Does it matter if it is really BPD? (or if it could be PTSD)

I used to think it didn’t really matter if it was BPD or not. If the
person is behaving in a “borderline fashion” I used to think “ok,
well let’s read SWOE and follow the directions for taking MY life
back” – but I have changed my mind about the importance of the
diagnosis. The reason behind my changing my mind is that I believe
that BPD is an emotional disorder and that the core feeling behind
it is shame (and pain) – unlike PTSD, where the core emotion is
fear. If a person has a great deal of fear (a phobia for example),
treatment for this problem can be quite different than treatment for
shame. One might use exposure therapy to gradually desensitize the
person to what they fear and gradually they might begin to fear
less. However, if shame is the core feeling, then the natural
reaction to that emotion is to hide it and exposure just creates
more shame.

Inconsistency also seems like a harbinger of BPD. I think that
with wildly swinging emotions, people with BPD are widely
inconsistent. My wife can be manic and organized and get things done
one moment of one day and then depressed, crying and avoidant the
next. Now, you might think she is bipolar – but her moods last hours
(and sometimes minutes), not days or weeks.

A lot of her moods are governed by her medication schedule. She
recently (last week) switched off Xanax (whew!) and is
now taking Ativan, which she says “doesn’t work”. She of course
takes high doses and mixes it with alcohol, and has periods of
dyscontrol. We went to a neighbor’s birthday party on Saturday and my wife did something embarrassing.
I just took her home and went back to the party. But the
key here is that she is highly unstable in her moods. She uses the
drugs and alcohol to try and quell the pain, but they cause even
more instability.

I think that is why we often make mistakes
in “self-diagnosis”. For all I know, half the people (or more)
viewing the messages in my group are not dealing with BPD at all, but instead
something else. That is one of the reasons that a couple of months
ago, I specifically asked a mother on an email list whether her
daughter was diagnosed with BPD and how old the daughter was –
because the behavior that she described could be attributed to
many “disorders” (including the disorder of being a teenager).

There is a movement within the psychiatric community to change the
name of BPD. Some also want BPD to be classified as an Axis I
disorder. So, it could be that “borderline personality disorder”
will not exist anymore and BPD will not be a “personality” disorder
anymore. The point of saying this is that I think the traits of
which you speak are shared among many different disorders,
personality or otherwise.

In the CBT community, one of the things they talk about
is “cognitive distortions” – basically thinking in a way that
doesn’t match the “objective” facts. At times everyone, disordered or not, does some of these
things. In the case of BPD, many of these distortion can into play.
But these distortions are shared with other disorders and
with “normal” thinking.

Self-harm is sort of a sure sign of BPD (although not all
self-harmers have BPD) versus, say, PTSD. And the basic self-image
thing is also key. In fact, one of the things that many “nons”
don’t “get” about people with BPD is that the borderlines hate
themselves. The nons come to the table saying “this person (the
borderline) is SO selfish!” and they are angry about all the
behavior (which they have every right to be angry, the behavior is
quite frustrating). However, they don’t understand that behind this
maddening behavior is a deep, painful self-loathing. If that self-
loathing (and shame) is NOT there, then it is not BPD. From my
experience, there are not people with BPD that are OK inside. They
are not evil (let’s not bring up Hitler again, please – I’m sticking
with Princess Di as my BPD historical figure), they are
just “broken” inside.

As for impulsiveness and extreme emotional liberation (especially via drugs or alcohol), I have seen
studies that say that those things can be transmitted biologically.
As you know, I have a 9 year old daughter (who has a fraternal twin
sister), who is specifically impulsive and subject to stormy
emotions. Over the weekend, she told me and her twin that she would
not want to run for student counsel because (in her words) she
gets “overtaken by anger” and would be really “furious” if people
didn’t vote for her. She also got angry and pushed my 3 year old son
over and he smacked his head on a bookcase (he’s ok though). When I
came in and spoke to her about it, she lied to me. So here’s a girl
that’s 9 years old and exhibits the signs of emotional unstability
and impulsiveness. But has she been abused? No. Has she been
invalidated? Yes, many times.

The reason I bring her up is that I think that BPD has a biological
base as well. There was a really interesting article that [a member of the list]
posted about biological and social contributors to BPD. Maybe I can
dig it up.

I brought up an unstable personality because, when mixed
with shame, causes extreme personalization – but it is
not unique to BPD (the unstable personality or the personalization).
The shame, however, IS (I think). I saw a study that showed that
people with BPD reported feeling shame 14 times a day.

SHAME is considered the core emotion
by some psychotherapists. That just tells me that I’m not completely crazy if I
say, “if there’s shame, there’s BPD – if not, it’s probably
something else”. But hiding shame is the natural reaction to it. So,
we nons may not see it initially.

My wife has BOTH BPD and PTSD – because of childhood sexual abuse
(the PTSD). However, as I said before, I think there is also a
biological component to BPD and I’m not sure that you HAVE to have
been abused to have BPD; whereas with PTSD, trauma is necessary
(it’s built into the name for heaven’s sake). On the flip side,
Marsha Linehan said “not everyone who is sexually abused gets BPD”
(I’m paraphrasing) – so it seems to be her belief that there must be
a biological pre-disposition there. So, if we look at her biosocial
model, we see that there are biological components in combo with
an “invalidating enviornment” (not necessarily abuse). So it could
very well be that shame is 1) built into some people (my 9 year old
feels a lot of shame herself BTW) or 2) that the “invalidating
environment” is not strictly abuse or 3) both. If I look at my 9
year old’s shame, it seems awfully unfounded to me. You can
attribute my wife’s shame to her being sexually abused (and a large
portion of BPs have been abused in some way), but my 9 year old, she
feels very shameful about the way she feels. She feels shameful in
her skin. She has already expressed suicidal ideation (at 9!).

As for cutting or “blood letting” – geting something out of your system – that’s quite wise. I don’t
know if you’ve ever read Jim Carroll’s books about his heroin
addiction (“The Basketball Diaries” and “Forced Entries”), but there
is a scene in one of them, Forced Entries I think, in which Carroll
lances and drains his infected needle sight on his arm. I know it
sounds yucky (and it is), but he really translates it in a wonderful
metaphor for getting all the filth out of his system and liberating
himself from the pain he is in.

The suicide gestures are usually impulsive with BPD.

Of course, I could take suicide out of the equation, because I
could make the same statement about cutting (or burning oneself) –
that is, 95%+ of the borderlines I have come into contact with
(through their parents mainly) cut (or burn) themselves. My wife
cuts herself. She also picks her nails until they bleed. My 9 year
old with the emotional “issues” picks her nails until they bleed.
Her twin (and just to clarify, they are fraternal) sister does not.

A trained professional that works with borderlines
every day can diagnose BPD. You might remember the case that happened on another
list (ATSTP) in which the guy’s girlfriend sounded about as borderline as
possible, but when she went to U of Washington to get evaluated,
they said, “No, you have PTSD.” I don’t know how they told the
difference, but I suppose it had something to do with the
distinguishing charactersitics of BPD that are mentioned here: self-
injury, toxic shame and self-loathing, uncontrollable impulsiveness
and “emotional liberation” with mind-altering substances. Still,
those last 2 might show up in other disorders as well.