Category Archives: Bpd Articles

Do BPD Sufferers Have A ‘Split Personality’?

do people with BPD have a split personality?

In terms of symptoms, there exists a clear overlap between the psychiatric conditions of borderline personality disorder (BPD) and Dissociative Identity Disorder (DID). DID used to be referred to multiple-personality disorder.

Borderline Personality Disorder, Dissociative Identity Disorder And ‘Splitting’

‘Splitting’ is a psychological defense mechanism in which one ‘part’ of the personality becomes separated / un-integrated with / isolated from another ‘part’ of the personality. In the case of individuals suffering from BPD, these two parts can, in simple terms, be described as PART ONE and PART TWO, where :

PART ONE represents the part of the person’s personality which is relatively accepting of him/herself and others

whereas :

PART TWO represents the part of the person’s personality which is full of self-hatred, as well as anger and hostility (and, underlying the latter two emotions, fear of being psychologically harmed) in relation to others.

When PART ONE is ‘operational’, it tends to enter a state of denial about the existence of PART TWO.

This may be because when PART ONE is ‘in charge’, the individual develops a state of mind similar to amnesia regarding  the existence PART TWO ; alternatively, the denial may be underpinned by feelings of profound shame. However, more research needs to be conducted in relation to these possibilities.

‘Splitting’ and amnesia (when one part of the personality is unaware of how another part of the personality has manifested itself) are also symptoms of dissociative identity disorder.

do BPD sufferers have a split personality?

Borderline Personality Disorder And ‘Switching’ Between ‘Part One’ And ‘Part Two’

As stated above, ‘PART ONE’ and ‘PART TWO’ have become un-intergrated in the personality of individuals suffering from BPD (the BPD sufferers personality, in this respect, may be described as having ‘disintegrated’). A more formal way to put this would be to describe the BPD sufferer as having an un-integrated ego-state (in contrast to the relatively integrated ego-state that psychologically ‘healthy’ individuals enjoy).

Those with BPD ‘switch’ between ‘PART ONE’ and ‘PART TWO’ and this can occur quite suddenly (but is not usually dramatically instantaneous).

Furthermore, these unintegrated ego-states interfere with each other (because they are not completely separate from one another) and this may cause symptoms such as the following :

  • unstable mood / affect / emotions (sometimes referred to as emotional lability)
  • unstable sense of identity (some sufferers describe this with phrases such as : ‘I have no idea who I am…’).

How ‘Splitting’ Affects The BPD Sufferer’s Relationships With Others :

When ‘PART ONE’ is ‘in charge’, the BPD sufferer desires emotional attachments with others. However, when ‘PART TWO’ is dominant, s/he becomes hostile towards others and withdraws from them – this leads to the classic ‘love-hate’ scenario.

Why Does This Unintegrated Ego-State Arise In Those Suffering From BPD?

The two separate parts can develop in a person who has suffered severe and prolonged abuse as a child.

When the abused child becomes an adult, PART TWO (hostility etc) can be kept in abeyance for much of the time to allow daily social functioning. However, PART ONE makes itself apparent when the BPD sufferer is reminded of the abuse s/he suffered as a child (such a reminder is called a ‘trigger’).

This reminder/trigger may be detected by the BPD sufferer consciously or unconsciously and occurs as a defense mechanism against real or perceived psychological threat (especially the treat of betrayal, rejection or abandonment as occurred in the individual’s childhood).

If the individual had not developed this defense mechanism as a child, s/he faced what may reasonably be termed as ‘psychological destruction.’ In other words, the development of the ‘splitting’ defense mechanism makes complete evolutionary sense as it allowed the individual to survive childhood – it is a normal, predictable, adaptive response to childhood loss, fear, distress and betrayal.

Conclusion ;

There is an overlap between symptoms of borderline personality disorder and dissociative identity disorder in as far as they both involve ‘splitting’ and ‘dissociating’. However, in the case of DID, the separation between the different PARTS of personality are MORE DISTINCT AND CLEAR CUT THAN THEY ARE IN THE CASE BPD. Those suffering from DID may have more than two un-integrated / separate PARTS of their personality / ego-state ; however, arguably, this can also be the case in those suffering from BPD (although this is beyond the scope of this article).

In conclusion, though, we can say, with some confidence, that BPD sufferers do have a ‘split personality’, but the division between these two parts is more nebulous than in the case of DID sufferers.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Diagnosing BPD In Adolescents : Why Some Clinicians Don’t Like Doing It

diagnosing BPD in adolescents

Whilst borderline personality disorder (BPD) can be diagnosed in adolescents, some clinicians may be reluctant to do so ; I summarize some of the main reasons for this below :

– Symptoms of borderline personality disorder (BPD) may overlap lap to some degree with non-pathological (‘normal’) adolescent behaviors which can somewhat muddy the waters when it comes to attempting to make a clear, unambiguous and unequivocal diagnosis.

– The personality of the adolescent is still developing and is not yet fully formed

– Although it is less the case now than it was (in even the relatively recent past) a diagnosis of borderline personality disorder (BPD) is still often perceived as being stigmatizing and can potentially make the adolescent feel yet worse about himself/herself when his/her self-esteem and sense of self-worth is already extremely low (low self-esteem and low sense of self-worth are hallmark symptoms of BPD).

However, some individuals also feel a great sense of relief to have a diagnosis as it helps them to understand the root causes of their dysfunctional behaviors and therefore feel less guilty (feelings of intense, irrational guilt are another hallmark symptom of BPD).

Also, of course, an accurate diagnosis helps to ensure appropriate and effective treatment is given (see RISK OF SUICIDE below); at present, the most effective treatment for BPD is considered to be dialectical behavioral therapy (DBT). Whilst DBT is a therapy that was initially developed in order to help to treat adults with BPD, it is possible to adapt it to the needs of the adolescent. However, the majority of clinicians are still reluctant to make the diagnosis of BPD in young people who are under the age of eighteen years.

– Because BPD has its roots in childhood experience, it is likely that some clinicians are worried about diagnosing BPD in the adolescent in case the parents may regard it as a negative judgment upon them and therefore become upset or angry.

However, if the parents’ behavior has seriously damaged their child, then alerting them to the fact may galvanize them into making a concerted effort to improve the manner in which they treat the young person (sadly, of course, this can’t be guaranteed ; indeed. abusive parents may feel humiliated at take it out on the child).

– Because BPD sufferers tend to be gravely misunderstood, even by those entrusted with their care and treatment, some clinicians may be reluctant to diagnose adolescents with BPD in case it results in them being treated with prejudice and discriminated against by other clinicians they may come into contact with in later life,

THE RISK OF SUICIDE :

It is vital to remember that one in ten (yes, 10%) of individuals with BPD end up dying by suicide. This statistic demonstrates the vital importance of the earliest possible therapeutic intervention for those suffering from this profoundly painful and complex condition. Clearly, a prerequisite to effective treatment is sensitive, timely and accurate diagnosis.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Controlling Emotions : The Emotional Regulation System

controlling emotions

We have seen from other articles that I have published on this site that if, as children, we experienced, significant and protracted trauma we are at increased risk of developing various psychological difficulties as adults, including an increased risk of developing borderline personality disorder (BPD) and complex posttraumatic  stress disorder.

One of the hallmarks of BPD, as we have also seen from other articles, is that the sufferer of the condition finds it very difficult indeed to control intense and volatile emotions. In effect, the emotional regulation system of individuals diagnosed with BPD is out of kilter and dysfunctional.

What Is The Emotional Regulation System?

The emotional regulation system is fundamentally comprised of three interacting parts of the brain ; these are as follows :

  1. THE THREAT SYSTEM (detects and reacts to threats)
  2. THE DRIVE SYSTEM (motivates us to identify and seek resources)
  3. THE SOOTHING SYSTEM  (helps balance the two systems above and engenders in us a sense of well-being, satisfaction and contentment)

Each of these three systems is neither good nor bad per seas long as they are in balance and interacting in a healthy and functional way. However, each system is vulnerable to becoming dysfunctional (as occurs in the case of those suffering from BPD, for example). TO READ ABOUT WAYS IN WHICH THESE SYSTEMS CAN BECOME DYSFUNCTIONAL AND THERAPIES THAT CAN HELP, YOU MAY LIKE TO READ ANOTHER OF MY POSTS ON THE EMOTIONAL REGULATION SYSTEM BY CLICKING HERE.

how to control emotions

THE ROLE OF NEUROPLASTICITY IN THE DEVELOPMENT OF THE EMOTIONAL REGULATION SYSTEM :

The way in which the brain is shaped and develops depends, to a large degree, upon our early life experiences ; this is because of a quality of the brain known as neuroplasticity which you can read about by clicking here.

Because of the brain’s neuroplasticity, if, when we are young, we are constantly exposed to fear and danger because, for example, of the abusive treatment we receive from a parent or primary care giver, the THREAT SYSTEM is at very high risk of being constantly over-activated in a way that leads it to operate in a dysfunctional manner ; this dysfunction takes the form of the fight/flight/freeze; response becoming hypersensitive, resulting in the affected individual developing grave difficulties keeping related emotions (such as anger, fear and anxiety) in check. Without appropriate therapy, such dysfunction may last well into adulthood or even for an entire lifetime.

On the other hand, if, when we are young, we experience consistent and secure love, care and emotional warmth from our parents / primary caregivers, our SOOTHING SYSTEM is ‘nourished’ and becomes optimally (or close to optimally) developed resulting in us becoming more able to cope with life’s inevitable stressors, less vulnerable to feelings of anxiety and fear, and more able to calm ourselves down and ‘self-sooth’ than those who had who were brought up in an environment in which they were constantly exposed to fear and danger.

However, even if we have had a traumatic early life and have problems regulating our emotions, there are various, simple things we can do to us control our feelings (see below).

 

  • AVOID REACTING IMMEDIATELY / IMPULSIVELY : For example, if someone triggers our anger, rather than making a reflexive response (such as saying something we’ll deeply regret later) it is better to wait until the rage has subsided – this may involve calming physiological symptoms like fast heart rate and tense muscles by using relaxation exercises such as deep breathing and visualization ; we may, therefore, need to remove ourselves for a while (if possible) from the presence of whoever it may be that has upset us.
  • MAKE POSITIVE ALTERATIONS TO THE SITUATION GIVING RISE TO OUR NEGATIVE EMOTIONS (although this will not always be feasible, of course)
  • ALTER FOCUS OF ATTENTION (e.g. undertaking a distracting activity)
  • ALTER WAY IN WHICH WE ARE THINKING ABOUT THE SITUATION : A therapy that can help with this is COGNITIVE BEHAVIORAL THERAPY (CBT).

USING NEUROPLASTICITY TO OUR ADVANTAGE :

Although the brain’s quality of neuroplasticity can work against us if we experience a traumatic early life, we can also take advantage of it later in life to help reverse any damage that was done to the development of our young and vulnerable brains. In order to learn more about how this may be possible, you may wish read my article MENDING THE MIND : SELF-DIRECTED NEUROPLASTICITY.

DIALECTICAL BEHAVIORAL THERAPY (DBT) :

Dialectical Behavior Therapy (DBT) is a therapy that was designed primarily for those who are suffering from borderline personality disorder (see above). A particularly useful skill taught within this therapy is called DISTRESS TOLERANCE which can be very helpful for those experiencing emotional distress due to intense, negative feelings.

COMPASSION FOCUSED THERAPY (CFT) :

Compassion Focused Therapy (CFT) can also be an effective therapy for those suffering from emotional dysregulation.

 

RESOURCE :

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Are Those With Borderline Personality Disorder (BPD) Manipulative?

are those with BPD manipulative?

Sadly, many individuals suffering from borderline personality disorder (BPD) are stigmatized by others and, amongst other perjorative terms, are frequently described as ‘manipulative’.

However, in recent years, it has been increasingly recognized that intentionally manipulative behavior is, in fact, NOT a defining characteristic of BPD sufferers after all ; this shift in attitude is best exemplified by the fact that the Diagnostic And Statistical Manual Of Mental Illness, Fifth Edition, or DSM-V (sometimes informally referred to as the ‘psychiatrists’ bible’), has ceased to list ‘manipulative’ as one of the personality traits associated with borderline personality disorder.

However, this begs the question : ‘Why has it been so common for those suffering from BPD to be scornfully dismissed as manipulative in the past?

According to the psychologist, Marsha Lineham (well known for having developed Dialectical Behavior Therapy (DBT) for the treatment of BPD), this mis-labelling of BPD sufferers as manipulative has been based on a MISINTERPRETATION of certain types of their behavior.

Lineham puts forward the view that, often, some of the behaviors of BPD patients are wrongly perceived as being  manipulative whereas, in fact, they are desperate manifestations of intense psychological and emotional pain.

Indeed, borderline personality disorder (BPD) is generally accepted as being the most excruciatingly, psychologically and emotionally, painful of all mental health conditions ; as I have stated elsewhere on this site, approximately one in ten of those suffering from BPD end their lives by suicide. (To read my article, Living With Mental Agony, click here, or to read my article, Anger May Operate To Soothe Emotional Pain, click here.)

Sometimes, an example some people may give of so-called ‘manipulative’ behavior from BPD sufferers is the threat of suicide. For example, someone with BPD may take an overdose of tablets but then phone a friend or family member to say what they have done. Lineham points out, however, that this is unlikely to be a coldly calculated ploy but, rather, a desperate and confused expression of inner mental turmoil (the intensity of which the individual may not have the words to convey) and ambivalence – ambivalence in the sense that a part of the BPD sufferer may genuinely want to die whilst another (say, instinctual) part may be driven to survive.

Indeed, the fact that, as stated above, one in ten BPD sufferers eventually die by suicide suggests that any threat to do so should be treated extremely seriously.

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BPD And Psychodynamic Treatment

bpd and psychodynamic treatment

Crucial Importance Of First Five Years Of Life :

Central to psychodynamic theory, initially developed by Sigmund Freud, is the assertion that events occurring to the child between birth and five years of age have the most vital effect upon his/her psychological development.

Safe World Versus Unsafe World :

Crucially, according to psychodynamic theory, it is during these first five years of life that an individual’s view of whether the world is fundamentally safe or unsafe is formed ; which of these two opposing views the child develops depends upon the treatment s/he receives from his/her mother / primary carer – I elucidate upon this below :

  • if the child’s mother / primary carer is loving and nurturing towards him/her then s/he is likely to develop the belief that the world is an essentially safe place
  • if the child’s mother / primary carer mistreats / neglects him/her then s/he is likely to develop the belief that the world is an essentially unsafe place

The Role Of The Unconscious :

Another concept of fundamental importance to psychodynamic theory is the absolutely critical role played by the UNCONSCIOUS MIND.

According to Freud, the unconscious mind contains memories, urges, impulses, thoughts and feelings that are cut off from conscious awareness ; frequently, according to Freud, this is because they are painful, cause us mental conflict, cause us anxiety or are otherwise unacceptable to us.

However, even though these ‘banished’, ‘buried’, ‘cut off’ memories, urges, impulses,  thoughts and feelings lie outside of our conscious awareness they, nevertheless, POWERFULLY INFLUENCE HOW WE FEEL AND HOW WE BEHAVE.

The Iceberg Metaphor :

unconscious mind iceberg

The metaphor most commonly used to help explain the unconscious mind is that of the iceberg. Just a very small part of an iceberg is visible above the surface of the water and, in this way, according to Freud,  it is similar to the mind. The visible part of the iceberg represents the conscious mind, whereas by far the largest and most powerful part of the mind – the unconscious mind –  lies below the surface of the water. In other words, the visible part of the iceberg represents the conscious mind whereas the submerged part represents the unconscious mind. (The surface of the water, therefore. represents the division between the conscious and the unconscious).

Transference :

One method that can facilitate discovery of what is going on in a patient’s unconscious mind is to analyse his/her relationship with his/her therapist. It is theorized that such an analysis can be insightful due to a process in psychodynamic theory known as TRANSFERENCE that operates within the context of this relationship.

What Is Transference?

Transference can be defined as : the redirection of emotions (usually onto a therapist) that were originally felt in childhood (towards the parents and/or significant others).

To provide a simple example : the anger a patient expresses towards his/her therapist may be redirected anger that the patient originally felt towards his/her mother during childhood.

Transference Focused Therapy :

Kernberg, of New York Hospital, Cornell University, modified Freud’s original therapeutic techniques to develop TRANSFERENCE FOCUSED PSYCHOTHERAPY which involves analysis of the process of transference that occurs via the patient’s relationship with the therapist ; it is the aim of the therapy that, by such analysis, the patient’s fundamental personality disturbance may be resolved, rather than just (relatively superficial) symptoms of the presenting psychological disorder.

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Four Types Of ‘Dysregulation’ Displayed By BPD Sufferers

types of dysregulation

BPD And Dysregulation :

We have already seen from many other articles that I have published on this site that those who have suffered severe and protracted childhood trauma are at greatly increased risk of going on to develop borderline personality disorder (BPD) than those who were fortunate enough to have experienced a relatively stable upbringing.

One of the main symptoms of this very serious and life-threatening condition (about ninety per cent of sufferers attempt suicide and about ten per cent die by suicide) is termed ‘DYSREGULATION.’

What Is Meant By The Term ‘Dysregulation?’

When the term DYSREGULATION is used in the psychological literature it most commonly refers to the great difficulty the BPD sufferer has controlling behavior and emotional states. However, more specifically, the dysregulation that those with BPD experience can be sub-divided into four particular types; these are :

1) EMOTIONAL DYSREGULATION

2) BEHAVIORAL DYSREGULATION

3) COGNITIVE DYSREGULATION

4) SELF DYSREGULATION

Below, I briefly define each of these four types of dysregulation :

  • Emotional Dysregulation :

This type of dysregulation refers to extreme sensitivity and difficulty controlling intense emotions. Individuals suffering from this type of dissociation not only feel emotions far more deeply than the average person, but also take longer to return to their ‘baseline’ / ‘normal’ mood.

For example, a person with BPD who is emotionally dysregulated may be easily moved to intense expressions of anger and then take far longer to calm down again compared to the average person. Others may disparagingly (due to their lack of knowledge and understanding of this life-threatening – see above – and acutely, indeed uniquely, mentally painful condition) describe such an individual as extremely ‘thin’skinned’, as ‘having a chip on his/her shoulder’, ‘a drama queen’ or as or as someone who is prone to extreme ‘over-reactions.’

A leading theory as to why individuals with BPD are emotionally dysregulated is that the development of their AMYGDALA (a brain region intimately involved with how we express emotions and how we react to stress) has been damaged as a result of severe childhood trauma.

emotional dysregulation

  • BEHAVIORAL DYSREGULATION :

This type of dysregulation refers to the severe problems those with BPD can have controlling their behavior ; such individuals may be highly impulsive and liable to indulge in high-risk behaviors that are self-destructive. Such behaviors may include :

    • excessive drinking
    • excessive drug taking
    • gambling
    • compulsive self-harm
    • risky sex
    • drink-driving / dangerous driving
    • excessive / compulsive spending leading to debt problems

 

  • COGNITIVE DYSREGULATION :

This type of dysregulation refers to disorganized thinking which may manifest itself as paranoid-type thinking and/or as states of DISSOCIATION.

BPD sufferers are also prone to ‘black and white’ / ‘all or nothing’ type thinking, indecision, self-doubt, distrust of others and intense self-hatred.

 

  • SELF DYSREGULATION :

This type of dysregulation refers to the weak sense of their own identity many BPD sufferers feel ( a typical BPD sufferer might express this by saying something along the lines of ‘I’ve no idea who I am‘), feelings of emptiness, and the difficulty many BPD sufferers experienced expressing their likes, dislikes, needs and feelings,

Dysregulation And Stress :

Individuals with BPD are far less able to cope with stress than the average person and dysregulation (relating to all four of the above categories) is especially likely to occur when such individuals are experiencing stress ; indeed, the greater the stress the individual is experiencing, the more dysregulated he/she is likely to become.

 

RESOURCES :

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David Hosier BSc Hons; MSc; PGDE(FAHE)

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Impulse Control : Study Showing Its Vital Importance

impulse control study

We have already seen that those who suffer such severe, protracted childhood trauma that they go on to develop borderline personality disorder (BPD) have very significant problems regarding self-regulation (i.e, controlling intense emotions) and with IMPULSE CONTROL (along with a wide range of other symptoms).

This impaired ability to control impulses, in turn, can have a seriously adverse effect on myriad aspects of the individual’s life, potentially leading to, for example, relationships problems, substance abuse, gambling, compulsive sex, poor financial control due to compulsive shopping, lowered work /academic accomplishments, violent outbursts and many other difficulties.

In this article, I will briefly outline a study that helps to show the relationship between poor impulse control in childhood and later life success :

THE STUDY ON IMPULSE CONTROL AS A CHILD AND FUTURE LIFE OUTCOMES :

The study was conducted by Walter Mischel and E.B Ebbeson. A group of children were given two options :

OPTION ONE : They could have one marshmallow immediately.

OR :

OPTION TWO : They could have two marshmallows if they were prepared to wait fifteen minutes for them.

The children were then left alone with the marshmallows.

the marshmallow test

RESULTS :

Some children gave in to temptation immediately and some managed to defer gratification for a short amount of time (but not the full fifteen minutes).

HOWEVER : About one third of the children were able to defer gratification for the FULL FIFTEEN MINUTES (in the main they distracted themselves from the temptation to eat the marshmallow by playing or singing to themselves, according to the researchers).

TWELVE  YEARS LATER, a follow-up study was carried out on these same individuals. The results of this follow-up study were :

The individuals’ PERFORMANCE ON THE IMPULSE CONTROL TEST (as described above) was more highly correlated with future life success than any other measure, including socioeconomic status and I.Q.

In other words, on average, the children who managed to wait the full fifteen minutes before eating went on to have significantly more successful lives (as defined and measured by the twelve year follow-up study) than those children who were unable to do so. The fact that the level of an individual’s impulse control appears, according to this particular study, to be a better predictor of that same individual’s future life success than either their socioeconomic status or I.Q. implies that how well we are able to control our impulses is of vital importance.

 

RESOURCES :

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David Hosier BSc Hons; MSc; PGDE(FAHE)

 

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Self-Acceptance More Helpful To Mental Health Than Self-Esteem.

developing self-acceptance

We have already seen that, most frequently because how they were made to feel about themselves by parents / primary care-givers whilst growing up, one of the most painful, demoralizing and soul-destroying symptoms those with borderline personality disorder (BPD) must strive to endure is irrational feelings of self-hatred, self-loathing and self-disgust. (If you would like to read my article entitled : ‘ Childhood Trauma: How The Child’s View Of Their Own ‘Badness’ Is Perpetuated’ , please click here.)

Indeed, many individuals with BPD suffer from frequent, intrusive thoughts such as : ‘I am a terrible person’ ; ‘I am of absolutely no value to anybody whatsoever’ and so on…

In other words, their self-esteem is extremely low and sometimes it is hard to change such deeply entrenched, negative self-views through therapy, at least at the beginning of any such therapy. (If you would like to read my article entitled : ‘Childhood Trauma : A Destroyer of Self-Esteem’ , please click here.)

self-acceptance

However, one effective way of breaking into, and disrupting, this profoundly ingrained and seemingly perpetual cycle of self-derogatory thinking may be to develop first an attitude of SELF-ACCEPTANCE.

In relation to this possibility, Huber (2001) suggests that, in order to develop an attitude of self-acceptance, we can start off simply by trying to attain ‘a single moment of self-acceptance.’ For example, instead of thinking a thought such as :

I am a terrible person‘, we can try to replace it with the self-accepting thought :

‘Given how I was made to feel about myself as a child, it is completely understandable why I view myself as a terrible person.

Gradually, we can try to increase the frequency with which we modify our self-lacerating thinking style so that, when negative thoughts arise, we compassionately accept why we are having them as a matter of newly acquired habit.

The advantages of developing a self-accepting style of thinking, as outlined above, has been backed up by research. For example, Neff (2009) found that self-compassion is more positively correlated with psychological health than self-esteem is.

Neff also points out that, whilst self-esteem, at least in part, depends upon how we perceive others’ evaluation of us and how well we perceive ourselves to be succeeding in life’s myriad aspects at any given time, self-compassion (by definition) is self-generated and comes entirely from within ; it is always available to us no matter what the external circumstances. Because of this, it is more reliable and dependable than self-esteem and can comfortably co-exist along with feelings of inadequacy or, even, gross inadequacy.

However, we need not equate self-acceptance with ‘standing still in life’ and with not trying to improve ourselves – indeed, self-acceptance can be a great aid to self-improvement as it allows us to take a compassionate attitude towards ourselves when we face inevitable set-backs on our journey of personal development (as opposed to despising ourselves and giving up).

 

RESOURCES :

SELF-ACCEPTANCE : SELF-HYPNOSIS DOWNLOAD.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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What Are The Differences Between BPD And Complex PTSD? : A Study

difference between complex ptsd and bpd

Because there is a considerable overlap in symptoms between those suffering from borderline personality disorder (BPD) and those suffering from complex posttraumatic disorder (complex PTSD) , those with the latter condition can be misdiagnosed as suffering from the former condition (you can read my article about this by clicking here).

In order to help clarify the differences between the two conditions and help show how they are distinct from one another, this article is about a research study which sought to delineate these two very serious psychiatric conditions.

What Are The Differences In Symptoms Between Those Suffering From Borderline Personality Disorder (BPD) And Those Suffering From Complex Posttraumatic Stress Disorder (Complex PTSD)?

A study into the different symptoms displayed by sufferers of borderline personality disorder (BPD) and complex posttraumatic stress disorder (complex PTSD) involving the study of two hundred at eighty adult women who had experienced abuse during their childhoods and published in the European Journal of Psychotraumatology in 2014 compared the symptoms of those suffering from BPD with those suffering from complex PTSD.

The following results from the study were obtained :

SYMPTOMS SHARED APPROXIMATELY EQUALLY BETWEEN THOSE SUFFERING FROM BPD AND THOSE SUFFERING FROM COMPLEX PTSD :

Some symptoms were found to be shared approximately equally between those suffering from  borderline personality disorder (BPD) and those suffering from complex posttraumatic stress disorder (complex PTSD). The symptoms that fell into this category were as follows :

  • AFFECTIVE DYSREGULATION (ANGER) i.e. frequent feelings of intense rage that the individual cannot control (regulate)
  • VERY LOW FEELINGS OF SELF-WORTH
  • AFFECTIVE DYSREGULATION (SENSITIVE) i.e. feelings of hypersensitivity that cannot be controlled (regulated)
  • INTENSE FEELINGS OF GUILT
  • INTERPERSONAL DETACHMENT / ALONENESS i.e. feeling cut-off and alienated from others, isolated and apart
  • FEELINGS OF EMPTINESS

However, some symptoms were found to be significantly more prevalent amongst those suffering from borderline personality disorder (BPD) than amongst those suffering from complex posttraumatic stress disorder (complex PTSD) as shown below :

SYMPTOMS THAT WERE FOUND TO BE SIGNIFICANTLY MORE PREVALENT AMONGST THOSE SUFFERING FROM BORDERLINE PERSONALITY DISORDER (BPD) THAN AMONGST THOSE SUFFERING FROM COMPLEX POSTTRAUMATIC STRESS DISORDER (COMPLEX PTSD) :

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

 

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Retraumatization Caused By Psychiatric Care Institutions

retraumatiztion

Retraumatization :

If the trauma we experienced as children was severe enough, we may, as adults, at one time or another, require residential psychiatric care (such as inpatient treatment on a psychiatric ward in a hospital, as was necessary in my own case on several occasions).

Obviously, the quality of the care we receive in psychiatric facilities can vary very considerably ; unfortunately, this means that, if we are unlucky, we may find ourselves in an environment that not only fails to be therapeutic, but is actively retraumatizing.

In What Ways Can A Psychiatric Facility Retraumatize Us?

According to Fallot and Harris (2001), the ways in which we can be retraumatized in psychiatric institutions can be divided into two main categories ; these are :

1) BY THE SYSTEM (policies, culture, procedures, rules etc). For example :

2) BY THE RELATIONSHIPS WE HAVE WITH THOSE ENTRUSTED WITH OUR CARE (e.g nurses, psychiatrists etc)

Let’s look at each of these in turn :

1)  RETRAUMATIZATION BY THE SYSTEM. Examples of how this may occur include :

– lack of choice regarding treatment ; for example, being prescribed medication when a form of psychotherapy may be more appropriate and more effective.

– not being given the opportunity to give feedback to the professionals caring for us about how we feel in relation to the treatment we are receiving

– being treated impersonally and not as an individual but, instead, according to how one has been ‘labelled’ by one’s diagnosis (two individuals with the same diagnosis may manifest very different symptom and have very different needs. In the case of those who have been diagnosed with borderline personality disorder, such individuals may experience the additional trauma as being regarded as ‘a trouble maker’ due to misinterpretation of the true causes of their behavior.

– constantly having to retell personal details relating to one’s psychological condition.

2)  RETRAUMATIZATION BY THOSE ENTRUSTED WITH OUR CARE.  Examples of how this may occur include :

– betrayal of trust

– feeling one is not being listened to and/or is being rushed when explaining one’s condition

– feeling one’s views are being dismissed /not taken seriously / invalidated

– being spoken to disrespectfully, insultingly or inappropriately

– being subjected to punitive ‘treatment’ methods (e.g. locked in isolation room without toilet or proper bedding)

– lack of communication / collaboration between patient and staff

My Own Experiences :

SECTIONING :  When my illness was at its worst, I was sectioned (despite my ardent protests) because it was felt I was a high suicide risk (which, in truty, I was) ; however, being sectioned accentuated feelings of powerlessness, humiliation and loss of autonomy

AGGRESSIVE/THREATENING PATIENTS : Unfortunately, some patients one is exposed to in psychiatric wards can be aggressive and intimidating, leading to feelings of being unsafe and constantly under threat

UNPROFESSIONAL STAFF : Sadly, occasionally one comes across staff who are not above behaving unprofessionally ; this can exacerbate feelings of mistrust

ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) : Because I was so ill – utterly unable to function and, indeed, almost catatonic at times, as well as a very high suicide risk, I was ‘strongly encouraged’ to undergo ECT treatment ‘voluntarily’ on several occasions ; in fact, though, there was no genuine choice as I was told that, if I did not undergo it ‘voluntarily,’ I would be sectioned and the act of sectioning me would, in turn, give the hospital the legal right to administer the treatment even without my consent. Due to the controversial nature of ECT treatment, this was an intimidating, degrading and, quite arguably, dehumanizing position in which to be placed. (To read my article about my experience of ECT, click here.)

COMPULSION TO ABSCOND :  Indeed, I often found the conditions to which I was confined so intolerable that, on three occasions, I absconded (each time with the intention of committing suicide – to read about one such incident, see my article On Being Suicidal (Or, Why I Carried A Rope In A Bag Around London For Three Months ).

Obviously, vulnerable patients who find themselves compelled to abscond, as I did, potentially expose themselves to a high level of risk in a multitude of ways.

The Trauma-Informed Environment :

Tailor and Harris (2001) state, based on the main ways in which retraumatization may occur, therapeutic environments that cater for the traumatized (e.g. those suffering from PTSD or complex-PTSD) should be trauma-informed. Trauma-informed environments should :

1) Be calm and comfortable

2) Provide the patient with choice

3) Empower the patient

4) Recognize the strengths and abilities of the patient

5) Involve the patient, as far as possible, in all decision-making processes.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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