Borderline Personality Disorder -- Real disease or lazy, catch-all diagnosis?

In My Humble Opinion
21

I don’t post a lot here; mostly stick to Cafe Society, but I’m reading this thread with interest and feel I can contribute. It was lavenderviolet’s post above that drew me in.

I’m pretty sure my 20-year-old daughter has BPD, although she has not been officially diagnosed. But she could be the poster child for the criteria, and after reading other moms’ stories from a parents of children with BPD email list I’m on, I feel our family doctor would diagnose her as BPD himself if he had the chance. But as mentioned above, she thinks she’s just fine. It’s all of us who are “fucked up” in her eyes.

And to be completely honest, I’m scared to death to have her see someone about this disorder. There have been moms on my email list whose daughters have told horrible lies about their fathers/stepfathers sexually abusing them and it has torn their families apart, although the accusations were lies. I could see my daughter doing this. For instance, I got a call from a teacher who said that my daughter told her that if the teacher called me to let me know my daughter hadn’t done her homework yet again and disrupted the class, I would beat her with a belt. Thank goodness the teacher could see through my daughter’s lies, but I’m afraid she’s gotten much better at conning people, at least strangers.

She has made our life a living hell for many many years, but it got worse the older she got. She lies, steals, has pitted me against my parents and brother (who considered me a horrible mother for the longest time, even though my other girls are perfectly normal kids), is in debt up to her eyeballs but refuses to work a full-time job, sleeps around, abuses drugs and alcohol, hates me one minute loves me the next, calls us assholes, has hit her younger sisters, has cut herself for attention - I could go on and on. She will never take any responsibility for her own actions and will blame everything that happens to her on other people. She had an abortion a few months ago, and blamed getting pregnant on “some psycho she met who made her get pregnant with twins.” And then said the doctor made her have the abortion without anesthetic to punish her for getting pregnant. Crazy, horrible stuff, and this what we hear all the time.

I read the thread about people who hate their children with interest. I don’t hate my daughter, but I sure don’t like her very much and I don’t like having her around. We had her move out this past February because the stress she was causing was just too much. We are almost estranged at this point, and while it sounds callous, I am just relieved at not having her disrupting our household all the time.

Some articles I’ve read say that BPD can be caused by trauma; others say it’s hereditary. In our case, I would say it’s hereditary. She is every inch her father’s daughter, who I divorced when she was just a baby because I couldn’t live with the abuse any longer (mostly emotional, very occasionally physical). I married my current husband almost 16 years ago, and we have had two girls together, who are just regular kids. They want absolutely nothing to do with their older sister.

One thing (out of many) that really gets to me is that my mom, although she now sees that my daughter isn’t the sweet, innocent abused child she made herself out to be, still takes her side, and has been enabling her by giving her money, although I have asked her to stop. I actually have a LOT of anger and resentment constantly churning inside of me due to this situation (and have had it for probably 15 years now). I’ve considered getting therapy to deal with the knot, but not sure how much it would help since I don’t see any end in sight to the whole crappy situation.

I’m not sure if I’ve made a lot of sense, and I haven’t really touched on just how horrible this all is, but I hope I’ve contributed somewhat to the discussion. I guess for someone who doesn’t post much here, I’ve really let it all out in this post! :slight_smile:

22

Raising hand I hate, hate, hate, hate working with borderlines, to the point where I have developed a scarily accurate internal warning system; I can pinpoint a BPD client within seconds of meeting them, and it’s become a bit of a joke at work (anyone questioning our doctor’s decision puts the kid in my vicinity, and if make an excuse to leave ASAP they know the diagnosis is correct).

It is most certainly a real disease. The criteria would appear vague to a lay person, but those of us who’ve had the pleasure of working with full-blown cases know that the criteria actually paints a very accurate picture. Way too long in the field, and the two populations I avoid as much as possible are pedophiles and BPDs- almost for the same reasons.

To answer another question from above: it’s a fairly common belief amongst psych professionals that BPD clients eventually get “better” around middle age. Definitely not 100%, but more functional. The theory is that by that point they have effectively alienated every single person in their life and they have no choice but to get better.

23

I’d continue to be wary. It’s entirely possible that the partner/kids/house thing is a crock of shit, and even more likely that she’s just finally found the perfect codependent schmuck to saddle with a couple of babies, a mountain of debt, and a metric asston of guilt.

My ex was fairly good at putting up a respectable facade to casual acquaintances. More-than-casual acquaintances soon realized the truth.

24

I don’t mind in an agency setting, but prefer not to in private practice because it takes too much focus on boundaries in that setting.

Another factor in this is that some people with these issues have killed themselves by middle age, and thus are no longer part of the statistic.

25

I’m quoting Rubystreak here because this statement has me curious, not because I expect an answer from you personally, Rubystreak. How far apart are Borderline Personality and Paranoid Personality Disorder if this type of imaginary slights can be preceived by people with either?

26

Maybe I can offer another perspective.

I was once diagnosed BPD. I don’t think I am–not because I think nothing’s wrong with me, but because I think the psychiatrist misinterpreted my symptoms.

I did self-injure (I don’t any more) but not for attention. I never mentioned my self-injury to anyone, and if people asked about my cuts, I’d usually lie and say they were accidental.

I do have a history of trauma, but trauma doesn’t automatically lead to BPD.

I also have a history of unstable relationships, but concurrent with those I have a history of several very stable and long-lasting relationships.

I do not see people/situations as “black and white”. If anything, I err too far on the side of examining differing shades of grey–misunderstandings, mitigating circumstances, cultural differences, etc.

What I think happened–and what I believe happens a lot with BPD diagnoses–is that my doctor, not knowing how to deal with a very troubled but obviously intelligent young woman out of her field of expertise, latched onto the most obvious characteristics and tossed me into a diagnostic vat that was and still is open to lots of interpretation.

This doesn’t make it an invalid diagnosis. It just, IMHO, makes it an abused one.

27

Excellent point. And a lot of doctors (ad professionally young counselors) are flipped out by any cutting or self-injury.

28

Exactly. Many doctors seem to automatically think that self-injury always means BPD. It doesn’t, and shouldn’t be treated as such. Sometimes self-injury is actually a “rehearsal” for a genuine suicide attempt. Treating it as attention-seeking behaviour only makes matters worse.

29

I was once diagnosed with BPD too and given a bunch of material to read. I can definitely see why he went down that road with me, but the worst aspects of it definitely did not apply to me.

To be sure, I’ve alienated a whole lot of people in my life. In the deep dark past I did it because I was such an unhappy, negative person. But in retrospect, I also see that I was associating with a lot of people who were just plain wrong for me or were just plain assholes. Then I’d punish myself, over and over, because I couldn’t make things perfect like I imagined (even knowing better) that it was like for other people. Because I somehow couldn’t allow the bullshit to roll off my back like so many people seemed to do.

(The really happy and social people I knew bacl then always gave me a strong ‘deer in headlights’ vibe when real shit went down, then they’d blink and be back to PARTY!!! WOOOO!! and doing their best to ignore the trauma, as if it had never happened. It mystified me. I knew plenty of people who absolutely REFUSED to talk about anything even remotely negative, even in their own lives, at all costs. It made me wonder what was wrong with me that I couldn’t do that, even as I recognized that I didn’t want to be like them.)

Well that makes me feel better about myself. While a very few people have called me “unlikable”, no one could ever accuse me of any kind of entitlement mentality or blaming everything on others (well, except for my ex-wife and her friends, for whom I was The Source Of All Evil. :rolleyes: ). Usually I’ve had the excessive tendency to blame everything on myself, even when it’s out of my control.
But on the whole, I agree that it’s been used as something of a catch-all diagnosis. Unfortunately, a lot of terms get used like that. Take Autism, which is the new ADHD, which was the new blah blah blah stretching all the way back to “Zok smart but stupid”.

30

My ex-wife was very much like this. She did a lot of destructive things, most of which seemed to be designed to gain attention. Very much like an attention starved dog - any attention, even bad attention, is good attention. I have called her a Sympathy Vampire in retrospect. Everything is designed to garner sympathy.

She too is on disability for mental illness.

She loved me, or so she said, but she also used me as the great villain in her life. She’d literally sit on the phone and go through her address book in alphabetical order, calling up people to cry to and gain sympathy from over all the bad things I was (not) doing and how mean I was and how I was mentally abusing her.

Before and after me, it was her step-father, who she hated and was “out to destroy” her.

She once came home crying her eyes out saying that her best friend in the entire world had been mean to her at lunch and she never wanted to speak to her again. (Sympathy ploy - in fact, the friend had merely disagreed with some of her long rants about ME). A couple of weeks later, the friend wanted to get together and she had changed her mind enough to go out again. Same net result. Her friend was being mean, oh woe is her. Never speak to her again! :rolleyes:
So I suggest that we invite the friend over next time she wants to get together. That I will remain in the room and we’ll see how it turns out.

Great visit, fun was had by all. Psycho wife is smiling and laughing as her friend leaves. Suddenly, like the flicking of a light switch, wife is wailing (literally wailing), tears running down her cheeks, screaming “You heard what she said to me!”. Shocked at the rapid change and bizarre accusations when NOTHING had happened, I said “I didn’t hear her say anything bad”. Like flicking the switch the other way, wife stopped crying, said “Oh, I thought she had” and stomped off in anger, not speaking to me for the rest of the night because I hadn’t given her the sympathy she was demanding.

31

Well, I can assure you that they are not mutually exclusive categories, at any rate.

(Having had “borderline personality disorder” and “paranoid schizophrenia” in my stamp collection of MH dx, as well as “manic-depressive” and “schizotypal personality disorder”)

I’ve never received “depression”, myself, oddly enough. (Kind of like collecting state quarters and never getting Pennsylvania).

The rare collector’s item is “hebephrenic”. They don’t mint that one for just anybody!

OK, in all seriousness, there is a measure called “inter-rater reliability”. It means the likelihood that Practitioner B will diagnose the same person with the same ailment that Practitioner A came up with, without having any access to Practitioner A’s writeup. It’s pretty high for ailments such as insulin-dependent diabetes or a greenstick fracture of the ulna. Psychiatric inter-rater reliability is low enough to constitute a grab bag.

32

Count me as another who would run out of the unit if he could when a Borderline is brought in (Luckily I work the night shift, so I don’t have it half as bad as the folks on the active shifts). Unpleasant to work with, and frustrating as hell.

33

With lawoot, susan and others (sorry I missed you on scanning for the names) mention therapists burning out and personally not wanting to deal with these people.

Can you tell me why? What are the issues and problems with providing therapy for BPD individuals?

Thanks

34

Or it should be. The experiences of my friends who have sought treatment for various problems tells me it can be hit-and-miss, and when it’s a miss, it’s incredibly frustrating.

35

Yeah, I’m curious too. Never knew there was so much hate towards 'em. What makes them so hard to deal with?

36

To the best of my layperson’s understanding, it’s because the patient doesn’t think anything at all is wrong with him/herself. It’s everyone else on the planet who has issues.

37

Because people with BPD tend to be so needy and sensitive to rejection, they constantly challenge patient-therapist boundaries.

Like, if the therapist ends the session just a second earlier than usual, the therapist hates them. If they call up the therapist during a crisis and they don’t get an immediate return call, the therapist hates them. If the therapist tells the patient that it’s inappropriate to call in the middle of the night just to chat, then the therapist hates them.

Alternatively, if the session lasts a second longer than usual, the therapist compliments the patient on their outfit, or the therapist seems to be unusually attentive and kind when the patient calls them off-hours, then the BPD patient interprets these as signs that their counselor is madly, deeply in love with them.

Because they’re so unstable emotionally, both hating and loving can have very violent, scary fall-out.

I also imagine it’s challenging dealing with someone who will harm themselves for attention. If you give them attention, you’re rewarding their bad behavior. But if you ignore the self-harm, you risk escalating it (as in: She doesn’t care about these cuts on my hands. Wonder what she’ll do if I slit my wrists!).

38

Why the hate?

The histrionics, I expect. BPDs have the notorious reputation of being incredibly hard to treat (they don’t think there’s anything wrong with them or their behavior) and incredibly manipulative. They’re usually attention-seekers and very demanding, so it’s hard to figure out whether or not you’re actually GETTING anywhere with them…

… at least, if my grandmother is any indication… :wink:

39

This explains why personality disorders in general are difficult to treat, not just BPD. But even this isn’t all together true. For instance, the problem with people with avoidant personality disorder is that they think everything is wrong with them. It’s just that, like folks with other personality disorders, they see nothing wrong with their perception.

I’ve read that borderlines are narcissicists who know they are screwed up, whereas narcissicists think their problems result from everyone else. So even with borderlines, it’s possible they know have problems, but they just don’t know how to fix them.

40

Damn, that’s intense. Is there such a thing as a “functioning” borderline or are they all unbearable like that?