Why we must start trying to help “Cluster B” people instead of stigmatizing them.

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#22 – Proof That Borderlines Are Motivated for Psychotherapy and Can Fully Recover

BPDTransformation used to be one of my commenters but has not posted anything in his blog in over a year, or made any more comments here.   Edward (his real name) wrote fascinating, intelligent, and extremely well researched articles about BPD, which he was diagnosed with. At some point he came to believe BPD was a bogus diagnosis, a catchall for an array of symptoms that weren’t easily classified or understood. (Some people believe BPD and C-PTSD are the same disorder, which does make sense to me).

Edward, who became BPD-free, writes here about how motivated many borderlines are to recover, and how effective psychotherapy can be in healing this disorder. This flies in the face of the common belief that because BPD is in the Cluster B group of personality disorders, that it’s just something you have to resign to yourself to having forever.

The article, like all of Edward’s articles, is a bit on the scholarly side, but is still a very good read and helps reduce the stigma against people with BPD.

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This post will answer critics who say: “Borderlines are not motivated to attend therapy. Borderline patients don’t stay in treatment. At best, therapy can manage but not cure BPD.”

These statements are absolutely false. Yet these myths continue to appear online, often being communicated to people recently diagnosed. As the studies below demonstrate, most people diagnosed with BPD do want help, most will stay in good treatment, and most do recover to different degrees.

Earlier posts have elaborated my dim view of the (non) validity of the BPD diagnosis. Since it cites studies using the BPD construct, this post might be viewed as hypocritical. That may be a valid criticism! Nevertheless, these studies provide evidence that people with “borderline symptoms”, however defined, can be motivated and recover both with and without therapy

Study 1:  88 Borderline Patients Treated Twice a Week for Three Years

Highlights: Led by Josephine Giesen at…

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Breaking Down BPD

Here’s a very detailed article about Borderline Personality Disorder that breaks it down into its components and in doing so, helps reduce some of the stigma. It’s a painful mental illness with a terrible fear of abandonment at its core. No borderline likes having it!   The article also includes examples of what exactly goes on inside the mind of borderline when triggered (the fictional rant about Donald Trump is hilarious).

Comments here are disabled, please leave comments under the original post.

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According to the American     Psychological Association, the prevalence rate of Borderline Personality Disorder (BPD) in the general population is approximately 1-2% of lifetime occurrence.  So no worries, we are not alone ;).a9a0fb9e-6e03-4b8a-bf25-a04fa3c497b5


So I was able to do the impossible, find my lost blog posts. Before I re-post this one, I would like to add that I have been practicing as a mental health clinician again, and many of my clients have been curious to learn about their diagnoses.  Interestingly enough, when asked about if learning and understanding more of the disorder helped, they all said yes.  One specifically stated “I don’t feel like I’m crazy anymore, knowing that other people feel how I do, it makes me feel normal.” I still of course can only speak for myself when I say learning about Borderline Personality Disorder, educating myself on it and understanding it has been a tremendous help…

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Where did BPD stigma come from?

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In recent years, BPD has earned a very disagreeable stigma, so disagreeable that people who have a BPD diagnosis are refused treatment, being told they cannot get better or feared by professionals who might treat them. NPD too, hasn’t always been as demonized as it is right now. NPD and BPD have become almost interchangeable in the narc-abuse community. I don’t recall it being that way in 1996 when I got my BPD diagnosis, and I don’t remember ever being told I was hopeless or unredeemable or evil or anything like that. I was treated pretty much like any other psychiatric patient, and was given therapy and put on antidepressants. I was obliged to take a DBT class, which at the time I blew off. (DBT is like CBT but exclusive to Borderlines–and it does work. The fact it worked for me makes me think maybe I *did* have BPD but no longer do!)

BPD was always classified as a Cluster B disorder, ever since its introduction into the DSM in 1980 (it was recognized, however, for much longer than that, and popularized as a disorder in the 1960s because of the research of Otto Kernberg, a German psychologist who studied “the narcissistic and borderline personalities,” and other “disorders of the self.”).* All “Cluster B” means really is the person has a weak, fragmented or nonexistent sense of self. Not being able to access a “true self” means they become either cut off from or cannot regulate their emotions. One of the results of this is a lack of empathy (but BPDs are the most empathetic of all the B’s, and some have normal levels of empathy). In NPD, a strong false self takes the place of the true one, which is a very dissociative symptom. In BPD, there’s not a strong false self like with NPD, but there is a weak and unstable one, and the person isn’t ALWAYS showing that false self. Some BPDs act quite a bit like over-emotional or unstable narcissists (or narcissists in the midst of a breakdown due to loss of supply). Others act like covert narcissists or just act neurotic and insecure but are otherwise nice people. Some feel their emotions too much, including empathy. A few are antisocial. I’m not sure why BPD (and maybe NPD) isn’t classified as a dissociative disorder, because essentially the person is cut off from their “self” in some form or another and that is what dissociation means. I’m not sure what the mechanics are in ASPD (antisocial personality disorder) but they are very different from either Borderlines or narcissists because they aren’t dependent on others to boost their weak egos. They are psychopathic and just do what they want.

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So the Cluster B’s, including BPD, were already around, but until the mid-1990s, no one thought of them as anything but mental illnesses or for ASPD, a kind of “adult conduct disorder.” They were psychiatric labels and nothing more. The narc abuse community started in 1995 or so, and Sam Vaknin was pretty much the first one online who wrote about it. Of course, he has NPD but even so, he first called attention to the “evil”-ness of NPD/narcissism (actually it was M. Scott Peck but at the time he wrote “People of the Lie” in 1983, the term “malignant narcissism” wasn’t in vogue yet and there was no connection of “evil people” to people with NPD. There was also no Internet to spread Peck’s concepts like wildfire the way they could have been in 1995 and later. But over time, M. Scott Peck’s book has become one of the most popular in the narc-abuse community) After Vaknin established his online narcissistic abuse community and wrote his popular book “Malignant Self-Love,” more narc-abuse sites got established (many or most of them started by victims, who were understandably angry at the narcissists who had abused them). Soon “narcs are evil” became a sort of meme, and by association, so did all the Cluster B disorders earn a “evil” reputation.

There are benefits to this, of course. Victims are being more heard than ever before. People are paying attention and avoiding narcissistic abusers. But some people who carry a Cluster B label are being hurt too, especially Borderlines (or people–usually women–who were erroneously diagnosed with it). Some experts want to get rid of BPD and just re-label BPD as Complex PTSD (probably not a bad idea). There are MANY similarities. The vast majority of BPDs are not anything like malignant narcissists and are not sociopathic at all. Most just act extremely insecure, needy, and maybe “high maintenance.” They can be manipulative or act out to avoid rejection. They may collude with people with NPD, however. But it’s possible to find these same types of behaviors in many people with Complex PTSD. Are they actually the same thing?

Another reason for the BPD stigma could be the tendency for narcissists and borderlines to form partnerships or be attracted to each other. In such a pairing, the Borderline is almost always the abused or codependent partner. In several “couple killings,” one of the criminal partners, usually the female, has had a BPD diagnosis. But they may have been so brainwashed by their abusers they were coerced into colluding with them against others (a form of Stockholm Syndrome).

Finally, a number of high profile criminals and serial killers have labels of NPD or BPD. But they almost always also have a comorbid ASPD diagnosis. Media icons like Joan Crawford who were known to scapegoat their children also had a BPD diagnosis. In Crawford’s case, she was also diagnosed with HPD (Histrionic Personality Disorder). It wouldn’t surprise me at all if she had NPD (malignant) or ASPD as well, as her behavior was very sociopathic behind closed doors.

Why am I “defending” people with BPD if I don’t have it?  Several reasons:

  1.  I was diagnosed with it and carried that diagnosis for two decades.   I have personally experienced being rejected by therapists once they saw my “red letter” on paper.
  2. Just because my current therapist thinks I don’t have it doesn’t mean I don’t.  Or maybe I did have it and no longer do.  If I no longer have it, that means BPDs are not “hopeless.”
  3. Maybe BPD isn’t a valid diagnosis.
  4. Many people I have cared about who were slapped with “BPD” have been hurt by it.

These are just my rambling thoughts about this matter; I’d be interested in hearing your opinions.

* Timeline of BPD

Personal bias and diagnostic labels.

Thought I’d throw this one here too.   Leave comments on the original post.

 

BPD: The fulcrum of mental illness.

It’s like a spinning black vortex sucking in the symptoms of every other mental illness and disorder. We’ve got all the bases covered!  We’re batsh*t crazy!  We need help and understanding, not judgment and fear.

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Borderlines: incurable demons or trauma victims?

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The symptoms of Complex PTSD are almost identical to those of BPD.

Something has come to my attention during the time I’ve been blogging, which I think is important enough to merit another post about it.

Borderline Personality Disorder (BPD, DSM code 301.83) is classified by the Diagnostic and Statistical Manual of Mental Disorders as a Cluster B (emotional/dramatic/erratic) personality disorder having many similarities to character disorders like Narcissistic Personality Disorder (NPD) and Antisocial Personality Disorder (ASPD). Both NPD and ASPD are characterized by a lack of empathy, entitled behavior, and disregard for the rights or feelings of others. It’s also true that some Borderlines act out in ways harmful to themselves and others. Hence, “Cluster B” has become a pejorative category and some ACONs (adult children of narcissists) and others have demonized people with BPD as being amoral, immoral, and almost inhuman, nearly or as bad as as people with NPD or ASPD. Some even go so far as to lump all borderlines in with the “narcs” and barely make a distinction between them. In their minds, if you’re a Borderline, you’re no better than a “narc” and that’s all there is to it. You’re a bad person and to be avoided.

To make matters even worse, many mental health professionals refuse to treat people with BPD, believing them to be troublemakers, incurable, or both. I remember one therapist I saw years ago for an intake session and seemed to connect well with, called me a few days later after he received my psychiatric records, and told me he couldn’t take me on as a patient. “I don’t work with borderlines,” he said.

It’s true that there are some similarities between the Cluster B disorders, and both BPD and NPD/ASPD have roots in childhood abuse or neglect. But the similarities don’t run very deep. What I mean by that is while both a borderline and a narcissist cn be manipulative or abusive to others, the reasons are very different. There’s also the matter of intention. Borderlines, if they act out against others, aren’t usually aware they’re being abusive and/or manipulative. If their bad behavior is brought to their attention, they normally become very upset and feel terrible about it (unless they have a comorbid NPD or ASPD diagnosis). They act out because of overpowering emotions that they haven’t learned how to control. In contrast, a narcissist or person with ASPD acts out because they can. If their behavior is brought to their attention, they’re likely to become angry and rage against the accusation, make excuses, blame-shift it onto someone else, or deny it.  Unlike most borderlines, they don’t feel remorse, guilt or shame for hurting others.

In addition, many borderlines are much more harmful to themselves than to other people. If they do act out against others, most are as frightened by their own outbursts as others are and sometimes more so. In a nutshell, people with BPD know they have a problem and wish they could be different. Untreated BPD makes a Borderline’s life miserable, while people with NPD or ASPD are usually not bothered by their disorder. That’s why, even though Borderlines can act “crazier” than narcissists, they can get better and are much more responsive to therapy or behavioral treatments such as DBT or CBT.

But we’re still caught in a gray zone, neither here or there.   The stigma against borderlines (in my observation) has grown worse, and most narcissistic abuse sites pretty much regard people with BPD  as the “female or over-emotional version of NPD.”  (actually, Covert/Fragile NPD or Histrionic Personality Disorder would come closer).   If we’re narcissistic abuse victims suffering from complex PTSD, it takes a great deal of courage to admit you also have a BPD diagnosis.  It took me a few months to come out about it on this blog. Fortunately,  I haven’t received too much (or really, any) flack about it.

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Click to enlarge graph.

The good news is, a number of BPD bloggers are helping to reduce the negative stigma that we’re “bad seeds” with an untreatable disorder just because we’re OMG “Cluster B.” Think about this: have you ever noticed that there aren’t too many people with NPD (or ASPD) blogging about their challenges and insecurities, or fighting to reduce the stigma against their disorder? If they blog about their narcissism or psychopathy, it’s usually to brag about how NPD/psychopathy makes them superior or allows them to have control over others and be successful in the world. That’s because they don’t think they have a problem (They just cause others to have problems). Most Borderlines know they have a problem and struggle with it constantly, since it makes them feel so crazy and lowers their quality of life. I can only think of ONE blogger with NPD who was unhappy with his disorder and successfully treated for it (or so he says). That man probably had low-spectrum and probably covert NPD; a person with malignant or high spectrum grandiose-type NPD will never have enough insight or willingness to admit that THEY are the ones with a problem. In contrast, I can think of about 20 bloggers with BPD who are in treatment or therapy or have even been healed! I’m sure there’s many more that I don’t even know about.

BPD also seems to co-occur a lot with complex PTSD or PTSD. Most BPD bloggers I can think of also have complex PTSD or are in treatment for it. The symptoms of BPD and Complex PTSD are almost the same. The DSM does not recognize Complex PTSD as a diagnosis; it only recognizes PTSD, which is not caused by chronic trauma over a long period of time (such as having been abused as a child), but by one traumatic incident (such as fighting in a war or being raped). Therapeutic treatments for complex PTSD and BPD are also almost the same (for that matter, NPD and other personality disorders are treated almost the same way). Both BPD and Complex PTSD have a higher cure rate than NPD. Since Complex PTSD isn’t recognized as a valid diagnosis, I think a lot of people (especially women) who might have been diagnosed with complex PTSD if it was recognized get slapped with the “Borderline” label instead. Although I accept my BPD diagnosis (and have even become a little attached to it), I wonder if I might never have been diagnosed with it at all had Complex PTSD been recognized by the psychiatric profession. I think in some cases, BPD may not really be accurate, or could even be the same thing as C-PTSD due to their many similarities. At least one blogger (BPD Transformation, who used to comment here but stopped for some reason), doesn’t even think BPD is a valid diagnosis and shouldn’t exist at all.

Further reading:

Are BPD and Complex PTSD the Same Disorder?

Is BPD a Real Disorder or Should it Be Eliminated as a Diagnosis?

BPD Awareness: end the stigma

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Borderline Personality Disorder is a serious mental disorder with its roots in childhood abuse (usually narcissistic or sexual abuse) and as you can see in one of the memes below, it shares much in common with Complex PTSD and may in fact be a variation of the same disorder.

But BPD is terribly stigmatized, with its sufferers being called everything from evil to incurable.  Many mental health professionals refuse to work with Borderlines because of this stigma.  They’re afraid of us!  While some more aggressive borderlines can certainly do bad things to others and be manipulative, for people with BPD, their actions are caused by an inability to control or regulate their emotions, so they act out instead of thinking before they act. Many Borderlines are more destructive to themselves than to others.  They can seem self-centered and narcissistic not because they lack empathy (many borderlines, in fact have an excess of empathy) but because they get too caught up in their own emotional turmoil to be mindful of others.    Unlike people with NPD, they also don’t have a sense of entitlement.   In fact, they often feel like they deserve nothing.

BPD is much more treatable and receptive to therapy than other Cluster B disorders like NPD or Antisocial Personality Disorder.   Unlike those disorders, too, people with BPD can be helped by medication.

 

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