Comments on BPD from Newsgroups

I guess I should first explain that the personality disorders are a little bit different than other psychiatric disorders. We believe that they develop as a pattern of behavior that was at one time somehow helpful to the survival of the individual, but has outlived its usefulness. For example, living with perfectionist parents may lead a child to develop obsessive-compulsive behaviors in order to survive the strict scrutiny of their parents. This is distinctly different from people who have obssessive-compulsive disorder in that those tendencies and behaviors are generally very arbitrary and appear to be the result of an organic dysfunction of the brain. One of my clients developed obsessive-compulsive tendencies to cover up the fact that her IQ was much lower than anyone suspected; as a result, she was able to work as a very successful clerical manager in an office for many years. It was only as her schizophrenia worsened that these tendencies became problematic. Still, if you wanted to get something done, she was a good one to ask to do it!

Having said that the personality disorders appear to be learned, we are finding that there may be genetic predispositions for some of them. Confusing, ain't it?

Borderline Personality Disorder is a disorder of extremes. The central feature appears to be an extreme fear of abandonment that generally has roots in abuse or neglect in childhood. It is characterized by extreme mood swings, feelings of boredom or emptiness, idealization of relationships, suicidal gestures and/or self destructive behaviors including self-mutilation, drug abuse, sexual promiscuity, over-eating and over-spending. There are other symptoms as well, but these are the main ones.

You probably won't find this in any psych books, but I think that there are at least two distinct flavors of BPD. One that I have named Dependent Type, and the other which I have named Asocial (or Asshole) type.

The dependent type tends to be in perpetual crisis. The theory is that the chaotic environment of their childhood is the only one that they really understand so that even the simplest of decisions becomes a crisis. If you take away those crisises, they will either sabotage your efforts so that it becomes a crisis again, or they will invent new ones or bring up old ones again. They are extremely needy and have no sense of appropriate boundaries -- so that they may call you repeatedly over the smallest little thing if they have identified you as a helper. And to them, there are only two types of people, helpers and haters. Once they attach to a helper, they can suck that person dry in no time at all, forcing that person to abandon them to preserve their own sanity, thus fulfilling their belief and fear that they will always be abandoned because they are unworthy of love and friendship. This group is also more likely to self-mutilate. One theory is that the pain of cutting themselves (or whatever self-mutilating behavior that they choose) provides a focus in the storm of their emotions as well as expressing their own self-hatred and feelings of unworthiness.

The Asocial or Asshole type is a quite different. They tend to be loners and rebels, fearing intimacy because of the risk of abandonment. Relationships are very difficult, because none of them can live up to the extreme ideals that this type believes should be true. They are more paranoid and more likely to suffer from bouts of extreme boredom. In some cases, the self-destructive behavior may be a way of dealing with the feelings of boredom and "emptiness." They also tend to be more manipulative -- so much so that they may force others away from them thus fulfilling their belief and fear that they will always be abandoned because they are unworthy of love and friendship. Interestingly enough, if they can manipulate you, then they lose all respect for you and actually may begin to despise you for your "weakness." They are always testing the boundaries of their relationships, looking for the proof that the relationship does not meet their "ideals."

Both groups tend to be extremely egocentric, but it plays out a little differently. The Dependent type focuses more on their feelings of worthlessness and the urgency of their needs (even if those needs may actually be quite unimportant). The Asocial type tends to demand attention in different ways -- by being the rebel or trying to be the center of attention. Dependent types fear being the center of attention because in their chaotic childhood, that frequently meant being the focus of abuse; Asocial types demand it because the only way they could survive the abuse was to be defiant and rebellious.

Okay, I could probably go on and on ... and on and on like the everready bunny, so let me just make a few concluding remarks. Dependent type are more likely to be female while Asocial type are more likely to be male. They are very difficult people. I, unfortunately, was rather successful in working with them, and as a result was frequently recommended when we got a new one in our system. The key is to create clear and concise boundaries so that the person knows exactly what they can expect from you. It takes forever, but it is the only way that you can work with them. For example, we may have to set limits on the number of phone calls we will accept from them in a given day. In some cases we divided specific areas among different staff members so that each of us had specific things we could do to help the client, but always referred the other issues back to the staff member who was in charge of that. We could act as negotiators for the client with other staff members, primarily to provide support so that they could address issues of disagreement with the other staff. The eventual goal of treatment is to teach these people better coping mechanisms so that they don't have to live in perpetual crisis, so that they can set realistic goals and make realistic plans about achieving them.
The most common attribute to BPD is rage, whether external or internal. Those how internally rage are those who take it out on themselves in many ways, the most common is self mutilation.
NIMH recommends the use of anti seizure meds for BPD, along with its close cousin IRD (intermittent rage disorder). Dr. Hellers first book "Life at the Border" are on the recommended reading list for treatment of BPD from both the NIMH & NIH. About 1/3 of those who suffer from BPD will show seizure activity on a EEG during a "rage". It is hoped that with 'deep scan" EEG ( using intelligent active filters to filter out noisy front lobe activity ) that number goes up.
Since there's a decidedly non-rational, subconcscious component to rage and associated problems, it's kind of chancy to assume that once you ''understand'' you will be able to do something about it. (I ''understand'' that I have arthritis, but if I didn't understand that I have to take meds as needed, it wouldn't do me much material good.)
A therapist has to gain a Borderline's trust in order for therapy to work. Borderlines are probably one of the most distrusting folks around. When a therapist offers to comply to certain needs, then progress can start. Not before.

When a therapist finally complies, and is consistent with those requests, *darn right* the Borderline is going to defend that relationship. It's probably the closed relationship that Borderline will ever have. So when you see someone state warmly about their therapist, try to think of it as someone being assertive with their needs, and is happy it worked, and that Borderline now has a relationship that's more or less stable.

Yes, it's true that some Borderlines go overboard ( be intense ) about their therapist. Yes, there's therapists that do some rotten things to gain your trust. One can spot that, especially when the Borderline "clings" to their therapist, despite being harmed.
It hurts so bad to "look normal" to the world, but to live in such chaos and despair"
I feel that my Borderline Traits--insofar as they can be identified--have served me quite well right along with the grief they have caused. So I am one who does not wish to be totally ''cured''--more like, adjust the squeaks and leaks, replace the gaskets, but don't rip out my entire personality and install a new one.
A Typical Case: In a north-central Pennsylvania hospital where I worked, the entire staff was divided and arguing about how to deal with a recent admission to the unit. But they agreed on the diagnosis: a borderline personality. The client created chaos as he acted out his pathology of living on the border of psychosis. To one staff member he presented the "best client"; to another "the most irritable and difficult client." ~~~~~~~~~~~~~~~~~