Living with Borderline Personality Disorder

[Mal12345]

There may already be a thread on this topic but I'm not going to look around for it. I'd rather begin anew instead of adding to some old thread.

I've been a psychology/philosophy buff since I was in my depressed 20s. I first learned about Borderline Personality Disorder (BPD) while reading the DSM III. I believe this was the first DSM to officially declare BPD to be real. But in a way I've known about it for a lot longer than that.

In 2006 I moved in with a family which turned out to be a BPD family for at least 3 of its members. Now, 10 years later, we have created a Family Home for the 23-year-old girl family member who was diagnosed in her teens as ADHD/Bipolar. She has an IQ of 61. And for those who don't think IQ is ever important, psychiatric studies have pointed out that those who are mentally ill and with higher IQs have a better prognosis than those with lower IQs. So IQ is a factor taken into consideration by professionals when making a prognosis for a patient.

After living with this girl for several years I came to realize that the ADHD/Bipolar diagnosis was completely wrong. She's not hyperactive, she's impulsive. She doesn't have problems concentrating, she has a problem grasping ideas because of her IQ. And she's not Bipolar. I believe the reason she was diagnosed as Bipolar is because she is (was) a cutter. I've heard that psychiatrists will look for cuts on the arm and immediately give a diagnosis of Bipolar. Someone on another forum stated that he got in a knife fight, was cut on the arm, and was diagnosed as Bipolar by a psychiatrist the next day because of the cuts. He said the psychiatrist made no effort at a diagnosis beyond observing the cuts which occurred during the knife fight.

But Bipolar is not defined as the "cutting" illness. And BPD patients can also be cutters (or not, it depends on the person). My 23-year-old step-daughter has BPD because she has turbulent interpersonal relationships, mercurial emotional states, is impulsive, blames others for her negative emotions, has a weak sense of identity, and is constantly seeking out love relationships. She eats too much probably because of feelings of emptiness which she calls boredom.

I found that she also has Oppositional Defiant Disorder. She has no objective sense of right and wrong, does not respect the boundaries of others, doesn't care about the law except to the extent that she may suffer legal consequences for her actions - and sometimes she doesn't even care about the consequences. Her reasoning, such as it is, is often delusional. But while she doesn't respect others' boundaries, she has extremely strong personal boundaries. Yet she is very thin-skinned and will explode in a fit of rage over the tiniest things, especially when it comes to certain people in her life.

On the other hand, most of the time she is very sweet but very rambunctious and emotionally needy.

I'm aware that there are BPD patients who are not rambunctious but are more introverted and conceal their problem well. These can be spotted through their incorrect thinking methods and problems with relationships, work, and other social arenas. They also have mercurial emotional states, only they are kept behind the scenes.

As the co-owner of a Family Home with a BPD patient I believe I should learn more about BPD and practice methods recommended for helping BPD patients. At present I am reading Sometimes I Act Crazy by Kreisman & Straus. They recommend using the SET method, which consists of Support, Empathy, Truth (also Understanding and Perseverance). But there's more to it than that. According to the book there also needs to be consistency.

Many, perhaps all, BPD patients come from very unstable families of origin. In this case, the family my step-daughter came from moved 17 times during 26 years of marriage. They were homeless on two occasions. And even when there was a stable living situation the household was in constant chaos. Crisis was a daily occurrence, a way of life, an expectation not to be questioned. So naturally, when faced with a living situation in which there is no constant chaos, they tried to bring it with them. And it has been my pleasant experience over the past 10 years to try to keep the chaos down to a minimum, pragmatically speaking. Because I realize it's going to exist, and it will always exist, and so it's best for me not to get caught up in it. But how to deal with it? I'm hoping that the principles of SET, among other coping mechanisms, will guide me through this existence.

 

[Mal12345]

As for the thread starter of http://www.typologycentral.com/foru...842-girl-borderline-personality-disorder.html

The answer is "yes, she has BPD."

 

[Mal12345]

Also from http://www.typologycentral.com/foru...842-girl-borderline-personality-disorder.html
"I think she has a distorted view of our friendship. She expects it to be on the same level as mature friends who I have known for years..."

Cognitive distortion regarding relationships is a big indicator of BPD.

 

[Mal12345]

Bobby returns to visit the "shrink" after an extended time away from therapy:

"I’m back, Doc. Thanks for seeing me. I just didn’t know where else to
turn. I know it’s been a while, maybe a year or two, so I’ll try to catch
you up. Frankly, the reason I didn’t come back after our first visit was I
just felt so depressed after our session. I know that’s a lousy reason, but
that’s how I operate sometimes: when I get depressed, I just go off someplace
and hide.
And well, I guess I was kind of pissed at you, too. You know, when
you said you thought medication might help, I felt you really didn’t give
a damn and just wanted to drug me up. And then when I said I was
reluctant to take medicines, you just said that would be okay and we
could talk about it some more the next time. You didn’t insist or anything.
So it was like you didn’t really care enough to even try to talk me
into it."

It's difficult to "win" with a BPD patient. You're damn if you do and damned if you don't. If you suggest antidepressants, it means you don't give a damn. If you don't pursue the antidepressants idea, then it means you don't give a damn.

 

[Mal12345]

A real-life example of misdiagnosing Borderline as Bipolar:

"Some psych resident, she must’ve been about twelve, took care of me
at Denver General. She seemed nice enough, but she looked at my chart
for a few minutes, asked me about ten questions, told me I was “bipolar,”
and needed to be on lithium."

 

[Mal12345]

"With her [his girlfriend] gone, I suddenly realized I didn’t have any friends. I had long
avoided my old gay group. I was just doing time at my job. Before, I had
crises to deal with. Now, when I came home, I was bored. I felt more and
more isolated."

3. Boredom and isolation: BPD symptoms include a feeling of boredom and emptiness, and constantly misunderstanding other people. Patients start avoiding other people and isolate themselves due to a lack of social support and a feeling of intense isolation.
Borderline Personality Disorder: Top Five Symptoms

 

[Mal12345]

BPD patients are sometimes diagnosed with Bipolar disorder for insurance reasons. BP (Bipolar) is an Axis I disorder, and as such it is treated differently than those with BPD by insurance companies and the state. For example, a diagnosis of BP will likely grant you a certain amount of state disability, while BPD will not, because it is Axis II and has a poorer prognosis.

 

[Mal12345]

I just ran across this while reading "Arleen's Story" (of a BPD victim):

Back home in her sublet studio, after sitting in a bubble bath for an hour
and changing into shorts and Greg’s “Go Buckeyes” T-shirt, which still
exudes the unique Greg scent..."

Those with BPD often make use of tokens such as the scent from a loved one's possession in order to comfort themselves and ease their anxieties.

 

[Mal12345]

These books and articles I'm reading on BPD are great. So many times I've responded to my step-daughter's BPD with a bland "stop being jealous" type of statement. That sort of thing qualifies as a "should," and it attempts to invalidate her emotion (which really is jealousy or some other negative emotion).

SET tells me that, although it is an objective T (truth) statement, it is obviously not effective, and that I should be using subjective S (Support) and E (Empathy) statements instead.

"It is important to use the support and empathy statements first, so that she is better able to hear what you are saying, otherwise the truth statement may be experienced as another rejection, creating even more defensiveness or anger."

 

[Blackout]

Are you sure her IQ is that low...?

Isn't that basically downs-syndrome? I think that trauma based mental instability and psychological disturbances could easily effect how a persons IQ comes out.

I just have a hard time believing somebody at that level does have downs or is seriously not having accurate results as the test is dependent on a specific set of variables, cultural norms and understandings etc

If you really want to gain a deeper understanding of psychology try read Mad In American, Anatomy of an Epidemic, and anything by Thomas Szasz.

 

[Mal12345]

Are you sure her IQ is that low...?

Isn't that basically downs-syndrome? I think that trauma based mental instability and psychological disturbances could easily effect how a persons IQ comes out.

I just have a hard time believing somebody at that level does have downs or is seriously not having accurate results as the test is dependent on a specific set of variables, cultural norms and understandings etc

If you really want to gain a deeper understanding of psychology try read Mad In American, Anatomy of an Epidemic, and anything by Thomas Szasz.

Her IQ has been measured 3 times by the state. It was 62, 61 and then 61 again. This is considered borderline retardation. About 39% of those with Down Syndrome have an IQ in that range.

 

[Mal12345]

Facial appearance of Down Syndrome people:
Flattened facial features
Small head
Short neck
Protruding tongue
Upward slanting eyes, unusual for the child's ethnic group
Unusually shaped or small ears
Poor muscle tone
Broad, short hands with a single crease in the palm
Relatively short fingers and small hands and feet
Excessive flexibility
Tiny white spots on the colored part (iris) of the eye called Brushfield spots
Short height
http://www.mayoclinic.org/diseases-conditions/down-syndrome/basics/symptoms/con-20020948

My step-daughter doesn't display these.

 

[Blackout]

Her IQ has been measured 3 times by the state. It was 62, 61 and then 61 again. This is considered borderline retardation. About 39% of those with Down Syndrome have an IQ in that range.

Ah yes, I suppose it happens.

But my point is that they have never checked for root causes and other possible reasons.

oh wait, does she have Fetal Alcohol syndrome?

 

[ChocolateMoose123]

BPD patients are sometimes diagnosed with Bipolar disorder for insurance reasons. BP (Bipolar) is an Axis I disorder, and as such it is treated differently than those with BPD by insurance companies and the state. For example, a diagnosis of BP will likely grant you a certain amount of state disability, while BPD will not, because it is Axis II and has a poorer prognosis.

I'm not quite sure this is the reasoning behind it. Although maybe. Purposeful misdiagnosis would be unethical, I would assume (I would have to do more research and if you have any solid info on this, that would be helpful) because they ARE treated differently and one is chemical the other behavioral in origin.

I can't see any doc I have ever been to fudging this type of thing for insurance benefit.

Moving on tho, you are correct that they are often missed for one of the other.

For myself, I didn't have the volatility of push/pull with OUTSIDE dynamic (people) more so, it was internal oscillation. (Bipolar II).

I was cutting also (a normally BDP symptom, in fact my doc had to rule that out first because that symptom is usually attributed to it)

But the reasoning behind my cutting was not self-hate, low self-image, attention, etc)

it was a way to calm my mind down and TAKE CONTROL of my mind running away with itself. Sort of physically taking my emotional steering wheel over. It was a self-medicating tactic. I never wanted scars and took pains to minimize them.

This I learned in hindsight. I just knew it put the brakes on my brain at that time. People don't realize the torture of thoughts you cannot control.

So sad when I say that now. But that is where I was. So glad I got help and am not living like that anymore.

 

[Mal12345]

I'm not quite sure this is the reasoning behind it.

Purposive misdiagnosis does occur, according to my reading. But it was not necessarily the case with my step-daughter. I just know that without the Bipolar diagnosis she would not have received any support from the state, so it's just as well. Also, the medication is much the same with BPD and BP. So from that perspective calling it BPD or BP doesn't matter.

There is another reason that I did not mention. The first book I read on BPD stated that diagnosing BPD actually leads to mental health professionals stigmatizing the patient diagnosed with it. This is due to the fact that BPD patients are notoriously difficult to handle. Some of these professionals will even refuse to work with them. This is another reason to purposefully misdiagnose BPD as BP or something less stigmatizing.

Although maybe. Purposeful misdiagnosis would be unethical, I would assume (I would have to do more research and if you have any solid info on this, that would be helpful) because they ARE treated differently and one is chemical the other behavioral in origin.
I can't see any doc I have ever been to fudging this type of thing for insurance benefit.
Moving on tho, you are correct that they are often missed for one of the other.
For myself, I didn't have the volatility of push/pull with OUTSIDE dynamic (people) more so, it was internal oscillation. (Bipolar II).
I was cutting also (a normally BDP symptom, in fact my doc had to rule that out first because that symptom is usually attributed to it)
But the reasoning behind my cutting was not self-hate, low self-image, attention, etc)
it was a way to calm my mind down and TAKE CONTROL of my mind running away with itself. Sort of physically taking my emotional steering wheel over. It was a self-medicating tactic. I never wanted scars and took pains to minimize them.
This I learned in hindsight. I just knew it put the brakes on my brain at that time. People don't realize the torture of thoughts you cannot control.
So sad when I say that now. But that is where I was. So glad I got help and am not living like that anymore.

"Part of the association with other illnesses may be a result of sloppy
diagnostics and/or of pressure to avoid the stigma or problems of the diagnosis.
Many psychiatrists, especially those whose orientation is more biological,
are more comfortable with Axis I diagnoses, which imply a
treatment regimen focusing on medications rather than psychotherapy.
Another significant contributor is the pressure of managed care, which
emphasizes short-term treatment for acute illnesses. Traditionally, insurance
coverage does not extend to Axis II disorders, especially BPD, which
are felt to be more ingrained and chronic. Therefore most clinicians
reporting diagnoses must cite an Axis I label to attain full coverage."
Kreisman & Straus

Sorry to hear about your BP II. It is easier to treat, and its prognosis is generally better than BPD. My step-daughter doesn't get that much help from her meds. The only thing that has really toned it down was Seroquel, but her mother refuses to put her on any more of that because she doesn't want a zombie.

 

[ChocolateMoose123]

Purposive misdiagnosis does occur, according to my reading. But it was not necessarily the case with my step-daughter. I just know that without the Bipolar diagnosis she would not have received any support from the state, so it's just as well. Also, the medication is much the same with BPD and BP. So from that perspective calling it BPD or BP doesn't matter.

There is another reason that I did not mention. The first book I read on BPD stated that diagnosing BPD actually leads to mental health professionals stigmatizing the patient diagnosed with it. This is due to the fact that BPD patients are notoriously difficult to handle. Some of these professionals will even refuse to work with them. This is another reason to purposefully misdiagnose BPD as BP or something less stigmatizing.



"Part of the association with other illnesses may be a result of sloppy
diagnostics and/or of pressure to avoid the stigma or problems of the diagnosis.
Many psychiatrists, especially those whose orientation is more biological,
are more comfortable with Axis I diagnoses, which imply a
treatment regimen focusing on medications rather than psychotherapy.
Another significant contributor is the pressure of managed care, which
emphasizes short-term treatment for acute illnesses. Traditionally, insurance
coverage does not extend to Axis II disorders, especially BPD, which
are felt to be more ingrained and chronic. Therefore most clinicians
reporting diagnoses must cite an Axis I label to attain full coverage."
Kreisman & Straus

Sorry to hear about your BP II. It is easier to treat, and its prognosis is generally better than BPD. My step-daughter doesn't get that much help from her meds. The only thing that has really toned it down was Seroquel, but her mother refuses to put her on any more of that because she doesn't want a zombie.

Thanks. Ok. So it looks like more a bias toward a "quicker fix" rather than the much more difficult chronic illness to treat. I can see that, as I was thinking it was a deliberate choice rather than bias.

I would love to see more of an ingrained method of treatments BETWEEN counseling and medications. If you have one half of treatment - you won't see results. It will be very frustrating for the patient.

Similar to someone who wants to lose weight but only diets and doesn't know how to exercise. Or someone who exercises but doesn't know basic nutrition. They go hand in hand.

I had Seroquel prescribed for sleep but I disliked the affects and I felt it was too strong for what was needed - I would rather deal with the insomnia that the side effects of the Seroquel.

I'm sorry to hear about your step-daughter. My father was BPD and I know the difficulty in dealing with it.

The IQ equation only exacerbates the situation. Does she have any developmental help outside of her meds? You may find counseling that narrows in on that side more beneficial as they may be able to explain things about her mental state in ways that she could grasp better than say, someone not educated in explaining or teaching in those ways.

 

[Mal12345]

Thanks. Ok. So it looks like more a bias toward a "quicker fix" rather than the much more difficult chronic illness to treat. I can see that, as I was thinking it was a deliberate choice rather than bias.

I would love to see more of an ingrained method of treatments BETWEEN counseling and medications. If you have one half of treatment - you won't see results. It will be very frustrating for the patient.

Similar to someone who wants to lose weight but only diets and doesn't know how to exercise. Or someone who exercises but doesn't know basic nutrition. They go hand in hand.

I had Seroquel prescribed for sleep but I disliked the affects and I felt it was too strong for what was needed - I would rather deal with the insomnia that the side effects of the Seroquel.

I'm sorry to hear about your step-daughter. My father was BPD and I know the difficulty in dealing with it.

The IQ equation only exacerbates the situation. Does she have any developmental help outside of her meds? You may find counseling that narrows in on that side more beneficial as they may be able to explain things about her mental state in ways that she could grasp better than say, someone not educated in explaining or teaching in those ways.

My step-daughter attends a development center 4 days a week and some kind of group therapy session one day a week. She says they teach skills such as avoiding "you" language - skills which I can tell you she does not put into practice.

 

[Mal12345]

Ah yes, I suppose it happens.

But my point is that they have never checked for root causes and other possible reasons.

oh wait, does she have Fetal Alcohol syndrome?

No. The only way to know causes is to order genetic testing.

 

[Blackout]

No. The only way to know causes is to order genetic testing.

Well no, there's always environment, socio-economic factors, food allergies, diet, exercise and just generally what is effecting someone psychologically. I know that chronic stress can act as to diminish your I.Q. a fair amount, in a sense that it makes it harder to do things like concentrate normally and effects your ability to problem solve etc (basically everything)

There's a lot of kids who just suffer outrageous abusive and stay in those environments, and then they have all these atrocious problems as a result and then everyone turns around and just completely labels them as hopeless and ill beyond help.

If someone is under emotional stress all of the time, is not eating properly and instead only food that not only fully nourishes but leaves them feeling only fatigued, depressed and with mood instability problems due to things like sugars and the amount of artificial additives in so many of the common place foods we eat to today, it's no wonder if somebody is not functioning adequately.

Has there even been a CAT scan done, and shown any abnormalities in her brain?

 

[Mal12345]

Well no, there's always environment, socio-economic factors, food allergies, diet, exercise and just generally what is effecting someone psychologically. I know that chronic stress can act as to diminish your I.Q. a fair amount, in a sense that it makes it harder to do things like concentrate normally and effects your ability to problem solve etc (basically everything)

There's a lot of kids who just suffer outrageous abusive and stay in those environments, and then they have all these atrocious problems as a result and then everyone turns around and just completely labels them as hopeless and ill beyond help.

If someone is under emotional stress all of the time, is not eating properly and instead only food that not only fully nourishes but leaves them feeling only fatigued, depressed and with mood instability problems due to things like sugars and the amount of artificial additives in so many of the common place foods we eat to today, it's no wonder if somebody is not functioning adequately.

True, but those things don't lower an IQ to 61.

Has there even been a CAT scan done, and shown any abnormalities in her brain?

No.