Yeah, I’d also have to assume the level of clinical and psychological understanding of the disorder was significantly lower 30 years ago.
Aha, you may be right. I’ve been reading the thread about that “restaurant freak-out” as well as this one, but until your post I never made the connection.
Anna Storelli seems more histrionic than than anything. She clearly wants attention more than anything. You obviously can’t diagnose a personality disorder from a single incident, but she seems to manufacture reasons for outrage and doesn’t show avoidance or seek acceptance. Who knows what is really up with this person, other than the found the need to confront the videographer and his girlfriend out of proportion with any public display of excess affection they might have presented.
Stranger
HPD & BPD often co-occur, but impossible to diagnose definitively with just one incident. But Cluster B for sure.
Borderlines I have known tend to take things hyper personal where relationships are involved without too much conflict in general interactions.
The term “borderline” derives from an earlier, psychodynamic description suggesting that the person was in a state fluctuating between psychotic and neurotic. Otto Kernberg is the author whose name is typically associated with this description, though others had similar ideas before him.
Yeah, I had a mother that was (arguably) narcissistic with borderline tendencies; to people who knew her casually she was charming and rational, but if you were in daily proximity to her, the crazy came out like sweat off of Richard Simmons listening to 'Fifties pop, and if you were one of her emotional capstones, regular physical and verbal abuse were the norm of interactions to the point of her alternately threatening suicide and homicide.
Ms. Storelli, on the other hand, is all out there with public declarations to strangers of increasing absurdity, (kissing, making out, “having sex”, prostitution) and finishes off with a rant worthy of early period Archie Bunker. “…those were the days.”
Stranger
As stated before, “Borderline Personality Disorder” is an out dated term based on older psychoanalysis theory. In some non DSM manuals it is called “Emotional Dysregulation Disorder” which is a much better description of the illness. Even though I am sure there are people out there that say it is not treatable or the patients do not get better, this is not true at all.
Any therapist or psychiatrist that claims to this belief probably is stuck in the older psychoanalysis perspective of the disorder or has no interest in the most up to date research. There are specialized therapies for BPD the most available is DBT (Dialetical Behavior Therapy) created by Dr. Marsha Linehan PhD. If anyone is interested, she has been treating people that suffer from this disorder for around 30 years or so. Her basic theory on how the disorder is developed is called the “Biosocial Model” which states that a combination of a child being exposed to an invalidating environment and a genetic predisposition to emotional sensitivity will increase the likelihood of someone developing the disorder. Here is a link for further reading.
Damn, I feel old (started one of those threads 9 years ago). Interesting how the diagnosis has evolved in the last decade. I wonder if they’ve been collecting brain samples so that one day they can look back on DSM criteria and see which ones had neurological bases…
I remember throwing this question at a psychiatrist or psychologist (forget which), and her response was basically that a personality “quirk” becomes a “disorder” when it interferes with daily life functions: careers, education, relationships, etc. Otherwise people just tolerate it. And her stance was that the DSM diagnoses are guidelines to treatment, that it doesn’t so much matter what you call something (there’s probably a Venn diagram of symptoms/diagnoses) except that you have to bill insurance something, and treatment best practices differ depending on which particular sets of symptoms you have.
Interesting stuff.
Borderline Personality Disorder got it’s name from the old Freudian ideas about mental disorders; it’s a condition that’s on the “Borderline” between being a neurotic and psychotic disorder. Professionals generally don’t accept those categorizations any more and they aren’t used in the DSM for categorizing mental disorders, but the name has stuck.
It’s definitely not just a catch-all or a generic term for a bunch of bad stuff. While some of the behaviors vary a lot, there are a lot of consistent patterns. I read the book Stop Walking on Eggshells when I was in a relationship with someone who I’m confident has the condition, and when I read the examples of arguments in the book I didn’t just go ‘oh, that seems familiar’, I went 'wait, I had that argument. When Ambivald posted about a weird breakup thing his SO did, a number of people here immediately said ‘that’s BPD’ (and it’s since been confirmed by professionals). If you go to support boards for people who’ve dealt with someone who has unmanaged BPD, you’ll see a lot of patterns emerge over and over.
Basically the BPD sufferer has their emotional development stuck at around two years old. They have little to no sense of personal identity, and adopt their identity from people around them (My ex- used to love very non-PC jokes, now that she hangs around with highly offended people she’s very much on the other extremey). They have little to no ability to regulate their emotions, and experience emotions extremely intensely (feeling stark betrayal or burning rage over something like turning off a light switch). This also leads to black-and-white thinking, where a person has to be either absolutely wonderful or an absolute monster. And the pain and extreme feelings lead to defensive rewriting of memories, so they’ll often remember the other person as saying something bad that they actually said, and sometimes this can lead to dissociation. It also leads to impulsive behavior and unstable relationships, for obvious reasons.
I disagree with the idea that there is a useful distinction between the two outside of psych professionals. If someone is engaging in asshole behavior towards you, they don’t get a pass on it because it’s a mental disorder. This was a huge mistake that I made in the relationship I had to have with a person with BPD, once I realized something was wrong I would excuse all kinds of abusive behavior on that basis.
It is not about “get[ting] a pass” but rather whether the person in question has the essential capacity to emotionally self-regulate. If they don’t, it is a pathology that requires professional treatment. If they do, then they’re just an asshole. In any case, if you are in a relationship with someone displaying BPD-like behavior, you should act to protect and insulate yourself first because they are unlikely (to the point of certainty) to self correct their behavior and will become dependent upon you to facilitate and apologize for their outbursts.
Stranger
According to Dr. Hwang (B.D. Wong) on Law and Order: SVU, those with BPD cannot handle rejection.
Good discussions already. I encounter people with BPD diagnoses regularly. IME, it is rare to see mental health professionals putting forth the effort to distinguish between ability vs unwillingness to self-regulate. Of course, same issue exists w/ so many other mental health diagnoses: ADHD, ODD, GAD, MDD…
IMO, there are unfortunately incentives to overdiagnose people with BPD - instead of simply acknowledging that they are jerks with poor values and role models. Diagnose a pathology and you can get paid to treat it, and the person can allege disability/seek accommodations.
What Stranger says sound really good - in theory. But I review mental health records from many locations every day, and RARELY see the standards applied that way in practice. It is far too common to see diagnoses and assessments of severity issued following an initial interview, based on nothing more than the individual’s presentation during that interview. And, as I suggested above, I perceive many incentives to designate individuals as having pathologies rather than simply being within the wide range of “normal.” The DSM itself may be the best we have, but we oughtn’t lose sight of the fact that it is promulgated by an organization representing a for-profit industry, and IMO ought not be considered an entirely objective source.
My personal opinion is that the mental health industry profits from overdiagnosing and treating personality traits. In the process, it hands individuals a crutch: their difficulties aren’t because they are jerks, but due to their “DISABILITY!” Apologies if my response exceeds the GQ forum.
Certainly, the psychotherapy industry tends to pathologize behaviors almost reflexively, and DSM guidelines are so vague you can probably see close associates or even yourself in many of the categories depending on the day. And diagnosing someone with a personality disorder should not be akin to excusing or accepting bad behavior, but rather a means to understand the possible causes and triggers of behavior so to apply effective treatment. But practically speaking, unless a patient wants to be treated and is willing to put forth the effort to adjust their behavior and consistently take psychopharmaceutical treatment for neurotransmitter imbalances, there is really nothing a therapist can do to affect a patient’s behavior except to appeal to the desire to be socially integrated and accepted.
Anyone using the “disability” label to justify outbursts is just being an asshole, period. It is one thing to have trouble with emotional regulation; it is another to not apologize for screaming or threatening violence without provocation or reason, or to even feel justified at acting out any time you feel like it. That isn’t even acceptable for two year olds, much less adults who can willingly seek treatment.
Stranger
I truly appreciate your posts.
Unfortunately, my work exposes me to the subsection (how large or small?) of folk looking for secondary gain. The fact that someone seeks treatment, and finds someone who is willing to provide it, does not - in itself - establish all that much. Also a problem of healthcare policy, and so much of medical care. For example, how significant of a diagnostic criteria ought subjective reports of pain be considered? How “symptom-free” ought an individual be to be considered “healthy”?
One of my greatest objections to much of US “disability” law as I perceive it, is that it skews the incentives. Believe me, I’m not the type who believes everyone has bootstraps by which to pull themselves up. But I perceive welfare, workfare, or guaranteed minimum income far preferable than designating great numbers of people as “disabled.”
I don’t doubt it, and one problem with personality disorders is that many of them feature emotional manipulation as a key characteristic, so it is unsurprising that sociopaths, histrionics, narcissists, and borderline people will use their diagnosis as an excuse or leverage to get unearned and undeserved benefits. I don’t have any great solution for this except to recognize that while those people may be getting a free living, they’re also alienating friends and family, and often suffering depression and anxiety along with their primary personality issues. It is not fun or healthy to be around such people, but I suspect it is even worse to be one.
Stranger
BPD is much more common among women then men. As a single eligible bachelor in NYC I feel like I meet one once a day. Doctors are usually willing to diagnose BPD often solely from the tendency of the patient to alternate between idealization/devaluation of their so/friends/families. The push-pull behavior exhibited by BPD’s has been attributed by some psychodynamic theorists to be resulting from the patient being stuck in the “rapproachement” period of development. That’s the period between roughly 1.5 and 2 years of age when the individual is first developing separation tendencies. It’s the time when the toddler will run off to be independent and then run back to the parents to be secure.
It’s on the “mood disorder” spectrum with a bunch of others.
When I was discharged 15 years ago for the umpteenth time from Payne Whitney, Cornell Presbyterian NYC (bipolar psychotic breakout), it was required/prescribed that it be on a 2-year/outpatient group (later to this day private) course of a cognitive behavior therapy offshoot called dialectical behavior therapy (DBT), which originally was geared for borderline patients, and which was extended after empirical research to suicidals and the rest of that merry brigade.(WebMD ref.) (From the horse’s mouth–Linehan, founder.)
The info in the intro to this is as good as any on what Borderline Disorder is about. The DBT aspects of establishing the problem is also not ground in stone; for that 
head over to the Diagnostic and Statistical Manual of Mental Disorders (cite TK).
Linehan groups the features of BPD in a particular way, describing the patients as showing dysregulation in the sphere of emotions, relationships, behaviour, cognition and the sense of self. She suggests that, as a consequence of the situation that has been described, they show six typical patterns of behaviour, the term ‘behaviour’ referring to emotional, cognitive and autonomic activity as well as external behaviour in the narrow sense.
Firstly, they show evidence of ‘emotional vulnerability’ as already described. They are aware of their difficulty coping with stress and may blame others for having unrealistic expectations and making unreasonable demands.
On the other hand they have internalised the characteristics of the Invalidating Environment and tend to show ‘self-invalidation’. They invalidate their own responses and have unrealistic goals and expectations, feeling ashamed and angry with themselves when they experience difficulty or fail to achieve their goals.
These two features constitute the first pair of so-called ‘dialectical dilemmas’, the patient’s position tending to swing between the opposing poles since each extreme is experienced as being distressing.
Next, they tend to experience frequent traumatic environmental events, in part related to their own dysfunctional lifestyle and exacerbated by their extreme emotional reactions with delayed return to baseline. This results in what Linehan refers to as a pattern of ‘unrelenting crisis’, one crisis following another before the previous one has been resolved. On the other hand, because of their difficulties with emotion modulation, they are unable to face, and therefore tend to inhibit, negative affect and particularly feelings associated with loss or grief. This ‘inhibited grieving’ and the ‘unrelenting crisis’ constitute the second ‘dialectical dilemma’.
The opposite poles of the final dilemma are referred to as ‘active passivity’ and ‘apparent competence’. Patients with BPD are active in finding other people who will solve their problems for them but are passive in relation to solving their own problems. On the other hand, they have learned to give the impression of being competent in response to the Invalidating Environment. In some situations they may indeed be competent but their skills do not generalise across different situations and are dependent on the mood state of the moment. This extreme mood dependency is seen as being a typical feature of patients with BPD.
My only advice is that if you are in a relationship with someone diagnosed or even exhibits the symptoms of your typical BPD, RUN LIKE HELL!!!. I do not shit you! I have never met anyone IRL or on SDMB that felt like they had a fulfilling satisfying relationship with anyone with this disorder.