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The Many Faces of Being Borderline

People with BPD are highly tuned into their environment. Hypervigilance is another hallmark of BPD.

The Many Faces of Being Borderline
By SONIA NEALE

Misreading neutral facial expressions as hostile is reported to be what distinguishes BPD from other mental illness disorders according to this article from US News Health

Rolling the eyes, the extended blink, the nose wrinkle, the eyebrow rise, the lip twitch; all these can be erroneously interpreted as provocative, insulting and combative and cause huge ruptures in relationships. However, sometimes these interpretations are spot on. We can display our deepest prejudices in our facial expressions and not even know it.

The eyebrow rise can display surprise, the nose wrinkle can portray disgust and the extended blink, an indication that the person is either bored to death or that you have tapped into some shameful secret or synchronous event or both. I’ve been eerily accurate on several occasions with my therapist through the extended blink and the nose wrinkle; all confirmed by subsequent personal interrogation, just short of thumb screws, to extract a confession. But the hotter my mood, the less accurate I am. Depending on my internal state, misinterpretation is also possible.

People with BPD are highly tuned into their environment. Hypervigilance is another hallmark of BPD. This is a learned survival skill, where accurately interpreting the finer nuances of another’s intentions can save one’s life. Getting it right albeit half the time means you can go on to live another day. It means you will survive long enough to pass your genes onto the next generation. This makes perfectly logical evolutionary sense.

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People With Borderline Personality Disorder May Misinterpret Facial Emotions

In studies, patients sometimes saw anger in a ‘neutral’ face and reacted to that threat

Facial Expressions

Facial Expressions

THURSDAY, May 23 (HealthDay News) — Symptoms of borderline personality disorder often mimic traits of other psychiatric disorders, complicating diagnosis and treatment. But researchers in Canada say they have identified a characteristic that may be unique to borderline personality disorder: a tendency to misinterpret emotions expressed by the face.

“They have difficulty processing facial emotions and will see a negative emotion on a neutral face,” said Anthony Ruocco, a clinical neuropsychologist and assistant professor at the University of Toronto. “This is not seen in bipolar disorder or schizophrenia.”

Inaccuracies in recognizing anger, sadness, fear and disgust also were noted in Ruocco’s recent study, with greater deficits related to anger and disgust.


Continue reading People With Borderline Personality Disorder May Misinterpret Facial Emotions

Motive-oriented therapeutic relationship (MOTR) – A new treatment for borderline personality disorder

Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD).

A new treatment for borderline personality disorder

A group of Swiss investigators reports on a new type of psychotherapy for borderline personality disorder in the current issue of Psychotherapy and Psychosomatics.

Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD).
This randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results.

After performing the inter-to-treat analysis, results suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems. However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM.

These findings suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.

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Brandon Marshall’s Comeback

Marshall believes his borderline personality disorder was triggered by the stresses of his NFL career.

Brandon Marshall’s Comeback

Chicago Bears wide receiver Brandon Marshall shares the story of his battle with borderline personality disorder.

BRANDON MARSHALL places a foot on the broken concrete ledge of the old schoolyard and hoists himself up. Two drained Miller Lite cans crunch underfoot. He tucks his thumbs under the straps of his orange backpack and peers up at the Larimer School, a once-grand Italian Renaissance building named after this neighborhood in the east end of Pittsburgh. All of the elders in his neighborhood matriculated here, but it’s been closed for 34 years, its terrazzo floors now littered with asbestos. Over the door, letters are blocked in yellow paint: know thyself.

Marshall’s videographer focuses his lens, framing him in front of the school. Three years ago, when Marshall got out of treatment for borderline personality disorder, he began taping a documentary. The videographer has been with him ever since. In this scene — meeting the property owner to discuss redeveloping the school — Marshall explains why he hasn’t been in touch sooner. “I’m just now getting right” is how he puts it.

This neighborhood was once home to myriad shops and bakeries and Italian immigrants, but gradually it lost almost 90 percent of its population, leaving behind empty lots and one of the poorest census tracts in Pittsburgh. Marshall moved to Florida in fourth grade, but most of his extended family is still here. He loves coming home and wants to help transform Larimer into a livable area. But it’s not a good place for him to stay for too long. It’s not just the risk of getting caught in someone else’s trouble. “When we look at how the disorder presented itself in me,” he says, “a lot of it comes from here.”

Following his diagnosis three years ago, Marshall, now 30 and a Pro Bowl wide receiver for the Chicago Bears, set an ambitious goal: become for mental health what Magic Johnson is for HIV. He wants to make an off-limits subject commonplace. He’s reaching out to players who might need help, teaming with mental health organizations through his charity and raising awareness and cash for early-detection programs. “Where we are now is where the HIV community was 25 years ago,” he says. “We can raise all the money in the world, but people might not go get help. They’re still going to see it as a taboo topic. So it’s important for us to get the conversation started.”

In July 2011, Marshall called a news conference to announce the diagnosis of BPD. Three months earlier, his wife, Michi, had been arrested and Marshall had been hospitalized after an argument. Police said Michi had stabbed him with a kitchen knife in self-defense; the two later said he was cut by broken glass. Out of respect for his marriage, he wouldn’t share details, he told reporters, but he wanted them to know that his wife was no villain. He remembered her looking up at him from the back of a police car, pain in her eyes, and saying, “Someone will learn from this story.”

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Clarifying Interpersonal Heterogeneity in Borderline Personality Disorder

 A latent class analysis clarified this finding by revealing six homogeneous interpersonal classes with prototypical profiles associated with Intrusive, Vindictive, Avoidant, Nonassertive, and moderate and severe Exploitable interpersonal problems. 

Clarifying Interpersonal Heterogeneity in Borderline Personality Disorder Using Latent Mixture Modeling
Aidan G.C. Wright, Michael N. Hallquist, Jennifer Q. Morse, Lori N. Scott, Stephanie D. Stepp, Kimberly A. Nolf, and Paul A. Pilkonis

The publisher’s final edited version of this article is available at J Pers Disord

Abstract
Significant interpersonal impairment is a cardinal feature of borderline personality disorder (BPD). However, past research has demonstrated that the interpersonal profile associated with BPD varies across samples, evidence for considerable interpersonal heterogeneity. The current study used Inventory of Interpersonal Problems – Circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990) scale scores to investigate interpersonal inhibitions and excesses in a large sample (N = 255) selected for significant borderline pathology. Results indicated that BPD symptom counts were unrelated to the primary dimensions of the IIP-C, but were related to generalized interpersonal distress. A latent class analysis clarified this finding by revealing six homogeneous interpersonal classes with prototypical profiles associated with Intrusive, Vindictive, Avoidant, Nonassertive, and moderate and severe Exploitable interpersonal problems. These classes differed in clinically relevant features (e.g., antisocial behaviors, self-injury, past suicide attempts). Findings are discussed in terms of the incremental clinical utility of the interpersonal circumplex model and the implications for developmental and nosological models of BPD.

Keywords: Borderline Personality Disorder, Interpersonal Circumplex, Mixture Modeling, Latent Class Analysis, Interpersonal Problems

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Today’s Take: Unique therapy gives hope to ‘hopeless’

There was a time not too long ago when clients with chronic suicidal, self-harming or other self-destructive impulses were considered impossible cases to treat.

Many of them were survivors of severe childhood trauma — trauma that left them feeling worthless, unable to trust other people and having difficulty responding to treatment.

For such clients, traditional therapy proved ineffective.

The dangerous pattern of self-harming/suicidal behavior makes it difficult for clients to accept help. It is both frightening and frustrating. Often, friends and family feel helpless and are not sure who to turn to for support.

In the past, these clients were often termed “impossible” or “hopeless.”

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