Hypervigilance is said to be an inhanced state of sensory sensitivity,which comes with intensity of behaviors whose purpose is to detect threats.Such sensitivity brings about an increased state of anxiety, which can and will lead to or cause exhaustion.There are other symptoms,increased arousal,a high responsiveness to stimuli,and always on the alert for threats.
This disorder is highly associated with post traumatic stress disorders,and many types of anxiety disorder. Go to Anxiety Some may view a state of hypervigilance as that of paranoia,but the two states are very different.Paranoia is a state of a thought process that carry with it anxiety and/or fear,often a delusional state.Another disorder that's differentiated from this state: DYSPHORIC HYPERAROUSAL, with this disorder a person that is a PTSD victim may lose contact with reality, and have flashbacks experiences with traumatic events.
People that suffer from such a state become so preoccupied with their cognizant behavior that they sometimes lose connections with their friends,and even family members,they also develop poor sleeping habits,they experience difficulty getting to sleep,and staying asleep.Many people who have had traumatic events know what it is like to have natural response whereby your body and mind remain instinctively alert to any possible additional threats,be they real or imagined,your mind and body learn how to protect your well being,even though it has a disorder that is highly associated with anxiety.
During a time of high alert,when this disorder has a heightened episode, many survivors have strong experiences of nervous energy,they have a tendency to keep during something,or just simply staying busy,in many ways this energy is subconsciously use or aimed at relieving the anguish,pain,and possible anger resulting from their violent experiences.The known symptoms of this disorder are anxiety,sleeplessness,panic attacks,and obsessive compulsive behavior.Knowing these symptoms will help you look for ways to find rest and relaxation.
Advice:gain an understanding of the sources of this disorder, acknowledge its advantages and disadvantages find ways to increase one's ability to manage unwanted behaviors that are driven by this disorder.Find someone who share the same symptoms,discuss when,where,and how long you have been hypervigilant.How do you react to others with the same disorder,and how do you intend to respond now and in the future,discuss when the disorder is good,and when it is bad,what has worked,and what has not worked.
http://www.humanlyexhausted.com/hypervigilance.html
Sunday, June 12, 2011
Hypervigilance
Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a high responsiveness to stimuli and a constant scanning of the environment for threats.[1][2] Hypervigilance can be a symptom of posttraumatic stress disorder[3] and various types of anxiety disorder. It is distinguished from paranoia. Paranoid states, such as those in schizophrenia can seem superficially similar, but are characteristically different.
Hypervigilance is differentiated from dysphoric hyperarousal in that the person remains cogent and aware of his or her surroundings. In dysphoric hyperarousal the PTSD victim may lose contact with reality and re-experience the traumatic event verbatim. Where there have been multiple traumas, a person may become hypervigilant and suffer severe anxiety attacks intense enough to induce a delusional state where the effect of the traumas overlap: e.g., one remembered firefight may seem too much like another for the person to maintain calm. This can result in the thousand yard stare.
Symptoms
An Equifinality Model of Borderline Personality Disorder
Borderline personality disorder (BPD) affects as many as six million Americans. It accounts for about 25% of all psychiatric hospitalizations. As many as thirteen percent of males and seven percent of females commit suicide (Stone, 1990). Approximately, 69% of people with BPD are also substance abusers (Miller et al., 1993). The causes of BPD are not well understood. Therapist folklore often labels people with BPD as difficult and treatment-resistant patients.
This article outlines a clinical model of BPD. The model is based upon the clinical practice of the authors and the research literature concerning the correlates of BPD. The model identifies the roles played by traumatic environmental conditioning, its effect on neurobiological processes, and biological vulnerabilities in the development of BPD. In this regard, the model postulates two factors which can lead, singly or in combination with equifinality, to BPD: early childhood Psychotraumatic Stress (PTS) exposure (Factor I) and Biologic Vulnerability (BV) (Factor II).
Equifinality is a systems theory concept (Miller, 1978) which means "that a final state of any living system [borderline personality disorder] may be reached from different initial conditions [Factor I, Factor II or both] and in different ways [antecedent or consequent biological and family system dysfunction]." The bracketed illustrations were added by us.
The purpose of this model is to serve as a heuristic guide to clinical intervention, treatment, and research as well as to stimulate creative thinking about borderline personality disorders.
We first review the evidence that supports Factor I initiation of BPD followed by a review of Factor II evidence. These two sections are followed by a description of the Equifinality Model of BPD. The article closes with a brief discussion of research questions generated by the model and clinical implications of the model.
FACTOR I SPD: Psychotraumatic Stress (PTS) Exposure in Childhood
A number of authors have suggested a role for environmentally mediated aversive events in the development of BPD. Kroll (1988) suggested that BPD symptoms rather than being psychotic come closer in appearance to those of post-traumatic stress disorder. He wrote, "I am suggesting that many borderline symptoms, especially the ones that have the appearances of ‘brief psychotic episodes’ and which I have included under the heading of cognitive disturbances, are no different from the symptoms seen in post-traumatic stress disorder." Kernberg (1975) observed that "A frequent finding in patients with borderline personality organization is the history of extreme frustrations and intense aggression (secondary or primary) during the first few years of life." Linehan (1993) postulated that in addition to being biologically vulnerable people with BPD are exposed to invalidating environments "in which communication of private experiences is met by erratic, inappropriate. and extreme responses In other words, the expression of private experiences is not validated; instead, it is often punished, and/or trivialized."
Perry et. al's Neurobiological Analysis of Early Trauma
Perry et al. (1996) have presented a neurobiological analysis of childhood trauma exposure. In it they outline the effect trauma has on the human "fight or flight" and "freeze or surrender" systems, and the implications that repeated psychotraumatization has for a developing child's brain systems. Perry et. al describes the effects psychotrauma can have on a child's brain as follows:
- The brain regions involved in the threat-induced hyper-arousal response play a critical role in regulating arousal, vigilance, affect, behavioral irritability, locomotion, attention, the response to stress, sleep, and the startle response . . . Initially following the acute fear response, these systems in the brain will be reactivated when the child is exposed to a specific reminder of the traumatic event (e.g., gunshots, the presence of a past perpetrator). Furthermore, these parts of the brain my be reactivated when the child simply thinks about or dreams about the event. Over time, these specific reminders may generalize (e.g., gunshots to loud noises, a specific perpetrator to any strange male). In other words, despite being distanced from threat and the original trauma, the stress-response apparatus of the child's brain is activated again and again.
The pattern described above reflects both stimulus and response generalization processes which have been exhaustively studied by behavioral researchers for some time (Mackintosh, 1974; Nevin, 1973). This body of research has established that a primary generalization effect is an increasing function of the number of shared elements between the original stimulus and the test stimulus (Nevin, 1973). This research provides support for Perry et al.'s analysis of childhood trauma by identifying the empirically validated operant and respondent processes that are responsible for conditioning all types of behavior including trauma responses.
Perry goes on to explain that the neurobiological effect of traumatic experiences delivered by environmental contingencies is governed by two principles of neurodevelopment: the use-dependent development/organization of the brain and critical and sensitive periods. They point out that during the early childhood years the brain requires (critical periods) or is more sensitive (sensitive periods) to certain types of organizing experiences. These experiences literally format some of the child's developing brain structures and functions: "Experience can change the mature brain-but experience during the critical periods of early childhood organizes brain systems . . . [it] can result in mal-organization and compromised function in brain mediated functions such as humor, empathy, attachment and affect regulation." Trauma, occurring during critical/sensitive periods, is an experience that is capable of affecting the organizational development of the brain.
The implication for the traumatized child is that the more frequent, intense and persistent the traumatization, the more the brain systems associated with fear are activated. Such-frequent activation "builds in" a chronic state of fear in the child. This state of fear can trigger hyperarousal (fight or flight) and/or dissociative (freeze or surrender) behavior in the child With repeated exposure, elicitation, and generalization this behavior pattern takes on "trait" characteristics.
Perry identified five factors which determine a person's specific response to PTS:
- history of previous stressors
- age at onset of PTS
- specific cognitive meaning attached to the event
- the specific type of trauma
- presence of exacerbating and/or mitigating factors
To this list we would add (6) intensity of the PTS and (7) the duration of the PTS exposure.
Perry's analysis identifies the neurobiological processes that translate environmentally delivered psychotraumatic contingency effects into altered neuro-behavioral function.
Trauma histories in BPO
A number of researchers have found an association between the diagnosis of BPD and psychotraumatization during childhood. Herman et al. (1989) found the following rates of psychotraumatization for BPD patients: 71% had been physically abused, 67% sexually abused, and 62% had witnessed domestic violence. Histories of early childhood psychotrauma (under age six) were almost always only found in BPD patients versus other personality disorder patients. Famularo et. al. (1991) reported that 79% of nineteen children ages seven to fourteen who had been recently diagnosed as having BPD by DSM III-R criteria reported significant traumatic experiences. Goldman et al. (1992) found in a sample of 44 children diagnosed with BPD versus 100 comparison children that BPD children had significantly higher rates of physical and physical/sexual abuse rates than the comparison group. They concluded that the hypothesis that a history of trauma is associated with the disorder is supported. Goldman et al. (1993) found higher rates of psychopathology among family members of people with BPD. Weaver et al. (1993) found that rate of childhood trauma (sexual abuse, physical abuse, witnessing violence) was significantly higher in 17 BPD females versus 19 non-BPD females. Salzman et al. (1993), however, found lower than expected rates of physical, sexual, or combined trauma in a sample of 31 patients. They found that only 19% reported such a history.
Stone (1990) in his landmark outcomes study of BPD found that the factor (in a factor analysis of 14 outcome moderating factors) which accounted for the largest amount of variance in outcomes for his combined sample of male and female BPD patients was what he termed parental brutality (physical abuse). This factor accounted for 7% of the variance with six additional factors accounting for an additional 5% of the variance. For females this factor accounted for 6% of the variance and for males it accounted for 15% of the variance. He also found the following percentages of psychotraumatization in his sample (broad definition of borderline): 38% had early loss; 19% of females had parental incest; 8% of males had parental incest; 13% of all borderlines had experienced or witnessed parental brutality.
In a study of 61 male subjects with BPD versus 60 non-BPD subjects, Paris et al. (1994) found that the BPD group had significantly higher rate of childhood sexual abuse, more severe sexual abuse, a longer duration of physical abuse, increased rates of early separation or loss, and higher paternal control score on the Parental Bonding Index. Childhood sexual abuse and loss/separation were significant in the muitivariate analysis. They concluded that trauma and problems with fathers are important factors in the development of BPD in males. Waller (1994) found that childhood sexual abuse prior to age fourteen rather than later in life was associated with a diagnosis of BPD in 115 eating-disordered females. Silk et al. (1995) reported a 76% rate of sexual abuse in a sample of 37 BPD inpatients
Runeson et al. (1991) reported that BPD patients who committed suicide showed more early parental absence, substance abuse in the home, and lack of permanent residence than other patient groups who committed suicide in a sample of 58 consecutive suicides of people ages 15 to 29 in an urban community
Berzirganian et al. (1993) found in a prospective study of 776 adolescents that maternal inconsistency coupled with maternal over-involvement predicted the emergence of BPD. Weaver and Clum (1993) reported that significantly more BPD patients reported sexual abuse than did non-BPD patients in a sample of 17 and 19 patients respectively. They also found that BPD families were significantly more controlling than were non-BPD families and that this factor significantly predicted dimensional borderline score even after controlling for sexual abuse.
Finally, Briere (1997) reported that the Trauma Symptom Inventory, a 100-item test designed to measure both acute and chronic PTSD symptoms, correctly identified, in a psychiatric inpatient sample. 89% of those patients independently diagnosed with BPD.
Neurotransmitter and EEG Findings in BPD
Other studies have reported neurological and neurotransmitter differences in people with BPD and people with psychotraumatic exposures. Bower (1995) reported that researchers found in MRI scans of 20 females with histories of prolonged sexual abuse before age 15 that, in comparison to 18 non-abused woman, the abused woman had markedly smaller hippocampal volume (the hippocampus is implicated in short term memory). A second study by Yale researchers confirmed this result in seventeen women who suffered severe childhood sexual abuse. Yale researchers also found that these abused woman scored significantly lower on a test of verbal short-term memory. Bower reports that similar MRI results (decreased hippocampal volume) have been obtained with male Vietnam veterans suffering from PTSD.
Hollander et al. (1994) reported results which suggest that males with BPD have serotonergic dysfunction as compared to non-BPD males based upon a challenge with a single dose of m-chlorophenylpiperazine (5-HT serotonin postsynaptic agonist). De Vegvar et al. (1994) summarized a series of studies linking serotonin functioning and impulsive aggression. In general the findings support a hypothesis linking serotonergic dysfunction to impulsive aggression toward others or self. Yehuda et al. (1994) reported a series of studies on peripheral catecholamine (epinephrine, norepinephrine, and dopamine) functioning. They concluded, "The fact that catecholamine metabolism in BPD is similar to that in PTSD in preliminary studies may reflect the role that chronic stress and trauma appear to play in the etiology of many symptoms found in these disorders." Perry et al.'s (1996) analysis implicates the catecholamine system as one of the systems effected by traumatic exposure
In a very interesting study, Teicher et al. (1994) argued that the limbic system, in particular the hippocampus and amygdala, may be affected by experiences which create posttraumatic stress disorder. They reported on the results of a study which compared a history of early abuse to symptoms of limbic system dysfunction. They devised a 33 item Limbic System Checklist (LSC-33) questionnaire to assess this latter effect. They evaluated 253 outpatients with the Life Experiences Questionnaire to assess abuse history. Their results showed that as compared to patients who reported no history of abuse, patients with physical but not sexual abuse scored 38% higher on the LSC-33; patients who were sexually but not physically abused scored 49% higher, and patients who were both sexually and physically abused scored 113% higher. The effect was the same regardless of sex. All differences between the abused patients and non-abused patients were significant. Abuse prior to age 18 had greater impact than abuse after age 18. Patients who were physically or sexually abused after the age of 18 had LSC-33 scores that were not significantly different from those of the non-abused patients. They concluded, "Our specific hypothesis is that early abuse can lead to a variety of neurodevelopmentai abnormalities with different behavioral sequelae."
Based on the findings reviewed above and our clinical experience we offer the following Factor I BPD postulate:
Factor I BPD reflects the neuro-behavioral effects of psychotraumatic stress (PTS) exposures mediated by dysfunctional family interactions (DFI). The PTS exposures occur prior to the age of 18 and have the following characteristics: (1) they are of sufficient aversive intensity, duration, and frequency to provoke fear (2) they occur during critical or sensitive developmental periods, and (3) they are psychologically salient, personal and meaningful. Consequent to these exposures, the child experiences neurological, cognitive, and behavioral dysfunctions which, if unmitigated or untreated (or inadequately treated), progress to borderline personality disorder The presence of a pre-existing biological vulnerability is not required for the occurrence of these effects.
FACTOR II BPD: Biological Vulnerability
The other factor which may initiate the development of BPD is a pre-existing biological vulnerability (BV). To qualify, a BV must biographically pre-date the occurrence of any psychotraumatic stress and may be expected to affect limbic system functioning and/or attention control. A BV that is caused by the effect psychotraumatic stress has on the developing brain would not qualify in our model as an independent biological cause of BPD. Potential independent BV's might include a genetic defect, an intrauterine neuro-toxin, or another psychiatric disorder of early childhood.
Torgerson (1994) reviewed published and unpublished studies of the genetic transmission of BPO. Torgerson concluded that there is little current evidence to support a genetic transmission model of BPD.
Gasperini et. at. (1991) concluded that a diagnosis of BPD predicts a higher rate of mood disorders in family members of people with BPD even in the absence of a mood disorder in the BPD person. Silverman et al. (1991) found greater independent risk of affective and impulsive personality disorder traits in 129 relatives of people with BPD than in people with other personality disorders or with schizophrenia. Korzekwa et al. (1993) concluded that dexamethasone suppression test, thyrotropin-releasing hormone test, and sleep studies indicate that BPD is not related to depression but that serotonin studies point to links with suicidal, aggressive and impulsive behaviors.
Muller (1992) suggested that a disruption of interhemispheric communication within the brain from 18 to 36 months of age may create a neural template for the borderline symptom of splitting. Towbin et al. (1993) defined a complex developmental syndrome which they hypothesize may be involved in the development of BPD and childhood schizophrenia. The criteria of this syndrome include disturbance of affect modulation, social relatedness, and thinking. Ogiso et al. (1993) compared EEG findings of 19 females diagnosed with BPD to 21 females without a BPD diagnosis. They failed to find EEG results that were characteristic of the BPD group. However, they did find that patients who scored high on the Impulsive Action Pattern of the DIB (Diagnostic Interview for Borderlines) did show EEG abnormalities. This effect cut across the two groups and was not solely characteristic of the BPD group. Zanarini et al. (1994) found that EEG abnormalities, while nonspecific to people with BPD, did affect 46% of the BPD subjects in the sample. They reported that these findings were not correlated with a childhood history of abuse. However, 40% of their BPD subjects had a confounding history of head trauma (62% of subjects who were physically abused also reported head trauma) and 12% had a confirmed history of grand mal seizures.
In our clinical practice we have seen a high rate of comorbid ADHD in males with BPD. In a sample of 26 males diagnosed as having BPD according to DSM-IIIR or DSM-IV criteria and treated by us from 1994 to 1996, 54% of them had a childhood diagnosis of ADHD in their records. Many ADHD symptoms such as impulsivity, affective lability, and anger outbursts are similar to BPD symptoms.
Childhood bipolar disorder (Biederman, 1997) is an under recognized disorder whose symptoms include unstable moods, distractibility, impulsiveness, severe aggressiveness, and hyperactivity. Unlike adult bipolar disorder, childhood bipolar disorder symptoms are chronic and continuous, This disorder is also correlated with ADHD. The two disorders may be genetically linked. All of its symptoms, especially impulsiveness and aggression, overlap with those of BPD. It is possible that untreated or ineffectively treated childhood bipolar disorder and/or ADHD could predispose the child to later develop BPD.
Based on the results reported above our Factor II BPD postulate states:
Factor II BPD is a set of biological vulnerabilities (BV) which either alone or in combination can cause early childhood neurobehavioral dysfunction. This results in hyperreactivity to stressors which conditions affective instability, impulsive actions, aggressive tantrums, and impaired interpersonal relationships. If unmitigated and untreated, the S V induced neuro-behavioral dysfunctions progress to BPD. This result does not require the prior occurrence of DFI mediated psychotraumatic exposure.
The Equifinality Model of Borderline Behavior
The diagram on page ten models the flow of events hypothesized to initiate and condition borderline behavior. The two factors are depicted along with their influence pathways. The model's equifinality assumption states that either factor can produce BPD despite starting at different points and following different paths to that end. The model has organized borderline symptoms into five groups: relationship control phobia (DSM-IV BPD criteria 1 and 2 are included here), self-image dysfunction (criteria 3 and 7), stress hypersensitivity (criteria 6, 5, 9), dependency on immediate gratification (criteria 4 and 5), and lifestyle mismanagement.
The Factor I Pathway
The Factor I pathway maps the effects of multiple stress/alarm reactions elicited by DFI mediated psychotraumatic stress exposures. The model defines DFI (dysfunctional family interaction) as the exchange of aversive communication behaviors and consequences (often unpredictable) among members of a family at a rate that is in excess of norms for that family's society and culture. PTS is defined as an aversive event which triggers a fear response capable of causing a person to become concerned about his or her psychological or physical safety while effectively inhibiting the person's ability to protect him or herself by terminating or escaping the aversive event.
As PTS exposure is repeated and generalized, neurobiological changes (as specified in Perry's 1996 analysis) begin to take place. According to some of the findings reviewed earlier, changes in catelcolamine functioning and serotonin functioning may occur. At the same time a relationship control phobia develops in response to the PTS emitted by members of the child's family. Basic trust, thought to form within the first years of life (Erikson, 1950), is compromised. As relationships, through generalization (the generalization dimensions appear to be intimacy and authority), become viewed as threatening, the child also develops a negative image of him or herself. Chronic aversive treatment, especially at the hands of loved ones, condition a negative self-image that leaves the child feeling that he or she is "bad." The core self-image of "badness" progresses to one of self-hatred. These core beliefs condition the development of other distorted cognitive beliefs and errors in thinking (e.g., black and white thinking).
The emergent neurobiological dysfunction further sensitizes the child to similar, stressful experiences (stress hypersensitivity) which trigger hyperarousal and/or dissociative behavior. Withdrawal, aggressiveness, and mood instability are postulated to be a product of this sensitization process.
Stress hypersensitivity (and dysfunctional neurotransmitter mediation), relationship problems, and a negative self-image combine to create dysphoric and labile emotional states which arrange negative reinforcement contingencies that shape and reinforce a variety of impulsive gratification (or escape) seeking behaviors. Addictive activities (such as drug and alcohol abuse, eating problems, or self-injury) develop that reduce the dysphoric states and negatively reinforce their continuing--and often escalating--use. Suicidal behaviors emerge as an albeit extreme form of negatively reinforced escape behavior. The repetitive and manipulative nature of BPD suicidal actions take on an addictive quality because of this negative reinforcement control.
As the child grows through adolescence into adulthood, lifestyle functioning is impaired in work, relationships, play, and education. Lifestyle failures further intensify the person's self-hatred and add to his or her dysphoria, which motivates further escape and avoidance behaviors of the impulsive and addictive type. This process creates the hallmarks of borderline living: self-inflicted crisis and self-inflicted psychotraumatization.
The childhood and later-life effects of PTS can be mitigated by several factors: strong, positive social support, personal skills and attractiveness (Stone 1990), low levels of ambient psychosocial stress, and reinforcement contingencies (structure) for healthy behavior. For example, if a child is exposed to PTS by one caregiver but another is able to maintain a warm and loving relationship with the child, the effect of the PTS will be reduced. A borderline adult living in a very supportive setting will function better than one living without any close support or structure.
The Factor I pathway of the model postulates that any child exposed to sufficient and critically timed PTS will develop chronically dysfunctional behavior patterns and will, in the absence of timely and sufficient treatment and/or mitigation, develop borderline behavior patterns and/or BPD. A second postulate states that the stress hypersensitivity a person experiences will be under discrete stimulus control defined by the stimulus parameters of their early psychotraumatization.
The Factor II Pathway
The Factor II pathway to BPD involves the presence of a BV that at the neurobiological level impairs the child's ability to develop age appropriate behavioral self-control in the areas of impulse control, mood stability, and aggression modulation. At present there does not appear to be a consensus BV candidate, The possibilities we reviewed included untreated attention deficit disorder, untreated childhood bipolar disorder, EEG abnormalities, genetic transmission, familial affective/impulse control dysfunction, or a complex developmental syndrome.
The BV is hypothesized to work by impairing the child's neurobiological functioning by presumably disrupting limbic system development and/or functioning. This then predisposes the child to becoming hypersensitive to his environment and its stressors. The child's moody, impulsive, aggressive. irritable, distractible, oppositional, and/or withdrawn behaviors initiate the model's stress hypersensitivity pathway. The model postulates that this behavior becomes aversive to the caregivers and other members of the child's family and creates dysfunctional interaction patterns within a previously functional family. In the absence of timely and sufficient mitigating or treatment factors, the DFI worsens the child's behavior and creates significant distress for caregivers and other family members. The child's self-image is impaired by the conflict their behavior causes at home and/or in school. Impulsive gratification emerges for the same reasons as it does in Factor I BPD.
The model postulates DFI as a consequence of BV in Factor II BPD. It also postulates the existence of a historical period, framed by a functional family environment, during which the child's behavior was observably and significantly dysfunctional.
Mixed Factor BPD
In mixed factor BPD both BV and PTS are independently present. The model postulates that for a given degree of PTS a more severe form of BPD develops when BV is also present. We speculate that Factor I type of BPD is the most common form, followed by mixed type BPD, and then Factor II BPD. Based on the childhood trauma prevalence studies reviewed earlier, about 70 to 75% of BPD is either Factor I or Mixed type BPD and about 25 to 30% is Factor II BPD.
Implications for Making a Diagnosis of BPD
As discussed earlier the symptomatic behavior of BPD overlaps with other disorders. In particular it is important to rule out adult bipolar disorder. In addition to bipolar disorder, attention deficit disorder and atypical depression should also be assessed. A rule of thumb that we have found helpful given the apparently high incidence of psychotraumatic childhood events in the histories of people with BPD is to tentatively assume that, in the absence of a credible history of childhood psychotrauma, the patient is not borderline and then to assess him or her for the above-mentioned disorders. When bipolar disorder has been ruled out, and if ADHD and atypical depression cannot completely account for the presenting symptoms, then a diagnosis of BPD can be applied.
A bipolar disorder differential should consider the following: (1) A history of bipolar disorder in the family; (2) It may begin in childhood as major depression; (3) In early adolescence look for irritability, explosive anger, sustained hating, hostility and hypersexuality; and (4) BPD patient usually does not have family history of bipolar disorder; decreased need for sleep is not seen in BPD; flight of ideas is not seen, borderline does not follow the four phases of bipolar disorder (depressed, manic-irritability, mixed depression and mania; hypomania).
Attention deficit hyperactivity disorder (ADHD) can be distinguished from BPD by taking a careful developmental history. Of particular interest is early hyperactivity especially at birth and even prenatally. Such infants are often hard to satisfy despite consistent effort to do so. Such children often have difficulty playing with other children and making friends. Often they will change the rules so they can win. In school they cannot achieve because they cannot sit and attend. They may have poor fine motor coordination. They can be very bright and hyper-curious but often have poor immediate recall. In BPD symptoms become apparent in late teen years, not at birth. BPD relationships are unstable. BPD has poor self-image due to rejection, but ADHD has poor self-image due to failure to achieve. BPD people hate themselves; this is not the case in uncomplicated ADHD. In BPD neurological soft signs are not necessarily present but are often seen in ADHD.
Clinical and Research Implications of the Model
Open questions for Factor I BPD:
Does everyone exposed1 during critical sensitive periods, to a certain intensity, duration and repetition of psychotrauma develop BPD? If not, then do they develop some borderline behaviors? If not, then what inoculates them from doing so? Could the inoculation come from a biological advantage of some kind? Would early intervention and treatment of DFI prevent the development of BPD?
Open questions for Factor II BPD:
What is the biological vulnerability? Is it a single condition or many conditions? If it is ADHD or child bipolar, then does it progress to BPD because of a failure to effectively treat these disorders? Does the BV progress to BPD in the absence of DFI or is DFI crucial to the development of BV initiated BPD? If it is crucial, must DFI be effectively treated to prevent progression to BPD?
Other research needs suggested by the model include the following:
- Studies that can define critical exposure parameters (the type, severity, duration, age at onset) of PTS that lead to enduring behavioral and neurological changes.
- A comprehensive assessment protocol needs to be developed and studies conducted of people with BPD to confirm or disconfirm the model's classification of BPD into PTS-only induced, BV-only induced, and PTS-plus-BV-induced.
- Studies that assess whether the hippocampus of people with BPD are reduced in volume.
- Studies which measure neurotransmitter (serotonin and NE) levels of people with BPD prior to and after imaginary and role play exposure to their childhood PTS events to determine whether neurotransmitter levels are response to simulated exposure.
- Primate studies to asses the effects of PTS exposure on their behavioral and neurological development.
- Development of definitions and reliable measures of dysfunctional family interaction patterns that produce psychotraumatic events.
- In-depth prospective studies of abused and neglected children to evaluate the behavioral, neurological, and learning effects of PTS.
- Development of a database register of psychotraumatic events complete with operational definitions, specific examples, relative severity, cultural modifiers, and measurement instruments.
- Studies that determine the effects of critical period exposure to PTS versus non-critical period exposure on the progression to BPD.
- DFI is a potential common link between the two types of BPD: in Factor I it is the antecedent of psychotrauma and in Factor II it is a familial behavioral consequence of biological vulnerability. Studies to confirm this are needed.
The model's implications for the clinical treatment of BPD include the following:
- Reliable and valid clinical measures of psychotraumatic events and the symptomatic impact of those events are needed. There are many psychometric instruments for the measurement of trauma symptoms and events (Briere 1997). A consensus diagnostic battery that meets the needs of clinical settings is needed to measure the PTS exposure of patients.
- Treatment of BPD depends upon the accurate assessment of PTS exposure. The presence of significant PTS history has major implications for the treatment protocol in theses areas:
- trust issues, need for desensitization/exposure therapy of PTS effects, PTS motivators of
- addictive activities, the use of medications, and the role of the family in treatment.
- If the role of PTS, as suggested by this model, is confirmed, the diagnostic criteria for borderline personality disorder may require modification.
Summary
The paper presented a heuristic model of the etiology of borderline personality disorder. Borrowing the concept of equifinality from systems theory, it postulated that BPD can develop if one of two factors is present during childhood. The data upon which the model is based were reviewed and the research and clinical implications of the model were discussed.
Saturday, June 11, 2011
BPD - Out Of The Fog*
Borderline Personality Disorder (BPD)
Borderline Personality Disorder is a serious condition which is believed to affect between 1-3% of the general population. Yet, despite being so prevalent, BPD is not commonly understood.
People who live in a relationship with a person who suffers from borderline personality disorder often know that something is terribly wrong with the behavior of their family member or loved-one but often do not know what to do about it or that there is even a name for it.
There are a number of different names used around the world for the same disorder:
- Borderline Personality Disorder (BPD)
- Emotional Regulation Disorder (ERD)
- Emotional Dysregulation Disorder
- Emotional Intensity Disorder (EID)
- Emotionally Unstable Personality Disorder (EUPD)
- Emotion-Impulse Regulation Disorder (EIRD)
- Impulsive Personality Disorder (IPD)
The most commonly used name today is Borderline Personality Disorder - or BPD - as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).
The term "Borderline" is a historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the "Borderline" label is misleading and stigmatizes the disorder. The fifth version of the Diagnostic & Statistical Manual (DSM-V) is scheduled for release in 2010. It is likely that the disorder will be renamed Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD) in the DSM-V.
The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from BPD /ERD. Click on the links on each one for more information about a particular trait or behavior and some ideas for coping with each.
Alienation - Alienation means interfering or cutting a person off from relationships with others. This can be done by manipulating the attitudes and behaviors of the victim or of the people with whom they come in contact. The victim's relationships with others may be sabotaged through verbal pressure, threats, diversions, distortion campaigns and systems of rewards and punishments.
"Always" & "Never" Statements - "Always" & "Never" Statements are declarations containing the words "always" or "never". They are commonly used but rarely true.
Anger - People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.
Baiting and Picking Fights - Baiting is the practice of generating a provocative action or statement for the purpose of obtaining an angry, aggressive or emotional response from another person.
Blaming - Blaming is the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.
Bullying - Bullying is any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.
Catastrophizing - Catastrophizing is the habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.
Chaos Manufacture - Chaos Manufacture is the practice of unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.
Cheating - Cheating is sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.
Circular Conversations - Circular Conversations are arguments which go on almost endlessly, repeating the same patterns with no real resolution.
Cognitive Dissonance - Cognitive Dissonance is a psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values. People who suffer from personality disorders often experience cognitive dissonance when they are confronted with evidence that their actions have hurt others or have contradicted their stated morals.
"Control-Me" Syndrome - "Control-Me" Syndrome describes a tendency that some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.
Denial- Denial is believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.
Dependency - Dependency is an inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.
Depression - When you feel sadder than you think you should, for longer than you think you should - but still can't seem to break out of it - that's depression. People who suffer from personality disorders are often also diagnosed with depression resulting from mistreatment at the hands of others, low self worth and the results of their own poor choices.
Dissociation- Dissociation, or disassociation, is a psychological term used to describe a mental departure from reality.
Divide and Conquer - Divide and Conquer is a method of gaining and advantage over perceived rivals by manipulating them into conflicts with each other.
Domestic Theft -Domestic theft is consuming or taking control of a resource or asset belonging to (or shared with) a family member, partner or spouse without first obtaining their approval.
Emotional Blackmail - Emotional Blackmail describes the use of a system of threats and punishments on a person by someone close to them in an attempt to control their behaviors.
Engulfment - Engulfment is an unhealthy and overwhelming level of attention and dependency on a spouse, partner or family member, which comes from imagining or believing that one exists only within the context of that relationship.
Entitlement - Entitlement or a 'Sense of Entitlement' is an unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.
False Accusations - False accusations, distortion campaigns & smear campaigns are patterns of unwarranted or exaggerated criticisms which occur when a personality disordered individual tries to feel better about themselves by putting down someone else - usually a family member, spouse, partner, friend or colleague.
Favoritism - Favoritism is the practice of systematically giving positive, preferential treatment to one child, subordinate or associate among a group of peers.
Fear of Abandonment - Fear of abandonment and irrational jealousy is a phobia, sometimes exhibited by people with personality disorders, that they are in imminent danger of being rejected, discarded or replaced at the whim of a person who is close to them.
Frivolous Litigation and Frivolous Lawsuits - Frivolous Litigation and Frivolous Lawsuits are methods of withholding support, harassing or prolonging conflict by bringing unsubstantiated accusations, meritless appeals or diversionary process into a relationship or a former relationship using the court system as a proxy.
Gaslighting - Gaslighting is the practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term "Gaslighting" is based on the 1944 MGM movie “Gaslight”.
Harassment - Harassment is any sustained or chronic pattern of unwelcome behavior from one individual to another.
High and Low-Functioning - A High-Functioning Personality-Disordered Individual is one who is able to conceal their dysfunctional behavior in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members behind closed doors. A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.
Hoovers & Hoovering - A Hoover is a metaphor, taken from the popular brand of vacuum cleaners, to describe how an abuse victim, trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship gets "sucked back in" when the perpetrator temporarily exhibits improved or desirable behavior.
Hysteria - Hysteria is inappropriate over-reaction to bad news or disappointments, which diverts attention away from the problem and towards the person who is having the reaction.
Identity Disturbance - Identity disturbance is a psychological term used to describe a distorted or inconsistent self-view.
Impulsiveness and Impulsivity - Impulsiveness - or Impulsivity - is the tendency to act or speak based on current feelings rather than logical reasoning.
Infantilization - Infantilization is the practice of treating a child as if they are much younger than their actual age.
Invalidation - Invalidation is the creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.
Lack of Object Constancy - A lack of object constancy is a symptom of some personality disorders. Lack of object constancy is the inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision. Object constancy is a developmental skill which most children do not develop until 2 or 3 years of age.
Learned Helplessness- Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.
Moments Of Clarity - Moments of Clarity are spontaneous, temporary periods when a person with a personality disorder is able to see beyond their own world view and can, for a brief period, understand, acknowledge, articulate and begin to make amends for their dysfunctional behavior.
Mood Swings - Mood swings are unpredictable, rapid, dramatic emotional cycles which can not be readily explained by changes in external circumstances.
Neglect - Neglect is a passive form of abuse in which the physical or emotional needs of an individual who is incapable of providing for themselves are disregarded or ignored by the person responsible for them.
No-Win Scenarios - No-Win Scenarios and Lose-Lose Scenarios are situations commonly created by people who suffer from personality disorders where they present two bad options to someone close to them and pressure them into choosing between the two. This usually leaves the non-personality-disordered person with a "damned if you do and damned if you don't" feeling.
Panic Attacks - Panic Attacks are short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as shaking, sweats, chills and hyperventilating.
Parentification - Parentification is a form of role reversal, in which a child of a personality-disordered parent is inappropriately given the role of meeting the emotional or physical needs of the parent or of the other children.
Passive-Aggressive Behavior - Passive Aggressive behavior is the expression of negative feelings, resentment, and aggression in an unassertive, passive way (such as through procrastination and stubbornness).
Pathological Lying - Pathological lying is persistent deception to serve one's own interests with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.
Projection - Projection is the act of attributing one's own feelings or traits onto another person and imagining or believing that the other person has those same feelings or traits.
Proxy Recruitment - Proxy Recruitment is a way of controlling or abusing another person by manipulating other people into unwittingly backing you up, speaking for you or "doing your dirty work" for you.
Push-Pull - Push-Pull is a chronic pattern of sabotaging and re-establishing closeness a relationship without appropriate cause or reason.
Raging, Violence and Impulsive Aggression - Raging, Violence and Impulsive Aggression are explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.
Sabotage - Sabotage is the impulsive disruption of a calm or harmonious status quo in a relationship or domestic situation, occasionally perpetrated by those with Personality Disorders, in order to serve a personal interest, to provoke a conflict or to draw attention to themselves.
Scapegoating - Scapegoating is the practice of singling out one child, employee or member of a group of peers for unmerited negative treatment or blame.
Selective Competence - Selective Competence is the practice of demonstrating different levels of intelligence, resourcefulness, strength or competence depending on the situation or environment.
Selective Memory and Selective Amnesia - Selective Memory and Selective Amnesia is the use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Harm - Self Harm, also known as self-mutilation, self-injury or self-abuse is any form of deliberate, premeditated injury inflicted on oneself, common among adolescents and among people who suffer from Borderline Personality Disorder. Most common forms are cutting and poisoning/overdosing.
Self-Loathing - Self-Loathing is an extreme self-hatred of one's own self, actions or one's ethnic or demographic background.
Self-Victimization - Self-Victimization, or "playing the victim" is the act of casting oneself as a victim in order to control others by soliciting a sympathetic response from them or diverting their attention away from abusive behavior.
Shaming - The difference between blaming and shaming is that in blaming someone tells you that you did something bad, in shaming someone tells you that you are something bad.
Situational Ethics - Situational Ethics is a philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be temporarily set aside if a greater good or lesser evil is served by doing so. However, situational ethics can be dangerous when combined with the distorted, crisis-prone thinking of those who suffer from personality disorders.
Splitting - Splitting is the practice of thinking about people and situations as if they were completely "good" or completely "bad" and to occasionally switch between thinking of them as "all good" or "all bad".
Thought Policing - Thought Policing is any process of trying to question, control, or unduly influence another persons thoughts or feelings.
Threats - Threats are written or verbal warnings of intentional, inappropriate, destructive actions or consequences.
Triggering -Triggers are small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.
Tunnel Vision - Tunnel Vision is the habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.
An estimated 2% of the US population is estimated to meet the clinical criteria for BPD. However, prevalence results vary widely as shown below. A number of studies have been performed to determine the prevalence of personality disorders and BPD. Prevalence results indicate that BPD affects anywhere between 0.5 and 5.9% of adults
People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. Those who suffer child abuse are also more likely to develop BPD.
Some people who suffer from BPD are prone to suicidal behaviors and self-injury, especially as adolescents. About 8%-10% of diagnosed BPD patients commit suicide.
See Our Statistics section for more statistics on Personality Disorders.
Click here for some statistics on the possible origins of BPD.Borderline Personality Disorder (BPD) is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR) as an Axis II, Cluster B (dramatic, emotional, or erratic) Disorder:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuous sex, eating disorders, substance abuse, reckless driving, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
There is no known cure for BPD / ERD. As a result, families of people who suffer from BPD / ERD are often left to fend for themselves and rely on their own resources.
However, some treatments do exist which have proven effective in managing symptoms. The most common approach is the combination of SSRI medication and DBT Therapy.
Definition:
DBT, or Dialectical Behavioral Therapy, is a psychosocial treatment developed for patients with borderline personality disorder which combines intensive individual and group therapy.
Description:
Dialectical Behavioral Therapy (DBT) was developed for treating Borderline Personality Disorder by Marsha M. Linehan. Some therapists avoid treating patients whom they suspect may suffer from BPD, because of the demands some BPD patients put on the therapist. These demands include multiple phone calls after hours, suicidal ideation and suicidal threats, lack of respect for the therapists boundaries or the boundaries of other patients and staff, aggressive outbursts and stalking.
DBT incorporates an intense program of weekly individual therapy sessions and weekly group therapy sessions.
Individual therapy focuses on addressing a prioritized set of issues starting with self injury, then behaviors which disrupt therapy, then behaviors which disrupt healthy living. Patients are trained in a regime of four skills known as mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.
Definition:
SSRI's, or Selective Serotonin Reuptake Inhibitor's, are the most commonly prescribed antidepressants for people who suffer from personality disorders. Popular SSRI's include Celexa, Lexapro, Prozac, Paxil, & Zoloft.
Description:
SSRI's relieve symptoms of depression by blocking the re-absorption (re-uptake) of a neurotransmitter in the brain called serotonin. More serotonin in the brain has been shown to improve mood.
SSRI's are generally considered milder than other types of antidepressants. Therefore, SSRI's are typically the first line of approach for practitioners.
Side-effects include: nausea, sexual dysfunction, headache, diarrhea, nervousness, rash, agitation, restlessness, sweating, weight gain, drowsiness and sleeplessness.
The causes for BPD are not precisely known. However, recent research has turned up some clues. Further study is necessary to definitively establish a cause. However, theories do exist.
There is some evidence relating the prevalence of BPD to the kind of environment a child grew up in. A significant percentage of people who suffer from BPD were also abused as children. However, this kind of correlation does not always prove that the environment they grew up in contributed to their own disorder - read our section on the Post Hoc Ergo Propter Hoc Fallacy for a possible explanation why.)
There is a higher incidence of personality disorders in those who have parents who suffer from a personality disorder. This has led some scientists to suspect there may be a genetic link for BPD.
There is also a higher incidence of BPD in females. Read our section on the Amygdala for some information on gender differences in neural activity which may some day lead to a greater understanding of why certain disorders may afflict one gender more than another.
Definition:
Amygdala - The Amygdala is a small region of the brain which plays a key role in emotional regulation, emotional memory and responses to emotional stimuli.
Description:
Recent technological advances have given neurologists two new ways to create 3-D images of the brain. These techniques are known as Positron Emission Tomography (PET Scanning) and functional Magnetic Resonance Imaging (fMRI). By scanning a person's brain while prompting them to think in a certain way, scientists are unlocking clues as to which regions of the brain are responsible for different kinds of thought.
Much of this work has focused on the amygdala - a small region deep in the brain shown below. There is one amygdala the right side of the brain and one on the left as shown below.
The Amygdala's Role in Emotional Reactions
It is believed that the amygdala has an important rule in producing lightning-fast emotional responses to events, whenever a person recognizes an event with a strong emotional element (good or bad) such as events that results in fear, anger or rage or events that result in delight, joy or excitement.
The amygdala is believed to be part of our fast, instinctive and reactive brains. Not much conscious thought is involved if an object is hurled towards us and we instinctively duck. This ability to react instinctively to danger is thought to have historically played a critical function in survival of most species. Similarly, witness the reaction of a crowd whenever a sports team scores a goal. There is a universal instant response of throwing hands in the air, widening the eyes, leaping into the air etc, without much thought given. When you see these instinctive reactions occur, the amygdala is at work.
The Amygdala and Memory
The amygdala has also been shown to have an important function in enhancing memory functions by releasing stress hormones, such as adrenaline. It has been shown experimentally that rats, who have had their amygdala disabled lose their fear of cats. It has also been shown that increasing stress hormones improves memory of an event. This helps explain why people can remember stressful moments in great detail - such as times of disasters or crises, when adrenaline is released and yet can easily forget long periods when nothing significant seems to have happened.
Gender Differences in the Way the Amygdala is Connected
Another interesting finding resulted from a study comparing amygdala activity in males and females. When shown images containing strong emotionally arousing content, it was found that the amygdala on the right side of the brain was the most active in men, while the amygdala on the left side of the brain was most active in women.
Other experiments with people who are relaxing have shown that in men, the right amygdala is more closely connected to the rest of the brain than the left, while women show a stronger connectivity between the left amygdala and the rest of the brain. Additionally, in men the right amygdala seems to be strongly connected to regions of the brain normally associated with interactions with the external environment while in women, the left amygdala seems to be strongly connected to regions of the brain normally associated with more internal thought. This suggests that in an emotional context, men are biased toward thoughts about the external environment and women toward thoughts about the internal environment.
The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder
In a famous experiment at Yale University, 15 people diagnosed with BPD and 15 people with no BPD diagnosis were shown photographs of faces with neutral, happy, sad, and fearful facial expressions while mapping the activity in the brain using fMRI. It was found that there is a lot more activity in the left amygdala of people who had been diagnosed with Emotional Regulation Disorder /Borderline Personality Disorder when exposed to an emotional stimulus than there is for most other people.
Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.
Borderline Personality Disorder (BPD) and Bipolar Disorder are similar in that both are characterized by dramatic changes in mood. It is thought that many people who suffer from BPD are inaccurately diagnosed as having Bipolar disorder because it generally carries less stigma and is easier to treat with pharmaceuticals. However, there are also some important differences between Bipolar & BPD:
Frequency of Mood Cycles
Mood swings for people who suffer from Borderline Personality Disorder typically cycle much faster than for people who suffer from Bipolar Disorder. BPD sufferers often exhibit mood cycles lasting from a few hours to a few days. People who suffer from Bipolar Disorder typically exhibit mood swings lasting from a few weeks to a few months.
It should be noted that some Bipolar patients are characterized or diagnosed with Rapid Cycling Bipolar Disorder which has the same symptoms as Bipolar Disorder but with a shorter cycle time.
Relationship Basis
People who suffer from BPD often exhibit an acute Fear of Abandonment. The mood swings a person with BPD exhibits are often attached to their fear of being left alone or their preoccupation with not being alone. Sometimes, BPD is described as a "relationship disorder" in that it manifests itself in interactions with others.
Bipolar Disorder tends to be less relationship-based. People who suffer from Bipolar Disorder often display cycles of mood which are more inwardly self-focused and have less to do with how they feel about the relationships they are involved in.
Dissociation
Borderline Personality Disorder comprises both psychotic & neurotic thought processes. This gives rise to the name "Borderline" because it is thought to be on the "borderline" between psychosis & neurosis. The thinking and behavior of a person with Borderline Personality Disorder includes more mental departures from reality, known as Dissociation or "feelings create facts".
In contrast, Bipolar Disorder tends to be more neurotic in that the mood swings tend to be based more on extreme exaggerations of fact.
Response To Treatment
People who suffer from Bipolar Disorder often respond positively to appropriate regimes of medication.
People who suffer from Borderline Personality Disorder may also exhibit some improvement when treated with appropriate medication but typically also require extensive therapeutic intervention such as DBT over a period of months or years in order to see comparable results.
Both groups are often reluctant to seek help and may be resistant to medication. Also, both groups have a tendency to stop taking prescribed medications when they begin to feel better which often leads to relapses.
Movies Portraying Borderline Personality Disorder Traits
A Streetcar Named Desire - A Streetcar Named Desire is a is a 1947 play written by Tennessee Williams, later adapted for film, which tells the story of a woman who displays histrionic and borderline traits, who goes to live with her codependent sister and her narcissistic husband.
Fatal Attraction - Fatal Attraction is a 1987 Movie Thriller starring Glenn Close & Michael Douglas about Dan Gallagher, a New York Lawyer (played by Michael Douglas) who is stalked by Alex Forrest (played by Glenn Close) with whom he has had an affair. The story portrays Alex's increasingly unstable behavior as a result of having Borderline Personality Disorder and feeling abandoned by Dan.
Girl, Interrupted - Girl, Interrupted is a 1999 Columbia Pictures movie which chronicles the experiences of a teenage girl with Borderline Personality Disorder, who is admitted to a mental health institution after attempting suicide.
Mommie Dearest - Mommie Dearest is a 1981 biography of Hollywood Actress Joan Crawford, played by Faye Dunaway, who, according to the account in the movie, exhibited Obsessive Compulsive, Borderline and Narcissistic Traits.
Single White Female - Single White Female is a 1992 Columbia Pictures Release starring Bridget Fonda and Jennifer Jason Leigh which portrays the events after a young woman takes in a roommate who exhibits some of the symptoms of Borderline Personality Disorder (BPD) and Dependent Personality Disorder (DPD) including mirroring, impulsivity and fear of abandonment.
The Wizard of Oz - The Wizard of Oz is a 1944 movie starring Judy Garland which is sometimes used as a metaphor to describe the disconnect between the dissociated reality of the personality-disordered individual (Oz) and the real world experienced by the Non-PD (Kansas). The metaphor is based on the iconic phrase: "Toto - I've a feeling we're not in Kansas any more".
Out of the FOG Support Forum - Visit the support forum here at Out of the FOG.
Psychforums BPD forum - Psychforums Site.
BPD Recovery - http://www.bpdrecovery.com/ BPDRecovery is a site that focuses on recovering from Borderline Personality Disorder. The Site is run by a recovered Borderline. It is a non-discriminatory website which means that all individuals are welcome - whether you've been formally diagnosed or simply recognize yourself or someone you know in the diagnostic criteria, you are welcome here!
Anything to Stop The Pain - information site, blog and support board for Non-Borderlines, with a particular emphasis on supporting people who have children with BPD and people in a committed relationship with a person who suffers from BPD.
http://bpdcentral.com/support/email.shtml The Welcome to Oz Online Community for Family Members with a Borderline Loved One.
http://borderlinepersonality.ca/board BPD Support Site run by BPD Author A. J. Mahari.
http://www.BPDCentral.com - An information and support site about BPD run by Randi Kreger, co-author of "Stop Walking on Eggshells".
http://www.BPDFamily.com - Support Site for the family and relationship partners of individuals with BPD.
http://outofthefog.net/Disorders/BPD.html
http://outofthefog.net/Disorders/BPD.html
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