Borderline Personality Series ~ Overview 2010

May is borderline personality disorder (BPD) awareness month and this is how it is experienced by those with BPD. This diagnosis is difficult as there is so much stigma attached to it and it takes a real committment and a lot of patience for a therapist to provide services and for the patient to perservere. Many therapists will not treat those with borderline personality disorder. I am diagnosed with this disorder and it is treatable, but takes a very long time.

The prevalence of BPD is about 2% of the general population. It is seen in 10% of psychiatric outpatients, and 20% of psychiatric inpatients. This disorder is more frequent in females (about 75%) than males. Emotional instability and impulsivity are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this emotional instability and impulsivity persists and intensifies into adulthood; thus they become diagnosed with this disorder. As with other mental disorders, the causes of borderline personality disorder are complex.

The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But, that view doesn't reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.

Meanwhile, the cause of borderline personality disorder remains under investigation, and there's no known way to prevent it. Possible causes include:

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  Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
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  Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
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  Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Personality forms during childhood. It's shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase your risk of developing borderline personality disorder. These include:

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  Hereditary predisposition. You may be at a higher risk if a close family member — a mother, father or sibling — has the disorder.
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  Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
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  Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.

Marsha Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings.

I also agree with A.J. Mahari's theory that compliments Linehan. Mahari states, "It is the core wound of abandonment in those who have been diagnosed with Borderline Personality Disorder (BPD) that is the source of insecure or non-existent attachment that leads to the toxic and unhealthy ruptured relationships that have at their centre emotional enmeshment and an insatiable need for love. These broken relationships, often rupture under the weight of the child-like behaviour and needs of the borderline still searching for the much-needed unconditional acceptance, validation and love of a parent as the result of unmet early childhood developmental needs.

Most, if not all, borderline behaviour is driven directly or indirectly by fear of abandonment and the fear of re-experiencing the intolerable pain of your original core wound of abandonment. What feels like it keeps happening to you, is in fact, a triggered, dissociative, regressed re-experiencing of what initially happened to you in the very early and formative developmental years of your life." With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships.

Individuals with BPD seem to have a much higher stigma than individuals with other disorders even within the mental health community and there is debate as to whether or not they are treatable. Many professionals will not treat people with BPD or must limit the number of patients. In order for treatment to be successful, it requires a significant commitment from the therapist and patient. My personal belief is that people with BPD can be treated. I, for one, have been receiving treatment and am near a point where I will no longer meet the criteria.

But, it has been a long time of much tumultuous and extremely painful hard work for both my therapist and I. There were times when I think both of us wanted to quit. Persons with BPD are often described, by the DSM as deliberately manipulative and difficult with extreme inner pain and turmoil, powerlessness and defensive reactions with extremely limited coping and communication skills. My translation, they take tremendous energy, extra attention, consistent limit-setting, terminate treatment prematurely and may return, and have a love/hate relationship with the therapist. But, there is hope.

And, I, for one, am getting there; however, it has taken a very long time and much commitment and painful work. I can see why people "give up" treatment. But, the reward for sticking it out is priceless. Well, really not priceless...therapy and medication is expensive, but that is a whole other issue. Don't even get me started.

Below is a Polyvore collage that I put together expressing how having a borderline personality disorder sometimes feels for me. I know the image is difficult to see, but if you click on the link below the picture you will be able to see it more clearly.

Fragmentation by ClinicallyClueless on Polyvore.com

The text in this post is an excerpt from my blog Clinically Clueless. Last year, I wrote a five part series about borderline personality disorder so if you want to see more please click on the "Borderline" picture on the right sidebar. Thoughout the month of May, I will be adding different types of posts related to this disorder, so keep your eye out on my blog.

I hope that this gives you a better understanding about borderline personality disorder and breaks some misconceptions. Any and all questions welcomed. How does this post effect what you thought or didn't know?

Mental Health Awareness Day, Week, Month

This week is dedicated to Mental Health Awareness with today starting off mental health month, October 10th being International Mental Health Day. So what are some examples of mental illness/disorders, you may be surprised or not:

Mental retardation
Learning disorder (reading, math, written expression),
Motor skills disorder,
Communication disorders (expressive language, mixed receptive- language disorder, stuttering),
Pervasive developmental disorder), (autism, Rett’s, Asperger’s)
Tic disorder (Tourette’s)
Elimination Disorders
Selective Mutism
Delirium
Dementia (at least 10 different forms)
Amnesic disorders,
Catatonic Disorder
Substance Related Disorders
Alcohol Related Disorders,
Amphetamine Related Disorders
Caffeine-Related Disorders (I was once diagnosed with this…I have know idea why, by the way where is my coffee!)
Cannabis-Related Disorders
Cocaine-Related Disorders
And the list goes on for each substance addiction
Schizophrenia (five different types)
Other Psychotic Disorders
Mood Disorders ( depression, bipolar, mood disorders, substance –induced mood disorder)
Anxiety Disorders (Panic Disorde, Social phobia, generalized anxiety disorder, post-traumatic stress disorder)
Somatoform Disorders (presence of physical symptoms that suggest an illness, but is actually attributed an underlying stress. For me, my psoriasis and rash on my neck expresses my anxiety)
Dissociative Disorders (five types)
Sexual and Gender Identity Disorders
Paraphhilias
Eating Disorders
Sleep Disorders
Impulse-Control Disorders
Adjustment Disorder
Personality Disorder (Paranoid, Schizoid, Schizotypal, Antisocial, Histrionic, Narcissistic, Avoidant, Dependent, Borderline, Obessive-Compulsive)

WHO (World Health Organization) statistics for 2002 show that 154 million people globally suffer from depression, only one form of mental illness. Mental disorder effects everyone as one in four have some type of disorder globally. Mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others. They must interfere with daily life functioning or cause significant distress. Mental, neurological and behavioural disorders are common in all countries around the world, causing immense suffering and staggering economic and social costs. People with disorders are often subjected to social isolation, poor quality of life and higher death rates.

For more information, go to Tasmania Department of Health and Human Services, WHO (World Health Organization), World Federation of Mental Health, World Congress Federation for Mental Health or do a Google Search. There is a lot of information available.

Do you or someone you know have a mental illness? Please describe your experience.
Tomorrow: Borderline Personality Disorder (Reposting)

World Suicide Prevention Day!!

What to do if you think a person is having suicidal thoughts? I obtained this information off the National Suicide Prevention Lifeline (USA) site. You cannot predict death by suicide, but you can identify people who are at increased risk for suicidal behavior, take precautions, and refer them for effective treatment.

Ask the person directly if he or she (1) is having suicidal thoughts/ideas, (2)has a plan to do so, and (3) has access to lethal means

Ask “Are you thinking about killing yourself?” “Have you ever tried to hurt yourself before?” “Do you think you might try to hurt yourself today?” “Have you thought of ways that you might hurt yourself?” “Do you have pills/weapons in the house?”

This won’t increase the person’s suicidal thoughts. It will give you information that indicates how strongly the person has thought about killing him- or herself.

IS PATH WARM?

Ideation—Threatened or communicated
Substance abuse—Excessive or increased

Purposeless—No reasons for living
Anxiety—Agitation/Insomnia
Trapped—Feeling there is no way out
Hopelessness

Withdrawing—From friends, family, society
Anger (uncontrolled)—Rage, seeking revenge
Recklessness—Risky acts, unthinking
Mood changes (dramatic)

If it is then, call for help. The following are some resources most of which are international:

http://suicidehotlines.com/national.html
http://www.suicidepreventionlifeline.org/
http://suicidehotlines.com/international.html
http://suicideandmentalhealthassociationinternational.org/Crisis.html
http://www.befrienders.org/
http://www.suicide.org/international-suicide-hotlines.html
Suicide Myths and Facts from Healthy Place
Myth: People who talk about killing themselves rarely commit suicide.
Fact: Most people who commit suicide have given some verbal clues or warning of their intention.

Myth: The tendency toward suicide is inherited and passed from generation to generation.
Fact: Although suicidal behavior does tend to run in families, it does not appear to be transmitted genetically.

Myth: The suicidal person wants to die and feels that there is no turning back.
Fact: Suicidal people are usually ambivalent about dying and frequently will seek help immediately after attempting the harm themselves.

Myth: All suicidal people are deeply depressed.
Fact: Although depression is often closely associated with suicidal feelings, not all people who kill themselves are obviously depressed. In fact some suicidal people appear to be happier than they've been in years because they have decided to "resolve" all of their problems by killing themselves. Also, people who are extremely depressed usually do not have the energy to kill themselves.

Myth: There is no correlation between alcoholism and suicide.
Fact: Alcoholism and suicide often go hand in hand. Alcoholics are prodded to suicidal behavior and even people who don't normally drink will often ingest alcohol shortly before killing themselves.

Myth: Suicidal people are mentally ill.
Fact: Although many suicidal people are depressed and distraught, most could not be diagnosed as mentally ill; perhaps only about 25 percent of them are actually psychotic.

Myth: Once someone attempts suicide, that person will always entertain thoughts of suicide.
Fact: Most people who are suicidal are so for only a very brief period once in their lives. If the person receives the proper support and assistance, he/she will probably never be suicidal again. Only about 10 percent of the people who attempt later kill themselves.

Myth: If you ask someone about their suicidal intentions, you will only encourage them to kill themselves.
Fact: Actually the opposite is true. Asking someone directly about their suicidal intentions will often lower their anxiety level and act as a deterrent to suicidal behavior by encouraging the ventilation of pent-up emotions through a frank discussion of his problems.

Myth: Suicide is quite common among the lower class.
Fact: Suicide crosses all socioeconomic distinctions and no one class is more susceptible to it than another.

Myth: Suicidal people rarely seek medical attention.
Fact: Research has consistently shown that about 75 percent of suicidal people will visit a physician within the month before they kill themselves.
Is Suicide a Choice? "No. Choice implies that a suicidal person can reasonably look at alternatives and select among them. If they could rationally choose, it would not be suicide. Suicide happens when all other alternatives are exhausted -- when no other choices are seen."~ Adina Wrobleski Suicide: Why? (1995)

“Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.” ~ Norman Cousins

“Have the courage to live. Anyone can die.” ~Robert Cody

"If I had no sense of humor, I would long ago have committed suicide." ~Mahatma Gandhi


“As anyone who has been close to someone that has committed suicide knows, there is no other pain like that felt after the incident” ~ Peter Greene

Okay, I'll try to explain!!

So, what happened. I’m not sure if I can explain or not. I’m feeling rather detached. I just really want to retreat right now. Several things happened in which I reacted by fragmenting and dissociating. One, you know about which is the comment about whether my memories were planted by my therapist. The other is therapy itself and coming to terms more and more with what I wanted and didn’t get from her started from when I was born…of not being wanted.

Then, there is this dilemma of when I don’t get what I want, which I generally don’t know, I feel like I’m bad for having it and for not receiving it. Which is the situation that I’ve always had with my mother except for the addition of her reinforcing that I was bad. So, basically…no matter where I turned I was bad. I don’t know if that mad sense when my therapist was explaining it, I was fragmenting and my memory gets fuzzy.

At the end of last week, a situation occurred on a social blog that triggered the feelings more intensely on a personal and human level. I was involved in a discussion where things got nasty and there was much conflict. I don’t do well with conflict even if it is just written, so I began to fragment.

Then, someone made light and joked about depression in a personal way where I felt personally attacked. No matter my response, I felt like I was being told I was too sensitive and that my depression was my fault. This combined with making light or fun of mental illness really angered me and then, my feelings were very hurt when I didn’t get the sort of response that I had hoped.

A couple of people were helpful, but by then I was not just fragmenting I was dissociating. So, I decided to first respond and then to stop all together because this was obviously hitting a trigger and a bad one. I’m still dealing with it in therapy and having a really tough time. I just feel like the pictures I’ve been posting. I feel quite raw and vulnerable and want to protect myself from being hurt anymore.

Anyway, the following is a part of my response with names changed to “protect the innocent.”

Having a mental illness, for me, unless the person knows me and I them, it is hurtful to make light or fun of my illness. Basically, no matter the intent, it is not a situation in which make light of. That is why it is personal because my feelings were/are hurt.

No, it isn’t just a different point of view when light heartenedness touches something painful. If you had cancer, would it be okay for someone that you didn’t know to be light hearted about it online. Think about it…for most, it wouldn’t be, so it is true for mental illness.

(Someone was renamed “suicidal thoughts. I was renamed “clinically depressed.”) I don’t know who that is, but when it comes to mental illness renaming people to reflect depressive and suicidal impressions is dangerous because you really don’t know how that person will react to that comment. Responsible blogging does not make light of a person’s illnesses no matter what they are unless it is in the proper context of the person themselves making the comment first.

“So, I can call you Cancerous Carla now? How about Epileptic Edward, Jaundice Jason, Asthmatic Anne, Bipolar Brian, etc. I am sorry if I offended anyone and I do not know people’s illnesses, so please don’t take it like I know what you have or anything at all. I am simply trying to illustrate my point.


Mental illness has a stigma associated with it and comments like the one made today added to the pain. The comment that was left about someone’s “psyche was bruised,” is exactly the point. Obviously, it was wounding and to me and in my opinion, in poor judgment to use someone’s illness as a point to make light or to attack.

It doesn’t help that I am being seen as the “sensitive” one than can’t handle lightheartedness. I felt like some were just telling me to toughen up. Well, that is part of the illness. I felt very little support or understanding.

I can handle quite a bit and have, but this is a very tender area for me. And when I was working and more social, I listened to all the whispers and negative comments and these were from other social workers. I can also be quite tough skinned, but this area gets poked at enough where there isn’t much time to heal. For some reason, people think it is okay to attack someone with a mental illness, which is why most moderate or make their blog private.

So, try living a day in my shoes if you simply think that it is a point of view issue and not something hurtful. To me and many other people, joking about mental illness is mean spirited. It makes me question what to share because I don’t need to experience this kind of pain again. Hugs do not soothe this type of pain.”

My therapist and I still have a lot to work through with what this all triggered, but the most important point is that my feelings were hurt and I wanted someone just to say they were sorry that I ended up getting hurt. I wanted someone to simply know how hurt I was. So, I acted it out on my blog. I think, it was one of the only ways to express how deeply hurt I was.

I know these are my issues and my response does not match the situation, but it triggered a really tender and well-defended part of me. So, I just want to hide and protect myself. My depression has been really up since this started. So, that is sort of what has been going on. My therapist even cautioned me about blogging about this given the place I'm in. I keep fragmenting or dissociating because I still am in pain which now has very little to do with the situation.

Are You Suffering?

Okay, I need to air a pet peeve of mine because it has been bugging me more and more as I’ve been looking at unfamiliar blogs. Please do not take offense, as it is not directed at one person, but it shows how the words we use can make subtle differences in the way in which we view and approach others. There are many phrases that mental health professionals and non-professionals use that I do not think are very helpful or are condescending, but I’ll admit to using them too with other professionals because there is instantaneous understanding. However, the phrase I am referring to does not help in that manner.

The phrase is “suffering from.” In very rare cases, do I think that this is an appropriate term to use. But, I really understand people using it and I know that it is old language and comes from the medical model. However, I’d like you maybe to think about the words that you choose. I’ve been reading things like “Those suffering from borderline personality disorder,” “I suffer from bipolar disorder, and “My patient suffers from depression.” Oh, that is like nails on a chalk board to me.

My problem with it is that is seems to automatically set up roles for a victim role, that the person is always suffering and is a victim of the illness. Which to me, would also imply that therapist subtly views the client as a victim and herself as the one to rescue the victim from the illness. Yes, there is a power differential in a client/therapist relationship, but it is not one that most call attention to at this level. It is usually a team effort. To me, it comes across as a bit condescending and it also makes me feel a bit defeated by my illness. My illness does not define me should be the primary focus of who I am. It is simply one of my characteristics.

Whose business is it to say that “I am suffering from depression.” Yes, I am a person diagnosed with a major depressive disorder which, at times, is excruciating. However, I may be managing, may be struggling, may be coping or may be in a really deep depression and in great pain. To me those are much more accurate and descriptive phrases. They also make me feel more like a person instead of the focus being on my illness.

Do we tell people that they are suffering from diabetes, from heart disease, from a broken leg, or a sprain ankle? What kind of subtle message do we send. You are a victim of your illness. Everyone who has this illness must, feel as if they are suffering. I don’t know maybe I just get lost in the semantics of it all.

But, please do not refer to me as suffering from major depression and post-traumatic stress disorder. I am a person who has been diagnosed with major depression and post-traumatic stress disorder which is very difficult for me to manage, but I actually have a great life except for the symptoms from my illnesses. Just changing a few words can make all the difference in the way someone feels or views themself.

Thanks for reading my vent…time to get off my soapbox. Next?