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The Myth of the High-Functioning Borderline

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UPDATE: see this link.

Today’s subject is the Myth of the High-Functioning Borderline. I have been scouring the research on BPD to find out if anyone in the research or therapeutic community uses this term or concept high-functioning versus low-functioning Borderline. I have yet to find any author in either the research community or therapeutic community reference this concept. It crops up in the support community (in “Stop Walking on Eggshells” and on both bpd411.org and bpdcentral.com). It also crops up in the “cross-over” community (see more later) but only in a sarcastic way. The idea of high vs. low-functioning BPD doesn’t seem to hold much weight in any other community than the support community.

What do I mean by referencing these “communities”? I think that there are basically three BPD/Non-BP “communities” out there: the research community, the support community and the therapeutic community.

The research community is comprised those scientists doing medical research (and psychological research) on BPD. They publish scholarly articles and research in medical and psychological journals. Some “supposed” psychological researchers publish in the less-well-known and scientifically suspect journals (see my article about “Demonic Possession and BPD” for an example of this type of researcher). For the most part, these researchers don’t try and “cure” BPD, they merely provide data to other professionals about the configuration of BPD, the biology of BPD and the “common” features of BPD. This group of people does not differentiate between high-functioning and low-functioning BPs. In fact I have found no reference to high- or low-functioning BPD at all in any of these research papers or reports.

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The therapeutic community is those practitioners (mainly psychologists, psychiatrists, social workers, other “therapists” and consultants) that try and “cure” or remediate BPD in patients. Some (very few) also serve the families, friends, spouses, children, etc. (the Non-BPs). Their purpose in life is to help the BP overcome or to effectively manage their disorder. In this group of people, I have found no mention of high- or low-functioning BPs. The only “partial” mention is that of Dr. Paul Mason, who co-wrote “Stop Walking on Eggshells” with Randy Kreger. Several of these people within the therapeutic community have written popular books about BPD, including “Sometimes I Act Crazy,” “Lost in the Mirror,” “The Angry Heart,” and “I Hate You, Don’t Leave Me.” None of these books, as far as I can tell, refer to the idea of high-functioning vs. low-functioning BPD. Of course, Dr. Marsha Linehan and Dr. John Gunderson are prominent individuals within the therapeutic community. Their theories about BPD have a distinct influence on how therapy is conducted with people with BPD.

The final community is the support community. This community is comprised of ex-BPs, Non-BPs and others who provide advice about how to “deal with” BPD or with someone with BPD. This community includes myself, the authors of “Stop Walking on Eggshells,” the author of “Tears and Healing,” A. J. Mahari, the proprietors of bpd411.org and others. Only in this community have I seen any mention of high- vs. low-functioning BPD.

Some individual and organizations actually straddle the support/therapeutic (or even the research/therapeutic) community split. These include: myself (at least I hope so), TARA, A. J. Mahari and others. Some of these are more therapeutic (or at least psycho-educational) like TARA. I try and be both psycho-educational and to offer support resources to Non-BPs; yet, in doing so, also try and dispel the many, many myths about BPD (where possible).

The problem with assigning either high-functioning or low-functioning to a person with BPD is that the very nature of the disorder debunks these categories. BPD is chiefly an emotional disorder (with impulse control issues). Emotions are ever-changing, like waves that carry the mind along for the ride. Whether someone is high-functioning or low-functioning at any given time will be subject to their current emotional state. If a BP is emotionally dysregulated they will adapt to that (usually) painful state in whatever way that they have learned will assuage the pain. Some people with BPD will cut themselves, take drugs, avoid situations or behave in other ways that might be considered harmful to themselves or those around them. If a BP is not dysregulated, he/she has no need to behave in these ways. The core point is that BPD is about emotional instability and no person with BPD will be always high- or low-functioning. A person with BPD will swing – sometimes wildly – between several polar ways of feeling and behaving.

I suspect many “high-functioning” BPs do not have BPD at all. I have read many, many posts on Internet boards in which the “BP” in question clearly does not have the disorder. Many times, if you read carefully, you will find that these “high-functioning” BPs are diagnosed by their (usually) ex-wives, just because the “xBPh” (ex-husband with BPD) raged or was selfish during their relationship. BPD is more than raging – and as a Non just because you’re “walking on eggshells,” it doesn’t mean that your “BP” has the disorder at all. In fact, recently the list owner of WTO (the Welcome to Oz Internet list) asked the women Nons on the list if there husbands (or, more appropriately, ex-husbands) exhibited the symptoms of Narcissistic Personality Disorder (NPD). Every “Non-BP” that responded to that request confirmed that their “BP” met the criteria for NPD.

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NPD (which IMO is more likely a disorder that appears to be “high-functioning ‘BPD’”) and BPD are distinctly different disorders. There may be a slight bit of overlap – deep, deep down within the psyche of the individual (and that is shame, most likely), but the basic configuration of the disorders are quite different. People with BPD do not like themselves, for whatever reason. People with NPD adore themselves, for whatever reason. That alone separates the two disorders. While people with BPD may exhibit “deserving” behavior (that they deserve love, riches or whatever), people with NPD believe that being “special” is their birthright and want to be surrounded by important or exclusive groups of people. The thing to note with BPD is that the “deserving” behavior is counter-balanced with “undeserving” behavior – polar opposite feelings and behavior that is the hallmark of BPD. So, it seems unlikely to me that “high-functioning” (or low-functioning) BPs can actually exist.

Let’s briefly look at the DSM-IV diagnostic criteria for BPD and NPD , and we can illustrate the differences. First, BPD:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called “splitting.”
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

And now NPD:

  1. has a grandiose sense of self-importance
  2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. believes that he or she is “special” and unique
  4. requires excessive admiration
  5. has a sense of entitlement
  6. is interpersonally exploitative
  7. lacks empathy
  8. is often envious of others or believes others are envious of him or her
  9. shows arrogant, haughty behaviors or attitudes

Clearly, these two conditions are different. Some interpersonal aspects may seem similar (#8 in BPD and #6 and #7 in NPD); however, the emotional aspect of BPD (#6) is not present in NPD. There seems to me to be a split between self-hatred and the instability of self (in BPD), and self-importance and self-love (in NPD). I’m not sure this a gulf that can be bridged sensibly between the two disorders.

Why does it matter? Well, IMO it matters a lot, because the “prescription” that is effective for BPD is not the same prescription that works with NPD (or other variants on the Narcissistic spectrum). NPD is not a chiefly an emotional disorder, and emotional tools that are so effective with BPD will not be effective with someone with NPD. Now, you might say, “My ‘BP’ is diagnosed and he/she is always thinking about his/herself.” That may be true, yet, IMO, this type of “thinking” about oneself is really experiencing overwhelming negative emotions. It is difficult for anyone to think about anyone else when they are in deep emotional pain. As I have said in the past, I have coined (with the help of others) the term IAAHF (it’s all about his/her feelings) to help represent this state to Non-BPs.

Which brings me to my final point: self-diagnosis. It is dangerous to diagnose your loved one with BPD (or any other mental disorder). Only a trained and knowledgeable (and yes, I know, there are too few of these) professional can diagnose a person with any disorder. Assuming on your own that your loved one has BPD can be troubling for the relationship (at best) and damaging to their (and your) mental health (at worst). After reading a self-help book, such as “Stopping Walking on Eggshells” (SWOE), one has to be careful to diagnose someone else with the disorder. Even my book, “When Hope is Not Enough” (WHINE), can be used to “diagnose” your loved one with BPD, but I’d like to dissuade you from doing so. Instead, I would suggest you use the tools in my book (or, for that matter, SWOE) and see if they work. If my tools do not work, I suspect either you haven’t practiced enough (it takes time, believe me, it took me 2 years) or your loved one does not have an emotional disorder. I personally tried what I learned in SWOE for months before I realized that those “tools” were not effective in my life – which is why I bothered to write a book in the first place.

If you are tempted to introduce yourself to a support group with the statement, “I am married to a high-functioning BP…,” I’d suggest you take a step back and see if your loved one has the other signs of an emotional disorder (which BPD is and NPD is not).

138 comments to The Myth of the High-Functioning Borderline

  • Markos

    Karen,

    Pardon me while I smile a bit at the fateful end to what was undoubtedly a wonderful missive. I’ve experienced the same and it simply is what it is.

    But, I get the drift quite well. And my response has been the same argument for a couple of years. If you read the first post on this page from 2 years ago, I was saying the same thing.

    I had dinner last night with a filmmaker after he screened a couple of segments of his documentary on BPD for a relevant group. He asked me for my thoughts. I queried him the with the same sentiment I’ve had. Why are the BPDs he interviewed, who have been through DBT, Mentalization, TBT, Analysis, and whatever….. still anxious, still melting down (albeit, not as bad), and still unable to sustain peaceful yet exciting intimacies? He has wondered the same. Why doesn’t anyone find happiness? Why, indeed…… as I am now happy all the time.

    So, we had a long conversation about what it takes to find the peace of mind that comes with a secure sense of self, and why the mental health industry is not equipped to take you there. Its a long story, so I’ll cut to the chase.

    I started a book club a while back because others from various support groups wanted to know how I got there. The path I took went through a lot of thought and a variety of titles; a few about BPD, but most were relevant to what creates healthy and unhealthy minds. Like any other illness, you have to get to the bottom line if you want to find effective resolution. Most are so tied up in the manifestations, they simply never ask the right questions.

    I have lead both borderlines and families through those questions and answers. Some follow through and find their peace, some are afraid and do not. Recently, I’ve been asked to develop programs based on those questions and answers; which is now under way. There will be an online component….. probably what you are looking for.

    I’m happy to lay out the landscape for anyone who feels they would benefit. Feel free to get in touch by writing Bon an email he can then send to me. So don’t throw your laptop out of the window quite yet…….

    Markos

  • Karen Murphy

    Markos,
    I asked Bon to send you my email, I just wanted to let you know that I did indeed finally figure out how to get a hold of him. I hope I hear from you soon.
    Karen

  • Markos

    Very good, Karen…… I’ll be in touch as soon as Bon sends along your contact info.

  • J-9

    Hi Markos:

    Thank you very much for your offer of help and for being willing to share your experience and information. I sent a message via the Contact link/form with my email address requesting that you be provided with my contact information. I am hoping that the contact form information goes to Bon as I could not find any email address for him.

    Again, thank you, and I look forward to communicating with you in the future.

  • Markos

    Logistics accomplished, thank you Bon. Karen, I’ll look forward to hearing from you…….

  • Markos

    J-9,

    Bon sent me your email, and have sent you my address. Be in touch as you wish….. thanks again, Bon……..

  • [...] Article by Bon Dobbs: The Myth of the High Functioning Borderline [...]

  • Ellie

    Hi, I’ve only recently been diagnozed as having BPD and I’ve come to terms with the fact that I fit in to that diagnosis, but I’m desperately wanting to face my demons and become well enough to function happily. I am only 22, yet it has caused so many problems already and has meant I am not able to work, I find your posts very inspirational and sympathetic Markos so if there is any way I could get in touch or be given some kind of material to read or direction to try then I’d be incredibly grateful to hear from you.

  • Markos

    Hey Ellie…… send me your email through Bon’s contact button above and I’ll be happy to share. At only 22, accepting of the diagnosis, and willing to read and learn…. you are already half way out of the woods. You have no idea how difficult it is for most BPDs to get there and remain determined.

    I’ll look forward to hearing from you…..

    Markos

  • Andy

    I would consider myself a “High-Functioning BPD”; in fact I find your article a little insulting. I was diagnosed with BPD twenty years ago (when I was 21), and I possess most of the symptoms. I have none of the symptoms of NPD.I’ve managed to get several degrees, a few publications, and I am a University Prof. at a small College. By no means have I achieved the goals I set for myself. I’m an alcoholic, and all of my relationships end in disaster. I have made a point of avoiding meaningful realationships; I have given up on being married or being a father (what I want more than anything). At my worst I carved a large “L” on my chest to scare away would-be girlfriends (to protect them and myself). I’m very involved in my community; in fact I have even foundened a youth foundation that currently has 15 members on the Board. Everyone knows me as an upstanding person and I excel at my job…yet I have made several suicide attempts and have been hospitalized serveral times over the past 20 years. I manage to hide it; and when I can’t I leave town and start again somewhere else. If the definition of “High-Functioning” is that no one else knows we exist…then I can tell you in all honesty that we do.

    I can do this because of guilt and self-loathing. I can’t kill myself until my parents die. Having people think I’m good makes me feel better about myself. I know what I need to do and I hate myself if I don’t…even when I need several drinks just to be able to look someone in the eye.

  • Markos

    Well, Andy, I’m sorry you feel you have no option but to capitulate your life and emotional well-being to disorder. Your profile is quite similar to many high-functioning BPDs I’ve known and worked with.

    It seems that being single, with no hope of ever having a stable, fulfilling relationship, is always the default position. If only history is considered, I would agree. Unfortunately for those who are misinformed and ignorant of the possibilities, you can’t see that you don’t know what you don’t know.

    The guilt and self loathing that drives you to prove your self worth, without ever attaining it, is a huge deceit. You actually are all the wonderful things you have done, you just don’t feel like it. So, if the facts are what they are, but you don’t feel they are true, your emotions are lying to you.

    So then, the real question is, why don’t your feelings match up with your reality? The journey to that answer is the one thats been waiting for you. You can’t hide from yourself, so why not confront what needs to be confronted?

    At any age, there’s lots of life and love out there. Yeah, I know, but its not available to you, right? Wrong. Its all available when you actively confront and deal effectively with disordered neuro pathways. They won’t go anywhere on their own. But, they will change if you want to and make the effort.

  • roller

    Hi all, as the friend of a very high functioning female (ex girlfriend) I can certainly testify that I have experienced all of the high functioning behaviours associated to BPD. She is highly successful, everyone loves her, very social, but hurts deeply inside. Her rages are inwards and in blame and critisising against me and me only. She has self hurt once to my knowledge. I am probably only one of two people who know her suffering with BPD, and now she senses I know which has made things worse. My point here though, is that I want to learn more about how to communicate with her as its hard to understand what she needs from a loyal friend that knows her deep suffering ? I would welcome any advice on this as she continually baits me to push me further away from her even as a friend, I just validate her feelings and then we return to light and airy banter and fun, whilst hanging out occasionally. She no longer of course shares those deep thoughts and lack of inner self with me – She abandoned our realtionship I think through engulfment fears. I am now the only person who she does rage at in a very polite, very controlling parental way (as if I’m the child). She never loses it but pushes all my buttons, never apologises, critises me, and try’s to wind me up in a very controlled, articulate manner. I know these are her defense mechanisms and it her outlet. she never loses her temper at work, but with me fluxes from angry and irritable to absolutely charming and great fun to be with. She gets angry and I think I trigger her when I try to get closer with deeper discussions. So, these posts have been a revelation but how do we as non’s act as the friends they need when we are the only ones that know their afflictions ? (non of her closest friends know – her masks are impeccable). She now is avoiding any further relationship trying to heal as she says, but Iknow she craves the love and amiration. Any ideas of how we can improve such communications to support them would be appreciated.

  • You might want to read this: http://www.anythingtostopthepain.com/mentalization-high-functioning-bpd/ which is an update about high functioning BPD and attachment.

  • Julie

    So what are you saying? Are you saying that because I am a highly functioning person that I don’t really have borderline personality disorder? Wouldn’t a person with BPD who has mostly recovered be someone who is a highly functioning borderline? Or do you see BPD like being pregnant – you either have it or you don’t?

  • I am saying that BPD behavior is situational. The negative feelings are stronger when there is more at stake – like with people that you care about and people that, if they reject you, are more likely to trigger negative emotions and thus dysfunctional behavior. A person with BPD can function highly at work, for example, or in a situation in which the people’s rejection is not as painful as the rejection of those close to them. I also believe that there is a spectrum of reactive feelings and behavior in BPD. Its not like you’re pregnant or you’re not.

  • Antoine

    Sometimes, when I think about my wife and BPD, I wonder if she really even knows herself at all. She is a really sweet, kind lady. Her mood swings do not define her. When the chips are down, her true, kind, caring self always shows up. When she is dark, she is really dark. She defines herself by the dark moods. MY problem has been that I have had issues with abandonment. We are both in our late 50s, by the way. Anyway, when she would go into the dark personality, she would completely wall me out, and at the same time, lob verbal and mental grenades over the wall. I would be so needy myself, that I would suffer for her abandonment of me. I don’t know which acronym fits MY disorder. We kind of fed each other’s. I always inagined and wanted a deep and normal relationship, but could never get anywhere near her emotionally. At a certain point, the door would slam and I would feel abandoned. I would then day dream of being with someone who could just have normal emotions and thought patterns. I would say and do things that must have exacerbated her BPD and the cycle would just continue. I have a real desire to be as much help to her as I can and I suspect that my lack of understanding BPD has driven her deeper at times. I’m sure she could sense when I was day dreaming about another situation, though I never verbalized it. There was NEVER an actual other woman-just a longing, born out of a deep feeling of loneliness and abandonment. I am wondering if it can really be helpful if, as her spouse, I can simply see her situation clearly, through less needy eyes of my own, and love her. I have wondered if my resistance to her BPD could have contributed to her wall.

  • Andy

    Hi Markos,

    Nice sentiment, of course not entirely true. First I’d just like to mention that my main reason for posting was to reject the article’s stance that there is no such thing as a “High Functioning Borderline”, which of course is complete nonsense. I outlined some of my self-destructive behavior in order to contrast it with my positive public behavior and public persona. I did this to advance my argument that high functioning BPDs do indeed exist. Secondly I’d like to point out that I was feeling rather low when I wrote my comments, and these are not feelings I would typically express publically (although they are seldom completely absent). Again, I think this adds credence to the idea that some individuals are very good at keeping inner turmoil hidden while presenting themselves in a normal or exceptional light.
    To address your comments, I do not define myself by ‘my disorder’. In fact I am not convinced I have BPD (although many of the symptoms do appear to fit quite closely at times – generally only when I am in a relationship). I have made numerous attempts at therapy. I have tried nearly a dozen medications over the past 22 years. I have always been at my best when I have been off the meds and out of therapy – when I get really bad, quitting the meds and therapy is the only thing that works. I am in tune with my emotions and my thought processes, which I suspect annoys the therapists because I can tell them the problems and solutions – I am ‘painfully’ aware of when my thought processes are harmful; all they are left with is trite clichés like the ones you have offered. My last therapist was rather progressive and acknowledged the effectiveness of the alcohol. Once again though, not much to offer but clichés and ineffectual medication (with additional side-effects). The best doctor I’ve seen agreed I should not engage in therapy as I already have the tools I need to survive and therapy causes me more harm than good; the worst doctor kept me tied to a hospital gurney for two months (during this second case I asked for and received ECT… I was hopeful, but it also failed to work).
    Bottom line is I’m unhappy, and I accept it. I’m glad you’re happy Markos, but you shouldn’t expect that everyone else has that ability. For me, and for many others, happiness is independent of experience. I am not unhappy because of what happens in my external world, I am unhappy in part because of what happens internally and in part because I am intrinsically unhappy. I have tried very, very had to fight this and it has always made things worse. Realizing this has made things easier. I have accomplished some things I am proud of, although I do regret what I have been unable to do. Having said that, my main goal is survival.

  • Markos

    Andy,

    I was editing a chapter in a book I’ve been writing, and I thought of what you expressed in your last post. I’ve learned not argue with those who have convinced themselves that this is it, nothing more is available. One friend in NY put it very simply, ‘its much easier when you give up all hope.’

    Hope implies the possibility of change, and disorder can only defend effectively if it convinces your cognitive mind that what you have is all there is. Hope also creates a Darwinian, motivational anxiety…. with the capacity to prompt initiative….. an unacceptable state if all attempts in the past have forged nothing but frustration.

    High functioning BPDs are a fascinating lot. They use their considerable left brain resources to rationalize their defenses, rather than expose their chaotic emotional brains to a challenge that can’t be met. In fact, the rationale is based on a perceptive summation of the events of their lives. Unfortunately, the perceptions are filtered through a disordered mindset…… with layers as deep as the IQ is high.

    Again, one can not know what one doesn’t know. And more so, if the mind is protecting the comfort zone of stasis by internalizing and identifying with disorder. This characteristic is common among many high functioning BPDs, and undercuts any willingness to explore other possibilities. You may not define yourself by your disorder, but you have allowed your disorder to define the potential of your intimate relationships. If this is acceptable to you, so be it. If it causes you to wonder if and why you have not turned all the stones, you might want to ask a few more questions from those you can’t snow with your rationale.

    Otherwise, the circle is complete and intransigence is assured. Below is the a paragraph from the writing I mentioned. I could not accept the limits my disorder imposed on the most vulnerable parts of my life.

    ‘I truly believed my own perceptions and calculated life accordingly. I trusted my intuition and skill to maneuver in what I thought was an antagonistic world. This was life, I thought, it was all I knew and I would have to be smarter than most to survive. I could not see I was wrong, that my struggle was based on a false premise. My perception was no truth at all. In fact, the beliefs and behavior manifestations of borderline disorder were all an illusion I had no choice but to believe. It was an elaborate deception, made necessary by a truth too painful to bear. The psyche hides what it must from conscious acknowledgement, expedient only to emotional survival, not an acceptable quality of life.’

  • Matru

    Hi Markos,

    My daughter has recently fled her marriage within weeks because her husband was constantly angry, raging, spying on her, controlling and showing other signs of instability. After reading extensively for 6 months I can say confidently that he is has a BPD along with NPD.

    His parents denied his behavior was anything but loving towards his wife.(His mum too seems BP)and therefore refused to come together as families to help resolve the matter. We wanted a discussion so that some anger management strategies could be put in place.

    My daughter often wonders if she had stayed on, could she have done something to solve the problem. Her husband had become absolutely silent and made no further contact. Actually he is so strangely close to his mum that we are sure this decision is her’s and that is why he, who was so obsessed with my daughter had not made any further contact in the last 5 months. In a way it is good because it will be a clean break, but there is the constant self doubt, whether this was the best thing to do or could my daughter have done anything to make the marriage work.

    Please reply.
    Thank you,
    Matru

  • Markos

    Matru,

    From the little information you have related, your daughter most probably made the right move. Her husband is typical of many BPDs, who have a codependent relationship with a BP parent. Had she stayed in the marriage, she would have not only had to endure the task of trying to convince her husband he had issues to address, but she would have been fighting his family every step of the way.

    I know of numerous cases where that is the situation, and it is nothing if not continually exasperating, progress is nearly impossible. Your daughter should lick her wounds, and count herself lucky to have removed herself from a very difficult situation. The issues take a tremendous amount of energy, fortitude, and perseverance to resolve….. or even bring to a manageable level. Your daughter could not have resolved his disorder, only he can do as much; with a lot of work and the right kind of help. She could have been supportive of a decision he would have to make over and over.

    His mother was probably jealous of your daughter, and I’m sure her son would have taken the mother’s side in any conflict. Its hard for Bps to move from their disordered paradigm…. but harder still if the family from which disorder comes is not involved in a positive manner. Even then, its tough, as what they think is ‘positive,’ is hardly anything like the honesty and objectivity everyone needs to have.

    Your daughter should take a hard look at why she was attracted to such a volatile man, as these archetypes are usually not co-incidental. She doesn’t want to make the same mistake in another form.

    There should be no self doubt, unless your daughter was up for a very tough road. The charm and excitement that came along her husband was indeed, more about his obsession with a perceptive idea of a attachment object, and not about a realistic love for your daughter.

    I’m sure the experience was quite traumatic, but I could relate many stories from families I mentor…… of what a marriage looks like after 20 years or 30 years of struggle with BPD. Its a long hard road.

    Markos

  • I think the most important problem with the idea of a “high-functioning” BP is that is assumes that there is a correlation between ADLs and BPD. Someone can fulfill all of the diagnostic criteria while appearing “high-functioning” to the outside world. Alternatively, someone can fulfill limited diagnostic criteria while still finding meaning in the BPD label. Associating “functioning” with BPD reinforces stereotypes of people with BPD necessarily having highly visible symptoms, such as in “Mommy Dearest” or other well known examples. In reality, I have known many people with BPD who hurt inside but also appear “nice” and “normal.” Does the absence of a painful stereotype lessen the suffering that makes the diagnosis appropriate?

  • Markos

    One doesn’t usually have to look very deep to find bountiful evidence of painful characteristics in any BPD, however cleverly camouflaged they may be. Regardless of how well it seems to be hidden to the unknowing, a few poignant questions from a trustworthy and understanding authentic can break the dams holding the tide. Functionality is usually defined by the amount of discipline that was practiced in the home of origin. Particular family values are intertwined with a perceptive ‘reality,’ filtered through a disordered logic. The resulting beliefs must be skillfully challenged to succeed in separating disorder from order; gaining the ability to observe the processing that needs to be changed. Its a lot of tough work for BPDs, or any other disorder.

  • Mrs. C

    I have a family member that suffers from this disorder. I have only been researching this for a few years but I think high functioning or low functioning is a term for the family only. When one has a child with BPD that isn’t working due to the disorder and then you find on a support group that another parent has a child that works at a high level job we nons tend to wonder “what is up?”. The first thing that comes to our mind is, are we being codependent when a loved one when they seem unable to work? When nons define the high or low functioning it makes a statement that BPD affects the person in different ways so we can’t all expect the same outcomes from our loved ones that suffer from it. I think it carries more meaning for the nons than the ones that suffer from it. Many of us have a hard time determining the lines/boundaries and reasonable expectations with our BPD’s. I can’t see that a BPD would be concerned with those terms since it really doesn’t help in the overall symptoms. If I am BPD and hurt, what does it matter if I make millions or am on welfare? All I know is that I am in great pain and want it to stop. We nons tend to look at externals since we can’t indentify with the internals.

  • LWH16

    Markos,

    I am the ex-girlfriend of a man I believe is very High Functioning BPD. He is extremely successful, and everything appears together & impressive on the exterior but meanwhile there’s more of a primal scream on the interior.

    He told me quite a bit about his intense, stormy inner feelings– obliquely, though, in little snatches, and while everything was going well. Then after about a year, he broke up with me out of the blue, to my great shock. (As we were breaking up he told me I was the only one who knew he wasn’t fine when he acted fine.) Completely withdrew, with scarcely any closure, followed by the silent treatment. It was Googling the silent treatment that brought me to a BPD site where so much fell into place.

    I do not know if this is part of what you discuss above as ‘playing the part,’ but he much later expressed genuine remorse for hurting me. At the same time, I have felt frustrated rage behind his withdrawal. I can’t explain that, but it’s what I perceive.

    Is he wanting me to guess his feelings and mad when “step back” produces the result of me stepping back? Is this a kind of tantrum?

    I know he knows he isn’t ‘normal,’ but I do not know if he has been diagnosed with BPD or any mental illness. I believe he never lets the therapist in close either. He is not in regular therapy. If he or his therapist thinks its BPD, I’d be surprised.

    Further complication: his mother was mentally ill, and she committed suicide when he was 25. I think he could have a lot of fear of being mentally ill too… shame, horror… and thus a lot of reluctance to look within, lest he get that news.

    I wonder if I am the only one who has felt the impact of his acting out (besides his ex wife, who is way out of the picture). I have felt sometimes– even now, well after the end of the relationship– that he communicates a lot by acting out feelings with me, pushing me into corners that resemble his corners. Like, our relationship is still very unsettled, ruptured; in this way I am made aware he is unsettled and ruptured.

    As I realized early on that something weird was going on, disproportionate to reality, I have tried to be compassionate and calm from my end, and not play the script of being a door-slammer and feeding his self hate. OTOH I have told him (over email) that the silent treatment was abusive; I have not minced words about the effect he had on me, and he seemed stricken and remorseful.

    We are vaguely in touch but that’s been at my initiative. I do not know if I am enabling a one-sided pseudo-friendship, or if I am holding a door open for someone who is carrying a large burden. I do not want to enable him but I do care that he stop suffering and get treatment. He deserves to be happy. He is not a malicious person, but he’s very afraid, and he is in pain. I can see that.

    What can a semi-split ex do that might be of help? I think he knows that I “know,” and is afraid to face me. I care about him.

  • Markos

    LWH16,

    So sorry I didn’t see this until now. You have articulated very well, the profile of a high functioning borderline whose defenses also include what you would also find in AvPD. BPDs tend to lean toward repressive or projective defenses, probably a matter of innate personality traits. I actually experienced repetitive ‘silence treatments’ from a girlfriend with BPD, to the point of exasperation. I had no idea why she couldn’t simply talk about whatever she was feeling, even rage if necessary. So, on one of the many upswings I told her what it did to me and how utterly frustrating it was, and asked her why she did it.

    She told me it was the only way she could not rage, when confronted with a stress she couldn’t control. Walking away was the least of the evils. She actually tried to keep herself from going there, but she was working against 40+ years of neural pathways. She usually lost that battle, bless her heart. I had only the slightest clue at the time, just sick she was, as I was on a determined journey myself; with or without her.

    Undoubtedly, this behavior was developed early in life, as a response to her very emotionally chaotic environment. It could have been that she watched one of her parents deal with stress in the same way. Most BPD defenses were observed as part of the BPD family archetype, where the invalidated child ‘learns’ disordered transactions from watching parents of caregivers deal with each other; and the rest of the family.

    I don’t believe that your ex is trying to send you a cryptic message, as the emotional impulse behind the reactivity never makes it to or through the executive function; where he would ‘think things through,’ and good decisions are made. And when BPDs do think things through, in stressful times, the thoughts are put through a perceptive filter which makes no sense to anyone but themselves. Usually they see the fault in their ‘logic’ some time later….. 30 minutes, to 3 days, to 3 weeks, whatever. Apologies do sometimes come, but the damage has been done. I know of someone who must pack up a leave a city when the lack of impulse control poisons the community well. Such a shame, so much pain and extra work. BPD is exhausting.

    Being caught in the drama of it all can be confusing to say the least, and very traumatic, but you have survived with your empathy and compassion. He has no idea how valuable you would be if he could decide to make his way out of the woods. The most you can do is learn as much as you can, and try to put him in touch with a recovered BPD who can speak to him in a way that no one else can. Someone smarter than he is must be able to be out in front of him and gently steer him toward the light….. it hurts if you’ve been living in darkness your entire life. Gotta be tender, honest, and know what you are talking about.

  • LWH16

    How can I find such a person? I would gladly pass the information on to him. I would be happy to see him seek help. I worry about the degree of his isolation.

    What is the way to present the idea of speaking to someone that is least shaming/ most effective?

    I believe he would with meet me, if I suggested it. Or I could send him a letter.

    When we last met about a 9 mos ago I suggested help/ ACA and I got “I’m not ready!” and then afterwards, the silent treatment. He’s pretty defensive about the idea of help.

    We share very close mutual friends so that is a small lever.

    He is very literary and metaphorical and musical, so responds to poems and songs very strongly.

    I don’t know about Avoidant but the strongest correlation other than BPD I have stumbled across was “counterdependency.” As for BPD he seems to have ‘hermit’ and ‘waif’ traits and a lot of silent rage when someone resists his control.

    I would appreciate any help or referrals you can give me.

  • LWH16

    Please let me know how to contact you directly. Thank you!

  • Markos

    He is not unlike many highly defended, high function BPDs, who are all tough to reach. However the reaching out is done, it must be handled very deftly, or he will run. Bonn has my contact information, send him a request through his contact button up top, and he will give you my email. Thank you for wanting to help, not too many people can look past the vitriol to see a desperate soul in need of a guiding hand….

  • LoveinLA

    Bon,

    I would really love your advice. I’ve been dating my girlfriend for about 3 years now, we are in our late 20s. I started noticing BPD symptoms / flags about 6 months after we met – idealization/devaluation (has probably said she hates me and never wants to see me again 20+ times in our relationship – often over things that no one else understands. for example, when i offered to read over her resume after she told me she hated her current job), volatile mood swings, saying she feels empty / like trash / wishes she was invisible, among others. At first I thought it was her job, which was extremely high pressure with an emotionally abusive management team (you can be a superstar one day and a ‘fool’ the next). At about 1 year I started to realize it may be BPD and have voraciously read your book, stop walking on egg shells, the essential guide to bpd, etc. She seems to have the extreme mood swings less often now (i’ve practised validation a looot), but seems to be distracting herself with work (working 830am-11pm) and I’m really concerned about her level of stress, anxiety, and shame. Of the three times I’ve directly mentioned talking to a therapist, twice she got incredibly angry at me for suggesting therapy.

    Just a few weeks ago, I had an epiphany, after the first time I ever heard her say she wished she could die/sleep forever, I called her Dr and told him I was worried about her emotional state. He said he’d talk to her about it during the next appointment she has with him (not sure when she’ll have time though). I’m excited about this step, my one concern is that Drs nowadays are quick to prescribe medication as a first line, and from the symptoms she seems to show, that wont resolve the fundamental feelings of shame and extreme emotion that can ruin her days.

    So my question: should I call her doctor and mention that she seems to be experiencing many borderline symptoms (minus physical self harm)? She’s almost 30 and admits that she has no friends (besides me and one best friend from college) – I think shes really young and we have an opportunity to improve the rest of her life. I’m just not sure if I’m going too far by suggesting BPD to the Dr. I will fully support her thru therapy, I know she’s fundamentally good and incredibly intelligent/gorgeous :)

  • Andy

    Would love some advice….

    I’ve been dating my awe-inspiring girlfriend for about 2.5 years and over the length of our relationship, I noticed she has been experiencing most of the symptoms of BPD (minus suicide attempts). I’d like to know whether you think it would be appropriate to let her Dr know the symptoms she has been experiencing because its so unlikely that she lets anyone close enough to see / hear her painful thoughts/rage. I got the idea because she has literally been saying she feels depressed the past two months and said something along the lines of ‘I just want to die’ – I called her Dr. immediately and he said he would talk to her about her depressive symptoms. I’d just like to mention the borderline symptoms because it seems Drs use pills as a first line when they see depression/anxiety symptoms but those won’t resolve the intense feelings of pain and shame she seems to feel. Any advice on this?

    tldr; should i tell my girlfriend’s (hopefully fiance) doctor that she seems to be experiencing borderline symptoms? she is awesome, incredibly intelligent, has a great job, and gorgeous – but privately she suffers / acts on really extreme pain/shame that probably only her family, exes, and myself have ever seen.

  • I don’t know what the guidelines are in your state, but here in NY, if you contact an adult’s doctor, the doctor must inform the person of the contact. I would suggest not doing that. Instead, I would suggest using the skills in my book to develop trust with her. The suggestion of therapy obviously didn’t go over well. That is a suggestion that something is WRONG with her, which, because of the shame associated with BPD, the facing of something wrong can be a big task. If she is having suicidal ideation, this can be a jumping off point to get her the help she needs – but SHE will have to seek and buy into the help. You can’t do that for her.

  • Missy

    I am a bit confused by this article. My husband has been diagnosed with BPD with narcissistic tendencies. DBT is the only therapy that has ever actually helped him. He is definitely high functioning, has a pretty successful job (but he has sabotaged it and never reached the heights that his intellect and training should have allowed). If he wasn’t on antidepressants, he would be suicidal but has been on them for 30 years. He has been to numerous therapists over the years and some have hinted at BPD but said that he was basically incurable. Now that he has actually gotten a BPD diagnosis and DBT, his life has changed. I am not a bitter x-wife and I did not diagnose him. He is, however, a high functioning BPD. Someone could meet him and he can put on a very convincing facade. Since the DBT therapist has several patients that meet this criteria, I think this article is not accurate in stating that high functioning BPDs are really just NPDS.

  • Missy,

    Thanks for your post. I think you might want to read this article http://www.anythingtostopthepain.com/mentalization-high-functioning-bpd/ about mentalization and the high functioning person with BPD. You say that your husband has “sabotaged” his job and not reached his full potential. I believe that people with BPD have triggers and that the emotional dysregulation is situational. In some circumstances, a person with BPD can be fine. In others, the triggers are pulled and they can experience emotional dysregulation. I don’t know if one or more of these moments were involved in the “sabotaging” but if he has BPD, it’s likely.

    My wife has a job and is a good mother. She has her moments, which is my point. I wasn’t suggesting that high functioning people with BPD are really just NPD people. What I was saying is that in the particular forum I participated in, the HF BPDs sounded more like people with NPD – not in every case, just in those cases. Even Randi Kreger has seemed to come to a realization about this because her psychology today blog changed from “when someone in your life has BPD” to “when someone in your life has BPD or NPD”. She write a lot about NPD now, in addition to BPD. She also changed her formulation from “high functioning” to “invisible”.

    For myself and in my experience, the HF borderline is a sometimes thing. It depends on the nature of the attachment. The higher risk the attachment, the more likely that emotional dysregulation will occur.

    Bon

  • kay

    My BPD relative can mask it around others, or she will only allow herself to be in certain situations where she appears fine, but the longer the others are in her life the more they tend to see it. She does drink and I think other people, including herself, can blame it on alcohol many times so no one really knows that alcoholism is a symptom of what is going on. They don’t see further than that but to be honest none of us are trained to see farther than that.

    I am in recovery for many years now and can understand this. I have been to many AA meetings and found that alcoholics can hide their behaviours from others for a long time. They also can convince those around them that they really are the problem. There are parallels in addiction and BPD behaviours. I grew up in an alcoholic home as well so attend alanon. Many of us in alanon really don’t want to face reality so it isn’t all the dis-eased person’s fault for appearing to be functional. There are a whole group of us out that that help in creating an appearance of high functioning in any given relationship. I think the river runs quite deep in all this. The family, or friend, circle can contribute to the façade as well.

  • Julie

    Hi, I was diagnosed with bpd about 14 years ago, also struggle with terrible anxiety. I’m completely isolated, have no one to turn to and hardly leave the house. I could really do with someone to communicate with, someone who understands this condition. If anyone is willing to do that I’d appreciate it. I just need contact with the outside world again.

  • Andrew

    Hi Julie. I could talk if you’d like. calm_blue_ocean’at’yahoo.com.

  • As the author of Tears and Healing, I want to make clear that I do not teach and don’t support the idea of a high functioning borderline. In my 2006 book Meaning from Madness, I devoted a section to this in which I identify this a narcissistic behavior, and I also criticized those who far too freely label people as suffering from BPD, when narcissism and sociopathy are more likely disorders.

    Your characterization of the online support groups is quite correct. I managed my own group for a time, and stopped when it became too difficult to keep unhealthy posts and attitudes out of the group.
    Richard Skerritt

  • Cameron

    I actually didn’t even read the whole article because it is based on a pretense. “I have been scouring the research on BPD to find out if anyone in the research or therapeutic community uses this term or concept high-functioning versus low-functioning Borderline.” Read anything about Marsha Linehan’s four stages of DBT treatment which are based precisely on how high or low functioning a borderline is. This isn’t just some random woman, either. You mentioned her in the first paragraph. DBT is the number one empirical treatment for BPD right now. Plenty of Linehan’s studies refer to the four stages that, while not specifically saying “high vs. low functioning BPD” are speaking about exactly that. It’s “a rose by any other name” as it were.

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