Ruji, a new commenter on this blog (and the maker of the personality disorder buttons I have featured in the sidebar), made an interesting observation–that BPD should be divided into at least two subtypes: Empathy Challenged/Character Disordered (closer to NPD/ASPD) and Highly Sensitive Person with Emotional Dysregulation (closer to the type I have, although at different times in my life or when extremely stressed I have displayed the more character-disordered subtype). I agree with her. Ruji’s idea is remarkably similar to The World Health Organization’s two subtypes of BPD:
1. F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):
–marked tendency to act unexpectedly and without consideration of the consequences;
–marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
–liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
–difficulty in maintaining any course of action that offers no immediate reward;
–unstable and capricious (impulsive, whimsical) mood.
2. F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:
–disturbances in and uncertainty about self-image, aims, and internal preferences;
–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.
–demonstrates impulsive behavior, e.g., speeding, substance abuse
Psychologist Theodore Millon has gone even further, proposing that BPD should be divided into four subtypes:
1. Discouraged (including avoidant features): Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.
2. Petulant (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.
3. Impulsive (including histrionic or antisocial features) Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.
4. Self-destructive (including depressive or masochistic features) Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.
Millon’s Types 1 and 4 would correspond to the Highly Sensitive Person/Emotional Dysregulation type mentioned above (and therefore closer to the Avoidant/Dependent PDs); Type 2 sounds very much like NPD; and Type 3 seems closer to ASPD or Histrionic PD.
There are so many diverse–almost opposite–symptoms that can appear with this disorder that one person with BPD can be very different from the next. In fact, you can take 10 borderlines and they will all seem very different from each other, with barely any similarities in their behavior at all. One will be shy, fearful and retiring, never making waves, acting almost like an Aspie or an Avoidant; while another may break the law, lie constantly, and act obnoxious and rage whenever things don’t go their way. A borderline could be your raging boss who drinks too much and ends every annual Christmas party with one of his infamous rages, or it could be the sweet and pretty schoolteacher who goes home every night and cuts herself. She could be the come-hither seductress or the nerdy computer programmer. He may have few or no friends or a great many.
This diversity is not the case with the other personality disorders, which have more cohesiveness in the symptoms their sufferers display. So I wonder–is BPD really a personality disorder at all? Does it even exist, or is it really just a group of trauma-caused symptoms the experts in their ivory towers stuck in a single box called “BPD” because they didn’t know how else to classify them?
In fact, all these diverse subtypes have one thing in common–they are all very similar or identical to the symptoms of someone with complex PTSD (C-PTSD). People with C-PTSD are often misdiagnosed as Borderlines because their behaviors can be just as baffling and manipulative, and both disorders also include dissociative, almost psychotic episodes. Extrapolating from that, I wonder if ALL borderlines actually have C-PTSD.
Earlier today I posted an article outlining 20 signs of unresolved trauma, and I was struck by how similar these were to the symptoms of BPD. And there is also this article that Ruji just brought to my attention that also describes how remarkably similar the two disorders are, but that the idea of fear of abandonment (which is recognized as the root cause of BPD) is not recognized as a factor in causing PTSD and that may be part of why they have been kept separate.
The BPD label, like any Cluster B label, is very damaging to its victims because of the “evil and character-disordered” stigma it carries. One psychologist has even included us, along with narcissists, among the “People of the Lie”!
Yes, it’s true some borderlines do act a lot like people with NPD or even Malignant Narcissism or ASPD, but most probably do not, and are really much more similar to people with Avoidant or even Dependent personality disorders, which hurt the sufferer more than anyone else. But if you have a BPD label, people start backing away from you slowly due to the stigma. Therapists are reluctant to treat you because they assume you will be either difficult and hateful in therapy sessions, or will never get better. Insurance companies won’t pay claims where there is a BPD diagnosis, because it’s assumed there is no hope for you. I’ve had this problem when I’ve tried to get therapy. I remember one therapist who I had seen for the intake session, who told me he needed to obtain my psychiatric records before we could proceed. The session had gone smoothly and I felt comfortable with him. A few days later I received a phone call and was told he did not treat “borderline patients” and wished me luck. So that’s the kind of thing we’re up against if we’ve had the BPD label slapped on us.
Also, as an ACON blogger who works with a lot of victims of narcissistic abuse, my BPD label sometimes makes people wary of me and they begin to doubt that my motives here are honest. At first I was reluctant to talk about my “Cluster B disorder” here, because I knew it might be a problem for some ACONs, who think borderlines are no better than narcissists. But I eventually decided that to hide it away like an embarrassing family secret would be misleading so I “came out” about having BPD (I never actually lied about it, but played it down in the beginning and rarely mentioned it). I’m glad I fessed up, but there have been a few people who left this blog after I came out about it or began to doubt my motives. So there’s that stigma and it’s very damaging.
Both C-PTSD and Borderline PD are caused by trauma. Both are complex defensive reactions against future abuse and both involve things like splitting, dissociation, psychotic episodes, self-destructiveness, wild mood swings, and behavior that appears to be narcissistic and manipulative.
The way I see it, the only real difference between C-PTSD and BPD is that the traumatic event or abuse happened at an earlier age for someone with BPD, perhaps during toddlerhood or infancy, while all forms of PTSD can happen at a later age, even adulthood. But the symptoms and defense mechanisms used to avoid further trauma are the same for both.