Tuesday, September 11, 2012

Is Borderline Personality Disorder a spectrum disorder?


Does Borderline Personality Disorder express itself in a range of intensity for different people? Can there be BPD “lights”?

Yes. The answer is a simple yes.  


My Therapist describes Borderline Personality (in fact all personality disorders) as lying along the line of a dissociative spectrum. Even if you don’t experience dissociation in terms of Dissociative Identity Disorder, depersonalization, derealization, etc, there’s still a distinct detachment between emotional experience and reality. I do agree, but it’s also important to keep in mind that there is a neurological impact created within our brains as well, and that will amplify or restrain the presentation of BPD symptoms (emotional outburst, etc) depending on the severity of the chemical regulation and transmisison.

My Therapist actually doesn’t like to focus on the label of BPD at all (for me this is both frustrating and reassuring), however she’s worked with many BPD patients, some that didn’t display as strongly as I have, and some that have been much, much more difficult to deal with… so on a range from low to high, I’d be just above the mid-range of my symptom presentation.  And this can increase or decrease depending on how you choose to handle or deal with our challenges. When I was younger I would have presented much higher on the range of symptom presentation. As things are progressing throughout my therapy, I’m definitely moving in the direction of lower BPD symptom experience and presentation.



I believe this ties in with our concept of High and Low Functioning Borderline to an extent, but they’re actually different. Someone can be high functioning to the point where they appear to “nomal” or just low on the expression range (this is me), but internally and in private they can be a mass of devastation and seething torment. It’s often difficult to measure this though because some of us don’t show it to other people so it’s not likely we’ll be classified as having a Higher level of emotional dysregulation. Low-functioning Borderlines, however, tend to wear their heart on their sleeves and are more likely to have their issues noticed and quantified as falling on the higher end of the emotion dysregulation spectrum.

I think it boils down to a combination of how we feel and how we cope.

·         Experience Range of Emotional Distress (Mild/Moderate/Severe) + Appropriate coping Both publically & privately = Normal/Low
·         Experience Range of Emotional Distress (Mild/Moderate/Severe) + Appropriate coping in public But Inappropriately in private = Moderate expression
·         Experience Range of Emotional Distress (Mild/Moderate/Severe) + Inappropriate coping in Both public and private = Higher range of severity in BPD expression





      *Publically/Privately & Internally/Externally  - It’s cumbersome to write so I truncated above. You get the point.


I think this is too simple though. The severity of how we cope needs to be taken into account. If I were to cry and scream about something minor both publically and privately… that could be quantified as a High level of dysfunction. If something minor happens, I remain calm and collected in public, but then come home and take a razor blade to my inner arms… technically that would be “moderate dysfunction” by my previous scale, but the severity of the self-punishment is clearly significant and indicates a Higher level of dysfunction. The person that cries and throws a temper tantrum may be lower on the range of BPD presentation severity scale than the person that keeps it together in public but is so severely punitive in private.

All this really means is that there’s no simple 1 to 1 ratio of classification. It’s clear that different people have different levels of emotional experience and different abilities to cope. Some better, some worse. Some more extreme, some more controlled. It all depends on how we cope and the methods we utilize to cope. What is clear, is that there is a range of emotional experience and responses. There is also a range of dysfunction and disorder that these symptoms present in our lives.
Fortunately, we absolutely can learn better ways to cope.

I also think that what people can mean by BPD “light” is actually someone that expresses some Borderline traits, but does not technically qualify as Borderline by DSM standards.  This is also very common. To be given a diagnosis of BPD you have to meet 5 of the 9 DSM criteria in a way that significantly impacts the functioning of your life and when those symptoms present at a point in your life when they are not considered appropriate.

Everyone experiences feelings of abandonment at times; break ups happen, loved ones die. Everyone has held an idealized vision of someone before and had the rosey colored glasses eventually fall off. When we’re growing and maturing, most people don’t know who they are yet and have some struggles finding their true selves. Depression is a huge problem in this world; one that often leads to suicidal thoughts and behaviors as a result of personal tragedy or grief. And everyone (at least everyone I know) has had some times of extreme anger or difficulty controlling their anger… but that doesn’t mean everyone is BPD… it’s when these are persistent problems that occur at inappropriate times over an extended duration and impact your quality of life that they become a disorder.

Then, of course, there are people that do experience a couple symptoms, full blown, in a way that does disrupt their life. The thing is, just because it looks like BPD because someone self-harms and has severe anger issues and feelings of emptiness, doesn’t mean it is BPD. They have BPD traits, but the underlying cause could be something completely different or a combination of things that are completely different. Anger, thoughts of suicide and feeling empty could be PTSD and depression, not necessarily BPD, for example. Only a professional can tell for sure.   It’s important that only a qualified clinician can make an reasonable diagnosis, and even then, it may be important to not slap a label on their patient for any number of reasons.

It’s okay to keep an eye out and to make not of things that are dysfunctional, but don’t jump to judgment. And remember, it can get better!

I've runt he gamut. When I was younger I was extremely volatile and very severe with myself both publically/to my family and privately... then I transitioned to very controlled (overcompensating) and outwardly "normal", but increasingly severe with my internal feelings, self-punishment and harm in private.... Now I'm pretty well outwardly controlled, but learning to stay connected and express emotions properly (not just controlled and bottle up), and I'm learning to cope better so my internal punishment and reproach isn't as severe. It's a long process, but it can get better. 



8 comments:

  1. Very interesting. Being as I lean towards high functioning, I can control the outward, visible, public manifestation of my turmoil, but am 'extreme' in the severity of the self-punishment in private.

    And I mean very extreme....

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    Replies
    1. ::nods:: You sound like what I'm recovering from. I've run the gamut. When I was younger I was extremely volatile and very severe with myself both publically and privately... then I transitioned to very controlled and outwardly "normal", but increasingly severe with self-punishment and harm in private.... Now I'm pretty well outwardly controlled at all times, and I'm learning to cope better so my internal punishment and reproach isn't as severe. It's a long, long process, but it can get better.

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    2. Thank you for that encouragement.

      Even approaching these 'issues' is new for me. I have only been in therapy for a few months and didn't even know why I did these things until very recently.

      Starting to understanding but am right at the begining....

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    3. You'll get there. The important thing is you started =)

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  2. I agree with the spectrum thing, and I think it can also depend on medications, triggers (some are more 'extreme' triggering than others) and certain people.

    I guess I tend to display what's been called a 'high-functioning', internalising, quiet borderline presentation- but I find it really hard to understand in myself sometimes!

    How can I be sooo 'normal' and put on masks around others, and yet so out of control on my own?? I feel a lot of guilt because 'if people only knew how I REALLY am' then they wouldn't like/love/trust me. grrrr.

    Or why can't I be ok on my own? I still tend to blame myself daily for being 'like this', although reading your site makes me view myself with slightly more compassion!

    Only my therapist has an inkling of how out of control things are- but trying to tell my family they all think that I couldn't possibly have emotional difficulties because I'm so nice and calm- it's tricky trying to ask/reach out for help. Even trying to find the words to express to my therapist is difficult- how can you be so 'ok but not ok' at the same time?! All it seems is confusion.

    Somedays I feel like there is this ever-widening gap between my outer life (work,friends, family) and me inside. But I'm working hard on schema therapy and strengthening my 'healthy adult mode', and working hard on trying to regain some health from ED behaviours. grrr.

    Anyway, love your views on things Haven- make me think and has really helped give me something tangible to connect with (as you know too well that can be almost impossible).

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  3. giving up cry for help. this helped however im so dangerous outwardly, i cut myself severely, drink alcohol to the point of oblivion every day, take unsubscribed drugs, am very under weight with an eating disorder, my mind is tormented on a daily basis with fear, what they call paranoia; is there ANY HOPE AT ALL FOR THIS TORMENTED SOUL?

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  4. Such an interesting post.

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  5. I also thing that there is a spectrum with empathy; some BPD's seem to lack empathy (narcissism, sociopathic behavior) and others, like me, seem to be hyper-empathetic. I think it is a survival mechanism and has more to do with how we manage our relationships with those we are vulnerable with; the better we focus and are aware of their emotions, the safer we are.

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Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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