h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Hi Sir Mort.. was just looking at your page (actually id lost my way to co-mapp so i thought id sneak in through here)and I noticed one of your editing specialities is Borderline Personality Disorder. I was just wondering if you could tel me an more about this as I was told I had that when I was about 17, but was never told what it was!

Thanks in advance.

Hi,

No probs,
One of the best sites is http://www.borderlineuk.co.uk
as it is run by people that have BPD

Basically it is people that have a particular way of coping and seeing the world around them. Although it is classed as a personality disorder, this is quite misleading as it fills people with dread when they hear the title.

They may use self defeating behaviours to cope.
Self defeating behaviours - well as the name suggests it is anything that a person uses as a coping mechanism for life that induces a lack of self esteem, self loathing, self hate etc, the behaviours feed any anxiety, depression and in turn increase the need to continue using such coping tools.

The most common are self harm/injury in all its many forms, drug and alcohol abuse, promiscuity, eating disorders can be classed as one in combination with BPD, although they are much more complicated and a whole different ball game.

Not every body uses all of them, sometimes even just one, but those are the most common ones that i can think of off hand.

It has often been claimed that people with BPD have a distorted view of the world or a situation and can't see the reality of it, untrusting, have difficulty relating to people and allowing themselves to be cared for.

Hope that helps.

Mort

PS after 17 years of depression I was diagnosed with it 6 years ago!

Thanks for that..certainly sounds like me too! ..though unfortunately I cant get into the website as im using a digibox.As I said i was told I had that and clinical depression at 17..but I was never told what bpd was.. or what if anything could/would be done about it!

Characteristics of BPD

A WORD OF CAUTION: The personality traits described below are usually experienced by most people from time to time, especially adolescents. For these traits to be indicative of a personality disorder they must be long-standing, intense and persistent. Personality disorders are a notoriously controversial diagnosis, and making a self-diagnosis based on information on a web-page or in a book is not to be recommended. If you are at all concerned about your mental health, then seek professional help urgently. If you're in the United Kingdom, talk to your GP and he or she will refer you to a trained counsellor to discuss your problems further.



We have used the DSM-IV defining criteria (shown in purple italics) of BPD as a basis for this introduction in to some of the characteristic behaviour of BPs. Most people, especially adolescents, will exhibit some of these characteristics from time to time - however, in the case of someone diagnosed BPD this characteristics will be intense, enduring over a long-period of time and have serious consequences for the individual and those close to them.

"A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1) Frantic efforts to avoid real or imagined abandonment. Do not include suicidal or self-mutilating behaviour covered in (5)

BPs frequently have difficulty tolerating being alone, even for short periods of time. They may experience intense abandonment fears and inappropriate anger when faced with the threat of separation (real or unreal) or even an unavoidable change of plans. Sometimes this condition is described as 'abandonment depression' leading those with BPD to be socially overactive and compulsive to avoid being alone.

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

Alternating between extremes of idealization and devaluation is known as "splitting". Splitting is a primitive defence mechanism whereby a person or object is seen as all good or all bad. BPs may have trouble tolerating human inconsistencies or integrating a person's good and bad qualities in to a coherent understanding of that person. Consequently a person can be seen as all good, until the borderline feels let down or betrayed or disappointed by that person, at which time they are then viewed as all bad without regard for how they were previously perceived. Although splitting is believed to develop as a technique to prevent the anxiety the borderline feels in trying to reconcile the contradictions in people, it often achieves the opposite effect. Typically, splitting is perceived as 'manipulative' by the people closest to the person with BPD. This is related to another characteristic symptom, that is, the problem borderlines have with object constancy in people. They read each action of a person as if there was no prior context, as if that action is completely definitive of that person. People tend to be defined by how they last interacted with the borderline, and not on the basis of their integrated actions over a period of time. They have great difficulty in recreating the feelings of love and affection from a loved one if that person is absent, even for a short time. BPs also tend to alternate between clinging and distancing behaviours in relationships. This push-pull behaviour, often pushing partners to their limits of frustration. anger and tolerance then alternating to a need for inordinate amounts of reassurance and affection, leads to unstable and intense relationships. If the borderline feels that the other person does not care enough. they may withdraw and seek elsewhere for the perfect, all-loving, non-exploitive love.

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

BPs often experience uncertainty and confusion is areas such as self-image, sexual orientation, career choices, long-term goals, friendships, values and opinions. They may not feel confident that they know who they are, or what they really think, or what their opinions are. As a result, they generally base their self-image on what others say about them or the reaction they receive from others. They often have a deep seated feeling of being flawed, defective, worthless or bad in some way, and have a tendency to go to extremes in thinking, feeling and behaviour.

"Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like." - Otto Kernberg

4) Impulsivity in at least two areas that are potentially self-damaging (eg spending, sex, substance abuse, reckless driving, binge eating). Do not include suicidal or self-mutilating behaviour covered in (5)

Poor impulse control and low frustration tolerance often lead to self-damaging behaviour in an attempt to avoid the intense dysphoria felt by BPs, particularly in times of stress. The most prevalent impulsive (and compulsive) behaviour involves alcohol and drug abuse, especially among young adults. Another common impulse and often addictive behaviour is sexual promiscuity and deviance.

5) Recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour.

Self-mutilating and suicidal behaviour may occur in an attempt to elicit help from others, as an expression of anger towards the self or others, or even to detract from intense and overwhelming emotions including those of panic or dysphoria.

6) Affective instability due to a marked reactivity of mood (eg intense episodic dysphoria, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days).

BPs often appear to be in a state of constant crisis. Their moods can swing dramatically and rapidly in response to the what may appear to be the smallest of provocations. They can be angry one moment, depressed the next and on the verge of panic a moment later.

"People with BPD are like people with third degree burns over 90% of their bodies, Lacking emotional skin, they feel agony at the slightest touch or movement." - Marsha Linehan

7) Chronic feelings of emptiness

The feelings of emptiness, boredom and depression associated with BPD may, it has been suggested, be the result of the BPdefending against intense anger that they feel. These feelings may also be connected to problems BPs experience with object constancy.

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

The anger felt by BPsmay also be experienced as temper tantrums, constant brooding or resentment, or even as a feeling of entitlement. BPs often fear their anger and their own ability to control it.

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

Dissociative symptoms may include derealization (the feeling that one has lost contact with external reality), feeling 'out of it', obessessive use of fantasy, daydreams or an inability to remember what you said or did. BPs often have difficulties with memory.

Other Characteristics of BPD

There are other characteristics that are common to borderlines, including:

A misleading ability to appear 'normal'.

BPs are often bright and intelligent, creative and can appear warm, friendly and competent. They can sometimes maintain this facade for a number of years. It is often only in situations of stress that more intense symptoms appear and it is often only those people who have been very close to a borderline for a significant length of time who are able to distinguish their dysfunctional traits. This particular characteristic of BPD is often a great obstacle in another person's understanding of the borderline.


BPs often seem unaware or not to understand the rules regarding behaviour, and have particular difficulty respecting other people's boundaries. This makes them appear excessively demanding or manipulative. It is as if there is an 'average collective reality' in the world and seperate to that, the reality of the borderline.


Acting-out, projecting or transference. A BP may often project their unpleasant feelings on to those around them, or will attempt to ellicit in others the feeling that he or she is having. These primitive defence mechanisms often lead to the borderline being abusive to those closest to them. This particular trait is probably responsible for the reluctance of many therapists to take on borderline patients.


Functional failures. Many BPsare unable to successfully apply their abilities. They show potential for high achievement, however, their emotional instability and cognitive disturbances prevent them from reaching that potential. Many BPs have a background of childhood physical, sexual or emotional abuse, or physical or emotional neglect.


Generally within the UK Mental Health profession is it regarded as a mental disorder and NOT a psychiatric illness. This may seem like splitting hairs, but the distinction is important as it has profound implications for anyone diagnosed with BPD.

The fact that it is not regarded as an illness means that anyone with BPD may experience great difficulty securing any treatment - there are many clincians in the UK who regard all PDs as 'untreatable'. There are also problems in accessing state beneefits, especially Disability Living Allowance, again because of the fact that it is not an illness. Depending on the view taken by your own GP, psychiatrist, therpaist etc, you may find that doors are slammed in your face, or held open.



Causes

There is still a great deal of debate concerning the causes of Borderline Personality Disorder. It is perhaps more meaningful to talk of the factors that shape Borderline Personality, about which there is increasing agreement and research. Broadly speaking there are two schools of thought on the processes that lead to the development of BPD.

Attachment Theories

These models of the development of BPD emphasises the pyschobiological and neurophysiological processes that influence personality. During the first five years of life, and in particular during the first two, a child's brain is still growing and developing at a substantial rate. All the experiences that child has are directly influencing how various parts of the brain develop. Of prime importance in this process is the child's interaction with its mother or primary care giver. Seperation from the mother, or poor or negative nuturing (eg abuse, violence), can have a dramatic effect on the development on areas of the brain, especially those which handle emotions and social functioning.

"traumatic experiences, especially if severe, sustained and, and repetitive, lead to cell damage and premature death in key centers [of the brain] and wiring patterns that evoke unmodulated and maladaptive responses to the ordinary events of life." Kernberg et al, "Borderline Patients: Extending the Limits of Treatability"

It is perhaps this 'hard-wiring' that makes BPD and other PDs resistant to treatment. Whilst the brain is in a state of constant flux throughout adult life, it is harder to change the wiring pattern in later life. However, it is possible to learn to manage the behavioural difficulties that a differently wired brain may produce.

Whilst more is becoming known about what processes influence the development of BPD, far less is known about why certain individuals seem more prone to develop BPD (and other psychiatric problems) than others. It increasingly appears that there may be a genetic predisposition, given an adverse environment, for certain individuals to develop BPD.

Poor nurturing and an adverse environment is not guaranteed to result in a child experiencing psychiatric problems in later life; equally, good nuturing in a positive environment is no guarantee that a child will be free from psyhciaitric difficulties as an adult. However, a genetic predisposition towards psychiatric problems coupled with poor nurturing is far more likely to result in problems later in life.

Physical Causes

There are a small number of clinicians (primarily in the United States) who believe BPD to be a 'neurological illness', most probably a form of epilepsy, that can be treated with medication and talking treatments. Perhaps the most high-profile advocate of this approach is Dr.Leland Heller and more infrormation can be found on his website: www.biologicalunhappiness.com

Treatments

Unfortunately, there are still health professionals in the world who regard personality disorders as basically untreatable. This extreme position is, of course nonsense, but there is no doubt that Personality Disorders constitute one of the greatest challenges facing mental health professionals today. Borderline Personality Disorder attracts an ever increasing amount of investigation and research, particularly in the United States.

Treatment includes psychotherapy and other 'talking therapies', in a one-to-one or group setting, that allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgemental therapist. Therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in their usual self-defeating ways. Different therapists will adopt different treatment strategies depending upon their particular school of thought.

Medications such as anti-depressants or anti-psychotic drugs may be useful for certain patients or during certain times in the treatment of individual patients. Treatment of any drug or alcohol probelm is usually necessary if therapy is to be able to continue. Brief hospitalization may be necessary during extreme stressful episodes, and, in the UK at least, you are likely to be hospitalised without your consent ('sectioned') if your therpaist, GP or an Approved Social Worker believes you are a danger to yourself or to others. There is some research to suggest that long term hospilisation for borderlines can be counter-productive.

Out-patient treatment is usually difficult and can sometimes take a number of years. Research suggests that borderlines being treated in an out-patient environment have an exceedingly high drop-out rate.

Effectiveness of Treatment

As yet, there have been only a few studies conducted assessing the effectiveness of the various types of treatment. These would indicate that the short-term prognosis is usually poor. Chronic symptoms, high relapse rates, poor employment and poor psychosocial functioning are reported in the short-term following treatment. The long-term outlook for borderlines is more optimistic as research suggests that symptoms such as dysphoria, impulsiveness, disturbed relationships and micropsychotic symptoms decrease over time, and also indicates that 75% of cases no longer meet the criteria for BPD fifteen years after initial diagnosis. So, if we can keep ourselves alive then the chances are we'll eventually get better!

Availability of Treatment

The availabilty of treatment, particularly therapies, within the UK is far from adequate. Waiting lists are often very long, and the type of therapy available can vary considerably depending on your geographical location. Age can also play a part in that many health authorities and clincians are unwilling to treat older people on the grounds that they respond less well to therapy. Long term therapy is expensive and it is worth remembering that cost effectiveness is usually the over-riding concern for Local Health Authorities.

This is taken from the site - hope it doesnt get yikesed for copyright although i do know Dale who runs it.

Thanks for that Sir Mort..
It really does explain a lot.
15 years isnt that far off for me then! Lovely of them not to tell me what it was n leave me wondering if I was just 'odd' all these years eh!Also maybe I wouldntve had so many relationships go out of the window if id been able to say to someone..look this is why i can be like this!.Thanks again ..

Sandra.

no probs - if you need any more info just let me know!

Half the docs in the world haven't heard of it and a quarter of the rest wouldnt know it if it bit them on the bum

Still it would have made life easier had i been given the right help in the begining.

Mort

Same here ..only last weekend I had a potential relaionship go down the loo..mainly because he was a selfish,disrepectful a**wipe..but he had always had trouble understanding why i could be so insecre .. and called me self focused! At least the next tim ill be able to explain myself better! I might not have had half the crap ive haad over the years if idve been able to explain to people or at least understood myself! They just said oh your depressed and have borderline personality disorder n left it at that! No mores ever been said..though Ive been treated for depression and seen a counsellor since!
I found the background of abuse/neglect part very fitting too..it was mostly emotional in my case though.Thanks again Dad!

Do you find you cope ok though?

just ing this thread so i can read the stuff you got for me again..sorry

Hi Mort This is excellent stuff. I shall give the link out for the personality disorder site to some of my students that come for help if that is ok with you? Oedipus says hello..he's trying to type at the moment....