Category Archives: Bpd Articles

Questioning The Borderline Personality Disorder (BPD) Diagnosis

We have seen that if a person has suffered significant and protracted childhood trauma, s/he is at greatly increased risk of being diagnosed, as an adult, with borderline personality disorder (BPD). According to the Diagnostic and Statistical Manual of Mental Disorders (usually abbreviated to DSM), a person diagnosed with BPD must meet at least FIVE of the following nine criteria:

1) Extreme swings in emotions
2) Explosive anger
3) Intense fear of rejection/abandonment sometimes leading to frantic efforts to maintain a relationship
4) Impulsiveness
5) Self-harm
6) Unstable self-concept (not really knowing ‘who one is’)
7) Chronic feelings of ’emptiness’ (often leading to excessive drinking/eating etc ‘to fill the vacuum’)
8) Dissociation ( a feeling of being ‘disconnected from reality’)
9) Intense and highly volatile relationships

NB These symptoms must have been stable characteristics present for at least six months

However, some theorists and researchers have pointed out certain problems with defining BPD in this manner and question the validity of the diagnosis; I outline the most serious of these problems below :

1) In order to be diagnosed with BPD, a person need display just five of the above nine symptoms. It logically follows from this that two people could each be diagnosed with five of the above symptoms, yet have only one of those five symptoms in common with one another. In other words, two people could each be manifesting very different symptoms, yet receive identical diagnoses.

2) Stipulating that an individual must have five or more of the above symptoms is essentially arbitrary (why not four or six?). Also, linked to this criticism, there seems to be a third problem with the diagnosis :

3) The third problem is this : a person with four of the above symptoms, even if they were very severe, would have to be (according to the diagnostic criteria) diagnosed as NOT having BPD whereas a person who just manages to be judged to be displaying five symptoms (even if none are as severe as the first person’s four symptoms) WOULD be diagnosed as having BPD. This brings us onto the fourth problem with the diagnosis :

4) In accordance with the diagnostic criteria, an individual is either deemed to HAVE BPD or NOT HAVE BPD. In other words, it is an ‘all or nothing’ diagnosis which doesn’t allow for grey areas. This is ironic as one of the symptoms BPD sufferers are said to show is ‘black and white’ or ‘all or nothing thinking’ (such as seeing others as ‘all good’ or ‘all bad’ but never as anything inbetween).

Because of this problem, some critics have suggested that it would be better to view BPD as a ‘spectrum’ disorder, with each individual occupying a specific place on this spectrum (in the way that autism is treated as a spectrum disorder).

5) A diagnosis of BPD does not seem to describe a unique, separate, distinct disorder clearly delineated from other personality disorders ; indeed, many who have been diagnosed with BPD are found to suffer from comorbid conditions such as antisocial personality disorder and narcissistic disorder

In conclusion it should be mentioned that many critics of the BPD diagnosis feel many individuals have been wrongly diagnosed with it (and unnecessarily stigmatized) and should be diagnosed with complex post traumatic stress disorder instead.

In relation to the above, you may wish to read these other posts:

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

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Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is usually diagnosed in adulthood or late adolescence. But can children suffer from this serious psychiatric condition?

Unfortunately, there exists a paucity of academic research published on this particular topic, but some research and evidence relating to the question does exist, some of which I look at here.

Anecdotal Evidence Reported By Parents Of Adult Children With A BPD Diagnosis :

Whilst anecdotal evidence is not scientific, many scientific theories, hypotheses and research projects are preceded by, and have their foundations in, anecdotal evidence, so it shouldn’t automatically be contemptuously dismissed. So what is the anecdotal evidence that has been collected from parents?

Many parents with (now grown-up) children who have been diagnosed with borderline personality disorder (the adult children, not the parents) have reported that signs of BPD in their offspring started to show in early childhood and included the following :

  • particular proneness to worry
  • particular proneness to bouts of sadness
  • a greater than normal need for attention
  • hypersensitivity, especially in relation to criticism
  • proneness to becoming very easily frustrated
  • a susceptibility to developing physical symptoms in response to stress (called psychosomatic illness) such as headaches and stomach upsets
  • proneness to irritability, anger, rage and temper tantrums
  • easily upset

However, it is important to point out that not all parents of adult children diagnosed with BPD reported that these offspring had such childhood symptoms.

Image result for bpd

Studies Related To The Question Of Whether Children Can Be Diagnosed With Borderline Personality Disorder (BPD).

In 1983, Cohen et al (Yale University) devised a set of diagnostic criteria for children suffering from what they called borderline syndrome; however, after further research they renamed the condition multiple complex developmental disorder (MCDD). This disorder incorporates three main categories of symptoms which are as follows :

  • poorly controlled (regulated) emotions
  • impaired perception and thinking
  • markedly disturbed relationships

NB The above symptom categories also occur in borderline personality disorder and complex post-traumatic stress disorder. (It should be noted, too, that MCDD has not been included in either DSM IV or ISD-10).


MCDD is also associated with anxiety conditions, psychotic thought processes and disruptive behaviour (de Bruin et al, 2007)

Physiological Basis :

Cohen also pointed out that many of these children were found to have physiological brain disturbances and believed that there was a biological basis to MCDD. This adds further to the obvious argument that children affected in such a way are in crucial need of understanding, treatment and therapy – not judgment.

Vital Importance Of Early Detection And Treatment:

Whilst it may well be stigmatizing to be ‘labelled’ with borderline personality disorder (or similar condition), early detection of the disorder, or of symptoms displayed in those at risk of developing such conditions, is vital so that effective therapy may be started. The earlier detection and effective, sensitive, expert treatment begin, the better are likely to be the results of treatment (indeed, if left untreated, such conditions are likely to become more severe, entrenched and complex).

 

Finally, it must once again be reiterated that environmental factors / childhood trauma / childhood abuse are strongly linked to the development of BPD and similar conditions. In other words, a child with a genetic/biological predisposition that puts him/her at risk of developing BPD, or similar condition, may not do so if s/he grows up in a secure, loving stable family, whereas a child similarly genetically/biologically predisposed is at far greater risk of doing so.

 

   

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

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Copyright 2016 Child Abuse, Trauma and Recovery

Often Craving High-Intensity / Highly Arousing Activities?

Those of us who suffered significant childhood trauma may, as adults, find it very hard to calm ourselves when experiencing stress and anxiety. This is sometimes referred to by psychologists as an inability to self-sooth or to regulate our emotions. The result can be that we find ourselves in chronic states of deep distress and intolerable emotional pain.

Such is the intensity of this pain that we might frequently find ourselves absolutely desperate to numb it. However, we may find, too, that the ‘ordinary’ ways mentally healthy individuals may use to calm themselves, such as talking to a friend, taking a relaxing bath, going for a walk or taking some other form of exercise are simply of very little, or no help. These activities can be categorized as low-arousal activities.

Instead, to reduce our mental anguish, we may be driven to seek out and undertake high-arousal activities, sometimes referred to as sensation seeking or thrill seeking.

Whilst such high-arousal activities may provide short-term relief, they tend, also, to cause us harm over the long-term and to be high-risk.

I provide examples of such high-arousal activities below :

Examples Of High-Arousal Activities :

  • getting very drunk
  • self-harming (eg cutting) . Whilst this causes physical pain it can simultaneously reduce psychological pain due to the biochemical effect it has on the brain. Also, physical pain can actually provide a welcome distraction from comparatively far more distressing mental pain.
  • abusing drugs
  • high-stakes gambling (read about my experience of this here).
  • excessive, promiscuous sex (possibly leading to feelings of self-disgust)
  • anti-social behaviours such as stealing cars, joy-riding, shop-lifting
  • planning suicide (not only can this produce a high level of mental arousal but can also provide one with a sense of control. Indeed, at one period in my life, which I have written about elsewhere, I contemplated suicide virtually all day and every day for a period of several months; the only way I could fall asleep at night, in fact, was by repeatedly reminding myself that it was within my power to end my suffering. Paradoxically, it was this thought that kept me alive, however odd that might sound.

The high arousal activities that I have listed above are sometimes referred to as ‘acting-out’ behaviours which you can read more about by clicking here.

NB Seeking out high risk, intensely arousing activities can be a major component of borderline personality disorder (BPD). At present, one of the most effective available treatments for this condition is dialectical behaviour therapy (DBT).

 

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OTHER RESOURCES :

Traumatic childhoodIMPROVE IMPULSE CONTROL.

 

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

 

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Early Trauma’s Effect On Development Of Id And Ego

According to psychodynamic theory, originally associated with Sigmund Freud (but modernized by various psychologists since), the most crucial part of our psychological development takes place in the earliest years of our lives, between birth and about five years old.

A central concept of psychodynamic theory is that our minds comprise three parts, namely the id, the ego and the superego, which I briefly describe below:

THE ID : According to Freud, the id can be viewed as the primitive part of the mind, driven by biological needs (such as for food and sex), which demand instant gratification ; it is completely unsocialized and its operations are unconscious. It is also described as acting according to the ‘pleasure principle‘ which means it is constantly and potently urging us to gain pleasure, irrespective of consequences (including harmful effects on others and harmful effects on ourselves).

THE SUPEREGO : Basically, the superego represents our conscience which we form by internalizing a sense of ‘right’ and ‘wrong’ (or morality) derived from the influence of our parents, education, social environment and culture. Freud stated that whilst some of the operation of the superego is conscious, much of it also occurs on an unconscious level. Our ‘punishment’ for transgressing the superego’s exacting moral standards is guilt.

THE EGO : Freud said that whilst the id operates according to the ‘pleasure principle’, the ego operates according to the ‘reality principle’. Essentially, its task is to mediate between the deeply conflicting demands of the id, the superego and the outside world (and it is this constant need to mediate and reach an unending series of compromises that contributes much to the inner turmoil, tension and anxiety being human must necessarily entail, Freud helpfully informs us). It acts according to reason and will try to inhibit impulses that, if acted upon, would lead to harm; in other words, it takes into account the possible consequences of our actions.

I remember, as a first year psychology undergraduate, our lecturer telling us that the ego’s job could, perhaps not wholly inaccurately, be compared to that of a referee who finds himself constantly obliged to oversee a fight between a ‘crazed chimpanzee’ and ‘a puritanical, pious and forbidding grandmother.’

 

Above : The perpetual battle between the id and superego, with the ego always having to act mediator.

It is theorized that if the infant is traumatized in early life, through lack of adequate care, s/he will fail to learn to control his/her basic drives and impulses and the development of his/her ego will be impaired. This can lead to various problems including :

  • poor ability to tolerate frustration
  • poor ability to inhibit impulses that may lead to harm (too likely to act in accordance with the dictates of the id due to deficits in ego development)
  • lack of consideration concerning the possible effects of one’s actions upon others / not taking into account the needs of others (including, as an infant, impaired ability to pick up on verbal and visual cues of the mother / primary care-giver)
  • impaired judgment
  • impaired ability to think logically and with clarity

It is thought that these problems occur as inadequate care that traumatizes the infant can damage the actual physical development of certain vital brain regions.

The infant who experiences satisfactory care, attention and nurturing, on the other hand, will learn to better control his drives and impulses, having learned from the mother to keep him/herself relatively calm and not exhibit unwarranted distress if his/her biological needs happen to not be instantaneously met (this ability is known as the competence to ‘self-regulate’).

Many of the symptoms of borderline personality disorder (BPD), which is linked to childhood trauma, reflect some the symptoms listed above.

 

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OTHER RESOURCES :

Traumatic childhoodIMPROVE IMPULSE CONTROL

 

Traumatic childhoodCONTROL YOUR EMOTIONS

 

 

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

 

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Symptoms Of BPD Require Early Intervention

It is problematic trying to diagnose borderline personality disorder (BPD) in children as their personalities are still developing. However, some children exhibit symptoms which seem to mimic the symptoms of BPD.

Ideally, BPD would be prevented before it fully develops so identifying symptoms which suggest BPD may develop later on in an individual’s life as early as possible is clearly desirable in order to start appropriate therapy before the problem becomes out of hand.

Early treatment is particularly valuable as the young child’s brain is at its most ‘plastic’ which means, by using the appropriate therapies, its physical development can be much more easily beneficially altered than would be the case in adulthood.

Also, the earlier therapy is given, the less time undesirable symptoms have to ‘take root’ and become ingrained into the young person’s behavioural patterns.

One therapy that may be used for therapeutic purposes in connection with the above is known as floor time therapy‘ (also referred to as the Developmental – Individual difference – Realtionship-based Model or DIRand was originally developed by Greenspan (1989).

Although the therapy was originally developed in order to treat children with autism, it can be used to treat a variety of childhood psychological conditions, including the treatment childhood symptoms similar to those of BPD such as dramatic shifts in mood and difficulty controlling impulses. (However, further research is needed to establish, more accurately, this therapy’s effectiveness).

It is called floor time therapy for the very simple reason that it involves the parent getting on the floor with the child and playing (in a specialized way taught by the therapist) with him/her.

Therapists trained in this type of therapy include some specialized psychologists and occupational therapists.

Finally, it should be noted that many children who might benefit from such therapies miss out as they are regarded as ‘difficult’, ‘troublesome’, ‘over-sensitive’ etc when, in fact, there may be a strong biological component underlying their behaviour over which the child has no control ; blaming such a child then severely compounds the problem.

RESOURCES :

You can visit Dr Greenspan’s site about this therapy by clicking here.

 

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

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Copyright 2016 Child Abuse, Trauma and Recovery

BPD Sufferers May Have Subtle Learning Difficulties

Research suggests that individuals who suffer from borderline personality disorder (BPD) may have mild to moderate dysfunctions in certain areas of cognitive processing, in particular in the area of learning and memory that involves the processing of complex information.

However, such problems tend to be subtle and are therefore difficult for doctors, psychiatrists, psychologists and other clinicians to detect.

Notwithstanding this difficulty of detection, brain abnormalities have shown up in EEGs of borderline personality disorder (BPD) sufferers that are consistent with the learning/memory problem hypothesis.

In particular, the difficulties in cognitive processing appear to be associated with both visual and verbal memory (including, it is currently thought, both the encoding and retrieval of information) in which complex information is involved.

Borderline Personality Disorder (BPD) Sufferers Frequently Seem Incapable Of Learning From Experience – Is This Why?

These findings have given rise to the hypothesis that these subtle problems relating to learning and memory may help to explain why those suffering from borderline personality disorder (BPD) so frequently seem to make the same mistakes over and over again, seemingly incapable of learning from their social and interpersonal experiences.

Why May These Subtle Memory And Learning Problems Exist In Borderline Personality Disotder (BPD) Sufferers?

Many people who suffer from borderline personality disorder (BPD) experience periods of dissociation ( you can read about my article on dissociation by clicking here), particularly when under severe stress, and this state is clearly likely to seriously impair their memory functioning and, it follows, their ability to learn.

Also, the majority of individuals who go on to develop borderline personality disorder (BPD) as adults have suffered significant childhood trauma due to abusive parenting and it is known that this can lead to damage being done to the vulnerable, highly plastic, developing physical brain (to read my article about how childhood trauma can damage the developing brain on an organic level click here).

Further, severe clinical depression frequently co-morbidly exists alongside borderline personality disorder (BPD) which itself can impair both memory and learning.

Finally, it should be noted that research into this area is still at an early stage so more research needs to be conducted in order to confirm or shred further light upon the above theories.

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

 

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Self-Soothing : Three Categories Of Techniques

If we experienced significant childhood trauma, particularly if we have gone on to develop conditions such as borderline personality disorder (BPD) or complex post-traumatic stress disorder (CPTSD) as a result, we may frequently find ourselves caught up in painful thought processes, negative introspection and distressing emotions. On top of this, our ability to calm, comfort and soothe ourselves, especially when experiencing emotions like intense anger, fear and anxiety, may have been seriously compromised by our stressful childhood experiences.

Unfortunately, if we have not learned how to sooth ourselves in healthy ways, we may have been relying on dysfunctional ways of calming and comforting ourselves which are self-destructive in the long-term such as heavy smoking, excessive drinking, narcotics, gambling.

Therapists treating such individuals often encourage their patients to gradually replace their ultimately self-destructive coping techniques by cultivating positive, alternative and healthy self-soothing techniques that help them to refocus their attention away from their disturbing thoughts and feelings (for example, the teaching of self-soothing techniques forms part of dialectical behaviour therapy).

These self-soothing techniques fall into three broad categories : a) very simple techniques that require no equipment; b) simple techniques that require only minimal equipment; c) techniques that require an investment of considerable time and effort.

Below, I provide examples of self-soothing techniques which fall into each of these three categories:

a) Very simple self-soothing techniques that require no equipment :

Examples include :

– systematic tensing, followed by systematic relaxing. of each of the major muscle groups in turn

– deep, slow breathing (the opposite is shallow, fast breathing which is both results from  anxiety and  aggravates it, thus creating a vicious cycle; at its extreme it is referred to as hyperventilation which itself is a symptom of panic attacks).

– self-affirmations (either thinking them or saying them out loud if by oneself)

– counting (eg counting down from 100 in threes either in one’s mind or out loud if on one’s own – this is sometimes called ‘thought blocking’ and can be used to temporarily ‘block out’ distressing thoughts)

– recalling pleasant memories

– imagining oneself in a very safe, secure and comforting place (see note at the end of this article)

 

b)  Simple self-soothing techniques that require only minimal equipment :

Examples include :

– reading

– writing (eg creative writing or writing a diary)

– listening to cathartic music

– skipping rope

– work / academic studies

c) Self-soothing techniques that require an investment of considerable time and effort :

Examples include :

– training for a sport

– learning a musical instrument

– learning to paint / draw

Another way of categorizing self-soothing techniques, concentrating upon PHYSICAL techniques that sooth the mind by soothing the body, is by organizing them in groups which correspond to our five physical senses, namely :

  1. TOUCH
  2. TASTE
  3. SIGHT
  4. HEARING
  5. SMELL

Again, I provide examples of self-soothing techniques that fall into each of these five categories below:

1) TOUCH :

For example, stroking a pet, taking a warm bath, using a foot spa, cuddling a soft toy.

2) TASTE :

For example, cooking a favourite meal and savouring it.

3) SIGHT :

For example, visiting a beauty spot

4) HEARING :

For example, soothing sounds in nature such as bird song, flowing water, breaking waves

5) SMELL :

For example, scented candles, aroma therapy

NOTE : Internal, mental visualization of a safe place, using self-hypnosis, can also be a very effective way of self-soothing. Click here for more information.

 

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

 

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Copyright 2016 Child Abuse, Trauma and Recovery

Overcoming Early Life Insecure Attachment

effects of insecure attachment

As we have seen in other posts that I have published on this site, some babies are prevented from forming a secure attachment (bond) with their mother and this can have disastrous effects upon their future mental health.

What Can Cause An Insecure Attachment To Develop Between The Mother And Baby?

There are numerous reasons why this failure in healthy bonding between the mother and baby may occur, including:

– the mother being an alcoholic/drug addict

– the mother suffering from clinical depression

– the mother being abusive

– neglect

– the baby being separated from the primary carer (eg due to divorce, hospitalization, death)

(The list provided above is not intended to be exhaustive).

The Adverse Effects Of The Development Of An Insecure Attachment Between The Mother And Baby:

Whether or not a secure attachment is created between the mother and her baby has very serious implications as the quality of the attachment effects how the baby’s brain physically develops.

If a secure attachment has not been achieved, the child is at risk of going on to develop poor self-esteem, difficulties forming and maintaining relationships with others, problems with trusting others, an inability to effectively ‘self-sooth’ and reduced ability to cope with stress / weakened resilience.

Compensatory / Alternative Attachments :

However, if the child has had a bad start in life and has not been able to form a secure attachment with the mother, s/he still has the possibility of forming compensatory /alternative attachments with:

  1. Other Individuals
  2. Institutions, clubs, societies, groups
  3. Pets
  4. ‘Site Attachments’

Let’s look at each of these in turn:

1) Other individuals :

Such as friends, members of extended family etc

2)  Institutions, clubs, societies, groups :

Such as sports clubs, political societies, social clubs etc

3) Pets :

Mammals like cats, dogs and rabbits have a need to bond as we do. Also, stroking a pet is soothing and can have beneficial physiological effects (such as reducing heart rate and lowering blood pressure). However, bonds with pets should not substitute completely for necessary human relationships. ) I myself have a rabbit (called Rambo) who hops around my flat and is currently in the process of gnawing his way through all my furniture

 4) ‘Site attachments’ (familiar/comforting/soothing places of perceived safety and security):

It is also possible to become attached to places (this is sometimes referred to by psychologists as ‘site attachment’).

Children tend to have special ‘safe-havens’ that they can retreat to in times of distress (such as a bedroom, ‘den’ or friend’s house).

Adults, too, may have their own preferred retreats (such as a garden shed or allotment).

It is also possible to retreat into ‘a place of safety’ in one’s imagination; a particularly powerful and effective way of achieving this is through the use of self-hypnosis and visualization.

 

If sufficient compensatory / alternative attachments are made and these are stable, reliable and of good quality, the individual can still move from insecure attachment to secure attachment.

RESOURCES:

Downloadable MP3 self-hypnosis audio :

Develop a ‘safe place’ in your imagination with self-hypnosis. Click here.

eBook :

Above eBook now available for instant download on Amazon. Click here.

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

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Copyright 2016 Child Abuse, Trauma and Recovery