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Just Another Teachin’ Tuesday: Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one of the most misunderstood and abused of the emotional and mental health diagnoses. And what better way to try to turn things around than to chat about it.

I’m going to be using a great book as the foundation for what I have to say. It’s Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, by Robert O. Friedel, M.D. One of the things that makes the book such a great read is Dr. Friedel’s obvious heart for the subject matter. And that’s, no doubt, based in the fact that his sister suffered from BPD.

Well, instead of wasting space discussing the myths of BPD, let’s cut to the chase and swirl around what it actually is. Diagnostically speaking, BPD is considered a Cluster B personality disorder and is placed on Axis II on a multiaxial diagnosis. Yada, yada, yada – much more on the personality disorders here.

Dr. Friedel elects to use the term, “borderline disorder (BD),” and he suggests its presentation is based in physiological and chemical issues; and, certainly, the environment in which one was raised can be a major contributing factor. Interestingly, the term, “borderline,” goes back to the days when it was referred to as borderline psychosis, pre-schizophrenia, pseudoneurotic schizophrenia, and latent schizophrenia. Wild stuff to be sure. And, by the way, BD is not a psychotic disorder.

It’s thought that BD affects 2% of the U.S. population, women three times more than men. And just so there’s no misunderstanding, Dr. Friedel states BD is a, “true medical disorder and, basically, is no more under one’s control than diabetes and hypertension.”

Dr. Friedel helps us understand BD by identifying what he calls The Four Groups of Behavioral Disturbance in BD. He goes on to say that most enduring BD don’t have all of the symptoms in each group; however, they have at least one issue in each of the four groups…

  • Poorly Regulated Emotions – labile (all over the board), hyperreactive (can include “emotional storms”), anxiety, intense anger, inability to control anger, chronic feelings of emptiness
  • Impulsivity – suicidal and self-injurious ideation and behavior
  • Impaired perception and reasoning – memory issues, brief episodes of paranoid thinking, dissociative symptoms, magical thinking, depersonalization, an unstable sense of self
  • Markedly Disturbed Relationships – a pattern of unstable and intense personal relationships, inability to perceive grey-areas in relationships, frantic efforts to avoid real or perceived abandonment

Now that we have a sketch of just what BD is, let’s take a look at its treatment. First of all, a pessimism with regard to BD being treatable at all very wrongly permeates the minds of those personally encountering it, as well as the minds of emotional and mental health “professionals.” Wrong, wrong, wrong. BD is definitely treatable!

Here are some helpful treatment notes…

  • As with any emotional or mental situation, BD sufferers have to take responsibility for managing their lives
  • It’s essential to find a psychiatrist and therapist who are experienced with BD, and who remain current with efficacious treatment strategies and techniques
  • As tough as it may be, those enduring BD have to be open to the possibility of the necessity for different levels of care – hospitalization, partial hospitalization, outpatient
  • Being open to meds – mood stabilizers, atypical antipsychotics, antidepressants – is a good idea (I know, easy for me to say)
  • It’s really important to be open to psychotherapy – individual supportive therapy, cognitive-behavioral therapy, dialectical behavior therapy (a derivative of cognitive-behavioral), interpersonal group therapy, and family work.

So there’s a thumbnail on borderline disorder for “Just Another Teachin’ Tuesday.” And, as always, we need your comments. Won’t you share?

 

  • Marianne

    Well, I discovered your forum while researching peudoseizures, but I did not realize how many topics you have touched upon. Thanks for all you do. A close family member actually has a diagnosis of Borderline Personality Disorder as well as Schizoaffective Disorder. She has all of rhe symptoms of BPD. She suffers from psychosis. She has seen all the psychiatrists in town. been.hospitalized many, many times, been on every medicine on earth, and been to psychotherapy over and over. I have read every piece of research I can get my eyes on to help her. She goes on and off meds.Currently, she is on them again. I would appreciate information on the subject. It is a tough diagnosis. Maybe you can give me some insight. I have been down a long, hard road, but I refuse to.give up!

    • You’re more than welcome, Marianne. Yep, been at this for working on four years, and Chipur has some 550 articles focusing upon the mood and anxiety disorders – and a few more topics. It’s quite a resource (if I say so myself).

      Yikes! BPD and Schizoaffective Disorder. That’s a tough combo, to be sure. Very kind of you to do all you can to help. In terms of insight, when it comes to BPD I’d really recommend the book by Fridel I mentioned in the article. Regarding Schizoaffective Disorder, I really don’t see how one could manage it efficiently without antidepressant/mood-stabilizing meds. Pertaining to both, a consistent relationship with a therapist is a must. There’s just so much to monitor and work through. And that applies to a psychiatrist, as well. Actually, there’s so much more to offer; however, I couldn’t possibly fit it in here – even if I could lay my hands on all of the information. Your continued support is so important, but be careful how much of self you sacrifice. It can be very stealthily draining.

      Bill

      • Marianne

        Yes, she is a hard case. I have dealt with her running off twice. I rushed to get her in Florida during a storm in the night at the age of 13. Dealt with her running off at 17 with a guy she met on the internet and being gone for a year! It was then I knew that she.must be mentally ill.I got her back a year after that psychotic and hearing voices telling her to kill me. She was hospitalized on 13 meds! I have taken care of her while she thought I was the devil and had black outs not knowing who she was for hours! She recently spent six months in jail for smashing my car door and threatening to beat me up! I left her there for the state to prosecute her, because she was always walking around homeless and out of control. I am still helping her and providing emotional support. She is in a shelter right now. A beautiful, intelligent girl! It must be love.

      • Marianne

        StShe is 25 years old now. I have noticed that she is listening to the bits of wisdom that I have passd on to her lately. She found full time employment at a store. Her employer lovs her. She usually does well until she becomes manc or panic sets in. She is gifted and an overactive most of the time. Some say she is the reason I have seizures. It may certainly be a trigger. I stay away from her as much as I can, but I am the only one she hss to turn to. I refused a restraining order, though the judge wanted one. It was against my better judgment to turn her away..

      • You’re a compassionate and giving woman, Marianne. Yeah, just be careful!
        Bill

      • Marianne

        That is what my Pastor says. You have to be where I work. I am a remedial reading and writing teacher. I work in a school in a high poverty area. Many of my kids have issues and spend much of my time being a counselor. :-D

      • …and I’m thinking a very fine one, at that. Your work is vital, Marianne.
        Bill