I have spent a lot of time reading and researching psychopathology and sociopathy. This past year a friend introduced me to the borderline personality diagnosis. I found the two links below and the excerpt very helpful in dealing with the questions I have asked myself regarding how I fell into the same hole AGAIN!
Sociopaths/Psychopaths and Borderlines have similar qualities. But where the Socio/Psychopath uses charisma, the Borderline uses excessive valuation which of course becomes an equal and opposite devaluation.
The socio/psychopath craves power and is extremely masochistic in their enjoyment of the effects of their cruelty and the way they cause suffering in others.
The Borderline while equally lacking in empathy for others, appears from the literature, to be fueled by more emptiness, insecurity, anxiety, transference and projection.
THIS SHOULD NOT PROVOKE EMPATHY FOR EITHER FROM YOU: THEIR VICTIMS!
Both can wipe out a home, a family, a community in an instant with no remorse. Both can rationalize and justify their behavior. Both are the victims because someone other than themselves really did it. Both can profess love and affection while the knife is turning inside your back.
I suspect that the diagnosis would actually be multi-layered and might include bipolar disorder, schizophrenia and narcissistic personality disorder and anti-social disorder among other categories in the DSM-IV.
I can imagine that many domestic and intimate partner abusers would fit one or more of these diagnosis.
So how do we defend ourselves?
The first and only step I know to work, may be the hardest to take. The first step is to trust and follow your first instinct No Matter What It Says. Accept It without question. At the first sign of discomfort...move on and drop the relationship. No matter how good it feels, that instinct is a foreshadowing of what is to come.
I ignored mine. I even joked about how wrong it was till I learned that it was dead on accurate. More accurate than what I saw with my own eyes.
Trust your instincts, they are Always, ALWAYS, right for you.
http://gettinbetter.com/fallout.html
http://en.wikipedia.org/wiki/Borderline_personality_disorder
Borderline personality disorder
From Wikipedia, the free encyclopedia
| Borderline personality disorder | |
|---|---|
| Classification and external resources | |
| ICD-10 | F60.3 |
| ICD-9 | 301.83 |
| MedlinePlus | 000935 |
| eMedicine | article/913575 |
| MeSH | D001883 |
The disorder typically involves unusual levels of instability in mood and black-and-white thinking, or splitting. BPD often manifests itself in idealization and devaluation episodes and chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.[1] It generally affects persons over the age of eighteen years, although it is also found in adolescents.
Splitting in BPD includes a switch between idealizing and demonizing others. This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. BPD disturbances also may include harm to one's self.[2] Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.[n 2]
There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline,[3] and some have suggested that this disorder should be renamed.[4] The ICD-10 manual has an alternative definition and terminology to this disorder, called Emotionally unstable personality disorder. There is related concern that the diagnosis of BPD stigmatizes people and supports pejorative and discriminatory practices.[5]
[edit] Signs and symptoms
Borderline personality disorder is a diagnosis about which many articles and books have been written but about which little is known based on empirical research.[6]Studies suggest that individuals with BPD tend to experience frequent, strong and long-lasting states of aversive tension, often triggered by perceived rejection, being alone or perceived failure.[n 3] Individuals with BPD may show lability (changeability) between anger and anxiety or between depression and anxiety[7] and temperamental sensitivity to emotive stimuli.[8]
The negative emotional states specific to BPD may be grouped into four categories: destructive or self-destructive feelings; extreme feelings in general; feelings of fragmentation or lack of identity; and feelings of victimization.[9]
Individuals with BPD can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, promiscuous and intense sexuality, gambling and recklessness in general.[10] Attachment studies have revealed a strong association between BPD and insecure attachment style, the most characteristic types being "unresolved", "preoccupied", and "fearful".[11] Evidence suggests that individuals with BPD, while being high in intimacy- or novelty-seeking, can be hyper-alert[6] to signs of rejection or not being valued and tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.[12] They tend to view the world as generally dangerous and malevolent.[6]
Individuals with BPD are often described, including by some mental health professionals (and in the DSM-IV),[13] as deliberately manipulative or difficult, but analysis and findings generally trace behaviors to inner pain and turmoil, powerlessness and defensive reactions, or limited coping and communication skills.[14][15][n 4] There has been limited research on family members' understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members.[16] However the effect of expressed emotion by family members may actually be opposite (paradoxical) from the anticipated effect on individuals with such illnesses as depressive disorders and schizophrenia. For BPD such effect may be neutral or positive as opposed to negative, a counter-intuitive result.[17]
Parents of individuals with BPD have been reported to show co-existing extremes of over-involvement and under-involvement.[18] BPD has been linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.[19]
Suicidal or self-harming behavior is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging.[20] The suicide rate is approximately 8 to 10 percent.[21][22] Self-injury attempts are highly common among patients and may or may not be carried out with suicidal intent.[23][24] BPD is often characterized by multiple low-lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high-lethality attempts that are attributed to impulsiveness or comorbid clinical depression, with interpersonal stressors appearing to be particularly common triggers.[25] Ongoing family interactions and associated vulnerabilities can lead to self-destructive behavior.[18] Stressful life events related to sexual abuse have been found to be a particular trigger for suicide attempts by adolescents with a BPD diagnosis.[26].
[edit] Diagnosis
Diagnosis is based on a clinical assessment by a qualified mental health professional. The assessment incorporates the patient's self-reported experiences as well as the clinician's observations. The resulting profile may be supported or corroborated by long-term patterns of behavior as reported by family members, friends or co-workers. The list of criteria that must be met for diagnosis is outlined in the DSM-IV-TR.[1]Borderline personality disorder was once classified as a subset of schizophrenia (describing patients with borderline schizophrenic tendencies). Today BPD is used more generally to describe individuals who display emotional dysregulation and instability, with paranoid ideation or delusions being only one criterion (criterion #9) of a total of 9 criteria, of which 5, or more, must be present for this diagnosis.
[edit] Diagnostic and Statistical Manual
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[1][13]- A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
-
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
- 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).
- Chronic feelings of emptiness
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms
[edit] International Classification of Disease
The World Health Organization's ICD-10 defines a conceptually similar disorder to borderline personality disorder called (F60.3) Emotionally unstable personality disorder. It has two subtypes described below.[27]- F60.30 Impulsive type
- marked tendency to act unexpectedly and without consideration of the consequences;
- marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
- liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
- difficulty in maintaining any course of action that offers no immediate reward;
- unstable and capricious mood.
- F60.31 Borderline type
- 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;
- chronic feelings of emptiness.
[edit] Chinese Society of Psychiatry
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.[28][edit] Millon's subtypes
Theodore Millon, a psychologist noted for popular works on personality disorders, has unofficially proposed four subtypes of borderline.[n 5][n 6] He suggests an individual diagnosed with BPD may exhibit none, one or more of the following:- Discouraged borderline — including avoidant, depressive or dependent features
- Impulsive borderline — including histrionic or antisocial features
- Petulant borderline — including negativistic (passive-aggressive) features
- Self-destructive borderline — including depressive or masochistic features
[edit] Family members
It is common for those with borderline personality disorder and their families to feel their problems compounded by a lack of clear diagnoses, effective treatments, and accurate information. This is true especially because of evidence that this disorder originates in the families of those with it[18] and has a lot to do with psychosocial and environmental factors (Axis IV), rather than belonging strictly in the personality disorders and mental retardation section (Axis II) of the DSM-IV construct. Conceptual, as well as therapeutic, relief may be obtained through evidence that BPD is closely related to traumatic events during childhood and to post-traumatic stress disorder (PTSD), about which much more is known.[29] Recovery can be faster with the help of family members and loved ones, however those involved must be trained for their assistance to have an effective impact. [1][edit] Adolescence
Onset of symptoms typically occurs during adolescence or young adulthood. While borderline personality disorder can manifest itself in children and teenagers, therapists are discouraged from diagnosing anyone before the age of 18, due to adolescence and a still-developing personality. There are some instances when BPD can be evident and diagnosed before the age of 18. The DSM-IV states: "To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year." In other words, it is possible to diagnose the disorder in children and adolescents, but a more conservative approach should be taken.There is some evidence that BPD diagnosed in adolescence is predictive of the disorder continuing into adulthood. It is possible that the diagnosis, if applicable, would be helpful in creating a more effective treatment plan for the child or teen.[1][30]
[edit] Differential diagnosis
Comorbid (co-occurring) conditions are common in BPD. When comparing individuals diagnosed with BPD to those diagnosed with other personality disorders, the former showed a higher rate of also meeting criteria for[31]- anxiety disorders
- mood disorders (including clinical depression and bipolar disorder)
- eating disorders (including anorexia nervosa and bulimia)
- and, to a lesser extent, somatoform or factitious disorders
- dissociative disorders
- Substance abuse is a common problem in BPD, whether due to impulsivity or as a coping mechanism, and 50 percent to 70 percent of psychiatric inpatients with BPD have been found to meet criteria for a substance use disorder, especially alcohol dependence or abuse which is often combined with the abuse of other drugs.[32]
Some hold that BPD represents a subthreshold form of affective disorder,[38][39] while others maintain the categorical distinction between the disorders while noting they often co-occur.[40][41] Some findings suggest BPD lies on a bipolar spectrum, with a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders.[42][43] Other findings suggest that the DSM-IV BPD diagnosis mixes up two sets of unrelated items—an affective instability dimension related to Bipolar-II, and an impulsivity dimension not related to Bipolar-II.[44]
General medical conditions can cause behavioral dysfunction resulting in a clinical picture that may resemble to some degree BPD. This may include hormonal dysfunction over a long period, and brain dysfunction (e.g. the encephalopathy caused by lyme disease).[citation needed] These conditions may isolate the patient socially and emotionally, and/or cause limbic damage to the brain. However, it is not BPD that results, but rather a reaction to the isolating circumstances caused by a medical condition and the possibly coincident struggles of the patient to control his or her mood given damage to the brain's limbic system. Heavy alcohol usage over a long period itself can cause an encephalopathy which may cause limbic damage, and various frontal lobe syndromes can also result in disinhibition and impulsive behavior resembling BPD.[citation needed]
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