Saturday, September 21, 2013

Borderline Personality Disorder and Autism

So I found this nifty article written by a woman with Aspergers who was originally potentially being misdiagnosed with Borderline Personality Disorder so she looked into it and decided to discuss the similarities and differences. I know there has been some interest in this previously but I really don’t feel qualified to talk about Autism, however as this is a first person experience I think this would be helpful and useful to those that have expressed interest before.


By aspertypical on June 12, 2013

Emotionally charged meltdowns, intense relationships, superficial friendships, miscommunications and incorrectly assumed intentions. A lot of people with Asperger’s syndrome could identify with this list. An equal number of those with Borderline Personality Disorder (BPD) could also identify with this list. With individual’s on both sides being misdiagnosed with the other condition, what are the key differences and how can we tell them apart?



Those with a Borderline Personality Disorder (BPD) often present with a pattern of significant impulsivity and instability of affects, interpersonal relationships and self-image. This can manifest itself in an intense fear of abandonment and intense anger and irritability, particularly when others fail to understand them. Typically they flip between idealization and devaluation of others, alternating between high positive regard and great disappointment, and frequently display suicidal and self-harming behaviors**. A world apart from the often black and white mechanical thinking of an individual on the autism spectrum, where objects and animals often gain a greater significance than humans, and where other people’s thoughts are not even understood let alone open to manipulation. Yet the functioning of both individuals can appear the same, and frequently those with autism are misdiagnosed as having a personality disorder, particularly BPD, before their autism is recognized*; this is especially true for females.

Faced with the choice of BPD or ASD my psychiatrist precariously leant on the side of the former. Borderline is most common in females and could be considered an extreme form of the female brain, in much the same way that autism has been considered an extreme form of the male brain. So of course being presented with a depressed and anxious patient, who seems to be oversensitive to all forms of treatment and a general pain in the arse (PITA), shoving them into the bracket of ‘unstable female’ would seem like an appealing option. Fortunately for me I had a team of Asper-believers (namely a therapist, my mum, girlfriend and a few friends), and an imminent date with an adult autism assessment clinic to squash those BPD rumors circling my mental health records. What others should have noted was my lack of displayed emotion, my evident self directed anger, and my desperate struggle to please everyone and not miscommunicate as key signs that my personality was not disordered, my entire neuronal network was disordered and I was desperate to gain control over it. So why did they look the same in me and so many other women?

Autism expert Tony Atwood believes that this misconception of females on the spectrum comes from their ability to hide their autism better than males, resulting in behavior patterns which can mimic those with BPD. This is particularly true if in an effort to mask social confusion and appease others, she models herself on someone else to achieve social success; in the unlikely event that that person happens to have BPD then she has no hope! This can lead to fake and forced social interactions, which can lead others to feel she is manipulative and superficial and completely divert away from the fact she has an ASD. On the other hand the Aspie’s experience of bullying, rejection and betrayal can lead to fears of abandonment and intense and unstable relationships with others, mimicking a BPD.

Fortunately there are some key differences between the two disorders which set them apart. Firstly, whilst those with Asperger’s Syndrome do not get social cues or misunderstand them, those with Borderline Personality Disorder are hyper aware of them, but often distort them. Whilst both can have impairments when it comes to empathy, those with Asperger’s do not understand the social norms that go with a situation, whereas someone with BPD may exploit and manipulate the situation.

Sorry this is the one place I’m going to interject. This whole manipulation thing is overblown and completely misunderstood. People read “manipulation” and think of it in a purposefully trying to take advantage of another person type of way that say, a sociopath might. That’s not what is happening here. With BPD it’s the fundamental lack of communication skills that lashing out from our own internal pain to gain the attention in times of need that is often misconstrued as “manipulation”. It’s not intentional, it just is.

Because of this those with a BPD are often better able to appear charming and sociable, but on the flipside they can be incredibly manipulative of others**, whereas the manipulation of those with Asperger’s derives from an almost obsessive need to control their surroundings and to please themselves. In terms of self-harming behavior both are vulnerable, typically though those with Asperger’s use it to release inner tension, whilst those with BPD may be using it as a cry for help. Generally BPD behavior seems to be a result of defense, usually manifesting itself in late teens and adolescence and commonly developing after a particularly unstable childhood. As we know (or should know, read more of my blog if not!), those with an ASD are born with the condition, it may only become apparent to others over time but it must have always been there.

The danger is in thinking that those with BPD are to blame for their behavior, and I am the first to admit that my prejudice led me to believe it was an attention seeking disorder. It was only after I researched the issue and spoke to those who have worked with them, that it became apparent that those with BPD are no more in control of their behavior than those with an ASD. There tends to be a lack of awareness on both sides as to why their behavior has manifested in the way it has, and actually the treatments for both disorders can benefit the other. Neither respond particularly well to medication, but therapy with an emphasis on interpersonal relationships can hold the key. Particularly work focused on mentalization, which encourages a greater awareness of the intentions of oneself and those around them. Mentalization-based treatment (MBT) was developed with Borderline Personality Disorder in mind, the object of which was to increase the mentalization capacity in patients which should improve affect regulation and interpersonal relationships. For those Aspies who lack a theory of mind (the ability to understand others mental states), this type of therapy can also be incredible beneficial, even in those like me who, on a much more mild level, just struggle sometimes to interpret the intentions of others.

So it seems that BPD is on the borderline of Aspergers in behaviors and functions alone, the gap between the two in terms of origin and mental processing couldn’t be any wider or the two any more diverse. Deemed as ‘incurable’ however, the treatment for both is focused on behaviors, and because of this the two are still tied together in harmony.

Treatment for BPD also focuses on reprogramming how we think. It’s not just about behavioral reprogramming.

If you’ve just scrolled to the end and couldn’t be bothered to read this, someone’s beat me to it and created a much more entertaining video!





So she makes a good point in the video. Her psychologist was point at aspect of things that could have indicated BPD but that she didn’t feel were very extreme or that inhibited her quality of life…. Which makes it NOT a disorder qualification. I think people really forget this this. Just because it looks like an item on a checklist does not mean it’s actually severe enough to meet the qualification for it.


Thursday, September 19, 2013

Random Update of Feelings In a New Relationship

Feelings are funny things. I like my New Lady a whole lot. She’s the loveliest thing I’ve known in a very long time. Yet, she still has the ability to infuriate me…. Then it disappears in a heartbeat the second I see her. I know Therapist wouldn’t like that but it happens and there’s nothing I can do about it. New Lady only has one flaw that I can see so far. She is perpetually and incredibly, incredibly late, all the time, late. Like, runs on her own time zone, late.  For someone like me that has panic attacks when they even perceive that they could potentially be run late (read: not be 15 minutes early), it’s starting to get to me. If it was just once or twice that would be once thing, but it’s been every single date we’ve had ranging from 15 minutes to an hour and half. The first 5 times I was able to brush it off with a ‘no worries, stuff happens, no problem’ though I have told her that I have panic attacks if I’m late and she knows that I have to be punctual, but that last time…. Usually it’s just to a dinner date or hanging out so it’s not to something we would miss… the last time we were going to a movie so there was a specific show time. Specific meeting times get to me.  The show was supposed to start at 7:20p. I of course text her to tell her that I’m leaving in plenty of time. She texts me at 7:17p that she’s lost her keys but she’s now on her way. She lives 15 minutes away. I’m sad and disappointed and for some reason waiting outside. I guess there was also an accident on the way there that delayed her even more? This in no way feels like an acceptable excuse because if she had left at an appropriate time she would have arrive before the accident would have happened. I was angry and seriously ready to just call off the entire damn date. I wanted to just go home. I had an entire picnic of wine, cheese, and crackers prepared but it didn’t matter I was trigger tripped anxious and angered and I was done.

I was done…. Until I saw her. And she promised me a glass of wine and swooped me into her arms and kissed me and my world was right again. All forgiven. Two glasses of wine really. I say the silliest things to her sometimes but she smiles and laughs and my heart soars so I guess she doesn’t mind. We made the next showing of the movie eventually and had our movie picnic. The movie wasn’t fabulous, but being in the movie was.

I was so anxious and furious and ready to leave. Seriously done for the first time in a month and half my patience had given. I needed a drink to get me through but one wasn’t at hand and I was over it and angry. Until she was in my presence and everything was fine again. More than fine again.

I was talking to Therapist about my New Lady and it was increasingly hard for me to tell her how I felt about her. It’s always hard for me to describe how I feel about someone when I’m not actually with them. I feel silly because they don’t feel real. When I’m with them though, they’re all that’s real. And it’s wonderful. It’s one of the wonderful things about being me, maybe about being Borderline… you really love and appreciate being in the company that you’re in to the exclusion of all other things. And forget completely the fury that you had felt the moment before.

Have I told you I’m a movie buff? I hate people that interrupt be during movies. But during this one we were laughing too much I couldn’t even remember if it was bad, good bad, or just not good at all. It was a horror movie and we were giggling the whole time.

We walked out to our cars after. Made out on our cars until the lot was practically empty afterwards…. I was glowing until I fell asleep… but now that she’s away from me, I wonder if those feelings are real or not. I’m sure they are, because I’ve written them down so I remember. Those feelings feel so far away though when she’s not actually with me though. It’s odd and disconcerting to feel so much and so little for someone is so small a time frame.

It’s no wonder it’s hard to hold onto the idea that someone would hold onto the idea of constant feelings for me. For us.

I have to remind myself constantly that’s it’s still early on. That this is normal for me. That we’ve only just met. That it takes me time to really internalize someone. It’s not something to be frantic about when I don’t feel a solid connection right away.


Especially as I do know that when I see them again, I feel something instantly. I’m in the moment. All the fears, all the loneliness, it all goes away. I wish I could find a way to remember that and always hold that to me so the anxiety of it would cease, but unfortunately it won’t, but at least I have the cognitive recognition of it now. It helps a lot that she texts me all the time. She tells me that she’s thinking about me. That she wants to make plans. Only time will tell really. Hopefully a lot of time. 

Wednesday, September 18, 2013

Study: Precursors to BPD in Females and Males

Since we’re talking about gender in Borderline Personality Disorder let’s take a look at the precursors that indicate BPD and the potential differences in this so called battle of the sexes.

Study: Precursors to BPD in Females and Males

Borderline Personality Disorder (BPD) doesn’t just suddenly appear. While the symptoms of BPD may become magnified and intensify with age, signs of Borderline Personality Disorder can start appearing as early as infancy.

A new study conducted by Marianne Goodman, M.D., assistant professor of psychiatry at The Mount Sinai School of Medicine in New York, explores the trajectory of Borderline Personality Disorder in females and males. The study shows precursors for Borderline Personality Disorder developing as early as infancy, through childhood and adolescence.

Goodman’s study, done in collaboration with the National Education Alliance for Borderline Personality Disorder (NEA.BPD), is one of the few that looks at Borderline Personality Disorder and its development in both males and females. The study compares the emotional, cognitive, and social development of people officially diagnosed with BPD to that of their non-affected siblings.

“So what do we know about developmental precursors in Borderline Personality Disorder?” asked Goodman during an NEA BPD call-in lecture. “When I went to literature, I was surprised to find not much.”

Childhood Indicators of BPD

Before Goodman’s study, little was known about the childhood precursors to Borderline Personality Disorder, especially in the case of males. Goodman pointed out that Nicki Crick, a developmental psychologist, proposed a theoretical model for five childhood indicators of BPD:

  • A hostile, paranoid world view
  • Intense, unstable, and inappropriate emotions
  • Overly close relationships
  • Impulsivity
  • Lack of sense of self


Goodman was impressed, finding that this looks similar to BPD symptoms seen in adults. But what about males? What is known about their developmental indicators when it comes to BPD?

Prior studies identified profiles of males with BPD as including precursors such as aggressive, disruptive, and antisocial behavior. But Goodman adds that adolescent males were not included in this model due to the small number of males in the sample.

Precursors to BPD

With the collaboration of nearly 2,000 parents, Goodman was able to compile information on this subject. What she discovered was that the trajectory of Borderline Personality Disorder doesn’t differ much between females and males in early development.

In infancy, the only precursor that shows a major difference is that of “unusual temperament,” at 9.8 percent in female infants and only 2.7 percent in males. The second notable precursor was “extreme separation anxiety,” being 8.7 percent in males and less than half that in females.

I know I had pretty extreme separation anxiety starting as early as 2.5 and that never really went away. Maybe earlier, but I haven’t asked.

Other precursors found in infancy, such as inability to self-soothe, sensitivity, social delay, and occurrence of sexual abuse, were similar in occurrence between males and females in the study. Similarly, those precursors and other BPD symptoms that begin to make an appearance in childhood, such as impulsivity and lying, remain relatively level between males and females.

So, not much difference. I don’t find this surprising but outside of my BPD blog I do a lot of sociological and neurobiological studies and frankly, socioeconomic environments have a lot more influence on the expression of male and female differences than biological ones.  Anyone that tells you differently has their own agenda.
           
BPD in Adolescence

“The diversion between male and female development of the disorder really begins in adolescence,” says Goodman.

            Not shocking at all.

One stand-out symptom that was overwhelmingly identified by parents of male children diagnosed with Borderline Personality Disorder as having prevalence in adolescence was “odd or unusual thinking.” More than half of the respondents with male children agreed that their child fell into that category. Zero respondents felt their female children diagnosed with BPD experienced “odd or unusual thinking.”
           
This I have to question. I don’t like that parents were asked without input from their kids. Also, zero respondents felt female children had “odd or unusual thinking”. Without clarification of what this means exactly I can’t say for sure, but I bet if you asked my parents this question they would have answered a big “yes” in that box. But then again, I was always an imaginative and creative child and this was never stifled in me. I was also a solitary child. I had friends, but I was no less likely to simply play on my own without the other children.

As these were yes and no questions, no data was gathered regarding what “odd or unusual thinking” looked like to the parents of these male adolescents, noted Goodman.
“The point is, these parents noticed something was ‘off,’” she said.
Another surprising find was the experience of body image issues among male adolescents with Borderline Personality Disorder. Nearly 16 percent of male adolescents displayed a proclivity to body image issues, as compared with 6.6 percent of females.

This is fascinating. Men are often overlooked in terms of body image issues but our society puts no less pressure on them. It often displays differently but it’s definitely an issue.

The aim of Goodman’s study was to discern children at risk for developing Borderline Personality Disorder so that BPD treatments and medications can be designed for prevention, or a change in the trajectory of the disorder, rather than letting the disorder fully manifest.

“The whole notion of intervening earlier has got to be higher on the priority scale,” said Goodman.


------------------------------------

It’s a start. It’s incomplete, but it’s a start. I definitely think that learning the signs to look for in children and adolescents in order to help them get treatment sooner is incredibly important. However if these are the main differences that they were seeing, it seems to me that both boys and girls typically have very similar profiles growing up when it comes to the display of Borderline Personality Disorder.

One big issue that they didn’t cover at all that they surely should have: Home environment. Severity of Borderline Personality Disorder is at least partially dependent on a person’s immediate environment and the challenges they are faced with and surrounded by in their everyday life. So perhaps in future studies they should look at environmental stressors. 

Monday, September 16, 2013

Lucid Analysis - Trials in Therapy : New Relationships and Old Memories

I haven’t been sleeping well and when I have been sleeping I’ve been having really awful nightmares. Haunted houses, Evil-Ex and his asshole friends behind me, catching up to us, taunting me, somehow getting ahead of me, us having to get through a door they’re blocking to get to a room beyond… But we did… I hate those kinds of dreams. Tech Boy at work following me around, being sweet as I wrap things up even though I tell him he needs to stop it and leave me be. He kisses me on the forehead fondly. 




Therapist asked me what I think the dream has to do with. Usually when I have nightmares with my Exes  back to back like this it’s when I’m starting a new relationship.  Which is what I’m doing now with my New Lady.

My dreams are always highly symbolic and tend help me work through my baggage and fears. I think I’m just a little afraid of letting in someone new, of course, because of the past abuses I’ve had to deal with. The nastiness of Evil-Ex and before, but then again, there’s the reminder of Tech Boy and my other relationships that things can be sweeter. And I’ve had time to get to know my New Lady for a while now and she’s really wonderful. Our pasts are similar too in many ways so I know she would never do things like that to me, because she knows what it’s like to be hurt like that. She’s someone who would put the needs of someone else in front of her own, which is what she makes me want to do for her.

I have a hard time internalizing people. I have a hard time trusting people. It scares me. What’s more I have a difficult time conceptualizing that people internalize me. This also scares me but in a different way. In a way I don’t know how to believe, even though I want to, and half the time I simply don’t think about it at all as a possibility. It just doesn’t strike me as something that happens unless they tell me they have.

Growing up I never believed I could trust anyone. I never believed I had anyone to rely on, to lean on, to trust. If I needed something I took care of it on my own, never asking, never trusting, never confiding. I earned everything I needed or I went without and I never asked for anything else.

Earlier in our session Therapist had talked about dissociated communication and the origins in families.

Growing up communication with my family was a mess. It wasn’t my parents fault. Well, on some level it was. I never learned how to express the bad feelings properly. I was never taught how to cope adaptively with the sad feelings, the bad feelings. I was only told to hide them, to bury them, to repress them. I’ve told you guys this before. My mom was never really around growing up. She worked 3rd shift, so she worked nights and slept during the day. My dad was home, but I don’t think he really understood that it was okay to let me be sad or angry and not shut me down. He had an abusive, alcoholic, military father. I don’t think he was in any way like his father, not really, but that doesn’t mean there wasn’t some transference in how he learned to communicate. I was an extremely sensitive child and anytime he told me to toughen up or suck it up it was how his dad used to talk to him, and I took that to heart. It stung like hell and before long I was afraid to show any emotions whatsoever. I know he didn’t mean it to affect me the way it did, he didn’t know it would, but it did. All I knew was to bury and repress. Keep the bad things inside. So I did. Until I was older, and then I started to burst at the seams and Act Out. Rebelling wildly. We were always yelling. Always.


I don’t think Therapist really realized the extent of it. We don’t talk about my childhood much. She doesn’t think it typically helps. But I told her that. I told her how when, by the time my grandma died, I was 6 or 7 (? Somewhere in that age range) I had already internalized the idea that I wasn’t allowed to let people see me cry. I used to see my grandma every Sunday. We would go to my grandparents house and have dinner and play games and have cookouts, go sailing, or to the beach every weekend, when I was younger. I knew her very well. I couldn’t express my sadness though. Not in front of anyone. I had to be strong for my brother and sister. I remember locking myself in my closet to cry. Alone. That was the only place it was okay. I haven’t cried at a funeral before or since.

Therapist was sad for me. I’m much better about it now. I’m learning now to express myself properly, to not repress and bottle so things don’t become so pressurized they need to explode.  I know full well where the origins of my shutting down comes from though. I’m not sure Therapist realized if I knew though.

She does recognize that I’m someone who is incredibly intuitive. Intuitive of myself and of others. I pick up on others feelings and emotions very easily. Therapist thinks it’s a gift to be able to read and adjust to the needs of other people so easily. I’m not sure I agree with her. I think it’s a burden often.  Too much of other peoples stuff mixing in with my own stuff is simply overwhelming. It makes me shut down. Shut down more than I already used to. Fortunately I don’t do this much anymore. I’ve learned to cope properly at this point, at least with most things.

What’s more Therapist thinks I’m a little afraid of people internalizing me.  Maybe I am. It feels like a lot of pressure when they take me in. Especially if they become attached to me too quickly. I don’t trust when people attach to me too quickly. I don’t understand how people can like me so much. I’ve been told too often and too much that I’m not good enough. But my own thoughts are starting to change on that too. Even the nasty ruminations I have are beginning to change. They’re stronger and in my own favor. I build trust so slowly though. And it takes me so long to really internalize people.  I can’t even fathom that people remember me. It’s the exact opposite of narcissism. Instead of believing you’re constantly the center of attention, it’s merely a sense that you’re alone floating without a tether, hoping that the people you care about remember.

I hate it. It’s terribly lonely. It’s no wonder we so often crave the company of the people we care about. The process of internalization and building trust properly can happen though. It just takes time, often a lot of time, and patience.


Which is what I’m working on at the moment with my New Lady. I like her a lot. When I’m with her I’m completely in the moment. I don’t feel dissociated. I do find myself having a hard time saying no every now and again, but it’s rare, because we actually have a lot in common, and it’s typically frivolous stuff. Therapist thinks this will be a good point of growth for me; To learn to say ‘no’ in a healthy way, without having to fear rejection. In general though I don’t feel like I’m being someone entirely new or different. Not even much different. I don’t generally feel like I’m mirroring or projecting just to make her like me. I’m being true to who I want to be, and she seems to be more than happy with that.  She still feels like a passing presence to me when she’s not around… but that’s to be expected. Most people do until they’ve been in my life for a significant amount of time or until we’ve had some kind of extreme bonding moment.  Time. It’s important to remember for myself that it takes time. I can’t rush it or it will only make me lonelier and frantic. Emotions and relationships take time and you can’t rush either. 









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