The Cluster B stigma and the nature of evil.

evil_face

I don’t care if what I’m about to say is controversial or unpopular.

There are some folks in the ACON community who think ALL narcissists are evil, and some think all BPDs are evil too. (In fact there are some BPDs who are worse than some narcs).
It’s understandable why people feel that way (and I did for a time myself), but the people who abused them were usually high spectrum malignant narcissists or sociopaths so they think all narcissists (and even all Cluster Bs) are as bad as the abusive or rejecting parents who raised them.

cluster_b

The stigma against Cluster B disorders is very pervasive and it’s getting worse. NPD used to just be a psychiatric diagnosis. Now it’s a condemnation to hell. Even if a low-mid spectrum narc or a borderline is self aware and wants to get better, they’re still put in the “evil” box along with the malignants, psychopaths and sociopaths. It’s always assumed they “have an agenda” or are “full of shit” and everything they say is a lie. I wondered why hearing people say this used to bother me; now I know why. It hurt my feelings because inside, I already knew I was one. I’m self-identified now and really, really want to change and every word I say on my blogs is my reality and truth. It’s my true self speaking, always. I think.

Cluster B’s are cut no slack by some ACONs. We are told we deserve no sympathy even though we were abused too and were victims too. This is extremely damaging to those of us who want to be rid of our Cluster B disorders.

The Cluster B stigma also makes it hard for those of us who want treatment to find it. Many therapists won’t get near someone with NPD or BPD with a 100 foot pole. I remember one therapist I had an intake session with, who I felt comfortable with, but said he’d need to order my psychiatric records before we could go any further.
A few days later he called me and said, “I’m sorry but I don’t treat Borderlines.”
Even if a therapists is willing to see someone with a Cluster B disorder, most insurance companies or government-funded health insurance like Medicaid or Medicare won’t pay a claim for a “Cluster B diagnosis” because it’s assumed they’re incurable. So we are given some other diagnosis instead and treated for THAT disorder (such as depression or anxiety) which doesn’t get to the root of our real problem but only treats symptoms.

victim_badge

People who judge and demonize all narcissists are doing exactly what NPDs and BPDs are so well known for-–engaging in black and white thinking. They don’t believe or realize that narcissism is a spectrum disorder and those in the bottom half of the spectrum probably aren’t evil, even if they’re usually PITAs.

I know there will be some of you who will disagree. That’s fine and we can agree to disagree. I’ll hold to my belief that narcissism is a spectrum disorder with many shades of gray ranging all the way to black (evil).

So what is evil? Evil to me means a person who wants to bring harm to others and has no remorse over what they do and doesn’t care about the suffering they cause–and even enjoys it. It’s a person who goes out of their way to hurt others. It’s a person who tries to destroy the reality or the soul of another human being. It’s a person who never feels guilt or shame over their actions and has no empathy for the pain they cause. All evil people (as far as I know) are of the Cluster B persuasion and most are narcissists (or ASPDs), but not every narcissist or borderline is evil.

To really get a handle on what evil is, Dr. M. Scott Peck’s book “People of the Lie” is the best analysis out there. Most of the stories in his book describe people who would today be called malignant narcissists (high spectrum narcissists with antisocial traits).

Is BPD a real disorder or should it be eliminated as a diagnosis?

bpd_treatments
The myriad ways experts “see” borderline personality disorder. (click to enlarge)

There’s a great deal of confusion and disagreement in the professional literature about the nature of Borderline Personality Disorder. The blogger BPDTransformation (whose blog is excellent if sometimes a little on the scholarly side), who was cured of BPD, thinks the label should simply be done away with and that BPD doesn’t really exist at all–the label being merely a placeholder for a group of symptoms that are widely variable, and that experts can’t even agree on. He believes BPD is categorized as a Cluster B (dramatic/emotional) disorder only because mental health experts can’t decide where else to put it.

The stigma of BPD as a Cluster B disorder.

borderline_stigma

The problem with labeling BPD in the Cluster B category of personality disorders is the stigma that classification carries–that people with BPD (like those with NPD or ASPD) are evil, untrustworthy, selfishly manipulative, grandiose, dishonest, lack empathy, and really no better than people with malignant narcissism or even ASPD. (It sure doesn’t help any that an obviously sociopathic criminal like Jodi Arias has a diagnosis of BPD, when she more likely fits the criteria for high spectrum [malignant] narcissism, at the very least.) Insurance companies assume anyone with a Cluster B disorder is incurable, and therefore will not pay claims where a person is diagnosed with a Cluster B disorder. This is very damaging to those of us with BPD who have either successfully learned to modify and control our symptoms–or have even been cured, as BPDTransformation has been. People continue to believe we are lying about the success of the treatments or therapy we have received. Borderlines who have never been treated may find it difficult to find a therapist willing to work with them.

BPD is far more amenable to deep insight therapy than NPD (which is extremely difficult to cure but not impossible for non-malignants) and light years away from a disorder like ASPD (antisocial personality disorder), which can probably not be cured. Because the symptoms of BPD are so disagreeable to the sufferer (and not just to others), it is common for borderlines to present themselves for therapy, unlike people with NPD or ASPD. The vast majority or borderlines are unhappy with themselves and the way their lives have turned out. But many therapists won’t work with borderlines (other than with behavior modification treatments like DBT) because they know insurance companies will not pay such a claim.

What are borderlines on the border of, anyway?

tightrope

The name “borderline” itself is confusing. What are borderlines on the border of anyway? Neurosis and psychosis? A normal sense of self and Narcissism? Mexico and the United States?

The experts are all over the map on this, with some recent theories stating that BPD is actually a less adaptive, more ego-dystonic form of narcissism. But the original term “borderline” actually referred to the belief that the disorder was on the “border” between psychosis and neurosis:

[…]It is called borderline because it was originally thought that people were on the ‘border’ of psychosis and neurosis. BPD is also sometimes called Emotionally Unstable Personality Disorder (Borderline type). Approximately 75% of people given this diagnosis are women and 50% have experienced physical and/or sexual abuse.

Because BPD is more commonly diagnosed in women than in men, it’s also been referred to as the female form of narcissistic personality disorder (which is more commonly diagnosed in men than in women).

Psychotic, neurotic, both, or none of the above?

bpd (1)
Credit: Judgybitch/Dzhokhar Tsarnaev

The reason why BPD is sometimes regarded as the midpoint between neuroses (mild and easily treated anxiety or depressive disorders) and psychoses (disorders where the victim is out of touch with reality, such as schizophrenia and the manic-depressive form of bipolar disorder) is because people with BPD can, when emotionally upset, display psychotic or delusional symptoms such as splitting (black and white thinking), dissociation (feelings of unreality either about the self or the environment), magical thinking, severe paranoia, delusions of grandeur or persecution, and sometimes even hallucinations and disorganized speech or thought. However, for a borderline, these psychotic symptoms don’t last and as soon as the emotional crisis has passed, the borderline’s “sanity” normally returns. Antipsychotic medication can be helpful, but isn’t always necessary, as it usually is for a truly psychotic individual.

Others have speculated that BPD is really a severe form of PTSD or C-PTSD caused by trauma, and should be treated the same way as PTSD. Personally, I think it’s more long-standing than a reactive disorder like PTSD and is a true personality disorder, but it does make sense that BPD may have originally begun as a form of PTSD at an early age, often due to sexual abuse.

There is so much confusion and contradiction in the literature about BPD that I’m slowly coming around to BPDTransformation’s way of thinking that it should possibly be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) until mental health professionals can get a better handle on what BPD actually is, and whether it’s even a valid diagnosis (or simply a group of symptoms that could indicate several other disorders). There should at least be more agreement among the professionals at any rate.