Borderline Personality Disorder: Treatment Resistance Reconsidered
psychiatrictimes.com
psychiatrictimes.com
It can be hard to maintain steady, honest empathy for people with Borderline PD, but their suffering is very real.
I'm not a professional, but think he's untreatable mostly due to his completely non acknowledgement of his disease. The added paranoia and delusion makes him aggressively dismiss any kind of intervention as "conspiracy" against him.
It's sad too see an individual waste his life this way for something that seems treatable, from this report.
Lack of insight is a feature of the disorder, to be able to treat BPD at all is partly to improve this.
Self-insight is developed in childhood in healthy interactions with a caregiver: roughly a parent displays an appropriate emotional reaction to your behaviour which allows you to recognise your own behaviour by observing this emotional reaction. Without an ability to observe yourself emotionally through the mirror the parent provides, you fail to develop an awareness of your identity/emotions/etc.
The process of developing it anew in an adult requires re-running childhood again in a particular kind of way, with a therapist, and have the therapist provide you with the healthy responses that your parent failed to provide. It is, in my opinion, an exercise in retraining the emotions -- particularly developing the reflective frontal-lobe responses and suppressing the fight+flight amygdala responses which is often way out-sized in traumatized people.
Insight into oneself is a trainable faculty like many others, and its deficit is not the end of treatment but the usual starting point.
But he won't start treatment?!
> As a result, the term “treatment resistant” can fuel views of patients as “oppositional” and recalcitrant, instead of expectably symptomatic.
I'm not claiming that the kind of dissociation a person experiences when psychotic can be treated by therapy. Pharmacology is essential, and actually I do think after awhile therapy can be helpful (I have family members who have had psychotic episodes too).
The lack of insight in both cases is a product of dissociation. In a personality disorder this is a "mild" chronic state (compared to psychosis) which is amenable to very long term (years+) therapy, unlike psychosis. It is why BPD people with quite severe dissociation or who have episode of severe dissociation report mildly schizoprenic-like problems with their identity (eg. thinking that they are multiple people, lost time, etc.).
I was assuming his BPD friend had this background state, which would not preclude treatment. Treatment would, in part, be to deal with that.
(per Wikipedia)
beep beep
And what would that particular kind of way be?
Two hints to anyone that might need help with this. If you think you cant feel anything, consider this. What is the feeling of not feeling anything?
Last suggestion: find a pillow and hold it to your chest. Hug the crap out of that thing. See if you can feel the comfort. Your job as a traumatised person is to learn to feel that same comfort when you need it, but without the pillow. Sounds weird but this is what un traumatised person learned to do before they could ride a bike and promptly forgot that they ever learned it. You need to learn it in adulthood. And fortunately its not that hard.
Yeah, this has been the entirety of my experience with people who have personality disorders.
How do you detect BPD when the subject is so uncooperative and knows how to act normal enough to trick you?
I suspect someone of having BPD who doesn't want any help at all (suprise?). What will convince a psychiatrist or counselor?
Edit: Don't take this the wrong way, but others have given you a bad name: you sound as professional as Microsoft support.
Our interactions were mostly them telling me all about themselves, troubles, and what I considered a bit too wrapped up in their family and essentially anything I said was forgotten. But they were nice to have a glass or two of wine with.
After the incident, I said maybe they should seek professional help. They said that they hated that I turned out to be one of "those people" that, when they were being 'different' or 'standing up' for themselves, were always saying that maybe they should talk to a therapist or that something was wrong with them and that they were "disappointed" in me. Over the three days following they tried to shrug it off, bring me gifts, etc. but I figured it best just to go "no contact" as they say online.
Anyway, I don't know if they have BPD (though a friend with a bipolar mom confirmed some things) but it's tough when 80% of the time the person is nice and functional but there are hidden faultlines that rapidly turn frightening.
If I could afford to, I would go see a therapist just to get a different perspective on my life from my friends but it's sad that someone who seems to really need it are in refusal. I recall when my mother told me about her taking depression meds and was sad that she was struggling with that and I had not recognized it but also happy that she had sought help.
I confess to a personal interest as I've sought at times for things like anxiety and depression, and frustratingly enough would not be able to tell you what treatment I was actually receiving under the name of therapy.
People should have a choice of what works for them.
http://www.crisiscareconcordat.org.uk/inspiration/meeting-th...
That document lists:
Dielectical Behavioural Therapy Mentalization Based Therapy Cognitive Analytic Therapy Transference Focussed Psychotherapy Interpersonal Group Psychotherapy Cognitive Therapy for Personality Disorders Schema Therapy
and it lists intensive therapeutic programmes, therapeutic communities, and arts therapies.
Of these DBT probably has best evidence, and has most people providing it.
please don't engage in armchair dx.
I ended up at a job working with someone with it. Let's just say the only winning move is not to play.
I've had work experiences with BPD co-workers and ended up just needing to extricate myself from the situation for my own sanity rather than to try to help or do anything productive that could've made their situations improve. I always felt bad about it, but I just don't have the patience and fortitude to help in those situations.
It's not just this, but it's the frustration that comes from not being able to, for lack of a better term, fix BPD. You can pour your heart and soul into a relationship with someone who is borderline (as I did), and it will all be for nothing as soon as they split you. You can have a relationship spanning back years, maybe it's even someone you've known since you were a child, and suddenly a switch goes off in their brain and you may as well be someone that they just met yesterday.
There is no parity between Cluster Bs and "normal" people when it comes to things like friendship, loyalty, and obligation, and that has the potential to really hurt people. Some (most?) never figure out what Cluster B personality disorders are -- to them, these people are simply evil.
At best you have some success getting them to change and improve themselves, but then they just discard you and move on without so much as a second thought about you or your feelings. Unless they need you again in the future, that is.
This is a perfect description of what it's like. It seems to happen in episodes, too.
Every time you think you've built up some kind of bond (not anything special, just a typical everyday person-to-person emotional bond), there's another episode around the corner to reset it to zero in the blink of an eye for no apparent reason.
I was in a years-long relationship with someone with BPD, and eventually what I realized is that time doesn't strengthen anything with them. Nothing builds up over time, there's no foundation being built, you are always one instant away from being nothing to them.
Time can make you a recurring candidate for bizarre episodes of infatuation and idealization after you've left. But no amount of time you spend with them will ever meaningfully strengthen whatever bond you think you have.
i’m sorry for your experience but this is also patently false applied as a general statement to “us”. you’re not helping the situation by putting all of us over “there” where there is always one instant away of you being nothing to us.
All untreated BPDs experience splitting. For me, that isn't up for debate. By that, I mean you can't convince me otherwise. It's a hallmark of the disorder. Maybe you are receiving treatment and able to suppress it, but as soon as treatment no longer works for you or you discontinue it, you will start to split again.
I don't know where you got that information from, but I'll assume it's the bad experiences you mentioned. I'm sorry you made them. "a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation" is one of nine criterias used to diagnose BPD. One must fulfil only five, however. Please try not to make those generalizations. It's important. People suffering from borderline are still individual humans. Even if they have similar (not the same) problems as the ones who hurt you, it's not fair to divert your disappointment.
Being the victim of childhood abuse or trauma does not give you the right to abuse people unrelated to those events today. You have agency, and you are responsible for your behavior.
Having a personality disorder does not give you license to abuse others and does not negate your responsibility for your behavior. Again, you have agency and your mental illness does not change that.
The fact that you did not choose to have BPD is irrelevant and does not give you the right to abuse others. It does not negate your responsibility for your own behavior.
I ran around for more than 20 years, pretty much non-functioning. I searched for help various times, and received help, but not always in my own best interest (e.g. if organisation X pays for your professional help, its in their interest; not yours). Now that I know I suffer from autism I have a much easier time recognising the patterns, and once my therapy starts I'll have an easier time coping with myself and society.
It makes me wonder how many people are running around with incomplete or inaccurate diagnoses.
Prescribed a drug that made me much more depressed and started cutting. I stopped taking it, and later met the person who is now my spouse. Early in the relationship I got fraught that it would end, so I tried to end it preemptively. That didn't work, thankfully.
It was really a relationship where I could for the first time just be myself and not "front", so it just felt right. My pysch was not convinced and warned me, rightly so. But, we moved away from that college, got married, have kids, and really haven't had any emotional rollercoasters since (over 10 years later).
But occasionally I have emotional scares/thoughts but they usually subside. Also, since I'm on a throwaway, when we first had our first child I kept getting murderous thoughts about how to kill it whenever I got frustrated. These scared me, and through some introspection, my own aim seemed to be to get an emotional response from myself. Especially since these thoughts typically included how I would immediately regret harming my child and how others would react.
So I feel like it's still there, but my hormones leveled out or something happened to allow me to manage it.
I imagine so. There are always errant thoughts of taboo things (well, I assume that's a common thing...), but to keep coming back to something like that without some obvious priming (such as media) sounds terrifying. Just experiencing those thoughts and wondering about myself would probably leave me a wreck, so good on you for recognizing them for what they were and finding a way to deal with them.
Other times it was more insidious, "would your baby still be so fond of you if you slowly crushed its head".
Ugh, I struggle just trying to type that last one out. They would always bring me to tears. I'm pretty good at compartmentalizing I suppose.
These have disappeared now that our kids is older and our emotional input is requited.
I am still contemplating whether I should mention it to my spouse. She knows about my diagnosis in college but not these intrusive thoughts.
[1] http://www.viruscomix.com/page590.html
As with pain, we can never really know the scope of anyone else's intrusive thoughts; but know that it is not a unique burden.
That's a tough one. I'm going to step inand give my two cents, even though I'm not trained in this and don't have a huge amount of experience.
Don't share it unless you have a specific setting that allows it to be digested by her slowly, and with professional help to put it into context, and even then have a good reason for doing so. Sharing this with her puts her in the situation of needing to balance her understanding and love of her husband with her love and protectiveness of her children. It's her job to worry about the kids, so even if she's 99% sure there's absolutely no danger, that 1% is hard to accept as a parent. As long as you're sure the situation is safe, saving her from having to obsess over the possibility of those scenarios is doing you both a favor.
This of course presupposes that you aren't really a danger, as you've noted. So as long as you're sure of that, I keeping it to yourself is better for your both. I'm of course an untrained outsider looking in though, so take this for whatever it's worth.
It's important to understand that emotions can't 'force' you to do anything. You fuel your intrusive thoughts by not allowing your frustration to vent in an appropriate manner. Just sighing and saying 'I am frustrated, oh well' when you are can help a lot.
Intrusive thoughts are like a mild case of OCD, and with a bit of psychotherapy the will disappear.
My diet has also changed a lot, like another commentator mentioned.
Too many variables!
And see also: https://en.wikipedia.org/wiki/Dialectical_behavior_therapy "This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions."
Of course, all easier said than done...
For someone in a relationship where it seems to rhyme but not fit understanding the two flavors can be eye opening.
There is also some exploration of the relationship between BPD and trauma as most people with BPD have a history of trauma. There may be some gender bias when diagnosing BPD. Men who report the same symptoms as women are more likely to be diagnosed with PTSD than BPD.
BPD is one of the cases where our current approach to mental health falls short in a way. We only consider someone mentally ill if their mental dysfunction impairs their life. If someone’s mental dysfunction only ruins the lives of the people around them, that’s not technically a mental illness.
Borderline is a perfect example of this. It’s true that a borderline will compulsively sabotage their own relationships, as well as any other relationships surrounding them (borderlines are great at turning third parties against each other and are savants of “Lets You And Him Fight”), but if they manage to find the right enablers, or jump from relationship to relationship fast enough, they can manage to avoid suffering too much from their dysfunction while leaving a trail of damage in their wake.
That’s why borderline is so fundamentally hard to treat. It’s so easy for some borderlines to develop the coping mechanisms to evade the consequences of their actions that they’re not affected, and “fundamentally caring about someone other than yourself” doesn’t seem to come naturally to a borderline.
I wonder how helpful psychedelics would be in treating the narcissistic aspect of BPD. Revelatory experiences (coming into contact with the Great Other) and ego death might reset the dysfunction of one’s personality. Or at least give that person greater perspective and insight into their condition.
So is that the same 1 'meaningful relationship' for 8 years? Did they try asking the other person in the relationship whether the patient was in 'remission'?
Or working with someone who has BPD. They don't get anything done. They play office politics to a ludicrous degree. They blame everyone else for anything that happens. But they know who to suck up to, and they know how to make it look like they're getting work done. So they don't get fired.
Keep a relationship or a job means nothing unless you ask everyone else if they're getting better. If the answer is "OMFG I'm still walking on eggshells around that person", then they only progress they've made is to fool the therapist.
Didn’t think so.
I get my work done, dude. It’s like no matter how much I try to keep other people happy, nobody gives a shit and assumes I’m like everyone else they’ve ever met who claims to have it, and they’re confidently able to predict who I am based on a label. You sure have the leprosy of BPD figured out; sounds like I should be playing more office politics, since that’s what I’m supposed to do, apparently.
A not-insignificant portion of this thread sucks, is just outright depressing, and suggests to me that there’s little hope for ever successfully loving or communicating with other people. And you know the worst part? I fall in love easily because I want absolutely nothing more than to feel that connection with another human being. Comments like this remind me of the futility that lies therein. I shouldn’t have read the comments, and I knew better when I clicked it, but I did it anyway in the vain hope that I would read something to inspire me to keep pressing forward. How’s that working out, you ask? Makes me relieved I bought a tall bottle of Goose at the store earlier, thank you.
Your other, horrible comment comparing BPD to incontinence makes me want to say something really nasty, emotional, and visceral to you, but I’m strongly resisting because it would just reinforce your fucked up belief structure about people who are genuinely suffering on a level that you can’t even comprehend. Seriously, I’ve clicked Edit and typed some of the meanest things I’ve ever said several times now, but I also know to resist that overwhelming urge for both of our sakes. How’s that for your opinion of people like me? Do I fit your box?
I genuinely hope you find it in yourself to develop empathy for people who aren’t as advantaged and in control of their lives as you. I’m sorry to rebuke you so harshly, but Christ.
She was otherwise an apparently successful masters student who I'm sure can hold down a job for years at a time. But taking completely senseless abuse just isn't worth it for the vast majority of potential partners, even if the BPD person has many redeeming qualities and can't control their outbursts.
I wish her (and everyone in a similar situation) all the best, but I am too emotionally sensitive and empathetic to be able to deal with that for the long term without going nuts myself.
As is typical in borderlines, you missed my point entirely. My comment was about the impact this disorder has on others. Because of the disorder, your pain is so large that you are blind to the impact that the disorder has on others.
That's the problem.
I sympathize with you, I really, really, do. I wouldn't wish it on anyone. But ultimately, it's your disorder, and is your responsibility to fix.
If you want to help yourself, read:
https://news.ycombinator.com/threads?id=throwaway29845
Then, take the advice to heart. You will be happier by far.
One problem with the disorder is that the lows are tempered by highs. It's exciting to be emotionally involved, to think the world of someone, to be on the "high". And then it crashes, and you feel like shit.
I've read a lot about BPD, and things written by BPD sufferers. Despite the lows, most are also addicted to the highs. And they can't deal with the underlying disorder until they break the addiction.
As an example:
> I fall in love easily because I want absolutely nothing more than to feel that connection with another human being.
That's the emotional high I'm talking about.
You can get away from the lows. But the cost is that the highs are also mitigated. This is how most people live. There are few extremes. Just every day fumbling through life. Life is this: just living.
> I genuinely hope you find it in yourself to develop empathy for people who aren’t as advantaged and in control of their lives as you.
That is another typical BPD comment. You know nothing about my pain, my experience, or my journey. But because you're in pain, then my life must be wonderful.
Stop splitting. Decide to just live. Decide to not inflict pain or suffering on others. Work on the addiction to the highs.
If you want to talk more, email me. My email address is in my profile.
I didn’t miss your point. The part that made that comment horrible is “you’re not allowed to come over until you stop peeing on my couch,” like human beings with a regrettable, painful, mortifyingly embarrassing condition are untrained dogs to you. Like it’s something they can just stop. That’s what you said: figure it out, then I’ll let you sit on my couch. I considered the possibility that I misinterpreted you here, then noticed that I wasn’t the only one, if so.
Then you did the exact same thing here, too. “Stop splitting.” “Decide to stop hurting people.” “Just flick off this light switch that’s taken years of therapy to even understand, buddy! Just live! Just be!” Okay, Julia. You’re talking about serious, life changing journeys that require a lot of help and support along the way, and paying them the same respect as taking the car through the wash.
I’m not blind to my impact on other people. As is typical in armchair psychologists, you missed the entire part of my comment where I talk about how intensely aware I am of my impact on others. That’s this entire comment: oh, he has this condition, let me ignore everything he said and talk to him with my years of psychological training. Maybe that will get through.
I’m not splitting with you and acknowledge that I know nothing about your pain or journey. I know only what you’ve chosen to share in commentary here, and brother, it’s enough of a display of malempathy to make me conclude that your opinion matters very little to me. I didn’t even need my disorder to make that determination. The follow up didn’t do a lot to help.
what an absolutely vile thing to say. This is a repugnant comment, and you should be ashamed of it.
jsmthrowaway - if you ever read this, you have my empathy and support. Ignore these a-holes; they are just ignorant and loud. Unfortunately there are many sick people in the world who don't understand mental illness, but remember that there are many people who do understand.
those of us who accept our diagnosis and work toward treatment (and it is a small subset) are often deeply aware of the impact our condition has on others. often i feel i go the distance to cultivate the good more than others in my circle because i am so distinctly made aware of my own inhered failings in the social arena.
how may i help you? how may i make your life a more pleasant experience? how may i alleviate your burdens? these are all questions at the forefront of my mind when communicating with humans generally and even more with those i have invested time and effort.
it’s a real effort which i am inclined to point out you may not fully be aware yourself of the enormity of despite saying so. you don’t live in this mind where every emotion is like a firestorm. we may talk of our disorder as a real sickness, as an illness to be eradicated but you on the other end have not felt what it was like to fall so deeply in love that self and other disappear in a moment of self-self knowing. if humans knew all other humans in such a fashion, humankind might be better off.
my goal is to eliminate the poisons and elevate what i know to be good in me. we can get better. i have seen the results myself. please don’t write us off as a population.
i’d urge the mentally healthy to also strive to be even more tolerant, compassionate and selfless than you may already think yourself to be. being human (”healthy” as it were) can be seen itself as a kind of mental condition that one is enslaved to: extraordinary people like the Buddha have made such observations.
we’re in this thing together.
This is a shocking personal attack and particularly painful to see here. You've followed it up with other things that are just as bad. This is not allowed on HN.
I've banned this account, mostly because you behaved so badly here, but also because you've engaged in flamewars and personal swipes in the past. We really don't want that kind of discussion on Hacker News. If you'd like to commit to using this site properly in the future—which means only posting scrupulously respectful remarks—you're welcome to email hn@ycombinator.com and ask to be unbanned.
Before you write off BPD people or assume you know how this disorder works or what the prognosis is, take the time to read up on more recent work in this field. BPD is one of the least-understood diagnoses in the DSM, and most people who write about it appear completely unaware of the last ~30 years of research on this disorder.
[0] https://en.wikipedia.org/wiki/Dialectical_behavior_therapy
That's funny because from what I've read, DBT is the only proven treatment for any of the personality disorders and it's used for BPD. My reading suggests that SPD is the least understood, and probably the most common among HN readers (that part is speculation on my part).
[1] https://en.wikipedia.org/wiki/Sensory_processing_disorder
https://en.wikipedia.org/wiki/Symphysis_pubis_dysfunction
For a second there I wondered why this would be very common on HN.
Dialectical Behavior Therapy is just another flavor of the day for a discipline that has embraced unscientific quack theories since the days of Freud, and continues to do that today.
This is a common misconception. In fact psychiatry were pioneers of the gold standard clinical evidence - the randomised controlled trial. I suppose if you were being ungenerous you could say that they weren't able yo do much other type of research.
Psychiatry is just a specialism within medicine, none of which are science unless you look at the disciplines from an academic perspective. If you want the least evidence-based specialism, you're probably looking at paediatrics, where there is pretty much no evidence for what they do, as it is very difficult to involve children in trials.
Another criticism of psychiatry is that there isn't a laboratory test for any of these diseases, but this is an unfair criticism of diseases that can be clearly defined (see criteria) and causes measurable harm (look at the overall survival of anorexia for example). It is also a criticism that can be levelled at many other diseases. If anyone can tell me what lab test you use to diagnose migraine I'd be interested.
It's unfortunate that psychiatry have this problem. As a specialty they can do a lot of good for people who would otherwise not live for very long - if you've seen someone having a psychotic episode you'll know what I mean.
Psychiatric theories can’t be falsified, making them not science.
Meta-analysis was really developed (although not originated) in psychology, attempting to wrestle with replicability issues in much the same way as is the case now. It's really the introspective nature of the human behavioral sciences that drives that as much as the complexity of what's being dealt with.
And I'm not sure why you think psychiatric theories can't be falsified. It happens all the time. If it couldn't, this registered replication stuff wouldn't be getting so much attention, because it would be a non-starter.
Meta-analysis also suffers from publication bias, agenda based bias, etc.
How does running a bunch of replications of a study ever falsify it? Based on statistical probability it's always possible the original study was accurate, and it's the replications that cheated. The realization that the results of these studies are essentially random goes a long ways towards establishing how unfalsifiable any of them are.
And beyond statistical studies into analytic theories, how do you falsify the theory of the "Id, ego and super-ego"? Transfer neuroses? How do you falsify "Dialectical behavior therapy"? It worked for someone somewhere, so it must be true.
The only thing that's come out of the whole of psychiatry and psychology that has any scientific merit is Skinners behavioral experiments.
Really? How would you convince me that, say, Nivolumab is a better treatment for cancer than the current standard of care? I doubt you have something better than a randomised controlled trial, given there is international acknowledgement that this is the gold standard - the only thing to top it is several RCTs spanning several centres and countries.
>Too easy to report random results
Subgroup analysis is always taken with a pinch of salt.
>impossible to control for all factors
Well that's the point of a randomised controlled trial. The 'controlled' part is 'randomised'.
>sample sizes never remotely large enough
For what?
>Psychiatric theories can’t be falsified, making them not science.
Not sure what question you have in mind, but the question "Does anti-psychotic medication 'A' improve overall survival in patients diagnosed with refractory schizophrenia" is certainly a question that can be tested in a scientific way.
I'm not a psychiatrist, but your comments don't make sense.
Fully… except for judgements. Because judgement would be bad?
Would a real Buddha have a contradiction in his teaching?
The only thing I really have an issue with is the misunderstanding that Gautama Buddha taught mindfulness. The meditation people teach and learn today is completely different from what he taught people. For one thing, he certainly did not teach people to remember the truth of goodness. He did not teach people to abandon or ignore right and wrong because that has a terrible effect on human society in the long run – even though you do not perceive it through your practice of meditation alone. That's why it's important to learn about teachings about enlightenment from a real enlightened being, not from someone who has not achieved it yet. Modern Buddhism exists in the state of people transmitting what they learned from others, with their own thoughts added.
I was raised by a BPD mother (who actually did an incredible job coping with it as an adult, but she wasn't perfect), and I have dated multiple women with BPD (an all-too-common scenario apparently). I found Stop Walking on Eggshells and similar sources (e.g. the BPD articles on http://gettinbetter.com/articles.html) extremely helpful when it came to recovering from my relationships.
The first one had all sorts of red flags, but I was inexperienced and desperate. The one after that completely caught me off guard. She had done some DBT, but that only taught her how to conceal and restrain her symptoms.
There is absolutely nothing wrong with writing off BPD people. Being in any sort of relationship with one is stressful, draining, and traumatic.
It’s like trying to teach empathy to a young child after they’ve done something cruel, and it’s clear you’re not really getting through to them and their brain just needs to develop more. People with BPD stay that way their whole lives, and have everyone around them walking on eggshells every day.
Why should I distance myself?
I have a partner with BPD, and she's put a lot of effort into getting better (and I've seen real progress), and at her worst she's never really acted maliciously or cruel. Still, way more extreme highs and lows than any other relationship I've been in, and I've stopped seeing them as much just because it's so exhausting.
If I thought she was truly sociopathic, I'd cut ties with her.
I praise anyone's attempt to help a BPD, but I hold no hope for a solution.
Some referred to "Stop walking on eggshells" as outdated, but I found it a revelation that significantly helped in my understanding and recovery.
boop beep
The headline may seem to be saying "BPD is now more treatable than before," but that is not what this is.
The tldr; is actually more like "framing BPD patients as resistant to treatment is wrong. The correct framing is that we don't have adequate treatments for the disorder."
I didn't realize that there was anything really wrong with me until the end of 2014. I had destroyed yet another relationship in a spectacular, irrevocable fashion. The pain was unbearable. And familiar.
I isolated myself for the next two years.
My childhood was chaotic. My father was an alcoholic. My mother booted him out by age two, but he remained a volatile and destructive force in my life until he dropped contact with me after my fifteenth birthday.
I had step-parents and step-siblings on both sides. People came and went. I had siblings and then I didn't. I learned that relationships are unreliable.
I was verbally abused by one of my mother's men. He was a violent man. He broke down doors, shook his children, and screamed a lot. I still remember how his eyes bulged when he was angry, which seemed to be always.
I remember how he would go out of his way in the mornings to drop his kids off at school first, even though we passed by my school on the way, just so that he could scream at me in private. Everything was my fault. Always.
At age eleven, I accompanied my mother to the police station because she'd just shot my father's deranged girlfriend, who'd followed my father to our house in the middle of the night threatening to kill us. I remember how she cried. I remember writing my deposition.
The girlfriends survived but was later murdered by someone else. She had two kids. I never saw them again. I had originally thought she was a cool person.
I didn't realize any of this was abnormal or damaging. I was a child. By the time I entered adolescence and began discovering that I was gay -- in a small, rural, Christian-dominated Texas down -- I had a total breakdown. I developed symptoms of panic disorder, OCD, hypochondriasis, paranoid thinking, and depression.
My mom took me to a psychiatrist, and he didn't know what to do with me. Mostly because he didn't know any of this. I was a weird kid. I talked to him about the origins of the universe because I was entering my philosophical phase. They put me on Paxil. It turned me into a zombie.
I started drinking in my early twenties. At first it wasn't much, but it grew and grew. I got to the point where I was no longer in control. After the calamitous end of my five year relationship (one that because of me, had grown incredibly toxic) I downed half a bottle of vodka and chased it with some clonazepam. I texted my ex and he, alarmed, summoned the paramedics. I was involuntarily confined for three days.
I destroyed many relationships and hurt a lot of people.
It took a lot of pain to make me wake up.
I stopped drinking. That was extremely difficult. I'm six months sober now. I go to therapy weekly. My relationships are stable (if few in number) and I no longer experience dramatic swings in emotion. Well. I still have days where I think about shooting myself in the head, but it's so mild compared to what it used to be. I can handle that, easily.
I still feel like my identity is a construct. I'm staggeringly insightful about people; I can read them very thoroughly and very quickly. I am subtly manipulative by default. It's not something I can turn on or off.
But I decided to do no harm. I started thinking about it as a sort of superpower I have, one that must be used with great care and responsibility.
People with BPD are often extremely empathic. That is not the same thing as having empathy. Being able to assess another person's emotions and state of mind is the raw instrument; deciding what to do with that information is what defines empathy (or lack thereof).
Mindfulness and meditation have been helpful to me. So has regular exercise, therapy, and a very great deal of introspection.
I still have doubts about my ability to form meaningful relationships. I am very lonely. All the time. I worry that I will go through decades like this.
But at least I'm not causing a lot of pain and turmoil all around me.
People with BPD can change. But it takes work. And you have to acknowledge and face the pain you've caused, which can result in unbearable guilt.
And you have to learn how to be alone.
Bingo. Well done you. I’ve struggled with mental/emotional problems all my life, thought that I was cursed even, and accepting that I’ll never be cured [1] is the game-changer. For readers: it forces you to think how you can >>manage<< them better, and how it can actually be >>useful<<. This can be hard at first, and will continue to be a lifelong struggle, so patience, lots of them. Eventually you’ll be able to pinpoint your ‘problems’ and their triggers, and build up the discipline to adapt via lifestyle change. You’ll also begin to understand how these can be turned into, well, ‘superpowers’ when you’re in a calmer state of mind. Like the ability to empathise is frequently overlooked when it’s actually very powerful. (But please, don’t start looking to be powerful, for sure this will cause grief sooner or later!)
Solitude imo is not necessarily a bad thing, it encourages more introspection and independence once you train yourself to embrace it. As long as you balance it with the right amount of positive socialising of course.
[1] If you feel severely affected, PLEASE sought out professional help. Or at the very least, people who you can trust to be kind
It also re-affirms my belief about the solution:
> But I decided to do no harm. I started thinking about it as a sort of superpower I have, one that must be used with great care and responsibility.
i.e. Accept it, and deal with it.
This is huge. Most sufferers find that impossible. Because....
> you have to acknowledge and face the pain you've caused, which can result in unbearable guilt.
It can get better. Living a quiet life is better than a life full of extreme highs and lows. It feels emptier, because it isn't full of drama. But it's how most people live.
[1] https://en.wikipedia.org/wiki/Dialectical_behavior_therapy
I'm not surprised that it's treatable in most cases, assuming it's not TBI related. False beliefs gradually go away; rough edges in character are gradually worn down with life experience and maturity.
Poor imprinting is difficult to overcome, I think certain tenancies always remain, but one can learn to direct emotional energy in better / more productive / less destructive ways.
There is strong evidence of a genetic component to BPD. It is a personality disorder and therefore a result of (abusive) training in childhood. And it is possible to learn to improve one's emotional instability.
I do have the sense that you're simplifying the issue in away that disguises the more complex reality of BPD. I do not recall the genetic factors pertaining to emotion. A failure to regulation one's emotions is partly connected to a general impulsivity which arises in a traumatic environment where you are always on high-alert.
NB.
It's always interesting what gets down-voted on hacker news. The police will chastise commentators who are too emotive in their phrasing but not the downvotes who most actively prevent open discussion.
I'm pretty sure my wife has BPD. To me, it seems hopeless for her to get treated. I haven't brought it up with her, I expect that would go poorly. One of the main symptoms is that she feels attacked by people even when they are making innocent comments on things. It is not just me who as noticed that. I have discretely brought it up with some others who know her and they have confirmed it. She has cut ties to her family as they are "toxic people".
Based on my readings, I understood that most psychiatrists think treatment is unlikely to work. If there is hope, that would be amazing. It is a difficult condition to live with, both for her and people who know her.
And I am curious, what happens when you delicately attempt to discuss this with her.
I've had discussions previously, in the right moment. She has admitted that she sometimes takes my comments as criticism when they are not intended as such. We did discuss getting couples therapy, which she was willing to try.
I feel like the real issue for someone with BPD is processing incoming messages (verbal/actions etc.). When you're starting position is defensive and highly emotional, it's hard to be rational.... hence why messages are often misinterpreted and why people w/ BPD appear to live in another reality...they need to learn to slow down and use their rational brain to keep their emotions in check... I'm not sure she'll learn this from couples therapy
You might find this book helpful: The Chimp Paradox: The Mind Management Program to Help You Achieve Success, Confidence, and Happiness
https://www.amazon.com/Chimp-Paradox-Management-Program-Conf...
With any kind of mental health, the person “suffering” from it has to be the one who wants treatment, and with BPD, most of the suffering ends up outsourced to others, which eliminates that motivation.
I know this is hard to hear, but part of BPD is an inability to form healthy relationships. The flip side is that it takes two people to maintain an unhealthy relationship. You’re not helping her by staying in this marriage; at best, you’re enabling her and at worst, you’re suffering from her mental illness at least as much as she is.
You don't know the poster or his/her wife.
You don't know the wife.
You don't have anywhere near enough information (unless you think a BPD diagnosis or suspected diagnosis is in itself sufficient information, in which case you're contradicted by a very well established line of research going back a number of decades; see links I've posted elsewhere in this thread) to assess the poster's wife's mental state or likelihood of recovery.
Your comment completely misunderstands how BPD works and completely misrepresents the likelihood of recovery. I understand that you may need to prove to yourself that you made the right call by cutting off someone with this disorder in the past, and maybe you did -- but that isn't epistemic justification for the very conclusory advice you're offering the poster.
If I’m going to give someone a nudge, I don’t need to nudge them to do that second guessing. They’re going to do that anyway. I need to nudge them to take the situation seriously and follow the logical consequences that follow if they are married to a borderline. If the wife is the rare borderline who actually cares to get treatment and overcome her BPD, I know that this guy is going to give her that second or third or nth chance because that’s exactly what I would have done in his place.
No you don’t. It’s clear that the poster is already taking it seriously. Personal advice is ok but the tone should be considered more carefully, especially given that you have had negative experiences before (bias.)
> If the wife is the rare borderline who actually cares to get treatment and overcome her BPD...
Sheesh.
When it comes to issues like this, there are people with biases due to their personal experience, there are trained mental health professionals, and then there are people who have neither the training nor the personal experience to know what they’re talking about. So I’d like to know which category you fall under.
Every single person who has close experience with BPD people (and is not actively being entrapped) will advise him the same.
To me, it seems the situation is manageable, especially now that I better understand what is going on. The suggestions I've received make me think I should try couples therapy.
But it's no different than when someone has alcoholism or a drug habit. If they don't want to get better, get out.
I'm wondering what to do as well, and I don't feel at all hopeful for the future. I wonder if I divorce if my children will develop her same problem.
I am concerned about my daughter inheriting the condition. She shows signs of being deathly afraid of being rejected by people. I guess I should study up more and talk to her about it.
It's very likely your sources are pretty stale. For several decades, yes, the prognosis for BPD was quite poor. But this is no longer true and has not been true really since at least the late 90s. BPD is much, _much_ better understood than it was in the 70s/80s, thanks in large part to the work of Marsha Linehan[0].
Depending on various factors the prognosis can actually be very good, and people can and do get better from even fairly severe BPD. (See e.g. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... ) I've watched this happen with a close family member and I'm happy to provide a bunch more resources etc (email in profile).
in short, we need more like her.
Did you know she had BPD and recovered from it? Yeah, we need more people who have personal experience solving their problems rather than analysts trying to figure them out ;-)
I found this website useful: http://outofthefog.website/personality-disorders-1/2015/12/6...
At the very least it sounds like your wife has critically low-selfesteem which would be part of BPD.
If there is any way at all you can get her in a therapeutic environment, that would be a profoundly important gift to her . The life of a person with BPD is not destined to be a happy one, they're living like a cornered mouse for most of it and are really in harms way. They're likely to keep traumatizing themselves. To have a person who cares to prevent that is the greatest gift a person with BPD can have.
My offhand suggestion is that you try therapy for yourself for a session and get some advice from a therapist. Keep moving between them until it's useful. It could be that you find away to have a couples therapy that is ostensibly for you but your wife might open up there.
Therapy works by having another person serve as a kind of mirror. Just like ordinary mirrors allow you to recognise yourself visually, human mirrors allow you to see yourself "emotionally" (in broad terms).
We are mostly just awash with emotion and experience -- all of us -- and we only become aware that we are experiencing some emotion (etc.) when we encounter another person who reacts to it. On a day alone we might be very frustrated but we only realise when our frustration causes another to recoil. It is this recoil that provides the "reflection" of what we are feeling that we can see.
It is very hard to be aware of one's emotional state, and the capacity is trained and not particularly reliable in healthy people. But present enough to stabilize emotions.
A therapist is only a person who serves as a good mirror for your wife. A person who is able to recoil at the things a healthy parent ought recoil at, a person who is able to be warm and accepting at the things a parent ought be accepting of.
A therapist that hides behind a chair is useless. You're after someone around whom your wife isnt on-edge, and offers observations and emotive-physical reactions that your wife recognises and trusts.
In a sense "that is it". It doesnt matter what superstitons the therapist uses to arrive at their questions and suggestions. By being experienced and empathetic -- and "parental" -- the right person need have no particular theoretical background.
It's hard to say how easy it is to distinguish the good from the bad here. I guess you need to trust your intuition about how your wife feels in the situation. You need to have seen a few yourself and be aware that some people simply make you profoundly comfortable because of who they are -- and it is these you are looking for.
I am myself incredibly set on-edge by anyone i sense faking any emotion, so I cannot even be near therapists who smile too much (etc.). Fortunately, you do not need to "put up" with being in any sense on-edge. Find one that fits.
There is no science of human emotional instinct (yet). Your wife's issues are extremely unique to her, in the sense that they are connected to her particular experiences and ways of thinking. What is needed is an opening up about these, to create a safe environment in which your wife feels able to recognise her self, and to relearn an emotionality (, identity, self-awareness, understanding of consequences, appreciation of the future, understanding that relationships remain constant when people go out of view...) and other things besides.
PS.
As far as criteria go, I believe years of experience is the main one. While the mechanism of change, I believe, is the interaction between the therapist and patient -- more experienced therapists will be able to spot more subtle problems. Newer ones will be easy for a person with BPD to fool.
People with BPD are often, essentially, in a constant state of acting where they are fooling themselves with superstitions about who they are. The therapist needs to be alert to these superstitions being employed as explanations in answers to their questions. Ie., they need to be alert to your wife lying (but a lie she is not herself aware of).
By way of example, I observed a therapist once say to a patient that he wouldnt tolerate anyone being different than he was. He made this observation based on the patient wishing to be "understood". The connection was: the patient was misdescribed people "misunderstanding" him to actually their disagreeing with him.. and he couldn't tolerate disagreement.
The therapist made this suggestion base on their experience with this not uncommon issue (anger and hostility may often be a product of a fear of difference).
Therapists are NOT medical professionals. There is research, but as we've seen in recent years, most of it is crap - see articles on p-values and meta analysis. The do produce some practitioners who produce better average results than zero intervention. They have also documented (if you believe their research) that some people are made worse by therapists. They seem to have a selection bias in their results too, anyone who dropped out is not included in results.
It can help. I've seen it help people. But there is no overthinking the selection of a therapist, they are not all the same by a long shot. Nor is their training and preferred modality of "treatment" the same - in fact some are contraindicated for certain conditions by some.
Don't bring this up directly of course.
Just talk about someone at work or in the news who always seems to be complaining -- and while you're reading the newspaper or chatting about work. Don't bring it up out of nowhere.
(this advice is may be worth what you paid for it of course)
This is really bad when you are the one believing you are surrounded by toxic people. My solution was to become a digital nomad and now I understand why. Travelling I don't feel like I'm around toxic people and when I feel I move on.
If someone believes others are out to get them, if they’re sensitive, or whatever behaviors they manifest, who is anyone to say what they feel is right or wrong? Their behaviors may not fit in with society at large, but nobody can speak to their perceptions.
The world is complicated now and people on average have a more intricate social universe than ever before. I’m sad to say that I couldn’t find my place in human society. Seeing where I am at personally relative to what I’ve learned from this thread is very painful.
Wishing for the best for everyone here. Nobody should have to suffer and it’s commendable that so many fight the good fight. Be well.
I've spent the past few years searching for ways of overcoming emotional and personality disorders in myself. Looking back, it's pretty clear that there were significant symptoms of narcissistic/borderline/histrionic personality disorders, that had devastating effects on my relationships and my career.
I've worked on myself daily for the past few years to understand and overcome these traits. In the past 1-2 years I've come out of the tunnel and am now living a very different life, with a thriving career, a wonderful home, dramatically improving relationships with my friends and family, a great relationship with a wonderful, caring partner, and every reason to be optimistic about the future.
Just 3 years ago I was like you, thinking it was all futile and questioning whether it was worthwhile to carry on.
Please get in touch. It's hard to find good advice and support but I think my experiences and learnings could be valuable to you.
My email address in my profile.
Please, you are valued and loved, and there is hope.