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

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There should be no “shame” in having a Cluster B diagnosis.

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Yes, another potentially controversial post.  Please hear me out before judging.

There are some (actually, many) people in the blogosphere who believe that people with disorders like Borderline or Narcissistic Personality Disorder made some kind of conscious choice to have their disorder.   With unusual exceptions (which I’ve discussed in others posts), I think this is wrong.

Bad seeds?

People with Cluster B disorders, in spite of what you probably read or heard, aren’t inherently evil or “bad seeds.”   Certainly, some become evil, because they’ve been programmed for a psychological need to obtain narcissistic supply in order to feel like they exist.  In order to get that supply, they became abusive and manipulative.   People addicted to drugs or alcohol are also abusive and manipulative, in order to get their chemical fix.

People with psychopathy may have been born without the brain capacity to feel empathy or have a conscience, but I don’t think Psychopathy should even be categorized as a Cluster B disorder at all, since it seems to have its roots more in brain chemistry than in early trauma.   Plenty of psychopaths came from normal, loving families.  The jury’s out as to whether Antisocial Personality Disorder is the same thing as psychopathy.  I think they may coincide often and their symptoms are similar, but I’m not at all sure they’re the same thing.    I don’t know a whole lot about ASPD, but I think it, too, usually has its roots in trauma as a child.   I know almost nothing about its treatability, but it’s my understanding it’s very difficult to treat, even more so than NPD.    But I digress:  talking about ASPD or psychopathy is not the point of this post.

Another blogger who commented on a post of mine today mentioned that she may have undiagnosed, recovered BPD.   I sensed from the tone of her admission that this might be something she’s  ashamed to admit.   I wondered why.   BPD, like NPD, has a terrible stigma, although in its favor, there’s a movement in the BPD community to reduce its stigma as “evil” and “incurable.”    Their efforts seem to be working, because BPD is seen today as being less of a “mark of the beast” than NPD is, although the stigma certainly still exists.

Why no anti-stigma movement for NPD?

I’m not sure why there is no grass-roots movement among narcissists to change the stigma against NPD, but from everything I’ve read from self-aware narcissists (and you’d be surprised how many of them there are online), they’re either: (a) proud that they are narcissists and wear the “evil” stigma like a badge of honor (these tend to be malignant, overt narcissists with antisocial or sociopathic traits), or (b) *this is a shocker* so ashamed of their narcissism that although they hate the stigma, they seem resigned to it and and seem to hang their heads in shame, quietly accepting how “bad” they are.  “I deserve it,” they say.   It may seem hard to believe, but some of them even defend the narc-haters.  Remember we are talking about self-aware narcissists.  Most narcs never get to that point.   Their grandiosity keeps them from having enough insight to do that.

Ego-dystonic vs. ego-syntonic.

Because people with BPD are almost always ego-dystonic about their disorder (they aren’t happy with themselves), and because generally BPD doesn’t lend itself to self-delusions  (in other words, having a false self) the way NPD does, BPD has a higher cure rate than NPD,  which also helps reduce its stigma.    NPD is usually more ego-syntonic, but not always.  Narcissists who are ego-dystonic (usually covert narcissists) tend to be frustrated, lonely, and depressed, and although they can be highly manipulative, entitled acting, and lack empathy, they lack the grandiosity and false pride that keeps them stuck in the delusion that their narcissism has worked for them.

I don’t see a whole lot of difference between BPD and C-PTSD.  Actually, BPD is like C-PTSD on steroids.  I’ve written about this subject before–the symptoms of both are nearly identical, and both Borderlines and people with C-PTSD are very prone to become codependent to malignant or overt narcissists.   They are also prone to self-harm, wild mood swings, and are sometimes suicide risks.  People with C-PTSD–especially women–often get slapped with the stigmatizing BPD label simply because the DSM doesn’t recognize C-PTSD as a legitimate disorder (and PTSD, while similar, applies more to those who suffered a single, intense trauma rather than the victims of chronic, long term abuse starting in childhood, so the treatments for someone with PTSD would be different).

Moving back to narcissism…

Many people believe NPD cannot be successfully treated, much less cured.   I admit I’m skeptical about its curability, though I do know there have been a few cases where it’s happened.   I also know there are narcissists who are ego-dystonic and unhappy with what they’ve become, once they realize they are narcissists.   I don’t think the adage that “if you think you have NPD, then you don’t” is necessarily true.    I have met a few here and on forums who desperately want to change their behaviors, usually because they’ve realized that they’ve missed out on things like knowing how to love and receive love, or having a healthy relationship with their spouse or children.   They want to know what love and vulnerability in a relationship feels like.  They want to know what real joy and empathy feels like.   They forgot how.   They’ve come to realize their lives are empty and shallow, and they are constantly under the stress of always having to act a part in a play.   They forgot who they were a long time ago.   Most narcissists did not have happy childhoods and most had parents who either abused or spoiled them (spoiling is a form of abuse because it fails to mirror who the child actually is, so the “love” they get is conditional).

As a mental illness.

I’m in no way defending narcissists or the way they act.   But as a cluster B disorder,  it started as a defense mechanism to cope with unbearable pain and feelings of emptiness. Many people believe narcissists love themselves, but nothing could be further from the truth.  They only love their false self.  Scratch any narcissist and you find a person who doesn’t even know who they are.  BPD is much the same that way, except Borderlines don’t have a functional or strong false self.    I’m not suggesting sympathizing with active, unrepentant narcissists or condoning their toxic behaviors. I’m not suggesting staying with one either!   But I think the stigma against NPD has hurt those people with the disorder who sincerely want to change.  These people do exist!  I don’t think they’re lying when they say they want to become non-narcissists–why would they? What would be their motive in doing so?   Much as with people with BPD, therapists refuse to treat them, insurance won’t cover them, and they are frequently demonized as non-human creatures or worse.

Maybe the treatment rate for NPD is so abysmal because they are given up on so easily by therapists who lose patience with someone who doesn’t show immediate improvement or acts aggressively or in a confrontational way.    NPD is a very difficult disorder to treat, but that doesn’t mean it isn’t possible.  Even if a narcissist can’t be cured, CBT and other mindfulness therapies have had good results on some narcissists who really want to change the way they treat others and have more mutually fulfilling relationships.  DBT (dialectical behavioral training), a mindfulness therapy similar to CBT traditionally used on people with BPD, has also been shown to be effective on some people with NPD.

As a Borderline myself (my therapist thinks I’m recovered, but I’m not at all sure about that), and having personally experienced the stigma against Cluster B, I have a great deal of empathy for anyone with a Cluster B disorder who is self aware and genuinely sorry about the way they’ve treated others or the choices they’ve made, and who sincerely wants to do the hard work needed to make changes in themselves.   People with Cluster B disorders didn’t choose to become that way; like people with C-PTSD, they have a mental illness caused by trauma and C-PTSD is almost always at the core of any cluster B disorder.

While it’s true that some will never get to the point of self awareness or even if they do, may not be interested in finding new and better ways of relating to others and the world, there are many who do, and we shouldn’t judge them or hate them just because of their stigmatic diagnosis (and the diagnosis could be wrong anyway!).  That’s why I don’t run a “narc free” blog.  I allow people with Cluster B diagnoses–including NPD–to post comments on this blog and share their experiences along with others who do not have those disorders and were abused by people who do.  As long as they don’t attempt to upset or trigger non-Cluster B abuse victims and remain civil and add to the conversation, they are always welcome here.

The “Four F’s” of C-PTSD

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I just began reading “Complex PTSD: From Surviving to Thriving” by Pete Walker. I can already tell I won’t be able to put it down (I will write a book review when I’m finished, which shouldn’t take long). I’m also going to bring this book to my next therapy session because I want my therapist to see it.

Walker, who is a therapist and also a survivor of narcissistic abuse and sufferer of C-PTSD, is an engaging writer and definitely knows his subject matter. In one of the first chapters, he discusses the “Four F’s”–which are four different “styles” of coping that people with C-PTSD develop to cope with their abusive caregivers and avoid the abandonment depression. Whatever style one adopts may be based on several factors–natural temperament, the role in the family the child was given (scapegoat, golden child, “lost” or ignored child), birth order, and other factors.

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Available on Amazon

The Four F’s are:

1. Fight (the narcissistic defense): often “golden children,” such children learn to project shame onto others; may go on to develop NPD
2. Flight (the obsessive-compulsive/anxiety defense): these children will grow up to become highly anxious, obsessive-compulsive, and avoidant.
3. Freeze (the dissociative defense): these children “protect” themselves by dissociating from others, themselves, and their environment.
4. Fawn (the codependent defense): the child learns to avoid harm by people-pleasing or siding with their abusers.

Walker speculates that if C-PTSD were recognized in the psychiatric literature, the DSM could probably be reduced to the size of a pamphlet, for many people diagnosed with other disorders actually have C-PTSD, which encompasses symptoms of many other disorders and have common roots.

What you may have been misdiagnosed with (or diagnosed yourself with) if you have C-PTSD (these are the most common):

Personality Disorders:
Borderline Personality Disorder
Narcissistic Personality Disorder

Dissociative disorders

Anxiety Disorders:
Generalized Anxiety Disorder
Panic Disorder
Social Anxiety
Obsessive-Compulsive Disorder

Mood Disorders:
Depression
Bipolar Disorder

Developmental Disorders:
Autism Spectrum Disorders
ADHD
ADD

Codependency

Addictive Disorders

While any or all of these diagnoses can be co-morbid with C-PTSD, they miss the mark or don’t tell the whole story. Personality disorders such as BPD can develop from severe, unrelieved C-PTSD and they do share many similarities, but personality disorder labels are stigmatizing and not very helpful for someone who has suffered prolonged childhood trauma and abuse. Labels like “panic disorder” or “depression” aren’t helpful because they only address one or two symptoms of C-PTSD and therefore can’t even begin to address the roots of the depression or anxiety. You can treat anxiety or depression with drugs or short term therapy, but you can’t cure the person of the C-PTSD that’s causing their chronic anxiety or depression. The same goes for labels such as alcoholism or codependency. These are merely symptoms. People with C-PTSD are also sometimes erroneously diagnosed with developmental disorders such as ADHD or autism, which not only don’t address the trauma that led to the ADHD- or Aspergers-like behaviors, but also have completely different causes.

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

Diagnosis: Complex PTSD

your brain on CPTSD

My therapist finally spilled the beans (at my insistence) and thinks PTSD or complex PTSD is the closest fit for what I actually have.   BPD may have fit once, but he doesn’t think it does any longer, if it ever did.   He said a lot of those “borderline” symptoms may really have been PTSD.   He also doesn’t think I fit the criteria for any other personality disorder.    Also I would not be responding to therapy as well (or as quickly) if I had an actual personality disorder.

This is wonderful.   Complex PTSD is a non-stigmatizing label that acknowledges that damage was done to YOU,  and you are just reacting normally to the abnormal.   Personality disorders imply that the problem is in the person and BPD is one of the most stigmatizing labels of all.

I’ve grown quite attached to my BPD label though, and I’m not quite ready to give it up yet. So I’ll still keep BPD under “Read About My Crazy” since I actually was diagnosed with it twice.  Maybe it was an erroneous diagnosis or maybe not,  but being a “borderline” has become so much a part of my identity I’m going to keep it for now.  I’m just overjoyed that my therapist does NOT think I have it and also that he’s aware of narcissistic abuse and the ways it can really f**k with your mind.

He says it’s fairly common for people with PTSD/C-PTSD to try to self-diagnose and it’s normal to be confused, as I have been very much so.

What’s my problem?

confused

After over a month of being convinced I’m a covert narcissist, now I’m starting to wonder if my assessment of myself could be incorrect. Most people are having trouble believing me (even good friends) and there are so many disorders that appear similar to it. I no longer think my symptoms are due to Aspergers the way I used to, but BPD + Avoidant PD in the same person can look exactly like covert NPD. So can complex PTSD in some cases.

I’ve been told again and again that real narcissists are unlikely to ever admit they are narcissists, and if they do, they won’t be beating themselves up that much over it. I don’t know if that’s always true (I’ve met a few low spectrum covert narcissists on Psychforums who actually have a diagnosis and feel terrible about things they’ve done and want to change, but maybe the diagnosis they got is wrong and they just have more than the normal amount of N traits). Victims of narcissistic abuse are often quick to diagnose narcissism in themselves and others. We’re hypervigilant and tend to see narcissism everywhere, and we don’t even exempt ourselves. The real narcissists are probably more likely to keep insisting that they are not. Abuse victims think too damn much. It’s all very confusing.

narcissism_selfies

I guess there was a reason why I never added “Covert NPD” to “My Disorders” in the header. Without an official diagnosis for that, I really can’t say that’s what my problem is. It could be, but if so I think it’s at a low level. I know I have a number of narcissistic traits, but most abuse victims do. That doesn’t necessarily mean I have NPD, covert or otherwise. I could just have a really bad case of “fleas,” or just BPD + AvPD, or even complex PTSD.

I’m still glad I started Down The Rabbit Hole because it’s also intended for people with BPD, which I have an actual diagnosis for. I still think my “trip down the rabbit hole” early in August was real but that doesn’t necessarily mean I have NPD. It was still a trip to the walled off parts of my mind, and most abuse victims are at least partly walled off from themselves. We may be partially narcissistic but not enough to qualify for the label.

I care about people with low spectrum NPD and BPD who want to heal or improve, so that’s another reason I’m going to keep DTRH going. It’s getting a good reception. Another one of my missions is to help reduce the negative stigma against people with BPD. I don’t ever expect DTRH to gain the amount of activity this blog has received, but if only one or two people can be helped by my posts, and I can help myself by continuing to do exactly what I’ve been doing, then it’s worth it to keep it going, isn’t it?

Really, at the end of the day, all these labels are just labels and don’t really mean anything at all.

The Cluster B stigma and the nature of evil.

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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.

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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?

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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.

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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?

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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?

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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.