Interesting information about BPD

It’s my holidays now and I’d originally planned to borrow a ton of BPD/PD/psychology books from the local library… but as it turns out, the library is crap. There was only one book on anxiety (wedged in between engineering books) although they had a ridiculous amount of self-help and organization books.

So anyway, I ended up searching in my uni’s online catalogue and actually managed to get my hands on some articles and books!

Here are a couple of lesser-known facts about BPD from the article “Borderline and Histrionic Personality Disorders: A Review” by Michael H. Stone:

1. BPD differs more noticeably across cultures than is the case with, for example, schizoid personality disorder. The aloofness that one encounters in schizoid persons is similar the world over. Yet when BPD is diagnosed in Scandinavia or Japan, for example, the typical patients are less angry or tempestuous than their American counterparts; those diagnosed in Japan, though they engage in suicidal behaviours, show most strikingly the traits of dependent personality disorder.
2. One of the more robust findings was that about two-thirds of the BPD patients, when evaluated 10 to 25 years later, were functioning at levels compatible with Global Assessment Scores in the mid-60s: ‘‘some mild symptoms . . . but generally functioning pretty well, has some meaningful inter-personal relationships’’. The larger samples yielded large enough subgroups of BPD patients to examine the impact of certain variables.Factors that augured well, prognostically, were high intelligence, selfdiscipline, artistic talent, attractiveness, and (in the case of borderlines who abused alcohol) ability to commit to Alcoholics Anonymous.
3. At 5-year follow-up, female BPD patients treated with multimodal therapy (that might include group, family, as well as individual supportive and exploratory therapies) at McLean Hospital showed a steady decline in suicidal behaviour, but suicidal ideation and (milder forms of) self-harm did not decline notably; in relation to self-harm, most patients showed a fluctuating course and had higher levels of baseline dysphoria. At 6-year follow-up in the larger group (n ¼ 290) of borderline inpatients at McLean Hospital, 74% no longer met (full) BPD criteria. In this study, it was noted that impulsive symptoms resolved the most quickly; affective symptoms were the most stubborn.
4. The experience of safety within the context of a close emotional relationship is essential for the development of an autonomous sense of self and anything that undermines the emergent self leads to anxiety and potentially an angry response as the child attempts to stabilize himself. Under conditions of chronic neglect and insensitivity, instability of the self results first in anger and then aggression, which is evoked so frequently because of repeated parental neglect that it becomes incorporated into the self-structure, with the result that self-assertion, demand, wishes, needs have to be accompanied by aggression if the self is to remain intact and stable. Such distortions to the self are not irreversible. The acquisition of the capacity to create a ‘‘narrative’’ of one’s thoughts and feelings, to mentalize, can overcome flaws in the organization of the self that can flow from the disorganization of early attachment. Thus the robustness of the self-structure is dependent on the capacity to mentalize.
5. PD scores tend to diminish with age. This negative correlation is strongest with the four PDs in Cluster B including BPD. Along with the criterion of physically self-damaging acts, it is the criterion of identity disturbance which is significantly less frequently met in older BPD patients: it was found in 55% of patients aged <35, but in 27% of older patients. Some patients will achieve their identity with a delay due to a later maturation, maybe helped by psychotherapy; some others develop their identity later on in accordance with their social role: role identity would transform into personal identity. Identification or even overidentification with a patient role may help some BPD patients to cope with the stigma of mental disorder and/or to stabilize their own identity. […] The majority of patients maintain some of their symptoms but, generally, are functioning pretty well; we are not sure whether this outcome reflects the impact of treatment or the natural course of the disorder.
6. When we look at published studies of the relationship between BPD and the five factor model of personality, we find that individuals with BPD are characterized by high neuroticism and relatively low agreeableness and conscientiousness, irrespective of whether BPD is assessed by interview or questionnaire. Extraversion is not related to BPD.
7. In summary, both treatments show similar effects on suicidal and selfmutilatory acts, but MBT is superior to DBT in terms of the reduction of anxiety and depressive symptoms. Furthermore, the data seem to indicate that the benefits are better maintained in MBT as compared to DBT. Thus I think that it is fair to state that, although the effectiveness of DBT has been documented in more studies than the effectiveness of MBT, the clinical results from the first trial on MBT are more impressive than those published for DBT. What does this mean? As far as I can see, there are three competing explanations: the differential results can result from theoretical and technical differences, or from dosage differences, or from a combination thereof. DBT is 12 months of outpatient treatment without aftercare, whereas MBT is 18 months of day treatment with aftercare. […] Across studies, however, DBT has not shown effectiveness in terms of a reduction of depression, hopelessness, and improvements in survival and coping beliefs or overall life satisfaction. In addition, Verheul et al. showed that DBT was differentially effective in reducing self-harm in chronically parasuicidal borderline patients, whereas the impact of DBT in low-severity patients was similar to treatment as usual. Together, these findings suggest that DBT should—consistent with its original aims —only be a treatment of choice for chronically parasuicidal borderline patients, and should perhaps be extended or followed by another treatment, focusing on other components of BPD, as soon as the high-risk behaviours are sufficiently reduced.

Unrealistic Expectations

Every time I make progress, I find myself thinking that I may have unlocked the secret code to BPD and that I’m finally done and dusted with it. And then I inevitably mess up; I get emotional and say/do things that I shouldn’t have, and I just get so crushed, like I was playing a game and I just ruined my combo.

What’s worse, though, is that I get frustrated and annoyed by myself. I wind up feeling like a failure because I didn’t miraculously recover from BPD after 3 months of therapy — I know it sounds ridiculous and silly to say it, but part of me genuinely feels like I should.

Of course, ‘should’ is a very big theme with BPD.

The irony about recovery and therapy is that I’ve begun expecting myself to consistently be ‘good’ and to be on my best behavior at all times. And when I fail and slip up, I focus on that one mistake and block out all the progress I’ve made.

2 days ago the Boyfriend went away for an event with his friends. I harbored thoughts of landing myself in the hospital so he would have to skip the event to be with me, but I didn’t. I thought of threatening him with a break-up, but I didn’t. I wanted to get angry and rage and scream, but I didn’t. Instead, I took the initiative to set boundaries for the both of us. I hated having to hang around waiting for him to reply my texts, so I suggested for him to check in on me every half an hour. I went out for dinner with my family. I drank a bottle of cider in my own room instead of getting drunk outside with strangers. I watched Friends and ate chocolate. I sat with my roiling emotions of fear and panic and jealousy instead of trying to get rid of them.

I was doing pretty great, until the event ended. The Boyfriend called me and I ended up crying into the phone asking him why he’d ‘chosen’ his friends over me. I did not raise my voice. I did not scold him or hurl vulgarities. I just cried and wanted to know why he didn’t want me anymore. Finally I guess he got a little annoyed so he said he wasn’t going to bother explaining it to me since I clearly wouldn’t accept it. I did not freak out. I said, “Okay, thank you” (sarcastically) and hung up.

In retrospect, that was pretty commendable! I’d done better than I would have a couple of months ago. But it still wasn’t enough. Instead of focusing on my progress, I started beating myself up for not being 100% perfect. I hated myself for being so needy and selfish and for getting upset with my boyfriend. I berated myself for being the worst person in the world… when I’d clearly done worse things before. Finally it got to the point where I became convinced I was a worthless awful bitch and slapped myself because I ‘deserved’ it.

Yeah, that was a bad night. It’s a tough fight, learning to be compassionate to yourself. I hope I’ll make it there someday.

BPD and its identities

I’ve been reading up about Dissociative Identity Disorder (DID) and while I don’t have it, it’s been giving me some insight about BPD as well.

In a way, I suppose everyone has different parts and facets of themselves; the shift just isn’t as extreme. You’re still able to spot the person you know and love under the surface. With DID, you get Parts with a capital P — a drastic shift in personalities and identities, complete with different names, ages and behaviors, and some degree of amnesia.

BPD falls somewhere in the spectrum between what people with DID experience and what ‘normal’ people experience. It’s commonly expressed by loved ones that when the Rage takes over, their borderline friend/family member/lover seems to be a different person altogether.

I managed to sit down and identity a few of these parts:

1. The Abandoned Child – this is the ‘core’ self that is at the heart of a borderline, and which all the other parts kick in in order to protect. The Child feels unloved and unlovable, worthless, scared, and like she is about to be abandoned at any moment.
2. The Rage Monster – this is the part that steps up to the plate when the Child is hurt. It operates as a defense mechanism to guard the Child’s vulnerability and gain some control over the situation so as to soothe the Child’s fears and hurt.
3. The Perfectionist – this is the hypervigilant, self-critical part that thinks that the best way to avoid rejection or abandonment is to be 100% perfect, all the time. This is the part that tells the Child what she should or shouldn’t do. This is the part that believes that love has to be earned and maintained, that one mistake will cause someone to stop loving the Child, and as a result seeks to ensure the Child is constantly perfect so that she is not abandoned. A subset of this is also the Wallflower, which believes another way to avoid abandonment is to be quiet and invisible and a good little girl who doesn’t cause trouble or rock the boat. This is the part that is most often in conflict with the Rage Monster — the Rage goes against the Perfectionist and the Wallflower’s mantras.

The other day I told the therapist that I often felt like Smeagol/Gollum. Gollum is the instinctive, knee-jerk reaction to manipulate and destroy and do everything necessary in order to get rid of the Child’s fears and insecurities, whereas Smeagol is on the other end begging Gollum to just shut up and stop it.

I explained that it often felt like a no-win scenario. Gollum’s actions only wind up pushing people away and later freaks Smeagol out even more — it confirms Smeagol’s perceptions of the self as horrible, hurtful and selfish. This aggravates abandonment fears because what person would want to stay with a selfish and disgusting person, right?

On the other hand, Smeagol’s decision to be quiet and falsely gracious results in bottled resentment that will inevitably explode somewhere further down the line. Smeagol’s needs aren’t getting met, and Smeagol will remain unhappy.

A middle ground needs to be achieved. The therapist called this part Gandalf. I must learn to express my concerns and feelings in a non-accusatory, non-aggressive manner in order to allow the other person to be able to help me. I must let them in. I must build a bridge and give them the chance to cross it instead of burning it down in hellfire.