The Torture of BPD

Borderline Personality Disorder is a global, relatively stable disorder that is torturous to both the person with BPD and the people around them. It is thought to occur in 1 out of every 33 women(*Females account for 75% of people with BPD), and is relative to four specific areas: Affective, Cognitive, Behavioral, and Interpersonal impairment that can be subacute at baseline level, but when a stimulus causes excitement, borderlines become incredibly dysregulated. An example of such is when a friend of someone with BPD analyzes their life in a way to give advice, and the person with BPD perceives being talked down to or being blamed (also referred to as being "invalidated").

What causes BPD?
It is thought that an emotionally invalidating, neglectful, or abusive early childhood--combined with a genetic predisposition--creates the recipe for someone who has BPD. Specific types of abuse include sexual abuse from or not from a caretaker, as well as emotional abuse and physical abuse from a caretaker. Furthermore, it is thought that secrecy or the lack of discussion surrounding sexual abuse increases the risk factor for BPD. Weak early attachments, which create an attachment schema that fluctuates between extreme neediness alternating with fear of involvement, are also prevalent in indivudals with BPD. Generally, diagnosis is not made until adulthood, but antisocial signs in females prior to the age of 15 are significant indicators of the potential for having BPD as an adult. It is important to note that "age of onset" of symptoms generally occur from age 10-18. Furthermore, disturbed parental involvement, entailing an antisocial parent, a neglectful parent, and/or parents that get divorced are common in individuals with BPD.

Linehan theorizes that BPD entails three dialectics which people with BPD constantly swing from, such as:

1. Vulnerability vs invalidation
2. Active passivity (seeking a rescuer, accepting incompetence) vs. apparent competence (portraying competence when internally things are falling apart)
3. Unremitting crises vs. inhibited grief


Gunderson's Psychoanalytic Conception of BPD entails:

1. Intense, unstable relationships, in which the borderline always gets hurt (or perceives it that way).
2. Repetitive self-destructive behavior, so as to prompt rescue; entails suicidality.
3. Chronic panic or fear of abandonment (that entails clinging) when forced to be alone.
4. Distorted perceptions of interpersonal interactions.
5. Hypersensitivity to both verbal and non-verbal communication.
6. Impulsive behaviors that later embarrass the borderline
7. Poor social adaptation in regards to what is acceptable regarding academic and vocational performance.

Correlational Signs: Comorbidities

Individuals with borderline commonly have:

ADD-like problems with concentration, anxiety, a major depressive episode, substance abuse that requires treatment, panic disorders, social phobias, eating disorders, and substance use in general. Remission of BPD-symptoms entail reduced mood, anxiety, and substance use disorders. All BPD suffers, basically, also suffer from Axis I DSM-IV disorders. Another relatively common disorder associated with BPD is Bipolar disorder. Other subclinical signs include ruminating or obsessing about the past, and having a blameful view of most interpersonal interactions.


Diagnostic Criteria

1. Shifts in mood that last for only hours.
2. Anger that is uninhibited or inappropriate.
3. Self-destructive acts, such as suicidal threats, gestures, attempts, as well as cutting.
4. Two Impulsive behaviors, including substance abuse, eating disorders, sexual compulsivity, reckless driving, excessive shopping, and gambling.
5. Marked Identity disturbances regarding: sexual orientation, long-term goals, career goals, view of friendships. Basically, an inconsistent self-image
6. Chronic feelings of emptiness or boredom, that may or may not be consciously acknowledged. Could be described as feeling as though they have a deep hole in their stomach, which is filled through relationships.
7. Unstable chaotic relationships that entail splitting between idealization and devaluation. One second you're amazing, the next you're an asshole.
8. Frantic Efforts to Avoid Abandonment, even if somewhat subconscious. Includes the alternating clinging and distancing behaviors, described by: "I hate you, don't leave me"; sensitivity to criticism or rejection; heavy need for affection or reassurance; and great difficulty trusting others and themselves.
9. Transient, stress-related paranoid ideation or severe dissociative symptoms. This is to say, feeling "out of it" or not remembering what was said or done during stressful situations.

Miscellaneous Features

People with borderline often are charismatic, the life of the party, when not 'acting out'.

May have problems with object constancy; this is to say that they may forget or disregard their feelings for someone when they are out of sight.

Frequently work to avoid being alone, even during benign periods of time.

Have a chaotic history of vocational and academic pursuits.

Almost all have a background of either physical, emotional, or sexual abuse, or a combination.

As with most Cluster Bs, a sense of entitlement, demandingness, and manipulativeness are very common, to the point that therapists and doctors need to establish firm, constant boundaries or else they risk being emotionally compromised by the borderline.

Borderlines often "freak out" over minutiae or perceptual distortion over minute aspects of social interaction.

Borderlines are notorious for being great sexual partners due to hypersexual impulsivity.

Borderlines often rage in the face of social frustration.


Prognosis:
The good news? Prognosis is generally better for individuals with BPD who have:

High IQ (>120)
Low narcissistic Entitlement
Non-divorced parents
A Presenece of physicalmutilation when admitted into inpatient treatment


The bad news? That is very few borderlines. Poorer prognosis occurs when:

The borderline has been sexually abused
There are marked impulsive behaviors, such as sexual compulsivity and/or substance abuse.
Multiple Axis I disorders
There is sexual abuse that is incestuous in nature.



Neurobiological Changes or Risk Factors
Brain evidence for borderline personality disorder includes:

Hyperarousal of the HPA-axis (Hypothalamic-Pituitary-Adrenal) to emotional stimuli.
Reduced Hippocampus, Amygdala, OFC, ACC, and Prefrontal brain size.
Hypometabolism in the prefrontal cortex and ACC at baseline.
Hyperamygdalar response to interpersonal interactions
Dopamine and Serotonin dysfunction or inefficiency that entails impulsivity.



What To Do If Involved With One?
Unless the borderline is a family member, has had substantial treatment for several years in a stable therapeutic environment, or is willing to consider such treatment, one may need to consider for one's own sake whether or not to get out before they get too far in. BPD is an ingrained and relatively stable interpersonal style, rather than an acute organic disease process. Borderlines generally do not improve unless involved in intense therapy for more than a decade and/or the condition remits after the 5th decade of life. There are treatments for BPD, such as Dialectic Behavioral Therapy, and generally the point for the non-BPD person should be to avoid these type of relationship dynamics wherever possible, because an uncontained borderline is skiled in unintentionally manipulating the non-borderline into the borderline 'matrix' as it is referred to.

Again, (as well said by a dissenting comment) this is not to suggest that borderline sufferers aren't people deserving of empathy and understanding, nor is it to say that people of sinister motive who themselves are incapable of such empathy (on the contrary, I have encountered the term "hyper-empathic state" on more than one occasion as it pertained to the borderline matrix). It is a complex neurobiological 'configuration', and insofar as this person needs help to manage and contain it, it is incumbent upon someone with BPD to ensure that they are committed to such for the health of the relationship. It is also strongly recommended that one who plays the role of the counter-borderline in the relationship also receive therapeutic treatment, as it can be a highly turbulent dynamic that requires such to keep sound footing.


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