Bon: I found an interview with Dr. Leland Heller about Borderline Personality Disorder. He does a good job explaining the pain associated with the disorder… Here are some excerpts. The entire interview can be read here.

Diagnosing Borderline Personality Disorder And Finding Treatment That Works

Dr Heller: Good evening, It’s great to be here. I have a way of explaining the Borderline Personality Disorder in layman’s terms that might be useful. It’s how I explain it to patients and their families.

Imagine you had a pet dog and it runs into the street and by accident it’s hit by a car. The dog’s leg is broken and it limps off into an alley to lick it’s wounds. A friend of yours sees the dog and comes over to help. The dog is now feeling trapped and cornered – a “wounded animal” – and misinterprets the friend’s attempts to help. The dog snaps at the friend’s hand who is trying to help. The BPD (Borderline Personality Disorder) is a malfunction in the brain’s trapped or “cornered” animal area. Under stress, a seizure develops in that area. That’s why under stress, while raging, a borderline will say to him or herself: “Why am I doing this” – yet be unable to stop it. It’s a seizure – nerve cells firing inappropriately and out of control.

David: And the cause of Borderline Personality Disorder?

Dr Heller: The BPD has many causes including head trauma and brain infections, but it appears that emotional hurts literally damage the brain. Most likely the brain’s support cells – the 90% of brain cells called “glial cells” – are damaged by traumas, causing the person to overreact to stress once puberty strikes. During puberty the brain’s limbic system goes into “overdrive” and adolescents are at their highest risk of seizures in their lifetime. “Sticks and stones may break my bones…but names cause brain damage.” So does incest, abuse, severe trauma, head injuries, attention deficit disorder, and other causes.

David: From my understanding, one of the biggest difficulties facing individuals who have BPD is maintaining stable relationships. This is a great cause of consternation for those people who are on the other side of the relationship. What causes this?

Dr Heller: There are a number of problems. The three most significant are 1) inappropriate mood swings; 2) misinterpretation of motives; and 3) remembering those misinterpreted motives as real. Oftentimes self-fulfilling prophecies occur, and self-hate eventually leads to a significant other coming to the same conclusion – that the individual isn’t worth being with.
…
janet: Would you please tell us more about the self-hate characteristic and how that damages the BPD or his/her relationships?

Dr Heller: Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.

crazy32810: How is self-injury related to BPD?

Dr Heller: We all injure ourselves to stop noxious neurological sensations. Interestingly we do it in a linear manner, ripping the skin. A common noxious neurological sensation is the toxins released with an insect bite. BPD dysphoria is about as bad as it gets. The pain is horrible. Many individuals have broken major bones and declared the pain of the fracture was nowhere as severe as dysphoria. When an individual with the BPD discovers that self-mutilation, or other techniques of self injury, work to temporarily stop the pain of dysphoria – they’ll do what it takes to stop it. This is no different than the individual with a fracture wants pain medication. I broke my shoulder last December and I tried to deal with it without taking narcotics. I was foolish and wrong. The pain was so bad it needed to be treated medically. Once individuals with the BPD have their chronic symptoms stabilized, and have safe medication options that work for dysphoria, the self-destructive patterns are no longer needed to stop their pain.

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TRAGIC AMY WINEHOUSE HAD ‘MENTAL ILLNESS’

TROUBLED Amy Winehouse suffered from an undiagnosed mental illness, a relative has revealed.

The talented soul singer could have been struck down by the little-known Borderline Personality Disorder.

Sufferers have feelings of anger, emptiness, shame and guilt and become emotionally volatile.

And it can also push them into substance abuse and eating disorders, both of which Amy succumbed to.

Yesterday a member of the Back To Black star’s family said: “It was never diagnosed, because unfortunately she would never agree to a proper diagnosis.

“I’m not an expert, but from what I’ve read on Borderline Personality Disorder it kind of fitted with her.”

Meanwhile Amy’s dad Mitch, 61, said he wished his daughter, who died in July aged 27, had sought counselling.

He said: “She never stopped trying.

“She hated the way she was when she was drunk and when she was ill.

“And you know, the way I look at it, she died trying.

“She didn’t give up. She died trying to make her- self better.”

This article, although short, points out several interesting things about people with BPD. Since there’s no guarantee she had it, I’m going to generalize a bit. First of all, it is tragic that BPD is “little known” because it is much more prevalent than bipolar disorder. The article says: “Sufferers have feelings of anger, emptiness, shame and guilt and become emotionally volatile. And it can also push them into substance abuse and eating disorders, both of which Amy succumbed to.” This is very true. A person in extreme emotional pain will do anything to stop the pain. The article ends with “She died trying to make her- self better.” I’d like to amend that statement to “She died trying to make feel her-self better.” That’s the nature of the disorder and that’s what many non-BPDs do not understand. It’s all about his/her feelings (IAAHF) and not about controlling, manipulating or calling for attention.

See larger image Lioness: Hidden Treasures (Audio CD) List Price: $13.98 USD New From: $8.84 In Stock Used from: $11.02 In Stock Release date December 6, 2011.

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I do not think that lying and manipulation are part of this diagnosis. If they seem to be present, look either to another PD or to shame and anxiety as the cause, along with a long history of learning to never overtly state what you needed to be okay, or to express how rotten you felt, as the consequences always seemed to be much worse…

Sometimes it seems as if people hate those that are dx BPD precisely because they haven’t quite gone off the deep end for good. It’s bewildering how many professionals seem to resent them for this too.
They may curl up in a fetal position for hours, but then they will struggle out of bed and go on. They smile at us, while their inner world self-destructs. They might seem as alive as anyone, but -in the best of times- they feel dead inside; and as intelligent and gifted as many of them are, they never realize their full potential. But they would rather die than admit this to the outside world.

Who would today be dx’d BPD? Vincent Van Gogh, Kafka, Proust, Nathanial West, Sylvia Plath, Anne Sexton, Janis Joplin, Jim Morrison…

It’s ironic that they are so often seen as “emotional” when what they lack is a full nuanced range of emotions. Inner tension keeps anxiety coiled, emotionally stressful situations release it, and before they have a chance to think through what they feel, they are overwhelmed by fear and anger and despair. They get mired in their negativity. Studies have shown that those with BPD do not get angry more often than anyone else, but they have trouble leaving it behind when they do. And afterwards they drown in remorse, because these reactions are NOT felt to be syntonic. No one seems to pay much attention to this, but all other “personality disorders” are understood to be PD’s because they are syntonic with the personality. This is radically different in BPD.

That right there should raise lots of doubts about what this dx is. Is it part of the affective disorder spectrum? Is a akin to partial seizures in frontal lobe epilepsy? Is it a developmental disorder akin to autism? This is all possible, and perhaps BPD is a dx given to many different people who do not share underlying causes. This should at least stop us from quickly claiming that they CHOSE to feel the way they do. As if they were hell bent on living in hell…

When they do awkwardly, fearfully, try to communicate this pain, when they do reach out for help, they generally do so when their psyche is at it’s most shattered. They will quickly learn that their behavior is not acceptable to anyone. So they’ll go through DBT or through some other behavioral therapy, and sink into so much shame and guilt that lo and behold they will no longer qualify on the DSM for BPD; they will have learned to suffer in silence and to isolate (if they haven’t before – many of those with BPD will never consult a therapist in their lifetime and go through life pretty much invisible), learned to not bother anyone, but the dysthymia, the insomnia, and the dysphoria will still be there, eroding their lives, their aliveness. And as hard as they try, fear will still strike them out of the blue when they least expect it. As hard as they try, they will still plummet down into misery with the least negative emotion. Skinless creatures, they can not tune out human suffering, they can do nothing about the heightened sensitivity that they were born with. Only now no one will know. And so hopefully, thankfully, no one will ever call them “Borderline” again.

 

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Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.

People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary.  I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors.

Self-injury

Self-injury can come in many forms and includes cutting oneself with razors or knives, burning oneself with cigarettes or matches, pulling out clumps of hair and picking at oneself (especially the nails and/or cheek) until blood is produced. Self-injury is one of the most difficult behaviors for the loved one to understand. In the case of BPD, self-injury is done for the purpose of pain relief, not to “get attention” or to manipulate the loved one. Most self-injury is done in private and done without the knowledge of the loved one. Occasionally, the self-injury cannot be covered-up (i.e. the blood and/or scars are apparent or the hair is missing in large area of the head) and others notice the activities. The actions themselves are fraught with shame and may lead to even more shame for the person.

In the hospital, ER doctors take a dim view of those who injure themselves and a person who engages in self-injury often avoid hospitals to avoid the inevitable judgment and lack of compassion these doctors (and nurses) will exhibit toward her. What is important for a loved one to understand is that self-injury has a purpose and that purpose is usually pain relief, not self-punishment or attention-getting. The person who engages in this behavior may feel and describe a deep “itch” inside her body that she has to rid herself of immediately.

While self-injury can provide relief from pain (through the release of endorphins, or natural, pain-killing substances within the brain), it can have risks and negative consequences. These include embarrassment, scars, infection and, in some cases, death.

Substance Abuse

As stated above, many people use alcohol and/or drugs to dampen the effects of emotional pain. With BPD, it is likely that alcohol and/or drugs will be used for this purpose. Drugs and alcohol CAN function to reduce pain. However, this pain reduction is temporary. What I have noticed from the ATSTP group is that people with severe BPD are likely to use large quantities of alcohol and/or drugs to deaden their pain. Some estimates of substance abuse by people with BPD are as high as 75%.

Many people with BPD use and abuse alcohol and drugs. Often, they will ingest large quantities (more than someone without BPD could handle) and not overdose or even pass out. They may take both prescription drugs with anti-anxiety medication, such as Xanax, Ativan and Klonopin (and others); painkillers, such as Oxycotin, Vicodin or Codeine (and others); or they may take illicit drugs, such as Marijuana, Cocaine, Heroin, or Methamphetamine (and others). The purpose, again, is to remove emotional pain. Unfortunately, these substances, especially in the quantities consumed, can have several negative effects and consequences, including overdose, driving violations and an increase in impulsivity or dyscontrol.  These periods of impulsivity and dyscontrol and the behaviors that result (such as “risk-taking behavior” below) may cause more shame and self-punishment when the BP sobers up.

Risk-taking Behavior

People with BPD also engage in risk-taking behaviors of various forms. These behaviors include risky sexual behaviors, reckless driving and thrill-seeking behaviors. Many of these activities could be considered life-threatening either in the short term (by having a car accident) or in the long term (by contracting HIV or another fatal sexually transmitted disease). The people with BPD will, at the time of the risk-taking behavior, most likely not consider the consequences to life and limb – either physical or legal. Again, the purpose is to halt and/or deaden the emotional pain. In other words: “it seemed like a good idea at the time.” Sexual activities can provide pleasure, dangerous driving can provide a thrill and other risky behaviors, like hanging out of windows or jumping off cliffs into lakes, can provide a rush of adrenaline that temporarily removes the emotional pain. The point is for you, the loved one, to understand that the motivation of these behaviors, however short-sighted and ill-conceived you think they are, is to remove pain.

One member of the ATSTP group reported that her husband had totaled four cars in a period of eight years. These behaviors are impulsive and therefore not “thought through.” They are another method to “put out the fire” within the person. Certainly, these behaviors can have significant consequences, physical, legal, financial and otherwise.

Eating Disorders

Another behavior that many people with BPD engage in (particularly females) is eating disorders. Whether it is starving oneself or binging-and-purging or overeating (especially secret overeating), the eating disorder is another tool someone with BPD can use to alleviate emotional pain.

Again, eating disorders can have negative consequences including starvation, ill-health, poor self-image and obesity.

Other Binge Behavior

Other binge behaviors (or indulgent/irresponsible behaviors) are binge shopping, obsessive plastic surgery and “running away” through binge travel. These behaviors provide temporary relief from emotional pain as well. And again, they can have negative consequences by damaging a relationship or financial consequences.

On a final note on dangerous behaviors: it is important to prioritize when you are trying to help the BP halt or alter their behavior. You will want to start with the most dangerous first. If your daughter with BPD is having unprotected sex and smoking marijuana, regardless of your feelings about drugs, the unprotected sex will have to come first. Also, you need to be practical about it. Giving her condoms and saying, “I can see how buying these or asking your boyfriend to wear one might be embarrassing to you” rather than insisting she no longer see the boy is probably more effective, again regardless of your feelings about premarital sex. Once the genie is out of the bottle, it is difficult to stuff it back in. You can, however, help make it safer and you do so by being effective. Of course, you also have to be brave in this situation. It can be very difficult for a parent to talk to a child about sex.

Adapted from When Hope is Not Enough

Related posts:

1. A Borderline describes cutting
2. 5th Anniversary of ATSTP List and Some Support for Non-BPDs
3. Ask Bon: Why does my loved one with BPD fear judgment so much?

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Judgment Hurts those with BPD

A person with BPD fears judgment almost to the point of being allergic to it. She is extremely sensitive to judgment from other people, even if that judgment is merely perceived. Because of the shame (the belief that she is a bad person and deserves to be deemed as such) and the rejection sensitivity, a person with BPD avoids situations in which her actions can be judged by others. When I say “judged” here and “judgment,” what I am referring to is not “using one’s better judgment” in a situation, but rather it is the sense that a person’s actions or the person herself can be judged as “right or wrong” in a given context.

Interestingly, even with a strong fear of judgment of herself and her own behavior and self, she also tends to judge other’s behavior and character harshly. How many times has your loved one with BPD told you that you were doing something “wrong” or that you are a “mean” or “bad” person?

Fear of judgment and emotional reactions to judgment (real or perceived) is a major issue for a person with BPD. Judgment of her actions causes emotional pain and to avoid judgment, she might lie or avoid social situations in which she feels she will be judged. If she is consistently concerned with doing something “the right way” or she feels that you think she “does everything wrong,” it is likely that she suffers from a fear of judgment.

Additionally, there is a stigma associated with being “crazy” when a person has BPD. A person with BPD might feel “not normal” inside and might have felt that way most of her life. However, if the outside world labels as “crazy” or “not normal” or “mentally ill,” it becomes an external validation for what she might already feel. The fact that others “know” about her can make her feel exposed. It is a form of judgment and fear of it that reduces the likelihood that the person will “admit” she has a problem.

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Rage burns and burns

In the support groups, rage is one of the most talked about aspects of BPD. Why? Because it is one of the most difficult for the Non-BPD to endure. Many people ask themselves, why is this person so angry (with me)? It seems to make no sense. A person with BPD will fly into a rage about seemingly nothing. The smallest thing that is out of place or not done the way that this person expects causes sometimes hours of anger and raging, yelling and screaming and sometimes physical violence. Again, many Nons ask: “what’s up with that?”

Anger and rage are usually secondary emotions to other primary ones. Sensitivity to judgment plays a major role in the triggering of rage. The symptoms and feelings associated with BPD interact and, at times, feed each other. In the case of rage, I believe that it is fed by two other symptoms: shame and sensitivity to judgment (which is also fed by shame).

When someone with BPD feels shameful and when you (as a “Non”) criticize or judge her behavior as “bad” or “negative,” the trigger for rage is pulled within the person with BPD. Why? Because your judgment reflects her shameful feelings and resonates deeply into her core beliefs about herself. She panics that you are “finding out” that she is a bad person. She has to (at all costs) defend her “goodness.” What I have found with my own borderline is that this is the point at which she will rage and introduce the “what about you?” argument. The “what about you?” argument is a way to rage at the Non and release anxiety about the Non finding out about her shameful “badness.” Some people in the support community like to call this “projection” or “denial.” I personally don’t believe it is actually projection or denial (although there are times in which projection is clearly there). It is a form of misdirection to try to take the focus off their inner shame and refocus the discussion on you and your faults.

Nobody is perfect, not even you. When a person with BPD rages against you, you often feel very imperfect – especially if she uses the “what about you?” attack. When someone with BPD uses the “what about you?” technique she is usually deflecting blame and judgment on you. However, you experience the rage as hurtful to your very self. You find that the rage “forces” you to defend yourself against her. That is what the “what about you?” attack/rage does best. That is its intention; it puts you on the defensive and shifts focus away from her and her behavior. As I said, it is form of redirection away from the person with BPD’s shame.

One interesting thing about raging is that once the anger and raging is done, it is usually over. Sometimes the person with BPD will be exhausted after the rage and will just collapse and go to sleep. The same is the case with tired children. Sometimes a tired child will have a temper tantrum (which is a form of rage) and then, once the emotions are released, she will either go to sleep or sit placidly in your arms. The inner agitation has been released and she is done.

Adapted from the FAQ from When Hope is Not Enough

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I believe that there is no right or wrong way to approach human emotions – there’s an effective way and an ineffective way and there are shades of grey in between those “polar” opposites. The effective way gets a positive outcome. That positive outcome is typically the return to baseline of the borderline and the establishment of a modicum of trust with others. One of the most important issues with borderlines seems to be the idea that they believe no one understands them (they feel “strange” – I said “broken” in WHINE, but I think that it was [a recovered borderline on the list] who clarified that it’s more like a “not feeling ‘normal’ and ‘fitting in’ feeling”), they can’t trust anyone with their emotions because many people have invalidated their feelings throughout their life and this leads to “silent desperation” and the inability to communicate effectively how they feel. If, through the use of my tools, you are able to gradually establish an environment in which your wife feels that she can safely express her emotions, which will go a long way toward establishing trust.

Secondly, you posted that you feel as through your feelings do not have a forum for airing and validation. Unfortunately for you, your wife sounds like a typical borderline. She is impulsive, she cuts, she abuses substances – especially painkillers. The divorce talk is probably born of either shame (“I will leave you before you leave me”) or of a feeling that she is being judged and/or disrespected (or not appreciated and accepted for whom she feels that she is). That leads to a certain mind-set that essentially makes her believe that, since no one has ever listened to her feelings before, she must dig in and hold on to her feelings as if she is the only person in the world. That is, “if I don’t fight for myself no one will”. This situation makes it difficult for you to express how you feel because she gets the message (even if it is not true): “YOU MADE me feel this way” because she thoroughly believes that about you. The reason she believes that you (and others, not just you) make her feel like she feels is that she is unable to self-regulate and looks to others to regulate her own emotionally states. When [a recovered borderline on the list] said something about her being more worried about what you think of her, she hit the nail on the head, because a borderline (and possibly for biological reasons) has a great deal of internal chaos and the usual strategy (also possibly biological) is to internalize other’s feelings and opinions about her self. It’s odd, yet I think that this dynamic is the one in which all the talk of not respecting boundaries arises. She feels at some level that you are actually a “part” of her, because she requires external validation. When that external validation turns to judgment, she has to cut you out of her mind. Sadly, she will continue to seek others (particularly men) to self-regulate until she can self-regulate.

As for IAAHF (“It’s all about his/her feelings”), one thing that many people read into that is that EVERY interpersonal situation is about her feelings and that she will not EVER be able to empathize with yours. This is neither the intent of IAAHF or the case. Borderlines are really empathetic (really no kidding they can be) but only when they are not on fire internally and emotionally. The intent of IAAHF is to EXPLAIN the “crazy” behavior, not to make a blanket statement about the relationship. When asked “why would she cut herself?” (for example) the answer is IAAHF. She’s in pain and the cutting helps alleviate that pain. Or asked “why is she raging at me over nothing?” (which happened to me the other night, presumably out of the blue). The answer is IAAHF.

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Potty training provides an excellent example of positive reinforcement and the ignoring of “backsliding.” That is the essence of this tool. When you teach a child to use the potty, you make a BIG positive deal about it when it is successful. The first time you see the poop in the potty, what happens? Typically, the parent praises the child, positively reinforcing the behavior in a way that is out-of-proportion with the accomplishment. You may say, “Yeah! You did it! That’s fantastic! Good Job!” and clap your hands and cheer. You also will tend to do it within seconds of the completed behavior. That is where positive reinforcement differs with general praise. Praise can be given much after the fact and can be bestowed for a number of reasons, including character traits. That is, you could say, “Wow, you are so smart” after your child receives a 100% grade on a math test. That is praise. (Although I’m not sure it is effective, but that is not the topic at hand). Positive reinforcement is for behaviors and should occur right when the behavior is completed. That is how animals are trained. The positive reinforcement (feeding, for example) occurs within seconds of the completed behavior so that the two can be connected in the mind of the animal.

If I return to potty training, you will notice that you also naturally ignore and don’t punish behaviors that don’t match the desired behavior. That is, if the child has an accident and poops in his/her pants (while not wearing a diaper) you don’t say, “You are a naughty little boy/girl!” No, that would be damaging to your child’s self-image. No, instead, you say, “Everyone has accidents at first. You can try again next time. It’s OK.” This is an accurate corollary to emotional regulation and reinforcement and punishment. Since the BP naturally has difficulties regulating her emotions, the idea of her “messing up” or “backsliding” is analogous to child pooping in her pants (even if this is more the “rule” than the “exception” in the BP’s life). It is not effective to punish her for behaviors that (at first) she can’t control. The behaviors are conditioned and the purpose of this tool is to help recondition a BP to behaviors that are more desired and effective. After conditioning, the child is able to control (or at least sense) when she has to go potty. After conditioning a BP is able to control (or at least sense) when she is becoming dysregulated.

- An excerpt from When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder. Available online in Print, eBook and Kindle
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I believe this feature is born of an unstable sense of self. A person with BPD has difficulty “locating herself in the world.”  While two of the other “core” features of BPD are “systems related” (meaning, those features are based on subsystems of the mind – the emotional regulation system, the impulsivity control system), shame and the preoccupation with interpersonal relationships are based more on a person with BPD’s view of herself. While it might seem that interpersonal relationships are outside of self, a more complex picture arises as we look more deeply into the mental configuration of BPD.

A recent study showed that the number one trigger of systems dysregulation (like wildly swinging emotions and impulsive behavior) is interpersonal distress. This interpersonal distress is more important as a trigger of dysregulated behavior than sweeping/major life changes – in fact major life changes, such as changing jobs, getting married, having a child – were ranked last of nine factors that trigger BPD distress. The interpersonal, moment-to-moment perception of the state of an important relationship is the most important trigger. That can be bad news for someone in a close relationship with someone with BPD. The person with BPD will be continuously scanning the interpersonal landscape for threats. Since shame is involved, people with BPD are likely to use others to regulate their internal systems and their self-view. In other words, a person with BPD uses others as a mirror to view their self.

Why is this so? I believe that a person with BPD’s lack of internal regulation causes her to internalize other people and use others to self-regulate. When someone has an inability to locate herself in the world, which very possibly arises from the emotional instability as a child, she seeks to have others locate her for her. She needs others to verify and validate that she’s “ok”. Unfortunately, because few of us are taught the language of emotional regulation, a person with BPD will likely learn that the interpersonal landscape is not safe; it is full of threats to their very self. It’s not an easy situation in which to live. If a person requires external validation and regulation, there develops a sense of a lack of control. Others are unpredictable, don’t understand how it feels and can damage the very core of her being.

People with BPD have described this internal feeling of emptiness and lack of internal controls as feeling “dead inside,” which is in itself, tragic. Extending this feeling to others through this preoccupation with close interpersonal relationships leaves a person with BPD with the feeling that others contribute to this unpleasant internal feeling. In other words, “it’s your fault that I feel this way.”

Many Non-BPD’s ask me why their loved ones with BPD don’t seem to trust them. To me, this aspect of BPD is a significant factor, along with other biological factors.

All of that being said, let’s suffice it to say that interpersonal relationships play a huge role in BPD. Social connections and attachments, including parent/child attachments, are the focus point of a person with BPD’s sense of well being. When these trigger dysregulation and/or ineffective modes of thinking and behavior, a person with BPD is lost in the world, floating free in a threatening sea of feelings, thoughts and behaviors.

One must understand that in order for the interpersonal tools to work properly, they need to be understood and applied in a step-wise fashion. I have often said to my list members that “you can’t boil the ocean” which means that you can’t jump to the end before you walk the path. You can’t do everything all at once. Instead, you have to take one small step at a time in a longer journey. The goal of all of my tools, attitudes, skills and approaches is (in my mind) a compassionate, trusting, respectful and two-way relationship in which both parties feel known, heard, understood and worthy. Achieving that goal is hitting a grand slam so to speak. Yet, I feel that a person must be given the fundamentals and practice those fundamentals before you can hit one out of the park. Emotions which are the first layer to unravel peel back from the onion that is BPD. Understanding emotions in oneself and others is vital to having a two-way relationship with someone with BPD.

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Why would Bethany Storro douse herself in acid? Experts try to explain

When news broke Thursday that a Vancouver woman admitted dousing herself with powerful acid, causing severe facial burns, one question reverberated:

Why would anyone do such a thing?

Friday, a leading researcher in the field of self-harm discounted theories that Bethany Storro, 28, was crying for attention, trying to manipulate others or attempting suicide.

“The biggest reason people do this,” said Kim L. Gratz, “is because it makes them feel better in the moment … It can really distract people from all the emotional pain that they’re feeling.”

Gratz, director of personality disorders research at University of Mississippi, is co-author of books on self-harm and borderline personality disorder. Before she was contacted by The Oregonian, Gratz hadn’t heard about Storro, 28, who told police an assailant threw acid in her face near Vancouver’sEsther Short Park on Aug. 30. Storro described the attack in detail, sending police searching for an African American woman in her 20s or 30s. A couple days later, before a crowd of reporters at Legacy Emanuel’s Oregon Burn Center, Storro said, “I have no enemies … I don’t get it.”
No one is sure how many people mutilate themselves each year; those who do typically hide it.

The U.S. Centers for Disease Control and Prevention put the number of emergency room visits for self-inflicted injury at 594,000 in 2006, the most recent data available. But the vast majority of people who intentionally hurt themselves don’t seek treatment, Gratz said, either because they don’t need medical attention or because they’ve become good at treating themselves.

“Our best estimate in adult populations,” she said, “is probably 4 percent … with much higher rates among adolescents and young adults.” Large-scale studies of college students around the world put rates of self-harm at 17 percent to 40 percent, she said. Incidence among females and males appears comparable.

The most common form of self-harm, or self-mutilation, as it’s also called, is by cutting; those who engage in the behavior frequently slice their arms, then wear long sleeves to hide the injuries.

Dr. Thomas Dodson said such patients describe a state in which they don’t feel any emotions. “They cut on themselves,” he said, “because they can’t tolerate a state of not feeling anything. It becomes habitual and relieves tension that they have.”

Dodson, a Southwest Portland psychiatrist, chairs the public information and education committee for the Oregon Psychiatric Association.

Beyond cutting, the list of self-harm behaviors is as long as it is gruesome, from burning to sticking the skin with needles, punching one’s self to banging the head or another body part repeatedly against hard surfaces. Use of acid, apparently, is rare.

The most typical diagnosis among self-harmers is borderline personality disorder, Gratz said. But the behavior also is associated with eating disorders, substance-use disorders, depression and anxiety.

If Storro has a diagnosed illness, it has not been publicly disclosed.

Self-harm is not a suicide try. Yet those who mutilate themselves are fragile, Gratz said, and are at higher risk of suicide than the general population.

Gratz has no idea what might have triggered Storro to hurt herself, but life transitions, always increase stress, she said. Storro recently divorced and moved from Idaho to Vancouver to live with her parents. She had just started a new job at Safeway.

The best treatment for self-harm, Gratz said, was developed by University of Washington’s Marsha M. Linehan, a psychology professor. Called dialectical behavior therapy, it involves a year of intensive psychotherapy, plus weekly group sessions in which patients learn to regulate emotions, tolerate distress, be more mindful of and negotiate relationships better. DBT, for short, includes telephone coaching, so therapists can help patients whenever a problem arises, and a consultation team offering peer support for the therapists themselves.

The method is the treatment of choice for borderline personality disorder.

At Portland Dialectical Behavior Therapy Program on Southwest Macadam Avenue, Tracy Jendritza, a psychologist on staff, estimated that half the clinic’s patients have engaged in self harm.

“People get so dysregulated emotionally that there’s something about self harm that actually calms people down,” Jendritza said. “Initially they feel better but in the long term it makes things worse.”

Self harm, Gratz said, frequently goes hand in hand with shame and feeling alone. She figures that Storro has landed in that deep well.

“My guess is that she’s experiencing incredible shame” since police learned the truth about the attack. “It’s so public … I’m sure she’s in a much more intense state of distress” than she was before applying the acid that burned the skin off her beautiful face.

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1. Woman indicted in fatal MySpace hoax on girl
2. Another Article about Treatment and BPD from NY Times
3. Self Injury Article on CNN

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The core problem with BPD is poor emotional regulation. That particular problem can cause other symptoms to arise as the person with BPD becomes emotionally dysregulated. This term emotionally dysregulated (or just dysregulated) is used to denote the state in which a person with BPD is overcome with powerful and, at many times, misaligned emotional reactions. Remember that emotions don’t arise on their own; they are based on cues or triggers from the environment and compared by our “emotional immune system” to the meaning of the cue. For a person with BPD, the meaning can be misjudged or, as is more often the case, the sensitivity to emotional cues is greatly heightened.

An example is a heat-sensing system that helps to detect and suppress fires. Sometimes companies will install heat-sensing equipment in addition to smoke detectors so that they can protect assets that need a certain temperature to operate (e.g. computer equipment which might cease working at a high temperature). The setting at which an alarm goes off might be 80 degrees Fahrenheit. In the case of someone with BPD, the setting (or “tolerance” as it is called in the control community) is naturally set much lower, at say, 50 degrees Fahrenheit. That means that the alarm will be raised much more often and lead to a reaction to the alarm. In other words, people with BPD will experience many, many (what you would consider) false alarms. However, these false alarms seem completely real to them, because their tolerance for emotional triggers is set very low. They are constantly running a fire drill. Unfortunately for you, the BP may drag you along unwillingly and unwittingly for the drill. (Pages 32-33 of WHINE)

As you can see, the position I take in WHINE is that emotional regulation is the “core issue” of BPD. This position is in line with the DBT way of thinking, which is why one of the “modules” of DBT is emotional regulation skills.

The question is today: is emotional regulation at the “core” of BPD? Or does it go deeper than that? Is there a “cause” for emotional regulation? What are the triggers and how does a person with BPD’s internal feelings affect this “systems dysregulation”?

In the American Journal of Psychiatry, Drs. Stanley and Siever recently (January 2010) publish an article entitled “The Interpersonal Dimension of Borderline Personality  Disorder: Toward a Neuropeptide Model “ in which they seem to posit (in my interpretation again, since I am a lay person and not a doctor) that this systems dysregulation actually has another cause instead of being a “core cause’ of the disorder. They begin the article like this:

Borderline personality disorder is a complex disorder associated with substantial morbidity, mortality, and public health costs. Prominent symptoms include suicidal behavior, nonsuicidal self-injury, aggressive outbursts, and emotional reactivity, all of which typically manifest in an interpersonal context. For several years, there has been an ongoing discussion about whether impulsive aggression or affective dysregulation is at the core of the disorder. While these factors are important in borderline personality disorder, it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.

They go on to say this:

It is noteworthy that many symptoms in the interpersonal domain of borderline personality disorder are actually manifestations of intrapersonal difficulties (e.g., difficulty being alone and misperception of the intentions of others as malevolent), and this dimension could perhaps be reconceptualized as “intrapersonal dysfunction.” We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.

So, what’s afoot here? What are they saying and what does it mean to the nons of the world?

It seems to me that they are saying two very important things about BPD that has previously been “unnoticed” as DBT has reigned the clinical community. These are:

• “…it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.” Basically, that the interpersonal sensitivity is the “control” of is sensitive to the (emotional) heat.
• “We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.” That means that the lack of internal well-being makes the person with BPD sensitive to interpersonal cues.

What do those two important factors mean to you – the loved one or family member? In my mind they mean that a person with BPD uses people in close personal relationships to self-regulate. In other words, being unable to self-regulate internally, they look to external people to regulate their emotions, reactions, sense of well-being and behavior.  They believe at some level that you, the loved one, is an extension of their mind, emotions and feelings and assume to you “should know what to do” when they are feeling dysregulated.

What SHOULD you do when this situation occurs? What should you do when they are triggered? What should you avoid?

I believe that the most effective answer is to help them learn to self-regulate and self-validate. This “lack of well-being” is an unpleasant feeling (I would imagine) and probably feels like a HUGE lack of control. I mean, if a person has to rely on other (unpredictable) people to self-regulate, how must that feel? Having compassion for that feeling is definitely a goal. However, before that comes (and it can be cultivated BTW), one can listen, ask, redirect the choice, validate, normalize and cheer lead when appropriate. Don’t defend or minimize. Living a life in which you’re always waiting for the other shoe to drop has got to be unpleasant.

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Shame and Implicit Self-Concept in Women With Borderline Personality Disorder

* Nicolas Rüsch, M.D., Klaus Lieb, M.D., Ines Göttler, M.D.,
Christiane Hermann, Ph.D., Elisabeth Schramm, Ph.D., Harald Richter, Ph.D.,
Gitta A. Jacob, Ph.D., Patrick W. Corrigan, Psy.D., and Martin Bohus, M.D. *

*OBJECTIVE: *Shame is considered to be a central emotion in borderline personality disorder and to be related to self-injurious behavior, chronic suicidality, and anger-hostility. However, its level and impact on people with borderline personality disorder are largely unknown. The authors examined levels of self-reported shame, guilt, anxiety, and implicit shame-related self-concept in women with borderline personality disorder and assessed the association of shame with self-esteem, quality of life, and anger-hostility.

*METHOD: *Sixty women with borderline personality disorder completed self-report measures of
shame- and guilt-proneness, state shame, anxiety, depression, self-esteem, quality of life, and clinical symptoms. Comparison groups consisted of 30 women with social phobia and 60 healthy women. Implicit shame-related self-concept (relative to anxiety) was assessed by the Implicit Association Test.

*RESULTS: *Women with borderline personality disorder reported higher levels of shame- and guilt-proneness, state shame, and anxiety than women with social phobia and healthy comparison subjects. The implicit self-concept in women with borderline personality disorder was more shame-prone (relative to anxiety-prone) than in women in the comparison groups. After depression was controlled for, shame-proneness was negatively correlated with self-esteem and quality of life and positively correlated with anger-hostility.

*CONCLUSIONS: *Shame, an emotion that is prominent in women with borderline personality disorder, is associated with the implicit self-concept as well as with poorer quality of life and self-esteem and greater anger-hostility. Psychotherapeutic approaches to borderline personality disorder need to address explicit and implicit aspects of shame.

http://ajp.psychiatryonline.org/cgi/content/abstract/164/3/500

Related posts:

1. Role of Shame in BPD
2. Fear and Shame
3. Why Shame is Corrosive in a BP/Non-BP relationship

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I post this message here because I am doing a review of my postings and discovering content that can be helpful or relevant to the non-BPD people out there. This particular one concerns the shame, self-image and pain of someone with BPD.

[Male member of list to female member: You asked him to "modify" his behavior.  That literally means he needs to change.  And, as you wrote to me, if people feel they're right -- they'll feel they don't need to change.  In other words, he's good.]

My reply: I will respectfully and forcefully disagree. No, he is NOT fine and that is his very issue. He KNOWS he is flawed, he KNOWS he “needs” to change. He is shameful about himself. He uses tools to make himself feel better – to escape his suffering. Those tools are: alcohol and drugs, cutting, suicide attempts and raging. He does this not because he is being criticized, he does this because he believes deep down he DESERVES to be criticized. What works better is to give him new tools – but doing that non-judgmentally is the key.

Jealousy has the same root as the suffering. Of course he thinks he “should be appreciated” but it ain’t because he is not appreciated, it is his deep sense of shame that he doesn’t DESERVE to be appreciated that scares the shit out of him and makes him rage. He thinks “you’re not appreciating me”, then “you think I’m a loser” and then “I am a loser”. But when you are being threatened, you fight back. He feels threatened because he is being “found out”.

[Male member to me regarding female member’s husband’s words: What about the underlying positive stuff... the "I'm hot, I'm brilliant, I'm special, I'm sexy, I'm fascinating, I'm irresistible, everybody loves me, I'm meant to be famous, etc.”  What filter is that?]

My reply: That’s the “I don’t really believe this, but I’m going to say it so you will confirm/validate it so I might start to believe it”. It is the needy, sad, shameful self, desperately seeking approval. The filter ain’t what he says, it’s what he HEARS.

BPD is an emotional disease. It is a disability. I’m not trying to let anyone off the hook here, but I think that you have assumed that everyone is slightly neurotic, but basically mentally healthy and extended that to this husband with BPD. I disagree because he has a mental illness (an emotional illness actually) and he thinks in a different fashion than you do. Inside he is profoundly shameful and dreads judgment. If anyone even HINTS at that, he blows up – either in a rage or with self-injury or with drugs or whatever. He is using those things to escape his suffering and to hide his shame from even himself. Those tools work: cutting makes the pain go away – but they are not “healthy” tools. He desperately protects that shame and when she says: “We have to discuss money” he hears: “You are a no good son-of-bitch who is crazy and lazy”. Why? Because he is disordered and has disordered thoughts. He is afraid that she can see right through him and see the shameful broken person inside.

When working with a BP, you have to think about what they’re REALLY saying and you have to think about what they’re REALLY hearing as well.

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1. Role of Shame in BPD
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Are you and your BP on the same team?

When someone is highly emotional, they need to know that they have an advocate and that someone is on “their side.” I often ask my consulting clients (especially partners of people with emotional regulation issues) if they feel that their partner and they are “on the same team.” Many times the answer is no. Why does someone have a desire to have someone on their side, even when the “sides” are not desired, intended or even clearly delineated? The answer in my mind comes down to shame and rejection sensitivity.

If a person has shame (or even low self-worth, which is similar), then the person is likely to have a high level of rejection sensitivity. Being rejected by others is painful, especially for emotional people. Having an advocate of their “side” of the issue, which is essentially answering, “I am on your side no matter what the situation,” is tantamount in these highly emotional, social interactions that involve rejection. One can be “on their side” emotionally without condoning whatever behavior that one doesn’t agree with.

There are teaching moments and there are times that one doesn’t teach. If you try and teach, punish or impart values during a period of emotional dysregulation, the relationship will be damaged and nothing effective will be accomplished. Instead, emotional validation and support can be used to cool the bonfire. Once it is cool, then a teaching moment can present itself.

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Shame is corrosive to a relationship because it keeps the BP or NP in “pretend mode” where they are behaving “as if” they are engaged in the relationship, but in reality their only real goal is to protect themselves from discovery. The closer you get to it, the more panicked they become. Often the shame is never revealed to others and covered up with bullshit (in the art term, not the common term). If a person is bullshitting their way through something (and sometimes they bullshit themselves too) then they are not genuinely engaged in the relationship. THAT is corrosive, especially when it is discovered and you think “was this EVER real?” That’s what leads people to think BPs can’t really love. But the bullshit is a defense mechanism to protect against mind numbing shame. In fact it could be argued that all defenses are at some level bullshit (or pretending things are ok). Still, we need them on some level to protect us from the brutal truth at times. Acceptance is not bullshit, it is taking things how they really are. If a BP can’t accept themselves as they are (and want to change) then you’re in for a steaming pile of bullshit in the form of protecting their shame – and that is no way to have a genuine relationship. Still, if they had no defenses against experiencing shame, they would all commit suicide.

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1. Role of Shame in BPD
2. Blast from the Past – BPD, Shame and Self-Image
3. Fear and Shame

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If we look at the diagnostic criteria of BPD, I’d say some of those features are REQUIRED to have the disorder (again this is my opinion). From the DSM IV:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following – and the diagnosis only applies to 5 or more of ANY of these traits….

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

OK, almost EVERY borderline I have come into contact with or have learned about has this feature including my wife. I didn’t think this was a big deal in my wife until she went into a crisis with one of her close friends and she told me (about the friend) “Don’t touch abandonment! That’s my ISSUE!” Abandonment by her father has had DEEP wounds for her. However, while it is very common, I don’t think it is required.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

I think this is a requirement, but not a “distinguishing characteristic” of BPD. Nons would not have a problem if this wasn’t an issue. It’s about splitting – however, splitting is not a feature that is exclusive to BPD. You see it in other disorders (although it might not be a diagnostic feature of others). You see it in PTSD, you see it in emotional immaturity… it is a very common cognitive distortion.

3. identity disturbance: markedly and persistently unstable self-image or sense of self.

I don’t know if this is required. I think this could be replaced with pervasive SHAME (which IS required IMO). The sense of self is more than “unstable” – it seems a bit self-judgmental… the invalidating of one’s emotions leads to shame, because it is wrong to feel like one feels. I think that causes an “unstable sense of self” because people have (or you yourself have) invalidated your very essence. It is not OK to be the way you are, so you have to search for a different way to be – in vain. That’s where acceptance can help.

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 Criterion 5.

Personally, I think the impulsiveness is a requirement too. Maybe not the behaviors mentioned here… but BPs are in my experience incredibly impulsive. If you look at this from wikipedia you will see how other countries view BPD:

Comparable diagnoses

The World Health Organization’s ICD-10 has a comparable diagnosis called *Emotionally unstable* personality disorder – Borderline type (F60.31). This requires the following, in addition to the general criteria for personality disorder: disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual); liability to become involved in intense and unstable relationships, often leading to emotional crisis; excessive efforts to avoid abandonment; recurrent threats or acts of self-harm; and chronic feelings of emptiness.

The Chinese Society of Psychiatry’s CCMD has a comparable diagnosis of *Impulsive Personality Disorder (IPD)*. A patient diagnosed as having IPD must display “affective outbursts” and “marked impulsive behavior”, plus at least three out of eight other symptoms. The construct has been described as a hybrid of the impulsive and borderline subtypes of the ICD-10′s Emotionally Unstable Personality Disorder, and also incorporates six of the nine DSM BPD criteria.

5. recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior

Self-mutilating… probably not. Although I have known of many, many BPs that do cut, burn or pull at their hair. Or starve themselves. I think suicidal ideation is a given. According to some sources 75% of BPs attempt suicide at sometime in their lives.

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).

THIS is IMO the CORE feature of ERD (and possibly BPD if it is the same diagnosis – see WHO above). This – in combination with impulsiveness – seems to the the very foundation for BPD/ERD. I don’t think someone can have the disorder that I describe in my book (which I call BPD – or at least my experience with it) without this. This is the main thing the skills in my book try and address, because IMO this is the engine of all other feelings and behaviors. If this can be healed/managed most other things will fall away. Again I am NOT a doctor.

7. chronic feelings of emptiness

Probably important, but not required. I think many BPs DO feel this. It is difficult for me to see this from the outside (or for any non, unless the BP reveals it).

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

Again, this is probably required and is what gets most nons to seek help. I think this is an out-growth of emotional dysregulation and shame. They FEEL angry, because angry is a powerful emotion and a natural reaction to threat – even if the threat is “imagined” (although felt).

9. transient, stress-related paranoid ideation or severe dissociative symptoms

Well, this is a hard one. I have seen this in my wife a couple of times. She walked around talking to pillows as if they were people at one point. It’s tough to say if this is “required.”

So, I have a certain view of the disorder that I think works in most cases (but possibly not all). I would encourage you guys to read the book and try it out. It takes some time to figure out what I’m saying though… because of the above view of BPs/nons is slightly “unstandard”. Again I’m not a doctor.

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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.

New! An eBook that can help you in your relationship with someone with Borderline Personality Disorder. Beyond Boundaries is the next step in the evolution of the Non-BPD/BPD relationship.

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).

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I think that many BP’s get paranoid about their self-image with other people. The combo of fear of judgment – which they perceive as judgment of their emotions and therefore judgment of their SELF mixes with the shame they feel about their self. Am I off-base here?

My wife has told me she has felt shameful about “the way she is” for years. Does that lead to personalization and thus to paranoia?

What do you think?

Related posts:

1. Role of Shame in BPD
2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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http://www.soulselfhelp.on.ca/drm10shame.html

The Role of Shame in BPD
© Dr. Richard Moskovitz

Can you discuss shame? Is shame not one of the most significant core wounds that must be healed in order to recover from BPD?

Shame is fundamental to the experience of anyone with BPD and is the most crucial emotion that must be addressed if recovery is to occur. Shame is often confused with guilt, but these emotions have very different meanings. Shame is about who we are, while guilt is about what we do. Shame therefore reflects more lasting beliefs about the self than guilt. When we feel guilt, we expect retribution for what we’ve done. When we feel shame, we expect contempt from others and feel contempt for ourselves.

Shame is connected with a wealth of negative self-beliefs that may include fundamental assumptions of defectiveness, the belief that one is helpless to survive alone, beliefs about physical defectiveness (“I am fat, deformed, repulsive to others), mental defectiveness (I am stupid, incompetent, inarticulate), or sexual defectiveness, and the belief that one is unworthy of the love and attention of others.

We feel shame about anything about ourselves that we would prefer others not to see. The body language of shame is about being invisible or not acknowledging being seen by others. We become small in posture by slouching or turning away. We avert our gaze from that of others, which is reminiscent of a baby covering its own eyes and imagining that it has become invisible to others. As adults, however, failing to meet another’s gaze is also a sign of submission.

We also feel shame whenever we fall short of our own expectations of ourselves, however unrealistic they may be. Impossible goals, such as the total eradication of body fat, inevitably lead to deepening shame, which in turn may be reflected in an increasingly distorted self or body image. This is the cycle of shame that fuels the compulsive self-starvation of anorexia nervosa. Shame is therefore connected with the fantasy of how we imagine we are supposed to be and obstructs our vision of who we really are.

While shame has many roots, it is a natural consequence of abuse and neglect. What all forms of abuse have in common is the contempt that an abuser has for a victim. The deeper pain of being abused is the shame that derives from being an object of contempt. Many abusers show their contempt explicitly in the form of degrading words, but all abusers show contempt by their assumption that their victim’s primary role is as an instrument for their gratification. Shame in turn results in submissiveness that tends to perpetuate the cycle of abuse.

Dr. Donald Nathanson has pioneered the study of shame and its relationship to the psychotherapeutic process. He defines four categories of learned responses to shame, which he visualizes as the four points on a compass. On one axis lies “Withdrawal” at one pole and “Avoidance” at the other. On the other axis lie “Attack self” and “Attack others.”

“Withdrawal” behaviors include various forms of hiding from others, ranging from averting ones eyes and maintaining silence in the presence of others to reclusiveness and flight. Withdrawal can lead to isolation and feelings of abandonment, confirming the belief that we are unworthy of the company of others and therefore reinforcing shame.

“Attacking self” includes a repertoire of behaviors that are designed to protect us from abandonment at all costs. These are self-negating, submissive gestures that acknowledge the superior power of another, whose presence has become important to us. This can also contribute to the cycle of abuse.

“Avoidance” includes all the behaviors that are designed to keep from feeling the shame. This ranges from the use of drugs and alcohol to obliterate feeling to the distractions of sexual indulgence, materialism, and vanity. Avoidant behaviors include a variety of things we do to cover up the defects that we imagine others see in us. They are often cosmetic in quality and serve to distract both ourselves and others from these defects.

“Attacking others” includes a repertoire of desperate behaviors that serve to belittle others as a last ditch attempt to rescue self-esteem by feeling bigger at another’s expense. The attacks may come in words or actions. These behaviors inevitably distance us from others, again raising the threat of abandonment. These behaviors also result in shaming others and pass the wounds along.

These four kinds of responses to shame are all intricately interrelated, are self-defeating, and therefore perpetuate the cycle of shame. They are behind the many impulses with which people with BPD must struggle. They are connected with the terror of abandonment that characterizes BPD as well as with the difficulty that people with BPD have in achieving intimacy.

Related posts:

1. Role of Shame in BPD
2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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http://www.helium.com/tm/339437/individuals-suffering-borderline-personality

In which the author gives some insight and advice about “dealing with” someone with Borderline Personality Disorder. I’d like to look at her advice by excerpting some of her text and then offer a little commentary.

First of all, she says this:

Individuals suffering from borderline personality disorder are very self-destructive and they have great difficulty forming any good relationships. A deep-seeded fear of abandonment is behind every wayward action and prolonged mood swing. It’s [sic] victims are mainly women who show frequent displays of inappropriate anger and who exhibit forms of self-mutilation. They also act on impulse, without regards to consequences and than [sic] hold others responsible for their actions. They are sexually permissive and may indulge in binge eating and drug abuse. Victims of this disorder may shop lift. Hell bent on harming themselves, they live with no discipline or boundary.

While this characterization is generally true, it suffers from what wikipedia calls “weasel words”. Basically, the words that are used slant the information toward being extremely judgmental. What I mean is the use of the words “great difficulty forming any good relationships,” “every wayward action and prolonged mood swing,” “show frequent displays of inappropriate anger,” and “they live with no discipline or boundary” all show us that the author is judgmental toward the sufferer. The idea of “prolonged mood swing” is incorrect as well, since the “moods” of a person with BPD generally last only hours. Also, the idea that “they are sexually permissive” MAY be true for some of the sufferers, but not for all. The idea that a “fear of abandonment is behind EVERY wayward action” is also incorrect. Much of the “actions” are motivated by pain relief and/or shame. Use of the words “no discipline” betrays the authors true feelings about people with the disorder and tells me she doesn’t understand the disorder very well (see below on “Tough Love”).

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The author goes on to say:

Group therapy can resolve self-destructive behaviors. These individuals learn better from their peers because of their resistance to authority. Impulse behavior can be curtailed in this same setting.

Which is basically wrong. Group therapy does work (especially in the context of DBT), but not for the reasons that the author suggests. It is not a “resistance to authority” that drives the effectiveness of group therapy. Instead, seeing that one is not the only sufferer and having the ability to support one another normalizes the disorder. You are not just the broken, shameful person that you feel you are. Interestingly, many people with BPD will criticize others in the group and report that they are not as “crazy” as those people are.

The thing I have the most problem with is this:

Tough love may be needed from family members and loved ones before the person asks for assistance.

This statement is completely false and possibly harmful. Here is the text of a post of mine in the ATSTP group which addresses Tough Love:

Depending on the actual problem with your son(s) the idea of “tough love” might be the worst thing for him (them). While it seems to work for substance abuse, tough love can be an awful mixture for those with ERD-like issues. The problem comes down to the “invalidating environment” as Marsha Linehan puts it. Tough love will invalidate a person’s basic feelings and lead to shame and the feeling of “brokenness”. I have seen this first-hand with one of my daughter’s friends. This friend is 16 now and is a classic BPD/ERD case. She has been kicked out of several “lock down” facilities. Recently her mother sent her to a “tough love”/boot camp. It was a total disaster for the kid and for the family.

A better approach IMO, is emotional validation + a sense of personal responsibility. This combination is built through letting the person know that feelings are not wrong or right, they just ARE. The second half comes through building mastery over their behavior associated with feelings. Bad feelings just exist. This is important because often a person with such issues will use behaviors (like drug abuse or cutting or raging) to make the bad feelings go away as quickly as possible. They need to learn to tolerate the distress and behave in an effective manner. Once this new behavior/reaction to feelings is practiced, they can eventually build mastery over the behaviors. This works backward to help quell the feelings.

It seems that most parents believe that emotional validation = “giving in” (or agreeing with the child or “poor discipline” or whatever). This is NOT the case. It’s difficult for me to express this more firmly. Remember the word “emotional” is important. If you validate invalid behavior, you are enabling. It is important to separate in your mind the emotions (which are natural) from the behavior (which can be painful to all involved). If that separation can be communicated to the person with ERD, it can be worked with. It is difficult, but possible.

Unfortunately, tough love is not the answer.

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Have you ever had your loved one ask you: “Are you mad at me?” Or has your loved one asked you: “Do you like me?” over and over again. Or have they said, “You could do so much better than me. Why are you even with me?”

These questions and others like them are indications that your loved one is suffering from rejection sensitivity. Someone with rejection sensitivity will also avoid tasks, meetings or other social interactions if there is any sense of rejection implied. They are unlikely to initiate social interaction or close personal contact. Often when forced to be in social situations, someone with BPD will constantly scan other people’s reactions for disapproval or rejection. They might rely on others from whom the signals of possible rejection are less strong. In other words, they might ask you to do things for them (like make phone calls or attend meetings at school), rather than risk social rejection themselves. This adaptation to rejection sensitivity is avoidance.

When actual rejection occurs or is perceived by someone with this feature, especially when the rejection originates with someone that the person with BPD is important to them, rage and even violence can occur. The person with BPD who perceives that he or she has been rejected by a significant person (one from which they are less likely to expect rejection), the person with BPD “becomes hostile not in general but specifically in reaction to potential rejection from a significant or important person.” [Miscal, 1996, quoted from Hamel, John & Nichols, Tonia, “Family Interventions in Domestic Violence”, page 126]

This feature is closely related to shame and to the fear of judgment. In both cases a person with BPD will judge themselves harshly because of the shame (they are a bad person) and will reject themselves (I don’t deserve acceptance). Additionally (and perhaps ironically), they may lash out, rage at or abuse people who do offer them acceptance, because they feel, based on their deep seated feelings of deserved rejection, they don’t deserve acceptance. They expect rejection because they deserve rejection. In this way, the feelings around acceptance versus rejection are a “no win” situation for you – if you reject the person with BPD, they get angry, if you accept them, they may judge you as “stupid for accepting someone as bad as me.”

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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.

No related posts.

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A quote:

“Invalidation is to reject, ignore, mock, tease, judge, or diminish
someone’s feelings. Constant invalidation may be one of the most
significant reasons a person with high innate emotional intelligence
suffers from unmet emotional needs later in life.(1) A sensitive child
who is repeatedly invalidated becomes confused and begins to distrust
his own emotions. He fails to develop confidence in and healthy use of
his emotional brain– one of nature’s most basic survival tools. To
adapt to this unhealthy and dysfunctional environment, the working
relationship between his thoughts and feelings becomes twisted. His
emotional responses, emotional management, and emotional development
will likely be seriously, and perhaps permanently, impaired. The
emotional processes which worked for him as a child may begin to work
against him as an adult. In fact, one defintion of the so-
called “borderline personality disorder” is “the normal response of a
sensitive person to an invalidating environment” (2)  ”

And another quote:

“Telling a person she shouldn’t feel the way she does feel is akin to
telling water it shouldn’t be wet, grass it shouldn’t be green, or
rocks they shouldn’t be hard. Each persons’s feelings are real.
Whether we like or understand someone’s feelings, they are still real.
Rejecting feelings is rejecting reality; it is to fight nature and may
be called a crime against nature, “psychological murder”, or “soul
murder.” Considering that trying to fight feelings, rather than accept
them, is trying to fight all of nature, you can see why it is so
frustrating, draining and futile. A good guideline is:

First accept the feelings, then address the behavior.

One the great leaders in education, Haim Ginott, said this:

Primum non nocere- First do no harm. Do not deny your teenager’s
perception. Do not argue with his experience. Do not disown his
feelings.

We regularly invalidate others because we ourselves were, and are
often invalidated, so it has become habitual. Below are a few of the
many ways we are invalidated:

We are told we shouldn’t feel the way we feel
We are dictated not to feel the way we feel
We are told we are too sensitive, too “dramatic”
We are ignored
We are judged
We are led to believe there is something wrong with us for feeling how
we feel”

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1. Role of Shame in BPD
2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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As for lying, I believe that all people lie (or are willing to lie) when the truth is too painful to be told – even if that feeling of pain is not based in reality. Do BPs lie more than other people? My short answer is “Yes”.

I think the main reason is because of the intense sense of shame that they feel. I have come to realize that shame is the core emotional component of BPD. I have also come to realize that many people mistake PTSD for BPD (although BOTH can be part of the mix,my wife has both components). In PTSD FEAR is the key emotional component. In depression, it is sadness. In Intermittent Explosive Disorder it is anger.

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Get the Non-BPD book that is designed for
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BPD is a “personality” disorder because shame is not a “primal”emotion – like fear, anger, joy, sadness, disgust and contempt. No,shame is an emotion evoked in relationship to other people’s senseof judgment. You can’t feel shameful without a sense that what you’re doing (or, in the case of BPD, what you ARE) is “wrong”.

All people have different capabilities for handling emotions. BPs seem to have a diminished capacity for handling theirs – and, since shame is key, they are more likely to “hide” the truth (even from themselves). In the case of lies, if they feel that the truth would reveal something shameful, they lie IMO. In the case of my wife, she lies if she feels that she will be judged for telling the truth.That is where the shame component arises. If she feels that I (or anyone) will judge her behavior (really, her feelings) as “wrong”or “bad”, she will likely lie, either by admission (actually sayingsomething that is not true) or omission (leaving out the truth). The deal seems to be that she feels the shame in telling the truth, that shame is painful (as it is for everyone) and to avoid that pain, she lies. In other words, her lies are all about protecting herself frompain and judgment (even self-judgment) and have nothing to do with me. It is not personal.

If avoidance of pain is considered “disassociation” (which in some cases avoidance of intense pain DOES cause real disassociation),then I think you could say that she “disassociates” from the painful truth.

On a final note, I also believe that this shame-sense is misplaced.They have nothing to FEEL ashamed of – sure, they do all kinds of “shameful” things, but only in relation to other people. If my wife cuts herself, she does so without shame and not to get other people’s attention. Still, at the core of her being is a sense ofshame – like she has a deep, dark secret she must protect – even though there’s no real secret there. I suspect this comes from the BP’s shaky sense of self. She will do anything (including lie) to protect what’s not even there.

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2. BPD and Lying – again…
3. Why Shame is Corrosive in a BP/Non-BP relationship

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Version A) they are just born that way. THEY are not even sure of what they are ashamed of. They carry around three core beliefs: “The world is dangerous and malevolent”, “I am powerless and vulnerable” and “I am inherently unacceptable.” But they don’t know WHY – they have just always been that way. The only reason that I can gather is that they have labile emotions and they lead to an unstable sense of self. That instability is what they are ashamed of (and scared anyone and everyone will know). It’s like a nightmare in which you’ve pissed your pants and you hope to god no one will notice. That’s the shame component as far as I can tell. It’s not about anyone other than themselves.

Version B) Same as version A but caused by the environment.

Oh and version C – mix and match versions A & B.

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1. Role of Shame in BPD
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3. Toxic Shame

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Dr. Donald Nathanson has pioneered the study of shame and its relationship to the psychotherapeutic process. He defines four categories of learned responses to shame, which he visualizes as the four points on a compass. On one axis lies “Withdrawal” at one pole and “Avoidance” at the other. On the other axis lie “Attack self” and “Attack others.”
“Withdrawal” behaviors include various forms of hiding from others, ranging from averting ones eyes and maintaining silence in the presence of others to reclusiveness and flight. Withdrawal can lead to isolation and feelings of abandonment, confirming the belief that we are unworthy of the company of others and therefore reinforcing shame.
“Attacking self” includes a repertoire of behaviors that are designed to protect us from abandonment at all costs. These are self-negating, submissive gestures that acknowledge the superior power of another, whose presence has become important to us. This can also contribute to the cycle of abuse.

“Avoidance” includes all the behaviors that are designed to keep from feeling the shame. This ranges from the use of drugs and alcohol to obliterate feeling to the distractions of sexual indulgence, materialism, and vanity. Avoidant behaviors include a variety of things we do to cover up the defects that we imagine others see in us. They are often cosmetic in quality and serve to distract both ourselves and others from these defects.

“Attacking others” includes a repertoire of desperate behaviors that serve to belittle others as a last ditch attempt to rescue self-esteem by feeling bigger at another’s expense. The attacks may come in words or actions. These behaviors inevitably distance us from others, again raising the threat of abandonment. These behaviors also result in shaming others and pass the wounds along.

Related posts:

1. Runaway Shame?
2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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Beck is a CBT theorist who sets forth the “schema” approach to fixing the self. DBT uses the “emotional dysregulation” approach. What I found interesting about the above quote is that borderlines themselves identify with it as if it completely describes them. Clearly, the shame aspect is there (I am inherently unacceptable) as well as the fear aspects.

As for the “powerless and unacceptable” I find it interesting that borderlines also play the other side of the argument – that is, I am tough, I am powerful, etc. This aspect, I suppose, is why the whole “trip to Oz” myth came about – that they are the allpowerful wizard, but, as I have said in other posts, they are really Dorothy (small and meek).

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…study of James Masterson’s work on borderline personalities, as well as my experience with watching his working films, convinces me that there is minimal difference in the treatment of some toxically shame-based people and his treatment of the Borderline Personality.

Don’t see shame in your borderline? Look more carefully.http://www.soulselfhelp.on.ca/tshame.html

Related posts:

1. Role of Shame in BPD
2. Blast from the Past – BPD, Shame and Self-Image
3. Fear and Shame

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