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Borderline Personality Disorder And The Physically Damaged 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 ends up killing themselves after years, or even decades, of appalling mental suffering. Due to the disturbed behaviour 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.

 

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 behaviours.

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 behaviours 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 behaviour? 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 pejorative terms, are frequently described as ‘manipulative’.

However, in recent years, it has been increasingly recognized that intentionally manipulative behaviour 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 mislabelling of BPD sufferers as manipulative has been based on a MISINTERPRETATION of certain types of their behaviour.

Lineham puts forward the view that, often, some of the behaviours 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’ behaviour 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).

 

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

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

BPD Sufferers Need To Be ‘Held’ According To Theory

holding

Buie And Adler :

Buie and Adler propose that the pathology displayed by sufferers of borderline personality disorder (BPD) such as instability, uncontrolled rage and anger, can be attributed, primarily, to early dysfunction in the relationship between the individual as a young child and his/her mother.

More specifically, Buie and Adler hypothesize that, as a young child, the BPD sufferer was insufficiently ‘held’ by the mother, particularly during the rapproachment phase of interactions.

What Is Meant, In Psychotherapy, By ‘Holding’?

In psychotherapeutic terms, the word ‘holding’ does not necessarily entail literal, physical holding (although, ideally, of course, a mother would physically hold her young child when s/he was distressed and in need of comfort), but can also involve its emotional equivalent (verbally comforting and soothing the child, for example).

However, because of the mother’s failure to sufficiently ‘hold’ (physically, emotionally or both) the BPD sufferer when s/he was a young child in distress, s/he never had the opportunity to internalize adequate maternal ‘holding’ behavior so that now, as an adult, s/he lacks the ability to self-soothe in response to the further distress that s/he will inevitably experience as an adult.

self-soothe

Profound Feelings Of Aloneness :

Buie and Adler further propose that the BPD sufferer’s inability to ‘self-sooth’ at times of high stress leads to a pervasive and profound sense of aloneness ; indeed, Buie and Adler consider this deep sense of loneliness to be a core feature of the BPD sufferer’s psychological experience and describe it in the following manner :

‘an experience of isolation and emptiness occasionally turning into panic and desperation.’

Projection :

Also, according to Buie and Adler, BPD sufferers use the psychological defense mechanism of projection in relation to their profound feelings of inner isolation which means, in short, that they project these feelings onto the external environment, and, as a result of this, perceive the outside world, and life in general, to be empty, meaningless and devoid of purpose.

Longing To Be Held By Idealized Others :

Furthermore, Buie and Adler propose that this inability to self-soothe and self-nurture (due to the original failure to internalize maternal holding behavior, itself a result of the mother’s dysfunctional interaction with the BPD sufferer when s/he was a young child) leads to intense, desperate longing and desire to be ‘held’ by idealized others.

Separation Anxiety :

Additionally, according to Buie and Adler, such longings perpetually leave the BPD sufferer vulnerable to feelings of extreme separation anxiety.

Rage :

Because of the BPD sufferer’s proneness to idealize others (see above), Buie and Adler point out that this can lead to him/her (i.e. the BPD sufferer) to develop extremely exacting expectations of such idealized others that it is not possible for them (i.e. the idealized others) to live up to.

This inevitable failure of the idealized others to live up to the BPD sufferer’s stratospheric expectations can then induce feelings of extreme rage and anger in him/her (i.e. the BPD sufferer) directed at the ‘failed’, idealized other.

Implications For Therapy :

In line with their theory, Buie and Adler put forward the view that it is the role of the therapist to provide the holding and soothing functions that the BPD sufferer is not capable of providing for him/herself. The ultimate goal of this is that the BPD sufferer is eventually able to internalize these functions (holding and self-soothing) so that s/he learns to provide them for him/herself in a way that s/he was unable to as a child due to the defective nature of the mothering s/he received.

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

 

BPD Sufferers May Avoid ‘Mentalising’ Due To Parental Rejection

BPD Sufferers May Avoid 'Mentalising' Due To Rejecting Parents

Peter Fonagy, an internationally renowned clinical psychologist, psychoanalyst and expert in borderline psychopathology and early attachment relationships, and who has produced some of the most influential work relating to this field, has stressed the importance of MENTALISING (or, more precisely, the avoidance of it) in relation to borderline personality disorder (BPD).

What Is Meant By The Term ‘Mentalising’?

The term ‘mentalising’ refers to a person’s ability to perceive, understand and make use of other’s emotional states (and their own).

Why Might Those Suffering From BPD Avoid ‘Mentalising’?

According to Peter Fonagy’s theory, children of cold and rejecting parents avoid mentalising because thinking about their parents’ lack of emotional warmth, rejection, absence of love and, perhaps, even, hatred would be too psychologically distressing and painful.

Prevention Of Recovery :

However, Fonagy also theorizes that this evasion (both conscious and unconscious) of the truth about how one’s parents treated one and felt about one prevents the individual from resolving the trauma and recovering from the emotional mistreatment. He proposes that it is necessary for those suffering from borderline personality disorder (BPD) to confront, and consciously process, the traumatic elements of their childhoods, and, in particular, their difficult, perhaps tortured, childhood relationships with their parents.

The Need For Understanding And Verbal Expression :

Only by understanding what happened to one in childhood, and by learning to express, verbally, this understanding, Fonagy proposes, is recovery possible.

Conclusion :

Whilst Fonagy’s theory has been influential, some researchers have criticized it for not placing enough emphasis upon the fundamental problem sufferers of borderline personality disorder (BPD) frequently experience – namely their inability to control intense emotional reactions (often referred to as ’emotional dysregulation’ ; to read my previously published article relating to this, entitled ‘Three Types Of Emotional Control Difficulties Resulting From Childhood Trauma’, CLICK HERE. )

Resources :

 

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

 

 

 

 

 

Explaining BPD In Terms Of The Diathesis-Stress Model

BPD, diathesis stress model

What Does ‘Diathesis’ Mean?

The medical definition of ‘diathesis’ is ‘a heriditary or constitutional predisposition to a disease or other disorder.‘ (The word ‘diathesis’ itself derives from the Greek word for ‘disposition).

What Is The Diathesis-Stress Model?

The diathesis-stress model is a psychological theory that proposes that a psychiatric disorder is caused not by heriditary factors (i.e. predispositional vulnerability) alone, NOR by psychologically stressful experiences alone, but by the way in which the two factors interact with one another.

Explaining Borderline Personality Disorder (BPD) In Terms Of The Diathesis-Stress Model :

The diathesis-stress model is an appropriate model with which to explain how borderline personality disorder (BPD) develops in the individual. It is appropriate because research suggests that BPD does not occur in a person solely because of his/her traumatic and stressful childhood experiences nor solely because of an unfortunate genetic inheritance. What is vital in determining whether or not a person ‘succumbs’ to BPD is  how their genes and childhood experiences combine and interact.

In other words, a person who is genetically vulnerable to developing BPD and experiences severe, protracted trauma during childhood may well go on to suffer from BPD in adulthood (see equation 1, below)

However, another individual who has low genetic vulnerability to the disorder and suffers a similarly traumatic childhood (although, of course, the ‘amount’ of trauma a person experiences is impossible to quantify – each case is utterly unique) may well avoid developing it (see equation 2, below)

So, we could represent the above with the following equations :

1)   HIGH LEVEL OF CHILDHOOD TRAUMA + HIGH GENETIC VULNERABILITY = HIGH CHANCE OF DEVELOPING BPD.

2)   HIGH LEVEL OF CHILDHOOD TRAUMA +LOW GENETIC VULNERABILITY = LOWER CHANCE OF DEVELOPING BPD (compared to 1, above).

And, of course, it naturally follows that :

3)   LOW LEVEL OF CHILDHOOD TRAUMA + LOW GENETIC VULNERABILITY = LOW CHANCE OF DEVELOPING BPD

4)   LOW LEVEL OF CHILDHOOD TRAUMA + HIGH GENETIC VULNERABILITY= HIGHER CHANCE OF DEVELOPING BPD (compared to 3, above)

More About Genetic Vulnerabilty To BPD :

In terms of genetic inheritance, what will make a person more susceptible to developing BPD?

The main consideration here is the person’s innate temperament. In particular, those who have naturally impulsive and emotionally labile personalities will, in general, be more predisposed to developing BPD if they also experience protracted and significant trauma during their childhoods compared to those more naturally inclined towards stoicism and timidity.

A Third Factor : Culture / Society :

However, the stress-diathesis model is not the whole story when we are considering the multiple, inter-relating causes that can lead to someone developing BPD. There is also the question of the culture / society in which the individual exists.

To learn more about this, you may wish to read my article entitled : Childhood Trauma, BPD, Genes And Culture.

 

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

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

Dr Jekyll And Mr Hyde: Do BPD Sufferers Have A ‘Split Personality’?

Do BPD Sufferers Have A ‘Dr Jekyll And Mr Hyde’ Personality?

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

Borderline Personality Disorder, Dissociative Identity Disorder And ‘Splitting’

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

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

whereas :

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion 

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

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

RETURN TO BPD AND CHILDHOOD TRAUMA MAIN ARTICLE

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

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

 

Because there is 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 that sought to delineate these two very serious psychiatric conditions.

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

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

 

The following results from the study were obtained :

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

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

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

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

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

INSTABILITY

FEELINGS OF PARANOIA / DISSOCIATION

UNSTABLE RELATIONSHIPS

SELF-HARM

SUICIDAL BEHAVIOR

DESTRUCTIVE IMPULSIVENESS

IDENTITY PROBLEMS / UNSTABLE SENSE OF SELF

EXTREME OUTBURSTS OF TEMPER

FRANTIC ATTEMPTS TO AVOID ABANDONMENT

 

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