Sanctuary for the Abused
Monday, March 19, 2018
Borderline Personality Disorder
DIAGNOSIS/CHARACTERISTICS
Borderline personality disorder is a complex of problems that tend to be long-standing. Perhaps the real key to understanding BPD is to realize that the hallmark of this disorder is emotional instability, or even instability in general. This instability is manifest in many areas of a person's life.
Mood:
1. People with BPD show marked shifts in mood, which often last only hours. One minute the person is apparently happy, the next the person is crying uncontrollably or is totally enraged.
2. Thus, another mark of mood instability is anger that is inappropriate, intense and/or uncontrollable.
Behavior:
3. The instability in behavior is marked by impulsive and often dangerous acts. Self-mutilation or suicidal threats and gestures are common among people with BPD. Many people with BPD say that cutting on themselves or burning themselves provides a sense of relief and calm that they have difficulty finding otherwise.
4. Other indications of instability in behavior is shown by potentially self-damaging impulsive behaviors: alcohol/drug abuse, compulsive spending, gambling, eating disorders, shoplifting, reckless driving, compulsive sexual behavior.
Identity:
5. In the area of identity, the instability is shown by marked, persistent identity disturbance: self -image, sexual orientation, career choice or other long-term goals; friendships, values. People with BPD often feel they do not know who they are or what they think or what their opinions are. Often they try to be what they think other people want them to be.
6. Such a lack of clear identity often leads to chronic feelings of emptiness or boredom.
Relationships:
7. Relationships for the person with BPD are understandably unstable, chaotic, and intense. These relationships are often characterized by what has been called "splitting". Splitting occurs when the self and others are viewed as all good or all bad. People with BPD tend to see the world in black and white terms, never grey. One minute the self or another person is seen as wonderful and the next, the self or the other person is seen as the devil incarnate. It seems like the person with BPD is unable to see the self or others in the full context of life. It doesn't really matter that yesterday you did something good. Only this moment's behavior counts in the evaluation.
8. Because of this inability to see things in context the person with BPD has difficulty seeing that others will continue to be involved with them. As a result, they become frantic to avoid real or imagined abandonment. "Just because you were my friend yesterday does not mean that you will be my friend today." To control these fears of abandonment, Borderlines often alternate between clinging and distancing behaviors. This phenomenon has been called: "I hate you, don't leave me."
Borderlines have a great difficulty in trusting people and themselves. They are hypersensitive to criticism or rejection and often feel they "need" someone else in order to survive. But since they do not trust others to stay and not abandon them, Borderlines show an extreme need for affection and reassurance by the other people in their lives.
Nevertheless, some people may have an unusually high degree of interpersonal sensitivity, insight and empathy, perhaps as a way to stay attuned to the signals given out by others of impending abandonment.
9. When under particular stress, the person with BPD may show transient, stress-related paranoid ideation or severe dissociative symptoms. In fact, a brief psychotic reaction can occur in which the Borderline experiences delusional thinking and hallucinations. This usually clears quite rapidly.
Other (non-DSM) characteristics:
As noted above, Borderlines typically have a lot of difficulty with what is called "object constancy." This is the realization that what a person was yesterday is a good predictor of what they will be today. Borderlines seem to have trouble seeing this. They do not trust that a person who was nice yesterday is likely to be nice today. It also extends to the concern that just because a person was here yesterday, does not mean they will be here today. As a result, the Borderline has considerable difficulty being alone. If you're not with me 100% of the time, how will I know you will stay with me?"
Boundary issues are also problematic for the Borderline. It is hard to place limits on others for fear of abandonment. The separation between "me" and "not me" are blurred.
Needless to day, because of all this instability in mood, identity, behavior and relationships, the person with BPD often leads a chaotic life.
Causes
According to Linehan (1993), the person who develops BPD is born with innate biological tendency to react more intensely to lower level of stress. They are temperamentally more reactive than other children. When such reactive children are raised in what she calls " an invalidating environment" the groundwork is set for developing Borderline Personality Disorder. An invalidating environment is one in which the thoughts, feelings and experiences of the child are negated by the adults in his/her life. For example, a child says "I'm sad" but the parent responds "No, you're not." This is an invalidation of the child's feelings. Over time, this leads to confusion in the child about the reality of his or her own perceptions of the world and self.
Many mental health professionals have found that a high number of people with BPD have experienced severe abuse as a child. In fact, some have gone so far as to assume that if a person is Borderline, they must have been severely abused when growing up. This has resulted in much blaming of families/parents. "However, the scientific evidence does not justify the conclusion that the family carries the primary responsibility for the development of borderline personality disorder." (Paris). Research has indicated that while many Borderlines have experienced severe abuse, not all have. It is therefore inappropriate to assume childhood abuse when presented with a person with BPD.
Low serotonin activity has also been implicated in this disorder but medications targeting serotonin levels do not seem very effective. It appears that BPD is more than simply a "chemical imbalance."
Course
Borderline Personality Disorder usually begins in adolescence or youth. Diagnosis at this stage, however, should be done cautiously since many of the indicators of BPD are characteristic of "normal" adolescence.
There is a discrepancy between the rates of BPD in men and women, with 80% of sufferers being women. The reason for this is presently unknown.
One out of ten people with BPD will complete suicide. However, if they live long enough, BPD tends to "burn out" in middle age. Functioning seems to improve by the ages of 35 or 40 with some Borderlines being able to manage a successful career, family life, etc. A minority will continue to be highly symptomatic into middle age.
Treatment
There is no specific treatment for BPD (PsychCentral). Medications may take edge off impulsive symptoms. Low doses of neuroleptics (antipsychotic medication) may be helpful. However, no pharmacological agent has any specific effect on the underlying borderline pathology.
Psychotherapy is the mainstay of treatment. However there is a high drop out rate from psychotherapy. When a borderline does stay in therapy, most of the work in therapy centers around decreasing impulsive behaviors and learning to exercise better judgment. Cognitive-behavioral therapy, particularly Linehan's Dialectic Behavioral Therapy, which targets impulsivity and emotional instability has been shown by research to be highly effective at least in the short term (i.e. 1 year).
Since many clinicians believe that BPD is caused by traumatic childhoods, there has been a tendency to focus on uncovering negative events so as to help patients "process" them. "However, there is no evidence that these methods are successful. In fact, there is some reason to suspect they can make patients worse by focusing too much on the past, and not enough on the present. In addition, borderline patients can be particularly prone to develop false memories in psychotherapy"(Paris).
Because of the risk of suicide, clinicians often use contracts to help ensure that the client does not commit suicide. However, hospitalization may become necessary if the risk becomes too great. Hospitalization is typically short-term and focused on reducing the risk of self-harm.
Support groups can also be of benefit for the Borderline. However, care should be taken that the instability of one Borderline does not "feed" the instability of another. This is a phenomenon that has been seen often in hospital settings where one borderline cuts herself and afterwards, several others start doing the same thing.
Final Thoughts
Because of the myriad symptoms shown by a person suffering from BPD, there is a risk that the person will be misdiagnosed. With a focus on the instability of mood, Borderlines are often called "Bipolar." If the focus is on the brief psychotic symptoms, the person may be diagnosed as "Schizoaffective." Such misdiagnosis can lead to inappropriate or over-medication by physicians.
Living with a person with Borderline Personality Disorder is painful and distressful. Finding a support group or even consulting a mental health professional may be helpful in dealing with this disorder.
CLICK HERE FOR ONLINE HELP OR INFORMATION ABOUT BPD
References
Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guildford Press.
Paris, J. "Borderline Personality Disorder" in The Journal
PsychCentral. "Borderline Personality Disorder."
Labels: abandonment, behavior, borderline, characteristics, needs, recovery, sensitive, suicidal
Saturday, February 24, 2018
The 10 Most Dysfunctional Things Ever Uttered
(if anyone says these to you, they are dysfunctional - run from them!! even if they are family. - Barbara)
They don’t get worse than these — the ten comments that signify the very most dysfunction possible.
In no particular order:
1. “I did nothing wrong. You’re just oversensitive.”
It’s not that there aren’t people in the world who are highly sensitive. It’s just that even if the person being spoken to were oversensitive, this comment is only going to make them feel much worse! It offers no help, and only rubs salt in the wound.
It is a critical statement of low empathy — there’s no effort to truly understand the other person’s feelings or to consider that maybe the speaker could possibly have done even one small thing a little more considerately to try helping matters.
In addition, it’s most often said by people who are not actually dealing with someone who’s “too sensitive”, but instead, someone who is actually expressing normal dismay about a valid concern.
2. “That’s just the way it is.”
While it’s true there’s no point denying that the sky has always been blue and grass will be forever green, making the above comment in order to shut down someone’s concerns or curiosity about a given situation is a different matter.
Such a comment displays a high level of dysfunctionality, typically related to disempowerment, denial, defensiveness, closed-mindedness and attempts at control of others.
Inflexibility and difficulty with change is common in the personality disorder called OCPD, and in autism spectrum disorders.
3. “Why can’t you be more like so-and-so?”
Trying to tell someone to be more like someone else is self-centered. If you’re dealing with a person who is self-important enough to think that other people should conform to their personal preferences (and need only be asked to do so) you’re likely dealing with someone characteristically narcissistic.
4. “I’m sorry you feel that way/I’m sorry if you…/I’m sorry, but…”
If a person cannot say, “I’m sorry I did that/I’m sorry I hurt you/I’m sorry I was wrong”, and dodges emotional responsibility with the kind of fake apologies and substitutions above, there’s a problem.
Healthy relationships require genuine apologies that are the result of empathy. Inability to truly sense other people’s feelings is at the root of an incredible amount of dysfunction, and unwillingness to admit mistakes is highly dysfunctional behavior.
5. “You always/You never…”
It’s unlikely the person NEVER or ALWAYS does whatever is complained about. It’s more likely it happens a lot. Or, it happens too often for the person’s liking.
Saying “always” or “never” when complaining about someone’s behavior makes them feel as if you aren’t trying to resolve the matter with them — you’re trying to condemn them.
When people have difficult issues they wish they didn’t struggle with, and they’re making very little progress on them, it’s very painful to be told by someone they care about that they “always” or “never” do something. It causes them to lose hope, and more importantly, it causes them to lose hope that you are on their side against the difficulty, and that you do believe in them and see their hard-earned minor improvements.
6. “You’re not smart enough to do that /you’ll never amount to anything /you’re an idiot.”
This one needs no explanation. It’s just abusive, plain and simple. If this has been said to you, remember, it’s projection — people who say this have a tremendous fear that they themselves are the “stupid” one.
Everyone has something to offer. Everyone is good at something, and a comment like this is nothing but a reflection of the speaker’s own insecurities and fears. Typically, abusive people will pick the moment of a mistake to utter this, but everyone makes mistakes, including the person saying it, and their comment means nothing about the listener. People are not their mistakes, and are not necessarily what other people say they are.
7. “I told you so.”
All people have a right to make their own choices, and to disagree with others. People who tell other people what’s supposedly best and then pounce on them if their alternate choice doesn’t work are seeking to gain future control of the independent person by shaming them. Shame fuels dysfunction, and should not be accepted.
8. “You are ‘choosing’ to feel bad about the upsetting thing I did or said.”
This is highly invalidating. The person who says this is not making any effort to empathize, is refusing to take responsibility for the impact of their behavior on others, and is trying to blame the person they have hurt.
Feelings aren’t even processed in the same area of the brain as thoughts. If someone threatens you, you will feel fear. You’re not “choosing” fear; fear is an immediate, natural and healthy response to being in a threatening situation. If someone you love dies, you will feel sad. You are not “choosing” to feel sad about their death. Sadness is a normal, healthy response to the loss of someone. If your sibling, partner or other person you are close to says something insensitive or cruel, you will feel hurt. You’re not “choosing” to feel hurt; it is a natural and healthy response to unkindness.
Telling someone who feels hurt that they have “chosen” to feel hurt is generally a way of avoiding responsibility by making the hurt person retreat in shame that they have done “wrong”. They’re supposed to “choose” properly by letting the person who hurt them off the hook, and instead, focusing on their own “bad choices”.
9. “You wouldn’t understand”.
This kind of dismissiveness and condescension is seen in people who harbor the belief that they are superior and should ideally be the one in control, because of their supposed superiority. The arrogance of such a statement is more than rude and devaluing — it indicates that the person’s intention is to shut you out and shut you down so they can propagate the perception that they are “better” than you.
10. “What they don’t know can’t hurt them.”
If a person hasn’t found out that their spouse is cheating, or that somebody took advantage of them in some way they haven’t realized, it’s true that they won’t feel hurt.
But… the person who says this is a cheater; the person who says this is taking advantage. It’s wise to steer clear of people like this, because they care much more about themselves than other people, and they lack integrity. This is highly characteristic of mentally disordered thinking, and the person who says it will most likely one day be the person who takes advantage of you, too. The presence of a good conscience doesn’t depend on circumstances or individuals present.
If there’s no conscience nagging at them when they take advantage of someone other than you, there will be no conscience nagging at them when it’s your turn to be the one in their way.
from this fantastic blog!
Labels: abuse, abusive, arrogant, communication, dismissed, dysfunction, fake, invalidating, sensitive, verbal abuse
