Category Archives: Borderline Personality Disorder And Its Link To Childhood Trauma

Articles about how severe and protracted childhood trauma is linked to borderline personality disorder (BPD), symptoms of which include : unstable relationships, fear of abandonment, impulse control problems, unclear self-image, emotional dysregulation, explosive anger and chronic feelings of emptiness.

Signs That A Parent May Have Borderline Personality Disorder (BPD)

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Borderline personality disorder (BPD) is an extremely complex psychological condition. Indeed, it is not infrequently misdiagnosed as some other type of disorder, such as bipolar disorder. For these reasons there is likely to be a very large number of individuals who have the condition but are not aware of it.

And the picture is further confused by the fact that BPD often exists alongside (comorbidly) with other psychiatric disorders such as depression and anxiety. Furthermore, many who have the condition do not seek psychiatric help for the problem.

Of course, a formal diagnosis of BPD can only be made by an appropriately qualified professional. However, there are many signs to look out for that may suggest a parent has the disorder. It is to these that I now turn.

Signs That A Parent May Be Suffering From BPD:

The parent :

– shows little emotional or physical affection for the child

– invalidates/ignores/minimizes/derides/dismisses feelings that are important to the child (eg. ‘Why or you upset? – for god’s sake stop blubbering you little cry-baby’)

– responds inconsistently to the child’s behaviour – gives the child ‘mixed messages’ (this is sometimes referred to as putting the child in a ‘DOUBLE-BIND’ – click here to read my article on this)

– subjects the child to verbal cruelty – my own mother referred to me as ‘scabby’ (I self-harmed) and ‘poof’ (I was highly sensitive). Often, when I returned home from school, she would glare at me and announce, ‘Oh Christ, the little bastard’s home’. She finally kicked me out when I was thirteen)

– makes the child feel unloved/unwanted

– expects the child to meet exacting/unobtainable standards – frequently changes expectations of the child

– hinders the child from developing his/her own identity

– disputes child’s version/recall of events if it involves criticism of the parent

– creates ‘role-reversal’ (i.e. the child is treated as if s/he is the parent’s parentthis is also sometimes referred to as ‘parentification’ of the child; it may include making the child take on responsibilities that are inappropriate for his/her age (for example, I frequently had to act as my mother’s personal counsellor from the age of about ten. She reinforced this by referring to me as her ‘little psychiatrist’).

– makes the child feel on-guard and defensive all the time

– over-confides in the child (e.g. provides intimate details of sex-life)

– expects the child to be the carer/provider of emotional support

– expects child to constantly demonstrate undying loyalty and unconditional love, but DOES NOT RECIPROCATE

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Of course, such treatment as described above can have a catastrophic effect upon the child. Indeed, if the child is seriously affected, these effects can last a lifetime unless proper treatment is sought. I list some of the possible effects on the child once s/he becomes an adult below:

Possible effects on the child’s future adult life of the kind of treatment described above:

The affected person may:

– suffer severe social anxiety

– feel inadequate, unlovable, of no value and guilty

– have pervasive and chronic feelings of emptiness

– feel incapable of enjoyiong him/herself (this condition is referred to by psychologists as ‘ANHEDONIA’ – click here to read my article on this) or feel guilty about enjoying self, believing him/herself to be undeserving of happiness

– expects always to be betrayed by others/be deeply mistrustful of others

– have no sense of direction in life

– have serious problems in relationships, perhaps due to ‘repetition-compulsion’ the tendency to seek out relationships in which one is abused in a way similar to how one was abused by parents (this acts on an unconscious level)

– question his/her intuition, judgment and memory as parent will not accept his/her view of his/her childhood

– have chunks of childhood missing from memory (for instance, I can remember almost nothing about what happened to me before the age of about eight years)

– have a deep rooted fear of rejection/abandonment so will not take risks with trying to form relationships

– have a low tolerance of own mistakes/perfectionism

It should also be noted that research shows that those of us brought up by a parent with BPD are of elevated risk of developing the condition ourselves. Currently, one of the main kinds of treatment for the condition is ‘DIALECTICAL BEHAVIOR THERAPY’ (DBT) – click here to read my article on this form of treatment.

NB: It is worth reiterating that a formal diagnosis of BPD must be made by a professional – as I have already said, it is a very complex disorder.

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Above eBook now available for immediate download from Amazon : CLICK HERE.

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

Splitting, Denial And Flooding : The Inter-relationship

childhood trauma, splitting, denial and flooding

childhood trauma, splitting, denial, flooding

‘SPLITTING’ :

This is an unconscious defense mechanism that involves us seeing things in extreme and exaggerated ways, either as ALL GOOD or ALL BAD ; this unconscious strategy is often seen in people suffering from borderline personality disorder (BPD). 

For example, those suffering from this disorder frequently vacillate between, at times, perceiving a friend or partner in an idealized way and then, at other times, often as a result of perceived rejection (which may frequently be a false perception), ‘demonizing’ this same individual.

‘DENIAL’ : A PREREQUISITE OF ‘SPLITTING’ :

However, in order for ‘splitting’ to take place, ‘denial’ must take place first. This is because, in reality, in order to see things (and, especially people) as ‘all good’ or ‘all bad’, or, to put it another way, in ‘black or white’, the grey areas must be kept out of conscious awareness – this process, which also occurs on an unconscious level, is known as ‘denial’ and causes our view of things to be skewed and distorted. In essence, denial prevents salient information about whatever (or whoever) it is that we are making a judgment about from permeating our consciousness ; this, in turn, prevents us from considering or taking into account factors that contradict our (unknown to us) biased view, often leading to dysfunctional decisions and reactions.

childhood trauma, splitting, denial and flooding

How ‘Splitting’ And ‘Denial’ Can Lead To ‘Flooding’ :

Paradoxically, although ‘splitting’ and ‘denial’ are, technically speaking, defense mechanisms, their combined effect can be to cause FLOODING, I explain what is meant by ‘flooding’, and how this happens, below :

When ‘splitting’ and ‘denial’ operate together our emotional experience is intensified and and this reaction, in turn, can trigger related, intense memories. This can lead to a sense of our consciousness being ‘flooded’ with copious intense emotions and recollections.

Research conducted by the psychologist Siegel suggests that this overwhelming process of splitting/denial/flooding can be triggered in less than half a minute ; in effect then, it can be like a lightning fast ‘hijack’ of our mental faculties.

If our views are skewed negatively, this can lead to irrational verbal outbursts and behaviors which we are likely to later regret. On the other hand, if they are skewed positively (e.g. idealizing an abusive partner) we are prone to making poor decisions (e.g. remaining in a relationship with an abusive partner).

Link :

Splitting : Effects Of The BPD Parent Seeing The Child In Terms Of ‘All Good’ Or ‘All Bad.’

eBook :

BPD eBook

Above eBook now available for instant download. Click here for further details.

 

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

The Importance Of Limbic Resonance In Early Life

One way of describing the brain is to represent it as comprising three parts which developed at different times during our evolutionary history :

  • The reptilian brain (this is the most primitive part of the brain) : this part of the brain is involved in basic functions such as breathing and heart rate.
  • The limbic system (sometimes referred to as the mammalian brain) : this part of the brain is involved with emotions.
  • The neocortex (this is the most recently evolved part of our brains) : this part of the brain is involved in higher level mental processing.

This three part model of the brain is often referred to as the triune brain and is depicted in the image below.

 

The concept of limbic resonance relates to, as the term suggests, the brain’s limbic system (sometimes referred to as the brain’s emotional centre).

What Is Limbic Resonance?

The concept of limbic resonance was first introduced in the book entitled  A General Theory Of Love and, in simple terms, refers to the idea that emotions are contagious and that, therefore, the emotions of others have a powerful effect upon our own inner state.

Due to our capacity for emotional resonance, our own internal, emotional state does not exist as an independent entity, but, instead, is dependent upon the emotional states of others, particularly those to whom we are very close. For example, if someone around us is anxious and fearful, we sense this and it may have an adverse effect upon our own inner state ; in other words, the negative emotions of others can ‘infect’ us (and, likewise, the positive emotions of those around us (such as warmth, compassion and love) can ‘nourish’ us.

Limbic Resonance And Babyhood :

Limbic resonance is of crucial importance in relation to how we relate to our primary carer (usually the mother) when we are babies / infants.

Limbic resonance is normally achieved between baby and mother via deep eye contact; However, if the process goes wrong and  our mother is consistently,  poorly attuned to us at this early stage of our lives, failing to attend to our basic needs, our brain’s chemical composition and its limbic system’s ability to interact with the reptilian brain and neocortex (see above) in a manner conducive to emotional health and well-being (referred to as ‘limbic regulation’) may be seriously disrupted leading to impaired development of the personality as well as emotional difficulties in later life.

LIMBIC REVISION

If, when we were very young, the poor quality of our relationship with our mother meant that she was unable to satisfactorily attune to us and to provide consistent, attentive, warm, loving care, the authors of A General Theory Of Love, (Lewis, Amini and Lannon) suggest that the resultant psychological problems we are at risk of developing  may be effectively treated with the use of a therapy known as LIMBIC REVISION.

 

RESEARCH THAT HELPS US TO UNDERSTAND THE VITAL IMPORTANCE OF LIMBIC RESONANCE IN EARLY LIFE :

In relation to this, you may wish to read my previously published article :

The book referred to in the above article, A GENERAL THEORY OF LOVE,‘ can be purchased from Amazon (see below):


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

The Type of Parent Borderline Personality Disorder (BPD) Sufferers Have.

childhood trauma, bpd

Parents of individuals who go on to develop borderline personality disorder (BPD) in their adult life are typically extremely needy, sensitive (especially to rejection), and inadequate (in as far as they lack the necessary inner resources to be an effective parent).

Often, such a parent is likely to be preoccupied with her own feelings at the expense of those of her baby/child (henceforth I will just use the word ‘child’ to refer to ‘baby or child). This can then frequently lead to the child’s own needs to be soothed and comforted going unmet. This state of affairs can be made even worse if the parent also sometimes takes out her own feelings of stress and anxiety on the baby, perhaps through verbal, or even physical, aggression. Such damaging behaviours by the parent may be triggered by, for example, the child’s continued crying.

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Essentially, then, because the parent finds it extremely difficult to constantly give her child’s needs priority over her own (and therefore is likely to treat the child in a very inconsistent manner) the child’s emotional needs remain unsatisfied.

So the child of such a parent will experience her as unpredictable and sometimes frightening (when, for example, the child senses the mother’s own anxiety or experiences her hostility). The child and the mother fail to bond adequately, and a kind of psychological barrier forms between them.

This inconsistent, unpredictable, inadequate and stress-/fear- inducing parenting means that the child does not learn how to consistently manage and regulate his own feelings and emotions and will therefore often find them overwhelming and out-of-control. He may become highly sensitized to perceived potential threat and thus be easily tipped into anger and aggression as a coping/self-defence mechanism (usually this response is operating on an unconscious level).

Indeed, the parenting style may be so damaging that the physical development of the child’s brain structure is adversely affected, leading to him developing acute sensitivity to even minor stress (click here to read my article on how adverse early experience can damage the developing physical brain, leading to acute problems managing feelings of stress, anxiety, fear and other emotions). A child so affected will frequently then go on to be an adult who finds it very difficult to be self-reliant and may thus become a highly dependent personality.

The psychologist Marsha Lineham suggested that children who go on to develop borderline personality disorder (BPD) (click here to read my article on this) grow up in what she calls an ‘invalidating environment’. She defines such an environment as one in which the child’s needs and significant experiences go unacknowledged or ignored. The environment may also be one in which the child is unwanted and viewed as a burden or inconvenience.

To end on a personal note, I myself grew up in a very invalidating environment – my disturbed mother always threatened to throw me out of the house and did just that when I was thirteen; I then went to live with my father and step-mother who both made it clear I was unwanted (both by what they said and did, and, equally importantly, by what they did not do and say). I remember, too, the invalidating comments – for instance my (not infrequent) crying would meet with phrases from my mother such as ‘stop that bloody snivelling’ or, alternatively, ‘not the bloody water-works again !’

Still. I’m now 46. Perhaps it’s time to move on.

borderline personality disorder

 

Above eBook now available for immediate download on Amazon. $4.99 CLICK HERE.

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

Thin-Skinned? Its Link To BPD.

BPD and being thin skinned

Do people ever accuse you of being thin-skinned?

If we have developed borderline personality disorder (BPD) as a result of our traumatic childhood, then one of the main symptoms we are likely to have developed is difficulties with interpersonal relationships. Most often, too, part of this difficulty resides in the fact that we are likely to be extremely thin-skinned. 

Our being thin-skinned can, most frequently, be explained by our having experienced severe negative attitudes expressed towards us as children (most commonly by a parent or primary carer), rejection, abandonment, emotional abuse or some combination of these.

BPD and being thin-skinned

Thus, in an unconscious, desperate attempt to protect ourselves from further psychological pain, we become hypervigilant and hypersensitive in connection with being on the look out for further signs that someone may be a threat to our psychological welfare by emotionally hurting us.

Rather like a dog who has been regularly beaten, we ‘snarl’ at  (or ‘run away’ from) anyone who remotely seems to represent such a threat lest they harm us like we were harmed before.

Do Those With BPD Imagine Others Are Behaving Negatively Towards Them When, In Reality, This Is Not The Case?

Do people with BPD constantly imagine slights against their character when, in reality, such slights have not occurred?  In fact, this doesn’t seem to be the problem (or, if it is a problem, not the main problem). Rather, people with BPD, due to their hypervigilant state when interacting with others, perceive real negative attitudes towards them which others may not be perceptive or sensitive enough to pick up on or let pass over their heads.

The problem from here is often how those with BPD react once they have picked up on such negative attitudes.

How Do Those With BPD Tend To React In Such Situations ?

In such situations, those with BPD tend to be very easily offended and feel intensely hurt and misunderstood ; this can then lead to becoming highly emotional or, as a form of self-protection, detached. Unfortunately, neither of these reactions tend to be useful in terms of resolving the situation; indeed, such reactions most often serve only to compound the BPD sufferer’s interpersonal difficulties.

Resources:

HOW TO STOP BEING DEFENSIVE : SELF HYPNOSIS DOWNLOADS

 

eBook :

 

borderline personality disorder ebook

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David Hosier BSc Hons; MSc; PGDE(FAHE)

 

 

Three Unconscious Psychological Defenses Against Inner Feelings Of Shame

inner shame

According to psychodynamic theory, if, as babies, we are subjected to significant emotional abuse by the primary caregiver (usually the mother) such as constantly being subjected to her extreme anger, rage and hostility, we are at risk of developing a profound and pervasive sense of inner shame – the unshakeable inner conviction that we are bad beyond redemption and worthless to humanity.

This can have extremely long-lasting, even lifelong (in the absence of effective therapy) effects, including great difficulty developing meaningful and satisfying relationships with others  and the unconscious adaptation of three main psychological defense mechanisms, according to the psychodynamic psychoanalyst, Burgo PhD.

inner shame

Burgo identifies these three psychological defense mechanisms against the almost unbearable emotional pain our feelings of inner shame cause us as follows :

1) NARCISSISM

2) BLAMING OTHERS

3) TREATING OTHERS WITH CONTEMPT

1) Narcissism : Narcissists feel a desperate need to be admired by others and to feel superior to them. They may try to achieve this through their appearance (expensive clothes, jewelry, cosmetic ‘enhancements’ etc), occupational/professional success, social popularity and various other means, ‘Above all, they need to be the centre of attention (even notoriety is better than being ignored in their eyes). Their interest in others tends to be superficial at best (unless it involves exposing said others’ weaknesses and ‘inferiority, of course).

All these devices are a largely unconscious (usually) way of trying to keep hidden, concealed and buried a (from themselves and others) their profound inner sense of shame and unworthiness.

2) Blaming others : Because those afflicted by deep, internal feelings of shame cannot bear to be reminded of their own imperfections or to have them exposed, they deflect any blame that it might be their responsibility to accept onto others.

3) Treating others with contempt : This psychological defense works in a similar way to the psychological defense of blaming others (see above). Viewing and/or treating others in a contemptuous manner is very frequently a projection of one’s sense of one’s own inferiority onto others.

RESOURCES :

 

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

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

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difference between complex ptsd and bpd

bpd-versus-complex-ptsd

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.

bpd-versus-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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Above eBooks now available from Amazon for instant download. For further details, click here.

 

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

 

 

 

 

When Is BPD Diagnosed? The Continuum Of Personality Problems.

personality

The Nine Personality Problems Associated With Borderline Personality Disorder (BPD) :

There is no clear demarcation between those who have borderline personality disorder (BPD) and those who do not ; this is because the personality problems that contribute to a BPD diagnosis lie on a continuum. I have described the symptoms of BPD in numerous other articles that I have previously published on this site, but, for the sake of convenience, will list them again :

Three Criteria That Contribute To A Diagnosis Of BPD :

According to DSM V (The Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition) an individual must display at least five of these symptoms to be diagnosed as suffering from BPD.

However, as implied above, an individual does not either have these personality problems or doesn’t have them – things are not that clear cut or black and white. So how is it decided whether or not each symptom is serious enough to count towards a diagnosis of BPD?

Essentially, it is a question of three considerations. For each of the above nine key symptoms, it is necessary to ask :

  1. Is the symptom chronic?
  2. Does the symptom cause the sufferer, or other people, significant problems?
  3. Does the symptom adversely affect multiple areas of the sufferer’s life?

peronality continuum

Let’s briefly look at each of these in turn :

Conclusion :

Essentially, the more of the above nine symptoms an individual has (as stated above, it is necessary to have a minimum of five to be diagnosed with BPD), and the more chronic, the more problematic and the more pervasive these symptoms are are, the more likely the individual is to be diagnosed with BPD ; so, BPD, like other personality disorders, lies on a continuum : deciding whether or not a person is suffering from it is not a clear cut decision.

However, diagnosis is not an exact science so there is always the possibility of unreliable diagnoses ; for example, person A may be diagnosed as having BPD by Dr X whereas person B may NOT be diagnosed as having BPD by the same doctor.

However, if both seek a second opinion from Dr Y, the diagnoses may be reversed (i.e person A is diagnosed as NOT having BPD whilst person B is diagnosed as having BPD. Of course, in the case of individuals suffering from particularly extreme (even within the context of the disorder) symptoms, diagnoses are likely to be more consistent and reliable.

RETURN TO BPD AND CHILDHOOD TRAUMA MAIN ARTICLE

eBook :

BPD ebook

Above eBook now available on Amazon for immediate download. Click HERE for further information.

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

Why Do People Self-Harm? Six Possible Reasons.

-do-children-self-harm

In my last post I wrote about a specific type of self-harm known as compulsive skin picking disorder and how, in the most serious cases, it can necessitate skin grafts to repair the severe damage done to the flesh.

In this post I want to look at the possible reasons why some people are driven to self-harm ( or, as its sometimes referred to as, self-mutilate).

First, it should be pointed out that those abused as children have a much higher than average chance of adopting self-harming behaviors (such as compulsive skin picking, as well as cutting and burning the skin). Also, females are at greater risk than males. And, finally, those who have an existing disorder of substance abuse and/or an eating disorder are also at elevated risk of becoming self-harmers.

-do-children-self-harm

Why Do People Self-Harm?

1) the physical pain induced by self-harming temporarily distracts the individual from overwhelming psychological pain.

2) many people who have suffered traumatic childhoods become adults who feel emotionally numb and dead, they may ,too, experience a sense of being somehow ‘unreal’ (psychologists call this sensation depersonalization) and of the world itself being ‘unreal’ (psychologists refer to this sensation as derealization). Self-infliction of pain, however, does feel real, thus, it may temporarily counteract the feelings of numbness and unreality.

3) those who have suffered childhood trauma have often been conditioned by their parents to believe (erroneously) that they are somehow ‘intrinsically bad'(click here to read my article on this). Self-harm may be driven, therefore, by an unconscious desire to punish oneself.

4) for those who have experienced significant childhood trauma, often the specific causes of their psychological suffering are far too complex to be expressed verbally. Self-harm, then, may be a way of expressing the acute mental pain one is in non-verbally. In this way, self-harm can be seen as a way to act out internal emotional turmoil.

5) if we were deprived of proper care and nurturing as a child, self-harm may be (again, on an unconscious level) an attempt to gain these things from which we were deprived (although it should be noted that many individuals who self harm injure parts of their body which are not generally on public view because they feel a sense of shame and embarrassment about their self-inflicted injuries).

6) finally, it is also theorised that self-harm can trigger a dissociative state (click here to read my article on dissociation).

Treatment:

For detailed advice (provided by the NHS) about self-harming behavior and how it can be addressed click here.

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

Wrongly Diagnosed With BPD?

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 co-morbid 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 stigmatizedsee below) and should be diagnosed with complex post traumatic stress disorder instead.

Indeed, it has been suspected for a while now that many people who have been diagnosed with BPD should really have been diagnosed with a different syndrome known as complex post traumatic stress disorder (Complex PTSD).

Whilst simple PTSD typically results from an intense, one- off, traumatic experience, complex PTSD occurs as a result of protracted and prolonged trauma. Complex PTSD is especially likely to occur in cases of child abuse that continued over a long period, especially when the abuser should have been acting as the child’s primary carer(e.g. a parent or step-parent).

It has been found that a very high percentage of those diagnosed with BPD experienced severe childhood trauma which is why (amongst other reasons, see below) many experts are now questioning whether a large number of those so diagnosed should, instead, have been diagnosed with Complex PTSD.

Complex PTSD is so damaging to an individual as it eats into the very core of how s/he perceives him/herself and affects, on a profound level, how s/he views others and the world in general. In short, it adversely impinges upon a person’s core and fundamental beliefs.

Symptoms of Complex PTSD

severe mood swings

– out of control emotions

– out of control behaviours e.g. shoplifting, pathological gambling, promiscuous and risky sex, severe overspending

– dissociation (click here to read my article on this)

– eating disorders

– overeating/obesity

–  impaired and distorted view of abuser (leading to emotional attachment). This is also known as Stockholm Syndrome.

– marked distrust of others

– intense jealousy

– extreme neediness

– hopelessness/despair

– feeling that life is utterly devoid of meaning

– inappropriate feelings of guilt/shame/self-disgust

– outbursts of extreme anger (sometimes with physical violence)

– severe anxiety

– suicidal thoughts/behaviour

Overlap With BPD Symptoms:

It is because these symptoms overlap substantially with the symptoms of BPD (click here) that it is thought many people are being diagnosed with BPD when they should be being diagnosed for Complex PTSD.

It is my belief that a main cause of such misdiagnosis is that  doctors do not spend enough (or, indeed, any!) time talking to supposed ‘BPD suffers’ about their childhood experiences.

Given the choice, I suspect, if there are valid reasons, most people would feel more comfortable with a diagnosis of Complex PSTD than one of BPD. This is because, sadly and wrongly, stigma still tenaciously attaches itself to a diagnosis of BPD.

Also, a diagnosis of Complex PTSD implicitly acknowledges the fact that the sufferer has had harm done to him/her and that Complex PTSD is a NORMAL REACTION TO AN ABNORMAL SET OF EXPERIENCES.

This could significantly help sufferers cast off, once and for all, the vast weigh of guilt many feel in one fell swoop.

 

If You Feel Your Diagnosis Of BPD Is Correct, Should You Tell Others That You Suffer From It?

Deciding whether to tell others about the fact one is suffering from BPD presents a very difficult dilemma: on the one hand, there is the worry of being stigmatized (see below) and discriminated against, and, on the other, there is the possibility that others will become more understanding of one.

Because few people, through no fault of their own, are well educated about psychological issues, the decision a sufferer of BPD must make as to whether or not to tell others is one that cannot be taken lightly. However, it need not be an ‘all-or-nothing’ decision: it is obviously possible to tell some people (if reasonably believed to be entirely trustworthy) whilst not telling others; similarly, it is possible to decide how much detail it is necessary (or not) to go into.

First of all, let’s look at the possible benefits (and it important to note the word ‘possible’, as they are by no means guaranteed) which might come from telling others:

– those told might become more empathetic, understanding and forgiving
– those told might feel closer to you as a result
– those told might wish to offer some help and support

I REPEAT, THOUGH, NONE OF THESE POSITIVE OUTCOMES CAN, IN ANY WAY, BE COUNTED ON:

So let’s now consider some possible negative repercussions:

– those told may hurt the sufferer further by ‘not wanting to know’
– those told may tell others that the sufferer did not wish them to tell, thus betraying their trust. Then, sadly as we all know, some people have an unlimited capacity to entertain themselves with malicious gossip
– the sufferer may be met with discrimination
– if the sufferer tells people that s/he has a personality disorder, which carries with it very negative connotations, they may consider the sufferer ‘crazy’ or ‘mad’ due to their lack of knowledge and, conceivably, fear
– people told may lose the confidence or motivation to interact with the sufferer further
– people may cynically think that the sufferer is trying to provide an excuse for their mistakes

It is worth re-emphasizing that, because it is impossible to predict with complete accuracy how another will respond, the decision about what to tell and whom to tell should be given a great deal of thought.

THE USEFULNESS OF FIRST GETTING PROFESSIONAL ADVICE AND SUPPORT:

It is recommended, very strongly, that anyone suffering from BPD should seek professional therapy. With more and more research being conducted on the condition, positive treatment outcomes for those with BPD are continually increasing in likelihood. Professionals who can help treat BPD, and provide advice and support include:

– psychiatrists
– psychologists
– counsellors
– social workers specializing in mental health issues
– family therapists
– community mental health nurses

Such professionals can help the sufferer to come to a decision about considerations which may include:

– whether to tell others/whom to tell
– any treatment being received/considered
– specific symptoms the sufferer experiences which are believed to stem from the condition of BPD
– the causes of BPD (particular care is adviseable hear if explaining these to someone the sufferer believes may have contributed to their development of the condition).

NB Any decision to inform an employer of one’s condition should definitely only be undertaken once the relevant advice (including legal advice regarding the relevant discrimination laws, which are a mine-field) has been sought. It should be borne in mind that legal disputes with an employer, especially regarding such a sensitive issue as discrimination law, can be extremely stressful and emotionally draining.

Finally, it is worth saying that, in general, is easier to discuss the condition with others if one has spent some to researching it.

STIGMA

As mental illness is dictated by a combination of environmental and genetic factors, it can happen to absolutely anyone. Even individuals a long way into adulthood, who have previously always enjoyed good mental health, can suddenly be plunged into a severe clinical depression by a single traumatic life event. Nobody is immune. Mental illness HAS NOTHING TO DO WITH PERSONAL FAILINGS.

However, stigma connected to mental illness is still far from uncommon. Others can stigmatize those of us who have suffered mental illness, and turn their backs in disdain and contempt with a feeling of smug, self-satisfied superiority, due to their lack of education on the matter; also, however, some people who suffer mental illness (having internalized society’s often less than compassionate take on the condition) can, in effect, self-stigmatize: because mental illness often causes negative thinking patterns and feelings of worthlessness, it is all too easy for us to fall into the trap of compounding our suffering by feeling bad about being mentally ill (we may see ourselves as weak, for example). In other words, we may add a kind of additional, unnecessary layer to our distress: feeling bad about ourselves for feeling bad about ourselves, as it were. This has been referred to by some psychologists as METAWORRYING.

It is, of course, generally easier to alter the way that we feel about ourselves than it is to change the way others feel about us; ignorance, after all, can have a dispiritingly tenacious quality. Therefore, a good place to start in the fight against stigma is to change how we see ourselves for having experienced mental illness: we need, in short, to stop stigmitizing ourselves.

mental illness and stigma

TACKLING STIGMATIZATION BY SOCIETY:

Whilst stigmatization by society, as I have said, still, obviously, exists, attitudes are improving all the time with greater public education and more and more individuals, with a prominent public profile, willing to talk openly about their own experience of mental illness (most notably, perhaps, in the UK, the writer, actor and comedian – and probably a lot of other things I can’t currently call to mind – Stephen Fry, who suffers bipolar disorder).

Progress has been made in society in relation to racism and homophobia, and, it would seem, there is no obvious reason why similar progress should not be made in relation to society’s attitude towards those unfortunate enough to experience mental illness.

THE FIRST STEP:

The first step we can all make, as I have suggested, is to stop blaming ourselves, and feeling bad about ourselves, for having suffered psychological difficulties.

If you would like to learn more about fighting the stigma surrounding mental illness you may wish to pay a visit to www.shift.org.uk to see what they are doing in their campaign in relation to this. The campaign, for those who are interested, is run by The National Institute for Mental Health, UK.

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

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Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

The Main Ways Trauma Continues To Ruin Our Lives Long After It’s Over

The effects of trauma, in the absence of effective therapy, can adversely affect our lives for years or even decades (for our WHOLE lifetimes, in fact) after it is over (indeed, the effects of trauma themselves can take years from when the traumatic experience ended to present themselves – in relation to this, you may wish to read my previously published article entitled : ‘Why Can Effects Of Childhood Trauma Be Delayed?’).

In his book, ‘The Betrayal Bond‘, Patrick Carnes, PhD, outlines eight main ways in which the experience of severe trauma can continue to affect us. I list these below :

Trauma reaction :

The ‘alarm’ response to the traumatic experience. These responses can be both biological and psychological. Extreme and prolonged trauma can lead to an individual becoming essentially ‘trapped’ in the alarm response which results in him/her becoming extremely, emotionally reactive and prone to flying into rages in response to the smallest of provocations. This state is sometimes referred to as hypervigilance or hyperarousal.

Furthermore, this ongoing trauma reaction frequently involves :

Trauma arousal :

This refers to deriving pleasure from taking large risks, sensation seeking, and exposing oneself to high levels of danger or even from getting involved in violent situations ; individuals who are traumatized may behave in such ways to detract from feelings of emptiness and emotional pain.

Individuals displaying trauma arousal may :

  • find it difficult being alone
  • be intolerant of ‘low-stress situations’ (as such situations do not satisfy their cravings for mental stimulation).
  • need ever increasing ‘hits’ of stimulation and excitement due to habituation, leading to taking greater and greater risks
  • use stimulant drugs (e.g. cocaine)
  • associate with dangerous people
  • become increasingly addicted to the arousal state

Trauma blocking :

Trauma blocking refers to the individual’s attempts to numb him/herself so as to escape / block out painful feelings associated with the traumatic experiences.

Individuals displaying trauma blocking behavior may :

  • over-eat, especially carbohydrates to induce drowsiness
  • consume excessive amounts of alcohol
  • sleep excessively (referred to as hypersomnia)
  • workaholism
  • undertaking excessive exercise
  • compulsive sex
  • ‘zone out’

Trauma splitting :

This refers to the unconscious process of avoiding the reality of the traumatic experience by ‘splitting it off’ from conscious awareness so that it is compartmentalized and unintegrated into personality so as to allow day-to-day functioning (if it was not ‘split off’ and compartmentalized, it would psychologically overwhelm the individual. Therefore ‘splitting’ can be categorized as defence mechanism ; however, such splitting prevents the information associated with the traumatic experience being properly processed which, in turn, prevents traumatic resolution. (For more about ‘splitting’, click here).

‘Splitting’ can manifest itself in various ways :

  • using hallucinogenic drugs (such as LSD) to ‘enter an alternative reality.’
  • In extreme cases, ‘splitting’ can take on the form of dissociative identity disorder (which used to be called ‘multiple personality disorder’) which may involve amnesia about what one has been doing and where one is
  • certain religious and spiritual practises
  • ‘obsessive love’ – see my previously published article about OBSESSIVE LOVE DISORDER
  • frequently retreating in one’s own mind to a ‘fantasy world.’
  • living a double life

Trauma abstinence :

This refers to a compulsion to experience deprivation. This is especially likely to happen when the individual is experiencing high levels of stress, anxiety or shame ( to read my article entitled, ‘Shame Caused By Childhood Trauma And How We Try To Repress It) or even at times when great success has been achieved (see my article on self-defeating personality disorder).

According to Carnes, self-deprivation may relate to the individual having been deprived and neglected during childhood, causing him/her to believe, as an adult, that s/he is unworthy and undeserving of ‘the good things in life.’ If such an individual also has a high level of arousal caused by childhood trauma such as severe abuse (click here to read my article about hyperarousal ), this may also have led neurochemical changes in the individual’s brain making him/her prone to addictive behavior. When these two two factors (i.e. self-neglect caused by a belief of being ‘unworthy’ and proneness to addiction) coalesce, s/he may become, as it were, addicted to self-deprivation.

Carnes provides the example of anorexia, explaining that self-starvation operates like an addiction to drugs because it can increase the production of endorphins, the body’s natural pain-killers (e.g. Tepper, 1992). He also states that such addictions to deprivation may operate to psychologically compensate for a sense of loss of control in other areas of life ; the example Carnes provides is that of a woman who is sexually out of control ‘compensating’ by becoming anorexic.

Food is just one example of what such individuals may deprive themselves of, other examples include :

  • heating
  • medical care
  • depriving oneself of success (self-sabotage)
  • sufficient rest and relaxation
  • holidays
  • anything that could be categorized as a luxury
  • vacations

Trauma shame :

This refers to feelings of shame (see my previously published article, ‘Childhood Trauma, The Shame Loop And Defenses Against Shame’ ) and self-hatred (see my previously published article, ‘ Childhood Trauma Leading To Self-Hatred And Intense Self-Criticism) that, all too frequently, arise following chronic and severe childhood trauma

Feelings of shame can manifest themselves in various ways, including :.

 

  • Trauma repetition :

This refers to an unconscious drive to recreate and re-experience the trauma through people (e.g. forming relationships with physically abusive partners if one was physically abused as a child) and situations and to repeat behaviors associated with the original trauma.

Trauma repetition may also involve the traumatized individual being unconsciously driven to treat others in the same abusive manner that they themselves had been treated.

There exist different theories as to why individuals often re-enact their original traumatic experiences later on in life. For example,  Levy PhD (1998) proposed that reenactments might be caused by :

To read Levy’s original paper on these four possible causes of reenactment of trauma, click here.

Trauma bonds :

This refers to the tendency to form relationships with others that are maladaptive and dysfunctional and expose one to harm, danger, shame, emotional pain, exploitation or, in extreme cases, even death. Examples of traumatic bonds operating in relationships include those that exist within a context of domestic violence or incest. Other examples include codependents who live with alcoholics or compulsive gamblers.

Carnes provides us with various examples of signs that a relationship may be based upon a traumatic bond, some of which I present below :

  • remaining loyal to those who betray one
  • keeping the abuse secret
  • staying in conflict with others when walking away would cost one nothing
  • being constantly attracted to / obsessed with / preoccupied by untrustworthy people
  • staying in a relationship which causes one great psychological pain

 

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

Borderline Personality Disorder And The Brain

 

Nobody chooses to suffer from borderline personality disorder ; this is obvious.

Borderline personality disorder (BPD) is probably the most tormenting and agonizing psychiatric condition known to man. One in ten sufferers end up killing themselves after years, or even decades, of appalling mental suffering. Due to the disturbed behavior that accompanies BPD,  sufferers may become social pariahs and/or be rejected by their families – in the latter case, often by the very family member/s who have played a major role in causing the disorder ; I have said elsewhere that this is rather like somebody cutting off all your limbs and then blaming you for bleeding for over them. Or injecting you with a cancer causing agent and then blaming you for wasting away and dying.

One of the great torments of BPD sufferers is a belief that they are bad and that their behavior is due to some fundamental character flaw rather than due to a desperately serious psychiatric condition. It is this false belief (frequently caused by internalizing parental negative views of them whilst growing up) that contributes to many of the suicides and, as such, is a belief which is in urgent need of correcting.

On what grounds do I make this assertion? I summarize them below :

  • DAMAGE DONE TO THE PHYSICAL DEVELOPMENT OF THE BRAIN:

The physical development of the following three brain regions is affected by our upbringing in early life and this physical development may be adversely affected if that upbringing is significantly dysfunctional.

  • AMYGDALA
  • HIPPOCAMPUS
  • ORBITOFRONTAK CORTEX

 

Let’s look at each in turn:

AMYGDALA : This part of the brain controls emotions and, especially, negative emotions like fear, anxiety and aggression. It follows that because the amygdala has developed abnormally in BPD sufferers, they will be prone to experiencing abnormal levels of fear, anxiety and aggression.

HIPPOCAMPUS : This part of the brain plays a significant role in our ability to exert self-control. Again, it follows that because the hippocampus has developed abnormally in BPD sufferers, they will have difficulties with self-control, leading to impulsive and self-destructive behaviors.

ORBITOFRONTAL CORTEX : This part of the brain is involved with planning and decision making. Yet again, it follows that because the orbitofrontal cortex has developed abnormally in BPD sufferers, they will have problems planning ahead (including poor ability to consider future implications of behaviors or to act in a premeditated or carefully deliberated manner) and be prone to irrational and illogical decision-making.

Furthermore, these three brain areas play a very significant role in mood regulation / our ability to control how we feel. As these three areas have developed abnormally in BPD sufferers, this helps to explain why their moods can fluctuate so dramatically, in turn leading to extensive problems both forming and maintaining healthy relationships with others.

Now, consider this : If a person was hit on the head with a hammer, causing brain damage which, in turn, affected how s/he felt and behaved, should s/he (the person hit) be blamed for this change in behavior? No, of course not. So, why should a different view be taken in the case of BPD sufferers? Indeed, to take a different view would seem suspiciously like discrimination against mental illness and a failure of imagination in regard to how devastating the infliction of emotional suffering can be.

Types Of Dysfunctional Upbringing That May Damage These Brain Regions :

These include :

  • suffering abuse from parent/primary carer
  • being neglected by parent/primary carer
  • being brought up by a parent with a significant mental health problem
  • being brought up by a parent/primary carer who is an alcoholic
  • being brought up by a parent/primary carer who is a drug addict

What About The Role Of Genes?

There is NOT a gene for BPD.

However, some may be born with a greater vulnerability to being adversely affected by stressful environments due to high levels of sensitivity.

 

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

 

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