Tag Archives: Borderline Personality Disorder

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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BPD – A Masked Illness : And Why It’s Hard To Identify

Bpd_and_childhood_trauma

We have seen from other posts how childhood trauma, especially multiple and cumulative trauma, is strongly associated with the development of borderline personality disorder (BPD) in adult life.

However, many BPD sufferers are at risk of going undiagnosed or misdiagnosed.

The reason for this is that BPD can generate a number of symptoms associated with other conditions that mask the underlying illness (BPD).

Sadly, because of this, BPD can go undiagnosed for years, decades or a whole lifetime. This means many go without the proper treatment they require.

When one considers that approximately ten per cent of those diagnosed with BPD end their lives by suicide, the full, tragic implications of this failure of accurate diagnosis can be appreciated.

What Symptoms Of BPD Can Mask It, Thus Making It Less Likely To Be Accurately Diagnosed?

They include :

– excessive use of alcohol, leading to a diagnosis of alcoholism

self-harm / suicidal thoughts, leading to a diagnosis of depression

instability of mood, leading to diagnosis of cyclothymic or bipolar disorder

aggression/violence, leading to diagnosis of sociopathy (sometimes still referred to as psychopathy)

eating problems, leading to diagnosis of anorexia nervosa or bulimia

Whilst this list is not exhaustive, it represents some of the ways in which BPD can seemingly, upon preliminary invetigations, present itself as other psychological conditions, leading to misdiagnosis or incomplete/partial diagnosis.

bpd

Because, too, many with BPD are able to work successfully, and/or socially integrate successfully, much of the time without displaying blatant signs of psychological pathology, identifying BPD in individuals becomes trickier still.

However, such individuals are still likely to display tell-tale signs of the disorder due to sudden, dramatic and unpredictable shifts in mood (such as explosions of rage) which may, by the layman (or even the professional) be put down to ‘a difficult temperament’.

In order to correctly diagnose BPD it is necessary to look at the whole tapestry of the interplay of the individual’s behaviours and emotions in the context of their lives as a whole, with a particular focus on their relationship history (tends to be tumultuous), mood stability/instability, drug/alcohol use, sexual history (tends to be promiscuous and high risk), internal/mental life (often marked by feelings of chronic emptiness and lack of identity), emotional reactiveness/lability, and, vitally, of course, experience of childhood trauma.

In short, accurate diagnosis calls for a holistic approach; only then will all BPD sufferers get the treatment they both desperately need and deserve.

Resources:

 

BPD

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

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Brain Areas That May Be Adversely Affected By Childhood Trauma

BPD_and_brain_areas

We have already seen in other posts that I have published on this site that, if we have been unfortunate enough to have been subjected to severe and chronic childhood trauma, it is possible that this adversely affected how our brain physically developed during our early life.

And, if we have been particularly unlucky, this disrupted brain development could have made us highly susceptible to developing borderline personality disorder (BPD) in our adult lives.

 

Indeed, research involving brain scans suggest that sufferers of BPD can have abnormalities in the following brain areas :

– prefrontal cortex

– anterior cingulate

– medial frontal cortex

– subgenual cingulate

– ventral striatum

– ventromedial prefrontal cortex

– amygdala

 

Below : Brain Areas Which May Have Had Their Physical Development Adversely Affected By Our Traumatic Childhood Experiences, Particularly If We Have Developed Borderline Personality Disorder ( BPD) :

BPD brain

 

What Are These Brain Areas Associated With?

The function of these brain areas are described below:

PREFRONTAL CORTEX:

– decision making

– conscious control of social behaviour

– speech / writing

– logic

– purposeful (as opposed to instinctual) behaviour

– planning for the future

– expression of the personality

ANTERIOR CINGULATE :

– decision making

– heart rate

– blood pressure

– impulse control

– emotions

MEDIAL PREFRONTAL CORTEX:

– decision making

– memory

SUBGENUAL CINGULATE :

– sleep

– appetite

– anxiety

– mood

– memory

– self esteem

– transporting serotonin

– our experience of depression

VENTRAL STRIATUM :

– decision making

– emotional regulation (the control of emotios)

– the extinction of conditioned responses

AMYGDALA :

– appetite

– emotion

– emotional content of memories

– fear

The Effects Of Disruption Of The Above Brain Areas :

Poor decision making ; poor control of social behaviour ; impaired ability to think rationally ; poor planning for the future ; dysfunctional personality ; increased physiological response to stress ; poor impulse control ; poor emotional control ; insomnia ; changes in appetite ; severe anxiety ; mood instability ; low self-esteem ; impairment of the brain’s ablity to make effective use of serotonin leading to clinical depression ; changes in appetite ; emotionally charged memories leading to flashbacks, nightmares, intrusive thoughts, panic attacks ; feelings of being under constant threat, fear, terror and extreme vulnerability.

Two types of therapy that may be useful are cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT).

Resources :

General Information :

NHS information about borderline personality disorder (BPD). Click here.

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

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Nine Key Recovery Targets For BPD Sufferers

BPD symptoms and treatment

We have already seen from other articles published on this site that those of us who suffered severe childhood trauma are at much increased risk of developing borderline personality disorder (BPD) as adults than average.

We have also examined the symptoms of BPD in other posts so there is no need to repeat that here.

Instead, in this post, I will look at nine important goals that BPD sufferers may need to aim for on their road to recovery (different individuals with BPD have different sets of symptoms, so not all BPD sufferers will need to address every goal and different individual BPD sufferers will need to address their own particular combination of treatment aims accordingly).

 

1) Learn to deal with feelings of intense anger.

Many sufferers of BPD experience outbursts of severe rage which may, in part, be linked to damage done to the development of the amygdala (a brain region involved in the processing of emotions) during childhood ( caused by growing up in a chronically stressful environment).

The BPD sufferers is particularly likely to experience intense anger when events occur that remind him/her of his/her childhood trauma, such as being rejected or abandoned.

2) Eliminate self-destructive and impulsive behaviours.

These may include self-harm (eg. cutting), binge eating, excessive use of drugs/alcohol, unsafe sex, reckless driving etc.

The BPD sufferers, consciously or unconsciously, may be carrying out such activities in a desperate attempt to numb psychological pain. Psychologists refer to this short-term (and ultimately damaging) coping mechanism as dissociation.

3) Overcome intense fear of rejection and abandonment.

Many BPD sufferers intensely fear rejection/abandonment and may make desperate attempts to avoid it, including threatening/attempting suicide. This is connected to the fact that many BPD sufferers experienced deeply insecure childhoods, and being rejected as adults can trigger memories, and the corresponding emotions, of having been rejected/abandoned as children.

4) Stabilize interpersonal relationships.

Often, BPD sufferers fluctuate between idealizing and demonizing those they are emotionally intimate with, seeing them as ‘all good’ one minute and ‘all bad’ the next. Indeed, many BPD sufferers think in terms of ‘black and white’ in general, ignoring the shades of grey in-between. Such thinking is unhelpful and over – simplistic. Life is much more complex than that.

5) Improve self image.

Many BPD sufferers were excessively criticized and made to feel unlovable as children. They are then likely to have internalized these negative messages and, consequently, to have grown up to believe, erroneously, that they are ‘intrinsically a bad and unworthy person’.

6) Learn to cope with stress more effectively.

We have seen in other posts that a very stressful childhood can physically damage the brain’s development (eg. by damaging an area of the brain known as the amygdala) which can lead to severe over reactivity to stress as an adult (psychologists refer to this as emotional dysregulation or emotional lability.

7) Stop self-harming behaviour.

BPD sufferers often self-harm as a way of coping with mental anguish and distress; this is a form of dissociation. They may, too, threaten or attempt suicide in response to real or imagined rejection.

8) Find meaning in life.

Often, BPD sufferers experience life is being empty, meaningless, pointless, futile and absurd.

9) Eliminate paranoia.

Because many BPD sufferers felt constantly in danger and under threat during their childhoods, this was fertile ground in which to develop paranoid thinking which may worsen and become pathological in adulthood.

 

More Advice On BPD : Click here for very informative and helpful link.

 

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

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Five Types Of Dysregulation Linked To Childhood Trauma.

 

I have written extensively on this site about the link between the experience of significant childhood trauma and the possible later development of borderline personality disorder (BPD).

One of the leading experts on borderline personality disorder is Martha Linehan (who developed the treatment for BPD known as dialectical behavioral therapy, or DBT) and, according to her widely accepted theory, those who have developed BPD as a result of their adverse childhood experiences are often affected by all, or combinations of some, of the following types of DYSREGULATION:

(If we are dysregulated in relation to a quality, it means, in this context, that we have difficulty controlling and managing whatever the specific quality may be.)

download

Above: DBT has been shown to be an effective therapy for helping people who suffer from BPD and problems connected to various types of dysregulation (see five types below).

The Five Types Of Dysregulation We May Experience If We Have Developed BPD As A Result Of Our Childhood Trauma :

1) Emotional dysregulation:

We may have very volatile emotions that are so powerful we can feel controlled and overtaken by them. We may experience particularly intense and fluctuating emotions in response to our relationships with others, particularly our closest relationships.

Also, we may have difficulty identifying what exactly we are feeling (ie. find it hard to name some emotions we experience) and have problems expressing and experiencing some emotions.

2) Interpersonal dysregulation:

This means we might experience significant difficulties both forming and maintaining relationships with others. We may, too, constantly fear rejection and abandonment, leading to us becoming ‘needy’ and ‘clingy’ which, most sadly, can often cause the very rejection we are trying so ardently to prevent.

We may, too, find our feelings for others often vascillate dramatically from idealisation one minute, to demonization the next, possibly apropos (objectively speaking) very little.

3) Cognitive dysregulation:

This type of dysregulation may lead us to experience dissociation, depersonalisation and paranoia.

 4) Behavioural dysregulation:

Our behaviour may become extremely self – destructive : we may self-harm, attempt suicide, have promiscuous and unsafe sex, take unnecessary risks (such as reckless driving), become addicted to drugs and/or alcohol in a desperate attempt to numb and temporarily escape from overwhelming mental anguish, or develop eating disorders.

5) Self – dysregulation:

We may feel confused as to who we are and have a very poor sense of identity. We may feel different aspects of our personality are not well integrated so we can find ourselves acting in rather one-dimensional ways.

Our self-image can be unstable as can our values. We may be confused as to who we really are and what are beliefs and principals are ( indeed, these may frequently alter).

This can leave us feeling lonely and empty.

To read my article on the therapy devised by Marsha Linehan called dialectical behavioural therapy, click here.

 

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

 

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The Injustice Of Prejudice Against BPD Sufferers.

It is indeed a tragedy and injustice that many people who suffer from Borderline Personality Disorder (BPD), a condition which can inflict excruciating mental pain on the suffer (10℅ eventually kill themselves), are not only not helped by others, but blamed for the symptoms they display as a result of their illness.

This can result in complete rejection from family and friends, and I state this with the benefit (if that’s the word we’re looking for) of my own bitter experience. Their lack of knowledge, understanding and imagination can lead them (family and friends) to view the BPD sufferer as having a flawed character rather than accept s/he is genuinely, and seriously, ill.

Of course, if one’s family has contributed to one’s illness (there is a strong association between childhood trauma and the later development of BPD) it can very much suit them to blame the sufferer rather than to face up to their own culpability for reasons that are far too obvious to require elucidation from me.

To use an analogy, it’s rather like one’s family beating one to a pulp and then blaming one for bleeding over them and spoiling their clothes, is it not?

The author of Borderline Personality Disorder Demystified, Robert O. Friedel, MD, Distinguished Clinical Professor at Virginia Commonwealth University, states:

Many people believe that the symptoms and behaviours of people with Borderline Personality Disorder should be entirely under their control. This is not the case. To a significant degree, Borderline Personality Disorder is the result of disturbances in brain pathways that regulate emotion and impulse control. In other words, this is a true medical disorder, and, basically, no more under one’s control than diabetes or hypertension.’

I rest my case.

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

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High and Low Functioning In BPD Sufferers.

I have looked in detail at the association between childhood trauma and its role in contributing to the development of Borderline Personality Disorder (BPD) elsewhere on this site, and, in this article, I intend to examine two different types of individuals with BPD: LOW FUNCTIONING and HIGH FUNCTIONING.

Just as there are high functioning and low functioning alcoholics, so, too, are there high and low functioning individuals who suffer from the serious psychiatric condition known as Borderline Personality Disorder (BPD). In other words, some people with BPD cope relatively well with the usual demands of day to day living (such as having a successful career, for example) whilst others are severely impaired in relationship to their ability to cope with everyday and so may need special care and financial support from the government.

Of course, many people with BPD do not neatly fit into one category or the other, but fall somewhere in between (for example, they may be high functioning at times, but low functioning when subjected to significant stress).

Characteristics Of Low Functioning BPD Sufferers:

1) Might be unable work or have their capacity to work severely restricted by their condition.

2) Often suffer from co-morbid conditions such as eating disorders and harmful addictions (alcohol, drugs, gambling etc)

3) May frequently require psychiatric, in-patient, hospital care (by both voluntary and involuntary admissions). Such hospitalisations may, frequently, be due to attempted suicide or a preoccupation with/intention to carry out suicide.

4) May seem to stagger from crisis to crisis ; no sooner is one over, another takes its place.

5) Prone to a variety of self-destructive behaviours (drinking very heavily, binging on drugs, gambling, getting into fights and unnecessary confrontations, self-harming – by means of cutting self with razor blades/burning self with cigarettes and other methods – or even suicide attempts. Such self-destructive behaviour is particularly likely to occur during periods of significant stress, particularly if s/he has no, or limited, social/familial support.

high_and_low_functioning_BPD

Above: The private and public faces of some of those suffering from BPD may be very different (see point 4, below).

 

Characteristics Of High Functioning BPD Sufferers:

1) Probably likely to work most of the time – indeed, may have successful career.

2) Likely to appear, for want of a better phrase, ‘pretty normal’ to those with whom s/he is not intimately connected.

3) Is likely to have little or no insight into his/her condition due to unconsciously employing the psychological defence of complete, impregnable denial. Due to this, whenever in conflict with others, will invariably view themselves as absolutely in the right and the other as entirely in the wrong, irrespective of what any objective and rational analysis of the conflict may suggest.

4) As implied above, tend to only show the symptoms of their condition to those they know intimately (eg family members. partners). These symptoms may include explosive rage, excessive and inappropriate criticism, vitriolic verbal abuse, threats of violence or actual violence.

5) Tend not to seek psychiatric help due to their psychological state of denial (see point 3, above). Researchers have therefore termed such individuals ‘invisible’. In other words, they cannot usually be included in research studies (as the researchers are unaware of their existence) and, also, are not included in the statistics which must inevitably lead us to the supposition that estimates of the number of individuals suffering from BPD are likely to be significantly too low.

Resources:

 

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

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The Association Between Child Abuse, Trauma and Borderline Personality Disorder (BPD).

childhood_trauma_and_early_signs_of_psychosis

‘Character depends essentially on whether a person is given love, protection, tenderness and understanding during the formative years or is exposed to rejection, coldness, indifference and cruelty.’

Alice Miller.


THE ASSOCIATION BETWEEN CHILDHOOD ABUSE, TRAUMA AND BORDERLINE PERSONALITY DISORDER.

Many research studies have shown that individuals who have suffered childhood abuse, trauma and/or neglect are very considerably more likely to develop borderline personality disorder (BPD) as adults than those who were fortunate enough to have experienced a relatively stable childhood.

it is thought marilyn munroe suffered from BPD

It is thought Marilyn Monroe suffered from BPD

Kurt Cobain bpd
Did Kurt Cobain Suffer From BPD?

 

WHAT IS BORDERLINE PERSONALITY DISORDER (BPD)?

 

BPD sufferers experience a range of symptoms which are split into 9 categories. These are:

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

For a diagnosis of BPD to be given, the individual needs to suffer from at least 5 of the above.

frequently rejected in childhood, BPD sufferers live in terror of abandoment

frequently rejected in childhood, BPD sufferers live in terror of abandonment

A person’s childhood experiences has an enormous effect on his/her mental health in adult life. How parents treat their children is, therefore, of paramount importance.

BPD is an even more likely outcome, if, as well as suffering trauma through invidious parenting, the individual also has a BIOLOGICAL VULNERABILITY.

In relation to an individual’s childhood, research suggests that the 3 major risk factors are:

– trauma/abuse
– damaging parenting styles
– early separation or loss (eg due to parental divorce or the death of the parent/s)

Of course, more than one of these can befall the child. Indeed, in my own case, I was unlucky enough to be affected by all three. And, given my mother was highly unstable, it is very likely I also inherited a biological/genetic vulnerability.

 

EXAMPLES OF DAMAGING PARENTING STYLES:

 

1) Dysfunctional and disorganized – this can occur when there is a high level of marital discord or conflict. It is important, here, to point out that even if parents attempt to hide their disharmony, children are still likely to be adversely affected as they tend to pick up on subtle signs of tension.

Chaotic environments can also impact very badly on children. Examples are:

– constant house moves
– parental alcoholism/illicit drug use
– parental mental illness and instability/verbal aggression

 

2) Emotional invalidation. Examples include:

– a parent telling their child they wish he/she could be more like his/her brother/sister/cousin etc.
– a parent telling the child he is ‘just like his father’ (meant disparagingly). This invalidates the child’s unique identity.
– telling a child s/he shouldn’t be upset/crying over something, therefore invalidating the child’s reaction and implying the child’s having such feelings is inappropriate.
– telling the child he/she is exaggerating about how bad something is. Again, this invalidates the child’s perception of how something is adversely affecting him/her.
– a parent telling a child to stop feeling sorry for him/herself and think about good things instead. Again, this invalidates the child’s sadness and encourages him/her to suppress emotions.

Invalidation of a child’s emotions, and undermining the authenticity of their feelings, can lead the child to start demonstrating his/her emotions in a very extreme way in order to gain the recognition he/she previously failed to elicit.

 

3) Child trauma and child abuse – people with BPD have very frequently been abused. However, not all children who are abused develop BPD due to having a biological/genetic RESILIENCE and/or having good emotional support and validation in other areas of their lives (eg at school or through a counselor).

Trauma inflicted by a family member has been shown by research to have a greater adverse impact on the child than abuse by a stranger. Also, as would be expected, the longer the traumatic situation lasts, the more likely it is that the child will develop BPD in adult life.

 

4) Separation and loss – here, the trauma is caused, in large part, due to the child’s bonding process development being disrupted. Children who suffer this are much more likely to become anxious and develop ATTACHMENT DISORDERS as adults which can disrupt adult relationships and cause the sufferer to have an intense fear of abandonment in adult life. They may, too, become very ‘clingy’, fearful of relationships, or a distressing mixture of the two.

This site examines possible therapeutic interventions for BPD and ways the BPD sufferer can help himself or herself to reduce BPD symptoms.

 

 

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

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