Walking the Thin Line
Impulsivity – that’s how this all started. I ran across it as a symptom of bipolar somewhere in my endless hours of research. It was an exact fit for much of my behavior, thus peaking my interest. Some of the forms it takes are impatience, risk taking, spur of the moment thinking, underestimated sense of harm, extraversion, sensation and pleasure seeking, rapid decision making and the inability to resist temptations and the expression of it in an inappropriate environment. This definitely sounded like me. Well, my impulsivity research has lead to more information on borderline personality disorder (BPD) than anything else. So, since I found that BPD is often comorbid with bipolar, I thought I might as well share what I discovered.
DIAGNOSIS
BPD usually surfaces in the early twenties, but like anything there are no hard and fast rules. A continual pattern of unstable interpersonal relationships, poor self-image, impulsivity, anger and fear of abandonment are the hallmarks of this disorder. Unfortunately common symptoms occur in mood disorders, schizotypal personality disorders, paranoid personality disorder, ADHD and a host of others. It is estimated that nearly 6 million Americans suffer from BPD. To be classified as BPD, the DSM-IV states that you must meet five or more of the following criteria:
1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships
3. Identity disturbance – markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self damaging:
*Spending
*Sex
*Substance abuse
*Gambling
*Reckless driving
*Binge eating
5. Recurrent suicidal behavior, gestures or threats or self mutilating behavior
6. Affective instability due to marked reactivity of mood
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress related, paranoid ideation or severe dissociative symptoms
Associated features include a depressed mood, addiction or dramatic/erratic antisocial personality. Some suffer from transient psychotic-like symptoms (e.g. hearing their name being called) during times of stress. People with BPD may undermine their own goals by sabotaging themselves right before nearing the completion of the goal. Many feel more secure with transitional objects (e.g. pet or inanimate objects) than they do having interpersonal relationships. Despite the continuum of relationship problems they have, they may deny that they are the problem. In fact, often they blame others for their difficulties.
The following is a list of feelings and behaviors that are common among people with BPD:
Affect
* Helplessness or hopelessness or worthlessness
* Guilt
* Shame
* Anger (including frequent expressions of anger)
* Anxiety
* Chronic/episodic depression
* Loneliness
* Boredom
* Emptiness
Cognition
* Odd thinking
* Unusual perceptions
* Non-delusional paranoia
* Quasi-psychosis
Impulse Action Patterns
* Substance abuse/dependence
* Sexual deviance
* Manipulative suicide gestures/self-mutilation
* Other impulsive behavior (gambling, reckless driving, binge eating)
Interpersonal Relationships
* Intolerance of aloneness
* Abandonment, engulfment, annihilation fears
* Counter dependency
* Stormy relationships
* Manipulative
* Dependency
* Devaluation
* Masochism/sadism
* Demanding
* Entitlement
STATISTICS
Common Childhood Histories of People with BPD
* Physical Abuse
* Sexual Abuse (40-70%)
* Neglect
* Hostile Conflict
* Early Parental Loss or Separation
General Information
* BPD occurs in an estimated 2% of the population
* People with BPD comprise nearly 10% of the patients seen in out-patient clinics
* 15-20% of in-patient admissions are for BPD
* Sufferers of BPD comprise 30-60% of the clinical population with personality disorders
* 3:1 ratio of women to men who have BPD
* 69-75% of BPD sufferers resort to self mutilation
Miscellaneous
* 3-10% of completed suicides are by people with BPD (50 times higher than the general population
* Difficulty with academic, occupational or role functioning. People suffering with BPD have trouble holding down jobs due to their behavior, especially anger or aggression.
* Physical handicaps or scars Results from self-mutilating can cause embarrassment, shame and guilt thus causing the action to repeatedly cycle.
* Social costs Only about 1/2 of BPD sufferers will have a stable job or marriage after attaining functional roles 10 – 15 years after being admitted to a psychiatric facility.
* Medications and Therapy Recent studies do show a greater lifetime usage of most major categories of medications and of most types of psychotherapy than do patients with schizotypal, avoidant, OCD or patients with major depression.
DIFFERENTIAL DIAGNOSIS
A professional should always do a diagnosis of anything. And I mean ANYTHING. If your tree is losing its bark you call a specialist to figure out the problem. If you have problems with your physical health you go to a medical doctor. If you are having problems that are emotional or mental in nature you go to a psychologist or psychiatrist or both. This is not something to fool around with. Never try to self-diagnose or diagnose someone else. Articles, books and information on the Internet are simply meant to provide you with facts, ideas and options. They should be used to help you decide if maybe you need to see a professional. Remember, I’m not a doctor, I just play one on the Internet – so don’t take my information to be the absolute truth.
The reason you want to see a professional is that lists of symptoms from any source, including the DSM-IV, are tools that they use along with special training to provide you with a correct diagnosis. In fact, it is so difficult a job to diagnose illnesses that many of us have been misdiagnosed or had our diagnosis changed as other symptoms presented themselves. This is because so much of the criteria for one illness may also be close to or the same as that of another illness. Also, a professional relies on what they see and what we tell them to make a diagnosis, and let’s face it, the mentally ill are not always forthcoming with their problems to someone they just met. Some people are never completely honest with their doctors and don’t realize they are only hurting themselves. Ok, enough preaching on my part, on to some examples.
Features such as affective instability and impulsivity are criteria for BPD and bipolar disorder, Hopelessness and suicidal symptoms are major symptoms for BPD and also for clinical depression. It can be particularly difficult to differentiate between dysthymic disorder and BPD since the symptoms mimic each other. The major difference between these symptoms is the motivation behind them. With BPD interpersonal stressors such as rejection, abandonment, feelings of emptiness and self-condemnation trigger these symptoms. To give you an idea of how tough a psychiatrist’s job is let’s take one of the big symptoms of BPD – ANGER. Often it is referred to as “pathological aggression” and it is a symptom of the following illnesses:
*Borderline Personality Disorder
*Bipolar Disorder
*AD/HD (ADD, ADHD)
*Psychotic disorders
*Dysthymia
*Antisocial Personality Disorder
*Major Depressive Disorder
*Psychoactive substance intoxication and withdrawal
*Pervasive developmental disorders
*PTSD
*PMDD
*Intermittent Explosive Disorder
*Kleptomania
*Pyromania
*Pathological gambling
TREATMENTS
The treatment for BPD is similar to that of most mental disorders – medication and psychotherapy. As mentioned earlier, the sufferers of BPD show a high lifetime average of compliance with both of these treatments. Neuroleptics are particularly recommended for the psychotic symptoms and for patients who show anger, which must be controlled. Antipsychotics and antidepressants are used but should only be for short term use as needed to control symptoms. If BPD is comorbid with bipolar disorder then a mood stabilizer should be used as well. In fact, Depakote has been shown to diminish interpersonal sensitivity, anger, hostility and depression.
Like all personality disorders, BPD is intrinsically difficult to treat. Besides basic cognitive behavior therapy a newer psychotherapy by Marsha Linehan has proven to be very effective. It is called Dialectical Behavior Therapy (DBT) and is quite intensive. It seeks to teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. Personality disorders, by definition, are long-standing ways of coping with the world, social and personal relationships, handling stress and emotions, etc. that often do not work, especially when a person is under increased stress or performance demands in their lives. Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most.
PERSONAL EXPERIENCES
In an effort to understand the plight of the BPD sufferer, I read many personal stories. What I discovered is that a few common themes infiltrated most of them. First is the amount of pain that is held inside that seems to be completely unbearable by the person. By most accounts the pain is indescribably horrendous and there is a universal belief that no one could possibly understand the depth of it no matter how hard they tried. This leaves them feeling alone, left out, scared and empty. Many will withdraw within themselves, thus the cycle of losing the sense of self begins. Eventually many end up with no sense of who they really are as a person. This hurt is typically triggered because of a fight, falling out or disappointment with someone who is very close to them. When they decide to make a friend or have a lover, that person becomes the center of their world so any conflict is a terrifying situation. In turn, once they have rejected a person, that person no longer exists to them.
During these conflicts someone with BPD can resort to tremendous acts of rage. Often they become violent or get into screaming matches with the person who has caused their pain. The black and white thinking that takes place in their mind makes it impossible to reason with them during these times. Their lashing out can be a way of controlling a situation and often they feel it is not the “real” them that is acting out. In other words, they dissociate or sometimes even split their personality. After these rages comes the overwhelming sense of guilt and shame. Without proper coping skills most will resort to some sort of self-harm. It seems to be the only way they can get the pain out of them – even though it is a temporary solution and most seem to know that.
An unusual paradox that takes place with BPD sufferers is the need to push loved ones away, yet most have a horrible fear of being left alone. They identify themselves in others and if left alone it’s as if they are nothing. This goes back to that loss of self and the inescapable pain they have trapped within. Most of this pain can be traced back to early childhood. Most of what I read mentioned childhood tragedies such as abandonment, emotional or physical abuse, sexual abuse or repeated rejection. Some of the stories brought me to tears thinking about what they had to endure and it helped me to understand why they push their true selves so far back that they don’t know who they are anymore.
Well, I found a lot more of myself in here than just the impulsivity that started the whole thing out. I identified with many other symptoms, especially the feelings of abandonment since my father left when I was 4 years old and I didn’t see him again for 19 years. I am always afraid of men leaving me. Certainly those who know me also know that I have quite a temper and can rage over the slightest thing. But, I don’t have BPD and I feel for those that do. It is my sincere hope that if you identify yourself in this article and think you may fit some of the criteria that you seek professional help. It can only make things better. And, even though you may feel like nothing and may feel worthless – you’re not. YOU ARE WORTH SOMETHING! Help yourself come into the light and out of the darkness of despair.
Impulsivity – that’s how this all started. I ran across it as a symptom of bipolar somewhere in my endless hours of research. It was an exact fit for much of my behavior, thus peaking my interest. Some of the forms it takes are impatience, risk taking, spur of the moment thinking, underestimated sense of harm, extraversion, sensation and pleasure seeking, rapid decision making and the inability to resist temptations and the expression of it in an inappropriate environment. This definitely sounded like me. Well, my impulsivity research has lead to more information on borderline personality disorder (BPD) than anything else. So, since I found that BPD is often comorbid with bipolar, I thought I might as well share what I discovered.
DIAGNOSIS
BPD usually surfaces in the early twenties, but like anything there are no hard and fast rules. A continual pattern of unstable interpersonal relationships, poor self-image, impulsivity, anger and fear of abandonment are the hallmarks of this disorder. Unfortunately common symptoms occur in mood disorders, schizotypal personality disorders, paranoid personality disorder, ADHD and a host of others. It is estimated that nearly 6 million Americans suffer from BPD. To be classified as BPD, the DSM-IV states that you must meet five or more of the following criteria:
1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships
3. Identity disturbance – markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self damaging:
*Spending
*Sex
*Substance abuse
*Gambling
*Reckless driving
*Binge eating
5. Recurrent suicidal behavior, gestures or threats or self mutilating behavior
6. Affective instability due to marked reactivity of mood
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress related, paranoid ideation or severe dissociative symptoms
Associated features include a depressed mood, addiction or dramatic/erratic antisocial personality. Some suffer from transient psychotic-like symptoms (e.g. hearing their name being called) during times of stress. People with BPD may undermine their own goals by sabotaging themselves right before nearing the completion of the goal. Many feel more secure with transitional objects (e.g. pet or inanimate objects) than they do having interpersonal relationships. Despite the continuum of relationship problems they have, they may deny that they are the problem. In fact, often they blame others for their difficulties.
The following is a list of feelings and behaviors that are common among people with BPD:
Affect
* Helplessness or hopelessness or worthlessness
* Guilt
* Shame
* Anger (including frequent expressions of anger)
* Anxiety
* Chronic/episodic depression
* Loneliness
* Boredom
* Emptiness
Cognition
* Odd thinking
* Unusual perceptions
* Non-delusional paranoia
* Quasi-psychosis
Impulse Action Patterns
* Substance abuse/dependence
* Sexual deviance
* Manipulative suicide gestures/self-mutilation
* Other impulsive behavior (gambling, reckless driving, binge eating)
Interpersonal Relationships
* Intolerance of aloneness
* Abandonment, engulfment, annihilation fears
* Counter dependency
* Stormy relationships
* Manipulative
* Dependency
* Devaluation
* Masochism/sadism
* Demanding
* Entitlement
STATISTICS
Common Childhood Histories of People with BPD
* Physical Abuse
* Sexual Abuse (40-70%)
* Neglect
* Hostile Conflict
* Early Parental Loss or Separation
General Information
* BPD occurs in an estimated 2% of the population
* People with BPD comprise nearly 10% of the patients seen in out-patient clinics
* 15-20% of in-patient admissions are for BPD
* Sufferers of BPD comprise 30-60% of the clinical population with personality disorders
* 3:1 ratio of women to men who have BPD
* 69-75% of BPD sufferers resort to self mutilation
Miscellaneous
* 3-10% of completed suicides are by people with BPD (50 times higher than the general population
* Difficulty with academic, occupational or role functioning. People suffering with BPD have trouble holding down jobs due to their behavior, especially anger or aggression.
* Physical handicaps or scars Results from self-mutilating can cause embarrassment, shame and guilt thus causing the action to repeatedly cycle.
* Social costs Only about 1/2 of BPD sufferers will have a stable job or marriage after attaining functional roles 10 – 15 years after being admitted to a psychiatric facility.
* Medications and Therapy Recent studies do show a greater lifetime usage of most major categories of medications and of most types of psychotherapy than do patients with schizotypal, avoidant, OCD or patients with major depression.
DIFFERENTIAL DIAGNOSIS
A professional should always do a diagnosis of anything. And I mean ANYTHING. If your tree is losing its bark you call a specialist to figure out the problem. If you have problems with your physical health you go to a medical doctor. If you are having problems that are emotional or mental in nature you go to a psychologist or psychiatrist or both. This is not something to fool around with. Never try to self-diagnose or diagnose someone else. Articles, books and information on the Internet are simply meant to provide you with facts, ideas and options. They should be used to help you decide if maybe you need to see a professional. Remember, I’m not a doctor, I just play one on the Internet – so don’t take my information to be the absolute truth.
The reason you want to see a professional is that lists of symptoms from any source, including the DSM-IV, are tools that they use along with special training to provide you with a correct diagnosis. In fact, it is so difficult a job to diagnose illnesses that many of us have been misdiagnosed or had our diagnosis changed as other symptoms presented themselves. This is because so much of the criteria for one illness may also be close to or the same as that of another illness. Also, a professional relies on what they see and what we tell them to make a diagnosis, and let’s face it, the mentally ill are not always forthcoming with their problems to someone they just met. Some people are never completely honest with their doctors and don’t realize they are only hurting themselves. Ok, enough preaching on my part, on to some examples.
Features such as affective instability and impulsivity are criteria for BPD and bipolar disorder, Hopelessness and suicidal symptoms are major symptoms for BPD and also for clinical depression. It can be particularly difficult to differentiate between dysthymic disorder and BPD since the symptoms mimic each other. The major difference between these symptoms is the motivation behind them. With BPD interpersonal stressors such as rejection, abandonment, feelings of emptiness and self-condemnation trigger these symptoms. To give you an idea of how tough a psychiatrist’s job is let’s take one of the big symptoms of BPD – ANGER. Often it is referred to as “pathological aggression” and it is a symptom of the following illnesses:
*Borderline Personality Disorder
*Bipolar Disorder
*AD/HD (ADD, ADHD)
*Psychotic disorders
*Dysthymia
*Antisocial Personality Disorder
*Major Depressive Disorder
*Psychoactive substance intoxication and withdrawal
*Pervasive developmental disorders
*PTSD
*PMDD
*Intermittent Explosive Disorder
*Kleptomania
*Pyromania
*Pathological gambling
TREATMENTS
The treatment for BPD is similar to that of most mental disorders – medication and psychotherapy. As mentioned earlier, the sufferers of BPD show a high lifetime average of compliance with both of these treatments. Neuroleptics are particularly recommended for the psychotic symptoms and for patients who show anger, which must be controlled. Antipsychotics and antidepressants are used but should only be for short term use as needed to control symptoms. If BPD is comorbid with bipolar disorder then a mood stabilizer should be used as well. In fact, Depakote has been shown to diminish interpersonal sensitivity, anger, hostility and depression.
Like all personality disorders, BPD is intrinsically difficult to treat. Besides basic cognitive behavior therapy a newer psychotherapy by Marsha Linehan has proven to be very effective. It is called Dialectical Behavior Therapy (DBT) and is quite intensive. It seeks to teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. Personality disorders, by definition, are long-standing ways of coping with the world, social and personal relationships, handling stress and emotions, etc. that often do not work, especially when a person is under increased stress or performance demands in their lives. Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most.
PERSONAL EXPERIENCES
In an effort to understand the plight of the BPD sufferer, I read many personal stories. What I discovered is that a few common themes infiltrated most of them. First is the amount of pain that is held inside that seems to be completely unbearable by the person. By most accounts the pain is indescribably horrendous and there is a universal belief that no one could possibly understand the depth of it no matter how hard they tried. This leaves them feeling alone, left out, scared and empty. Many will withdraw within themselves, thus the cycle of losing the sense of self begins. Eventually many end up with no sense of who they really are as a person. This hurt is typically triggered because of a fight, falling out or disappointment with someone who is very close to them. When they decide to make a friend or have a lover, that person becomes the center of their world so any conflict is a terrifying situation. In turn, once they have rejected a person, that person no longer exists to them.
During these conflicts someone with BPD can resort to tremendous acts of rage. Often they become violent or get into screaming matches with the person who has caused their pain. The black and white thinking that takes place in their mind makes it impossible to reason with them during these times. Their lashing out can be a way of controlling a situation and often they feel it is not the “real” them that is acting out. In other words, they dissociate or sometimes even split their personality. After these rages comes the overwhelming sense of guilt and shame. Without proper coping skills most will resort to some sort of self-harm. It seems to be the only way they can get the pain out of them – even though it is a temporary solution and most seem to know that.
An unusual paradox that takes place with BPD sufferers is the need to push loved ones away, yet most have a horrible fear of being left alone. They identify themselves in others and if left alone it’s as if they are nothing. This goes back to that loss of self and the inescapable pain they have trapped within. Most of this pain can be traced back to early childhood. Most of what I read mentioned childhood tragedies such as abandonment, emotional or physical abuse, sexual abuse or repeated rejection. Some of the stories brought me to tears thinking about what they had to endure and it helped me to understand why they push their true selves so far back that they don’t know who they are anymore.
Well, I found a lot more of myself in here than just the impulsivity that started the whole thing out. I identified with many other symptoms, especially the feelings of abandonment since my father left when I was 4 years old and I didn’t see him again for 19 years. I am always afraid of men leaving me. Certainly those who know me also know that I have quite a temper and can rage over the slightest thing. But, I don’t have BPD and I feel for those that do. It is my sincere hope that if you identify yourself in this article and think you may fit some of the criteria that you seek professional help. It can only make things better. And, even though you may feel like nothing and may feel worthless – you’re not. YOU ARE WORTH SOMETHING! Help yourself come into the light and out of the darkness of despair.