30's, I half heartedly attempted suicide. I wanted to die at the moment but didn't have the courage to do it. I think I wanted someone to stop and stop my pain in some other way...*I* didn't know how but figured the one someone who loved me would. And if they didn't care enough to stop it, then I might as well be dead anyway. I haven't felt like actually killing myself for many years and know I wouldn't again. However, I have felt that *somehow* I wish I were dead if I lost my rock (my husband). I couldn't imagine life without him and wouldn't know what to do. Either if he left me, or if he died. That throws me into a panic. Otherwise I can handle anything else.

Diane

--------------------------------------------------------------------------------

Not suicidal. No suicidal ideations. I don't know why I escaped this.   V.

--------------------------------------------------------------------------------

Yes I have. It's not anything I'm proud of. I did because I wanted to leave. I wanted to get close to God, who is in heaven. I wanted to be with my Dad, who died 16 years ago. I wanted because I couldn't stand to be in such a big pain. My sorrow of life was overwhelming. I was not good enough for my kids (what I thought). I was not worth to be alive. I didn't know the meaning of life. I still don't. Noone liked me, I thought. I was just so depressed... There was no meaning... I rather leave myself than be left by anyone else... This is so much pain in this... I can't even describe it good enough... I didn't think things could ever get better. There was just darkness without any light at all... What's the point to stay alive then?

I still have sucidial ideations and it's hurting bad. Not as strong as before nor as often as before. But right now I'm having a rough time to talk myself into not doing such a thing again. I think I have these thoughts of suicide because I'm very tired. I haven't slept well for a while. Always when I haven't I get worse, and when I am to have my period, too. And when my therapist is gone for vacation, and when she is about to come back... When I feel loneley... When I'm very sad and can't get any rest... When I feel confused and double about things... When I get too much pressure on myself... When I don't get enough space for just me and my thoughts... When I feel unsecure about what's happening around me and my family... When I think all of the bad things that happen all over the world and in my own family... Oh, this is already getting too much....... Y.E.

--------------------------------------------------------------------------------

The first time I tried to commit suicide was when I was age 10 because I was terrified of being punished by my abusive parent and felt hopeless about my life ever changing. Feelings of hopelessness drove me to attempt suicide twice more when I was in my twenties. Now I simply hold the idea of it as a last resort and not something that I am likely to do.   Claudine

Top


SUICIDAL SELF-INJURIOUS BEHAVIOR IN PEOPLE WITH BPD
by Jessica Gerson, Ph.D., and Barbara Stanley, Ph.D.    12-4-08

Unlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?

Borderline Personality Disorder (BPD) is characterized by unstable relationships, self-image and affect, as well as impulsivity, that begin by early adulthood. Patients with BPD make efforts to avoid abandonment. They often exhibit recurrent suicidal and/or self-injuring behavior, feelings of emptiness, intense anger, and/or disassociation or paranoia. Suicidal and non-suicidal self-injury are extremely common in BPD. Zanarini et al. (1990) found that over 70% of patients with BPD had self-injured or made suicide attempts, as compared to only 17.5% of patients with other personality disorders. Nevertheless, clinicians consistently misunderstand and mistreat this aspect of BPD. There has been considerable controversy surrounding the diagnosis of BPD, ranging from a sense that the term itself is misleading and frightening, to the fact that the diagnosis is often made in an inconsistent manner (Davis et al., 1993), to a lack of clarity about whether the diagnosis should be Axis I or Axis II (Coid, 1993; Kjellander et al., 1998). Furthermore, these patients are often excluded from clinical trials due to perceived risk. More important, however, is the fact that suicidal self-injurious behavior is usually understood within the context of major depressive disorder, while the phenomenology of this behavior within BPD is quite different. In addition, self-injurious non-suicidal behavior is often understood by clinicians to be synonymous with suicidal behavior, but again, it may be distinguished separately, particularly within the context of BPD. It is possible that, although self-injury and suicidal behavior are distinct, they may serve similar functions. This phenomenon has important implications for treatment recommendations.


Suicidality in BPD vs. Major Depression

In traditional conceptualizations developed from suicidality seen as an aspect of major depression, suicidal behavior is usually understood to be a response to a deep sense of despair and desire for death, which, if unsuccessful, typically results in a persistence of depression. Vegetative signs are prominent, and the suicidal feelings subside when the major depression is successfully treated with antidepressants, psychotherapy or their combination. In contrast, suicidality in the context of BPD seems to be more episodic and transient in nature, and patients often report feeling better afterward. Risk factors for suicidal behavior in Borderline Personality Disorder show some differences, as well as similarities, with individuals who are suicidal in the context of major depression. Brodsky et al. (1995) noted that dissociation, particularly in patients with BPD, is correlated with self-mutilation. Studies of comorbidity have produced unclear results. Pope et al. (1983) found that a large number of patients with BPD also display a major affective disorder, and Kelly et al. (2000) found that patients with BPD alone and/or patients with BPD plus major depression are more likely to have attempted suicide than patients with major depression alone. In contrast, Hampton (1997) stated that the completion of suicide in patients with BPD is often unrelated to a comorbid mood disorder (Mehlum et al., 1994) and to degree of suicidal ideation (Sabo et al., 1995).

Conceptualizing Self-Harm

Suicidal behavior is usually defined as a self-destructive behavior with the intent to die. Thus, there must be both an act and intent to die for a behavior to be considered suicidal. Non-suicidal self-harm generally implies self-destructive behavior with no intent to die and is often seen as being precipitated by distress, often interpersonal in nature, or as an expression of frustration and anger with oneself. It usually involves feelings of distraction and absorption in the act, anger, numbing, tension reduction, and relief, followed by both a sense of affect regulation and self-deprecation. Confusion in the field regarding the definition of the term parasuicide can lead to a misunderstanding of the differences in function and danger of suicidal and non-suicidal self-injury. Parasuicide, or false suicide, groups together all forms of self-harm that do not result in death--both suicide attempts and non-suicidal self-injury. Many people who engage in non-suicidal self-harm are at risk for suicidal behavior.

We propose that non-suicidal self-injury in BPD uniquely resides on a spectrum phenomenologically with suicidality. Perhaps the most distinguishing factor, as pointed out by Linehan (1993), is that self-injury may help patients to regulate their emotions--an area with which they have tremendous difficulty. The act itself tends to restore a sense of emotional equilibrium and reduces an internal state of turmoil and tension. One striking aspect is the fact that physical pain is sometimes absent or, conversely, may be experienced and welcomed, as validation of psychological pain and/or a means to reverse a sense of deadness. Patients often report feeling less upset following an episode. In other words, while the self-injury is borne out of a sense of distress, it has served its function and the patient's emotional state is improved. Biological findings pointing to relationships among impulsivity and suicidality support the notion that suicidality and self-mutilation, particularly within the context of BPD, may occur on a continuum (Oquendo and Mann, 2000; Stanley and Brodsky, in press).

It is crucial to recognize, however, that even if patients with BPD self-mutilate and attempt suicide for similar reasons, death may be the accidental and unfortunate result. Because patients with BPD try to kill themselves so often, clinicians often underestimate their intent to die. In fact, individuals with BPD who self-injure are twice as likely to commit suicide than others (Cowdry et al., 1985), and 9% of the 10% of outpatients who are diagnosed with BPD eventually commit suicide (Paris et al., 1987). Stanley et al. (2001) found that suicide attempters with cluster B personality disorders who self-mutilate die just as frequently but are often unaware of the lethality of their attempts, compared to patients with cluster B personality disorders who do not self-mutilate.


Treatment of Suicidal Behavior and Self-Injury

While non-suicidal self-harm can result in death, it is more likely not to and, in fact, only occasionally leads to serious injury such as nerve damage. Yet, patients are often hospitalized on a psychiatric unit in the same way that they would be for a frank suicide attempt. In addition, while the intent is most often to alter the internal condition, as opposed to an external condition, clinicians and those in relationships with self-injurers experience this behavior as manipulative and controlling. It has been noted that self-injury can elicit quite strong counter-transference reactions from therapists.

Although there is clearly a biological component to this disorder, the results of pharmacologic interventions have been inconclusive. Different classes and types of medications are often used for different aspects of the behavior (e.g., sadness and affective instability, psychosis and impulsivity) (Hollander et al., 2001).

One class of psychological intervention has been cognitive-behavioral therapy (CBT), of which there are a few models, e.g., Beck and Freeman (1990), cognitive-analytic therapy (CAT) developed by Wildgoose et al. (2001), and an increasingly well-known form of CBT called dialectical behavior therapy (DBT), developed by Linehan (1993) specifically for BPD. Dialectical behavior therapy is characterized by a dialectic between acceptance and change, a focus on skill acquisition and skill generalization, and a consultation-team meeting. In the psychoanalytic arena, there is controversy as to whether a confrontative, interpretative approach (e.g., Kernberg, 1975) or a supportive, empathic approach (e.g., Adler, 1985) is more effective.

Top

 
ABANDONMENT

Under "Diagnostic Features," the DSM-IV says "The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician's announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment). they may believe that this "abandonment" implies they are "bad."  These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors."

back to Main Page
Top

 
 
BOREDOM      opinion of website owner

Another curious and interesting trait is boredom.  This is not a destructive as the other traits.  As a matter of fact...it can be kinda productive, yet of an obsessive-compulsive manner.  It is a frequently observed trait that Borderlines are always seeking something to complete.  They seek "projects" and work diligently to complete a task with diligence and sometimes perfectionism.  What often results can be brilliant works of art, research findings or similar accomplishments.  All can provide an instant gratification of personal success--but this can be short-lived;  often searching for another "project" takes over the BPD's forethoughts.

back to Main Page
Top
 
How to Spot a Girl with Borderline Personality Disorder by Mrs. Treasures

Is the girl you're dating very seductive, explosive, charming, warm, wild, ecstatic, fantasy-fulfilling and emotionally vulnerable? Does she think you have such a sweet, sexy voice?

She thinks you're the funniest guy on the planet. And you think she is so brilliant. She is absolutely without any hang ups. She enjoys just being with you. She ignores all the other men around her and fixes her gaze upon your eyes. She tells you all the stuff you want to hear. She has a remarkable talent to focus on your greatness. She has an amazing ability to mirror your attributes to appear like you. Thus, you feel an instant connection.

First phase: Her Intriguing Life Story

She engages you to her life story. The numerous stories of childhood betrayals in her life keep you intrigued. The drama in her life surpasses the TV soap operas. She starts her story as an abandoned child. She narrates how her mother was abusive. Sometimes, there is some kind of incest. Her mother left her with relatives who molested her. She also tells about a fascinating story about how her mother taught her to shoplift.

She continues her story to describe her father. He is someone she hardly knew. He was a heroin addict. He loses his temper quickly. He would indulge in alcohol and extra-marital affairs. He recalls her miserable life with him.

She remembers how her mother would sleep with different strangers. She describes them as drinking beer and smoking. In her fear, she would hide under her bed. Sometimes, she admits seeing things that a child shouldn't see.

You ask her if she was molested. She will tell you that she had no memory of certain periods in her life. Then, she suddenly has crocodile tears in her eyes which turned to unstoppable sobbing. She said that she cannot talk about it further. You tell yourself, "This poor girl doesn't deserve this life. This girl has never experienced love before. I will show her what love is. I will rescue her from her horrible life."

Second Phase: Idealization

In this phase of the relationship, she is very interested in your whereabouts. She likes to know the nitty-gritty details in your life. She adores your talents. She is interested in what you do. She puts you up on a high pedestal. You feel like a king around her. She tells you that you are everything she could possibly want in a man.

She worships you like you're the perfect guy. In her eyes, you could do no wrong. She would tie your shoe laces, fix your collar and offer to do errands. She would call you many times a day to make sure that you are alright, need anything or just praise you for being the most beautiful being in her life. She will even apologize unceasingly if it rained outside. Every inch of you matters to her. She even becomes involved in everything you like. You feel that for sure compatibility is not an issue.

Third Phase: Snares

This stage of the relationship consists of ongoing cooling off, breakups and reunions. Within the same day, she perceives you as one that could do no wrong. Her behavior shifts dramatically to the opposite. She puts words into your mouth. . Now, she assassinates your character. She spews profanities at you that you have to leave the scene especially if she does it in public places. Caught off guard, you feel resentful, angry and rejected.

The next day you feel relieved it's over. A few days after, you'll come to think of her and replay your fights. She is like a drug that you can't live without because you got used to her attentiveness and availability. You obsessively long for her return justifying what she did wrong. Then, one day she calls you about her financial, emotional and sexual predicaments. You can't resist because of suicide threats or attempts. You rescue her. She actually shows you cuts on her wrists and bruises on different parts of her body.

She felt abandoned by you, whether real or imagined. She gives you guilt about it. She wants you to idolize her or she feels unloved. Her emotions are intense. You feel important but confused. You feel overwhelming, yearning sensations to connect. Now, that she has lured you back in her life. She feels satisfied and she is pregnant.

You have second thoughts committing yourself to marriage but episodes of emotional turbulence occur so frequently. You think twice if not marrying her are causing all these turmoil. Maybe marrying her will end the nagging and pressure. Now, you feel trapped. You are in her snare.

Fourth Phase: Emotional Terrorism

In this phase, little Hitler's rules come out. Her favorite line is "I don't appreciate it when you make me wait, or when you make me do this." She can't tolerate when a pretty girl enters the room. She thinks you are definitely attracted to this girl. You exclaimed, "What girl?" She hates you for denying her truth. Then, from nowhere she shows rage and becomes hysterical.

She likes to give negative opinions on those around her. One day she might say, "Did you see how that cashier looked at me? What a bitch." She expects you to come to her defense or empathize with her. If not, she will most likely confront the girl and spew more swear words.

She likes to be the focus of your life. If anything takes you away from her such as school work, parents, friends, or job, she will torture you with negative comments about these. She sees your friends and families as threats so she talks down or belittles them. Her frequent statements are "I don't see why you have to spend time with them."

Her emotional outbursts become very frequent. She cuts or puts herself in dangerous situations to get your attention. She threatens suicide. She asks for more money. If she does not get her way, she throws things at you or physically hurt you. She challenges your manhood.

Fifth Phase: You're the Enemy and Revenge

You've had it. You cannot stand her ridicule, criticisms, rages and threats. You break away. She will seduce you back but with vengeance. She will have sex with your best friend or have an affair.

You feel like you brought this to her so you try to save her. Or, you worry about your child. But, she is now detached. If the new man is dependable and supportive, she is very prepared to leave you. You agonize on how easy it is for her to replace you.

But life doesn't end there. Negative propaganda starts within your family circle as she wants to feel justified for leaving you. She exaggerates on stories about you and intentionally lies. This is to show people that you are the villain. Her dexterity to twist facts elicits eager listeners to her woes. She is able to put sense in other people's doubts about you. Even if her statements are contradictory, she is often believed because of her acting skills. She will not hesitate to go into a smear campaign in front of an audience. Her false claims astound you for she has an amazing ability to remember in detail what people say or do and twist it for her purpose.

If you have a child with her, she will use the legal system to create real or imagined accusations. She will drain you financially. Your child is now her pawn to further control you. You are the enemy. You are the cause of her miserable life. You deserved to be punished for all the pain she feels.

Spotting the Borderline Personality Disorder Traits

Many girls with Borderline Personality Disorder have a problem with regulating their emotions. Is your new girl highly sensitive? Is she too intense? Does she shower you with too much compliments and admiration? Borderlines like to go into rebound relationships. How many relationship stories did she share with you?

Borderlines have compulsions that lead to addiction. It includes self-medication, alcohol abuse, overeating, self-mutilation, shopping sprees and sexual affairs. Did she mention any stories in her family about these compulsions or addictions?

Having highly developed logical skills, a Borderline appear very smart. She can have a stack of information at her disposable to convince you on a lot of different issues. A borderline is verbose and articulate. You are amazed at her photographic memory. They can have memories that never actually occurred. Sometimes, these memories may be intentional lies. In the long run, they believe that their lies are the truth.

In their world, there are no grey areas. Events and people are either perceived as "black or white". A borderline is jealous of your relationship with your children, mother, father, therapist, etc. It triggers abandonment emotions. They can put a wedge between you and your families and friends. She loves pitting her children, families, and friends against each other.

Conclusion

Dating is a risky game. There are red flags to take into serious consideration on your first few dates. Borderlines have intriguing life stories. They engaged you and then they skillfully find your weak spots. Then, she puts her trap. Once in her snare, you are controlled and manipulated. You will try harder to be on her good side. But, she will push you away by her constant cruel gestures and remarks.

Borderlines are near the border of psychosis. Their reality is twisted. Unfortunately, Borderlines require a psychiatric evaluation and treatment. A different approach to therapy like Dialectical Behavior Therapy (DBT) is required. It will take a lot of courage to leave a Borderline. They will not make it easy for you to leave. They will blackmail you with your weaknesses.

Just as you thought everything is over, she will engage you or "hoover", a term derived from the vacuum cleaner to represent "sucking in". Her self-worth depends on feeling connected to you. Any disappointments occurring in her life, like current love affairs or job stresses, will make her impulsively call you.

She does not know her boundaries. She is very angry at you. She will not hesitate to hurt you in the most inconceivable and damaging ways. Sometimes, an escape plan and "no contact" are the only safe options for you.

Top