What is a Personality Disorder?

Perhaps you suspect that your loved one has a "personality disorder". Perhaps someone has told you that they think that you have a "personality disorder". You may not know what they are talking about.  So what is it?

Definition: Personality disorders represent the failure to develop a sense of self-identity and the capacity for interpersonal functioning that are adaptive in the context of the individual’s cultural norms and expectations.

A.  Adaptive failure is manifested in one or both of the following areas:

      1.  Impaired sense of self-identity as evidenced by one or more of the following:

• Identity integration. Poorly integrated sense of self or identity (e.g., limited sense of personal unity and continuity; experiences shifting self-states; believes that the self presented to the world is a façade)
• Integrity of self-concept. Impoverished and poorly differentiated sense of self or identity (e.g., difficulty identifying and describing self attributes; sense of inner emptiness; poorly delineated interpersonal boundaries; definition of the self changes with social context)
• Self-directedness. Low self-directedness (e.g., unable to set and attain satisfying and rewarding personal goals; lacks direction, meaning, and purpose to life)

      2.  Failure to develop effective interpersonal functioning as manifested by one or more of the following:

• Empathy.  Impaired empathic and reflective capacity (e.g., finds it difficult to understand the mental states of others)
• Intimacy. Impaired capacity for close relationships (e.g., unable to establish or maintain closeness and intimacy; inability to function as an effective attachment figure; inability to establish and maintain friendships)
• Cooperativeness. Failure to develop the capacity for prosocial behavior (e.g., failure to develop the capacity for socially typical moral behavior; absence of altruism)
• Complexity and integration of representations of others. Poorly integrated representations of others (e.g., forms separate and poorly related images of significant others)

B.  Adaptive failure is associated with extreme levels of one or more personality traits.

C.  Adaptive failure is relatively stable across time and consistent across situations with an onset that can be traced back at least to adolescence.

D.  Adaptive failure is not solely explained as a manifestation or consequence of another mental disorder

E.  Adaptive failure is not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)

Looking at this more broadly:

"Personality disorder, formerly referred to as a Character Disorder, is a class of mental disorders characterized by rigid and on-going patterns of thought and action. .... The inflexibility and pervasiveness of these behavioral patterns often cause serious personal and social difficulties, as well as a general functional impairment.

Personality disorders are defined by the American Psychiatric Association (APA) as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". These patterns, as noted, are inflexible and pervasive across many situations...(and) perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to late adolescence and the beginning of adulthood, and, in rare instances, childhood."

The Diagnostic and Statistical Manual of Mental Disorders, defines ten specific personality disorders, one of which is "borderline personality disorder".  

The current system (DSM - IV) lists 10 personality disorders organized in 3 "clusters

Cluster A (odd or eccentric)

• 301.0 Paranoid personality disorder
• 301.20 Schizoid personality disorder
• 301.22 Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic)

• 301.7 Antisocial personality disorder
• 301.83 Borderline personality disorder
• 301.50 Histrionic personality disorder
• 301.81 Narcissistic personality disorder

Cluster C (anxious or fearful)

• 301.82 Avoidant personality disorder
• 301.6 Dependent personality disorder
• 301.4 Obsessive-compulsive personality disorder

The APA is also proposing a consolidation into 5 subtypes:

• Borderline,
• Antisocial/psychopathic (possibly with subtypes),
• Schizotypal,
• Avoidant, and
• Obsessive-compulsive.

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If you have a loved one that seems to be suffering from borderline personality disorder, please visit BPDfamily.com . We will welcome you warmly! If you believe that you have borderline personality disorder, check here for resources to help you.

Author:  Skip

85% of pwBPD Go Into Remission

Although borderline personality disorder (BPD) has traditionally been considered a chronic and intractable disease, it is has high remission and low relapse rates, new research suggests.

Collaborative Longitudinal Personality Disorders Study

In the latest findings from the Collaborative Longitudinal Personality Disorders Study (CLPS), 85% of participants with BPD remitted during 10 years of follow-up. In addition, only 11% of these relapsed — which was significantly lower than for participants with major depressive disorder (MDD) and a group consisting of cluster C personality disorders.

However, those with BPD had significantly more social dysfunction than the other 2 groups.

"We found that [BPD] psychopathology, which has not really been adequately studied before, improves more than generally expected, and once it remits, it usually stays remitted. Not many psychiatric disorders can claim that," lead study author John G. Gunderson, MD, professor of psychiatry at Harvard Medical School and director of the McLean Center for the Treatment of Borderline Personality Disorder, Belmont, Massachusetts, told Medscape Medical News.

"It was also amazing that this was found without treatment designed specifically for this disorder. So this is really not an effect of treatment but a statement about its natural course," said Dr. Gunderson.

The study was published online April 4 in Archives of General Psychiatry.
http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.37

In "the only other 10-year prospective study of BPD," reported on last year by Medscape Medical News, coinvestigator Mary Zanarini, EdD, also from McLean Hospital, and colleagues found that many (but not all) patients with BPD got better with time.

Attitude Adjustment

He noted that a change in attitude is now needed because most have typically thought these are people who have chronic disease and are considered "frequent flyers" because of their many hospitalizations and emergency department visits.


"A small minority of patients that conform to that characterization has given the whole group a bad name. But for clinicians to realize most of these patients will get better makes it much less pejorative, and they can take a lot more pride in even short-term interventions that may make a lasting difference."

Psychosocial Functioning Often Remains Severely Impaired

 Dr. Gunderson pointed out, though, that psychosocial functioning for these patients often remains severely impaired.

"One of the implications of that is that we need to try to help borderline patients with their social adjustment, such as getting a job or joining social organizations. So it moves treatment away from just symptom remission to social rehabilitation."

"Despite the high prevalence of BPD in psychiatric facilities, attention to BPD remains woefully low relative to that paid to other major psychiatric disorders. Indeed, the diagnosis is underused and most mental healthcare professionals avoid or actively dislike patients with BPD," write the investigators.

In addition, past BPD research has mainly consisted of either short-term prospective or long-term retrospective studies or were conducted before 1995, they report.

In addition to using different methods, Dr. Gunderson said that his team sought to examine both the psychopathology of BPD and its associated social dysfunction.

"Their study looked at 1- or 2-year increments, whereas we looked at small intervals of change. We used measures that allowed us to look at month-by-month changes, which is important in terms of 'what predicts change' and 'what changes predict other changes,'" he explained.

"We also had comparison groups made up of specific forms of personality disorders that were matched demographically. And whereas the other study had a population of all inpatients at McLean, ours was much more demographically representative of a clinical community."

The investigators evaluated data on patients between the ages of 18 and 45 years who participated in CLPS at 1 of 19 clinical sites in the northeastern region of the United States.

For this analysis, the investigators assessed 3 subgroups of patients: those diagnosed as having BPD (n = 175), those with MDD (n = 95), and those with either avoidant personality disorder or obsessive-compulsive disorder (cluster C group, n = 312).

Criteria and changes in disorders were assessed with several measures, including the Diagnostic Interview for Personality Disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the Structural Clinical Interview for DSM-IV Axis I Disorders, the Longitudinal Interval Follow-up Evaluation, and the Global Assessment of Functioning (GAF) scale for up to 10 years.

High Remission, Low Relapse

Results showed that 66% of the participants completed all 10 years of follow-up, including 111 of those with BPD, 211 of those in the cluster C group, and 62 of those with MDD.

"While the overall rates of remission at 10 years were high for all 3 diagnostic study groups, the time to remission for BPD was significantly longer than for MDD (P < .001) but only minimally longer for cluster C (P = .03)," report the researchers. However, the 11% relapse rate for the group with BPD was significantly less frequent and slower than for both the MDD (P < .001) and cluster C groups (P = .008). BPD relapses "largely occurred in the first 4 years before leveling off," write the investigators, adding that only 9% of the BPD patients "remained stable disordered" (defined as meeting ≥5 disorder diagnostic criteria) at the 10-year mark. GAF scores showed severe impairment for those with BPD and "only modest albeit statistically significant" improvements. These patients also remained statistically more socially dysfunctional during the 10-year period than the other 2 groups (P < .001). Finally, criteria reductions significantly predicted subsequent improvements in GAF scores (P < .001). These results "are consistent with the theory that if patients with BPD can achieve stable supports and avoid interpersonal stressors they will remit clinically," write the investigators. "The low relapse rate suggests that during the remission process, the patients changed either psychologically, perhaps having acquired more resiliency or new adaptive skills, or situationally by attaining more supports or less stress," they add. Dr. Gunderson said there is now a real need for "more practical" BPD treatments. "We can see that they don't need to be long term and intensive to be helpful. But we do need them to be more focused on social rehabilitation." The study was funded by grants from the National Institute of Mental Health. The study authors have disclosed no relevant financial relationships. Arch Gen Psychiatry. Published online April 4, 2011. Abstract

Why Breaking-up is Hard to Do

The Biology of Breaking Up

Our brains are wired for bonding. Break-ups challenge us biologically. According to Rutgers University anthropologist Helen Fisher, everyone biologically reacts to rejection in a way similar to that of a drug user going through withdrawal. In the early days and weeks after a serious breakup, there are changes in the ventral tegmental area of the midbrain, which controls motivation and reward and is known to be involved in romantic love; the nucleus accumbens and the orbitofrontal/prefrontal cortex, part of the dopamine reward system and associated with craving and addiction; and the insular cortex and anterior cingulate, associated with physical pain and distress.

As reported in a recent issue of the Journal of Neurophysiology, Fisher studied 15 people who had just experienced romantic rejection, put them in an fMRI machine, and had them look at two large photographs: an image of the person who had just dumped them and an image of a neutral person to whom they had no attachment. When the participants looked at the images of their rejecters, their brains shimmered like those of addicts deprived of their substance of choice.

“We found activity in regions of the brain associated with cocaine and nicotine addiction,” Fisher says. “We also found activity in a region associated with feelings of deep attachment, and activity in a region that’s associated with pain.”

Fisher’s work corroborates the findings of UCLA psychologist Naomi Eisenberger, who discovered that social rejection activates the same brain area—the anterior cingulate—that generates an adverse reaction to physical pain.

Why do some behave so badly after a breakup?

The intensity of the pain may be what compels some spurned lovers to do just about anything to make the hurt go away -- and that includes a host of unhealthy things ranging from demonizing their ex-partner, to excessive anger, to bashing whole groups of people. The intensity of the pain may be what compels some spurned lovers to stalk their ex-partners. Fisher believes, for example, that activation of addictive centers in response to breakups also fuels stalking behavior, explaining “why the beloved is so difficult to give up.”

Attachment styles that emerge early in life also influence how people handle breakups later on

Biology is nowhere near the whole story. Attachment styles that emerge early in life also influence how people handle breakups later on—and how they react to them.

Those with a secure attachment style—whose caregivers, by being generally responsive, instilled a sense of trust that they would always be around when needed—are most likely to approach breakups with psychological integrity. Typically, they clue their partners in about any changes in their feelings while taking care not to be hurtful.

On the receiving end of a breakup, “the secure person acknowledges that the loss hurts, but is sensible about it,” says Phillip Shaver, a University of California, Davis psychologist who has long studied attachment behavior. “They’re going to have an undeniable period of broken dreams, but they express that to a reasonable degree and then heal and move on.”

People with inconsistent parental attention during the first years of life—are apt to try to keep a defunct relationship going rather than suffer the pain of dissolving it 

By contrast, people who develop an anxious or insecure attachment style—typically due to inconsistent parental attention during the first years of life—are apt to try to keep a defunct relationship going rather than suffer the pain of dissolving it. “The anxious person is less often the one who takes the initiative in breaking up,” Shaver says. “More commonly, they hang on and get more angry and intrusive.” On the receiving end of a breakup, the insecurely attached react poorly. “They don’t let go,” says Shaver. “They’re more likely to be stalkers, and they’re more likely to end up sleeping with the old partner.” Unfortnately, their defense against pain—refusing to acknowledge that the relationship is over—precludes healing. They pine on for the lost love with little hope of relief.

People with low self-esteem took rejection the worst: They were most likely to blame themselves for what had happened and to rail against the rejecter. 

Whether we bounce back from a breakup or wallow in unhappiness also depends on our general self-regard. In a University of California, Santa Barbara study where participants experienced rejection in an online dating exchange, people with low self-esteem took rejection the worst: They were most likely to blame themselves for what had happened and to rail against the rejecter. Their levels of the stress hormone cortisol ran particularly high. Such reactivity to romantic rejection often creates unhealthy coping strategies—staying home alone night after night, for example, or remaining emotionally closed off from new partners.

People with high self-esteem were not immune to distress in the face of romantic rejection, whether they were rejecter or rejectee, but they were less inclined to assume a lion’s share of the blame for the split. Best of all, they continued to see themselves in a positive light despite a brush-off.

Some helpful tips...

1. Don’t protest a partner’s decision. The best thing a dumpee can do to speed emotional healing is to accept that the relationship has come to an unequivocal end. In her neuroimaging studies, Helen Fisher found that the withdrawal-like reaction afflicting romantic rejectees diminished with time. Start the clock working in you favor.

2. Don’t beg him or her to reconsider later on. The recovery process is fragile, says Fisher, and last-ditch attempts to make contact or win back an ex can scuttle it. “If you suddenly get an email from the person, you can get right into the craving for them again.” To expedite moving on, she recommends abstaining from any kind of contact with the rejecter: “Throw out the cards and letters. Don’t call. And don’t try to be friends.” At least for now. When you have healed, things can change.

3. Resist thinking you’ve lost your one true soul mate. Don’t tell yourself you’ve lost the one person you were destined to be with forever, says Florida State University psychologist Roy Baumeister. “There’s something about love that makes you think there’s only one person for you, and there’s a mythology surrounding that. But there’s nothing magical about one person.” In reality, there are plenty of people with whom each of us is potentially compatible. It might be difficult to fathom in the aftermath of a breakup, but chances are you’ll find someone else.

4. Don’t demonize your ex-partner. It’s a waste of your energy. And avoid plotting revenge; it will backfire by making him or her loom ever larger in your thoughts and postpone your recovery.

5. Don’t try to blot out the pain you’re feeling, either. Face it head on. Short of the death of a loved one, the end of a long-term relationship is one of the most severe emotional blows you’ll ever experience. It’s perfectly normal—in fact, necessary—to spend time grieving the loss. “Love makes you terribly vulnerable,” John Portmann, a moral philos­opher at the University of Virginia says. “If you allow yourself to fall in love, you can get hurt really badly.” The sooner you face the pain, the sooner it passes.

Based on: psychologytoday.com

28% of the US population have either a mental or addictive disorder

According to BPDFamily.com, the US Surgeon General estimates that 28% of the US population suffer from either a mental or addictive disorder in a given year.

The current prevalence estimate is that about 20 percent of the U.S. population are affected by mental disorders during a given year. This estimate comes from two epidemiologic surveys: the Epidemiologic Catchment Area (ECA) study of the early 1980s and the National Comorbidity Survey (NCS) of the early 1990s. Those surveys defined mental illness according to the prevailing editions of the Diagnostic and Statistical Manual of Mental Disorders. The surveys estimate that during a 1-year period, 22 to 23 percent of the U.S. adult population—or 44 million people—have diagnosable mental disorders, according to reliable, established criteria.

In general, 19 percent of the adult U.S. population have a mental disorder alone (in 1 year); 3 percent have both mental and addictive disorders; and 6 percent have addictive disorders alone.3 Consequently, about 28 to 30 percent of the population have either a mental or addictive disorder (Regier et al., 1993b; Kessler et al., 1998).

Individuals with co-occurring disorders (about 3 percent of the population in 1 year) are more likely to experience a chronic course and to utilize services than are those with either type of disorder alone.

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of 55,000 volunteer members and alumni formed in 1994.

Author: Skip 

Are the Children of a BPD Parent Likely to Suffer Emotional Abuse?

The short answer is "yes." Do you know a mother who suffers from Borderline Personality Disorder - possibly your daughter in law - your wife - a friend?  Did you know that even when the family appears to be doing well and the child appears to be overachieving, the children may be suffering psychological damage that will affect them far into adulthood.

Many BPD sufferers work very hard at being good parents. However, BPD thinking and behavior patterns can lead to problematic parenting in several ways. For instance, a BPD sufferer is prone to black and white thinking, which can lead a parent to "split" one child--or the same child at different times--as “all bad” and thus deserving of punishment and another as "all good." In "all bad" child suffers never learns human bonding. An "all good" child is not given a chance to develop a normal sense of independence and identity as the parent idealizes, rescues, or turns to the child for support.

High-Risk Parenting

Thus, a sufferer’s ways of coping can become a source of neglect such as when addictive behaviors distract the parent, leaving the child untended or abuse, with impulsive behaviors and rages resulting in emotional and physical scars or inconsistent parenting leaving the child feeling confused and unsafe. Experts consider parents with BPD to be "high risk":

Even the act of care giving itself may trigger painful memories from the mother’s history of trauma, making it very difficult for the mother with BPD to cope with the daily challenges of parenting (Main, 1995). These triggers often cause her to engage in maladaptive, “frightened/frightening” behaviors, whereby the she is both frightening to the child and frightened herself at the same time (Holmes, 2005; Hobson, et al, 2005). In this way, mothers with BPD are often classified as “high risk” parents (Newman & Stevenson, 2005), at risk of child abuse and/or drastically overprotective behaviors. (From How a Mother with Borderline Personality Disorder Affects Her Children)

A child who is faced with a frightened parent will often, in a reversal of a healthy parent-child interaction, try to provide comfort or to solve the problem for the parent. The child is parentified, trying manage situations beyond his or her maturity. At the same time, the child's own fears are not soothed. The result can be a highly anxious child who tries to be "perfect" but ultimately turns to destructive coping strategies like eating disorders, drugs, and addictive relationships to deal with buried fear and self-esteem issues.

What Can a Concerned Adult Do?

Parents, grandparents, aunts and uncles, and other caring family members come to Coping with Parents, Relatives, and Inlaws with BPD concerned about the interactions such as these between the BPD sufferer in their life (perhaps the children's mother, father, stepfather, or stepmother) and the children. They may feel that something is wrong or they may know the actions are wrong, but they don't know how to intervene.

BPDFamily.com can provide education, support, and tools as to work toward improving the lives of the children with a parent with BPD. Members find shared ideas and resources on Parenting and Co-Parenting, along with numerous articles and workshops discussing ways of supporting kids with a BPD caregiver and effectively meeting their needs. The Parenting board is also a place to get much needed emotional support from others who really do understand the challenges of trying to offer kids the best environment possible. Depending on the relationship to the child and the severity of the problem, there is as lot a concerned adult can do, including:

• Ensure the child’s physical needs are being met.
• Take the child out regularly for some “down” time.
• Reassure the child that the mistreatment is not his/her fault.
• Teach the child healthy coping mechanisms, like thinking of a happy place or time when things are difficult or to focusing on breathing and counting to 10 when angry.
• Provide counseling for the parent and the child.
• Talk—and listen—to the child.
• Validate the child’s feelings and sense of reality. If a BPD parent says the child is “not cold” when the child has said he is freezing, say, “I think he is feeling cold. I’ll get a sweater for him.”
• Find ways to check regularly on the child’s well being.
• Reduce the amount of time the child spends alone with the stressed parent. Offer alternatives, such as to babysit or pay for activities.
• Create small rituals of security and happiness. Go to a park every Saturday. Take the child grocery shopping and let her choose one small treat.
• Remove the child to safety.
• Call a child abuse or domestic violence hotline or 911.
• If you are not the child’s parent, consistent with your own safety and need for boundaries, stay in the child’s life to the greatest extent possible.
• If you are the child’s parent and you feel that you must look at all options to protect your child, consult with an experienced family law attorney and a counselor to map out a plan.

Author: BlackandWhite

Is Your Marriage Breaking Down?

BPDFamily.com encourages couples to spot the classic pattern of relationship breakdown and take action before it goes too far.

According to Mark Dombeck, Ph.D., Director of Mental Help Net and former Assistant Professor of Psychology at Idaho State University, there is no single reason why a relationship begins to break down. However, once a relationship does start to break down, there is a predictable sequence of events that tends to occur. Highly regarded psychologist and researcher John Gottman, Ph.D. suggests that there are four stages to this sequence which he has labeled, "The Four Horsemen Of the Apocalypse".

Stage One The first stage of the breakdown process involves intractable conflict and complaints. All couples have conflicts from time to time, but some couples are able to resolve those conflicts successfully or 'agree to disagree', while others find that they are not. As we observed earlier, it is not the number or intensity of arguments that is problematic but rather whether or not resolution of those arguments is likely or possible. Couples that get into trouble find themselves in conflicts that they cannot resolve or compromise upon to both party's satisfaction. Such disagreements can be caused by any number of reasons, but might involve a clash of spousal values on core topics such as whether to have children, or how to handle money.

Frequently, couples assume that misunderstandings are at the root of their conflicts. "If my spouse really understood why I act as I do, he or she would agree with me and go along with what I want", is a commonly overheard refrain. Acting on this belief, spouses often try to resolve their conflicts by repeatedly stating and restating their respective rationals during disagreements. This strategy of repetition usually doesn't work because most of the time couple conflicts are not based on misunderstandings, but rather on real differences in values. When this is the case, stating and restating one's position is based on a mistaken premise and can only cause further upset.

Stage Two In the second stage of the breakdown process, one or both spouses starts to feel contempt for the other, and each spouse's attitudes about their partner change for the worse. For example, initially each spouse may have mostly positive regard for their partner and be willing to write off any 'bad' or 'stupid' behavior their partner acts out as a transient, uncommon stress-related event. However, as 'bad' or 'stupid' behavior is observed again and again, spouses get frustrated, start to regard their partner as actually being a 'bad' or 'stupid' person, and begin to treat their partner accordingly. Importantly, the 'bad' behavior that the spouse demonstrates doesn't have to be something he or she actually does. Instead, it could be something that he or she doesn't do, that the spouse expects them to do (such as remembering to put the toilet seat down after use).

Conflict by itself doesn't predict marriage problems. Some couples fight a lot but somehow never manage to lose respect for each other. Once contempt sets in, however, the marriage is on shaky ground. Feelings of contempt for one's spouse are a powerful predictor of relationship breakdown, no matter how subtlety they are displayed. In a famous study, Gottman was able to predict with over 80% accuracy the future divorces of multiple couples he and his team observed based on subtle body language cues suggesting contemptuous feelings (such as dismissive eye-rolling). Contempt doesn't have to be expressed openly for it to be hard at work rotting the foundations of one's relationship.

Stage Three Most people find conflict and contempt to be stressful and react to such conditions by entering the third stage of breakdown, characterized by partner's increasingly defensive behavior. Men in particular (but women too) become hardened by the chronicity of the ongoing conflict, and may react even more acutely during moments when conflict is most heated by becoming overwhelmed and "flooded"; a condition which is psychologically and emotionally quite painful. Over time, partners learn to expect that they are 'gridlocked'; that they cannot resolve their differences, and that any attempts at resolution will result in further overwhelm, hurt or disappointment.

Stage Four Rather than face the pain and overwhelm they expect to experience, partners who have reached this third 'defensive' stage, may progress to the forth and final stage of breakdown, characterized by a breakdown of basic trust between the partners, and increasing disengagement in the name of self-protection. Like a steam-valve in a pressure cooker, the partners start avoiding one another so as to minimize their conflicts. Gottman calls this final stage, "Stonewalling", perhaps after the image of a partner hiding behind a stone wall designed to protect him or her from further assault. Unfortunately, there is no way to love your partner when you are hiding behind a wall to protect yourself from him or her.

The "four horsemen" breakdown sequence plays out amongst the backdrop of partner compatibility. Basically compatible partners may demonstrate a whole lot of conflict, but they don't often become contemptuous and angry with their partners, because there are by definition few things that they will disagree upon. In contrast, partners who start out with incompatible goals, values or dreams are far more likely to get into seemingly irresolvable conflicts. Also, once the process of contempt, defensiveness and avoidance begins, small incompatibilities can become magnified as spouses pursue other interests as an alternative to conflict.

Author: Skip 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

The most common mental health conditions.

There are many different conditions that are recognized as mental illnesses. According to BPDFamily.com, the more common types include:

• Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or nervousness, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person's response is not appropriate for the situation, if the person cannot control the response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and specific phobias.

• Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, mania, and bipolar disorder.

• Psychotic disorders: Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations -- the experience of images or sounds that are not real, such as hearing voices -- and delusions -- false beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.

• Eating disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders.

• Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.

• Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the person's patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person's normal functioning. Examples include antisocial personality disorder, borderline personality disorder, obsessive-compulsive personality disorder, and paranoid personality disorder.

Other, less common types of mental illnesses include:

• Adjustment disorder: Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job, or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within six months after the stressor stops or is eliminated.

• Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or "split personality", and depersonalization disorder are examples of dissociative disorders.

• Factitious disorders: Factitious disorders are conditions in which physical and/or emotional symptoms are created in order to place the individual in the role of a patient or a person in need of help.

• Sexual and gender disorders: These include disorders that affect sexual desire, performance, and behavior. Sexual dysfunction, gender identity disorder, and the paraphilias are examples of sexual and gender disorders.

• Somatoform disorders: A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness even though a doctor can find no medical cause for the symptoms.

• Tic disorders: People with tic disorders make sounds or display body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourette's syndrome is an example of a tic disorder.

Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer's disease, are sometimes classified as mental illnesses because they involve the brain.

Author: Skip 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

Do people with Borderline Personality Disorder lack of Empathy?

To show empathy is to identify with another person’s feelings.  Empathy is a sophisticated human response.

It begins with awareness of another person's feelings. It would be easier to be aware of other people's emotions if they would simply tell us how they felt. But since most people do not, we must resort to asking questions, reading between the lines, guessing, and trying to interpret non-verbal cues. Emotionally expressive people are easiest to read because their eyes and faces are constantly letting us know how they are feeling.

Once we are aware of another persons feelings, we briefly imagine ourselves in their place - feel what they feel - and then respond to them in ways that would comfort us. This requires great deal of emotional maturity.

When Do Our Empathy Skills Fail

Having empathy isn't so easy when we are in a distraught emotional state ourselves. It can be hard to give when we are needy. We have all been there at times. Showing empathy isn't so easy when the person we are trying to comfort is having an experience we can't relate to - either in terms of noticing it or it terms of how to respond to it. We have all found ourselves in this situation at times.

A Person With BPD Fails for the Same Reasons as We Do

Having empathy isn't so easy when one is in a distraught emotional state. Keep in mind that BPD sufferers are often flooded with conflicted and painful emotions. During times of dysregulation, an emotional response that is more intense than normal, Borderline Personality sufferers can be so overwhelmed with emotion that makes them, at worst, incapable fo normal functioning , and at best, internally focused, self centered and self absorbed.

Often a person with BPD doesn’t have emotional energy to spare to consider the emotions of others. 

Showing empathy isn't so easy when it's an experience we can't relate to.  People suffering from BPD have a problem with poor emotional vocabularies, meaning they find it hard to label and understand - their own feelings - let alone understand others. This inability to understand or accept their own feelings leads to feelings of confusion, shame and self hatred, one of the defining traits of a BPD sufferer. Additionally, a person suffering from Borderline Personality Disorder is often not very kind to themselves. They often comfort themselves by dysfunctional means - cutting and self injury are a good examples of dysfunctional soothing.

Even worse, if a pwBPD perceives they are being attacked or criticized by our pain and suffering, or that there is even the possibility of being attacked, their defenses may go into over drive and the attack rather than empathize.

What Can We Do?

Being hurt and defensive doesn't help.

Being the target of someones dysregulation (which can often feel irrational and unjustified) is painful. And while the natural reaction is to become defensive – this takes us further from receiving the empathy we desired or need. This is why independent support is very important to individuals in relationships with people suffering from Borderline Personality Disorder. 

BPD is a true mental disorder. A person with this disorder often can't be empathetic. We need to recognize this and find comfort elsewhere.

If we see that the person with BPD can't respond appropriately we need to just step away - let it go - find support in another way. Family, friends, and support groups are very important for those in a relationship with a person suffering from this disorder.

Do We Need to be Show Empathy for the Person with BPD?

When we try to understand others behaviors from a logical standpoint, we are judging our loved one based on how we believe they “should” perceive. This focus on “logic” leads to the conclusion that the pwBPD "should" be able to do better. Believing these “should’s” prevents us from full acceptance that our loved one is mentally ill. But, lets face it, it’s hard to comprehend how someone’s emotions can get in the way .

A recent study at Harvard Medical school using brain scanning to analyze how anger is processed, demonstrated that people who were depressed had a decrease in blood flow to critical areas of the brain, reducing their inhibitions and interfering with their ability to consider the consequences of their actions. They experienced what researchers described as a double hit, “A decrease in blood flow to these areas of the brain reduces both their ability to control impulsive acts and their feelings about the consequences of those acts, say punching someone in the mouth. There is both a lack of emotion and a lack of control. A double hit that adds up to inappropriate, even violent rage.”

Someone who suffers from BPD is constantly on the alert for any possible invalidation. Even the slightest criticism or hint of rejection hurts them and drives them into defense and attack mode. They become hyper vigilant to any possible threats (often making mountains out of molehills in the process) as a defensive measure to protect themselves.

Until we can accept this, we won't be able to adjust and make our lives and theirs less chaotic and hurtful.

Authors: Skip and United for Now 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

Childhood sexual abuse more than doubles the likelihood of developing psychosis

BPDFamily.com reports that a study published in the November Archives of General Psychiatry suggests that children who are sexually abused may be at twice the risk for developing schizophrenia and other psychotic disorders.

In this study, Margaret C. Cutajar of Monash University, Victoria, Australia, and colleagues linked data from police and medical examinations of sexual abuse cases to a statewide register of psychiatric cases.  They compared the rates of psychiatric disorders among 2,759 individuals who had been sexually abused when younger than age 16 to 4,938 random individuals. Over a 30-year period, individuals who had experienced childhood sexual abuse had more the twice the incidence of psychosis (2.8 percent vs. 1.4 percent) and schizophrenia disorders (1.9 percent vs. 0.7 percent).

This is consistent with prior studies studies that have established that abused children are more likely to develop depression, anxiety, substance abuse, borderline personality disorder, post-traumatic stress disorder and suicidal behavior, according to background information in the article.  This study found that a history of sexual abuse with penetration especially increased the risk.

Participants experienced abuse at an average age of 10.2, and 1,732 (63 percent) of cases involved penetration of a bodily orifice by a penis, finger or other object. Those exposed to this type of abuse had higher rates of psychosis (3.4 percent) and schizophrenia (2.4 percent).

“The risks of subsequently developing a schizophrenic syndrome were greatest in victims subjected to penetrative abuse in the peripubertal and postpubertal years from 12 to 16 years and among those abused by more than one perpetrator,” the authors write.

“Children raped in early adolescence by more than one perpetrator had a risk of developing psychotic syndromes 15 times greater than for the general population.”

The results establish childhood sexual abuse as a risk factor for psychotic illness, but do not necessarily translate into abuse causing or increasing the risk of developing such a disease, the authors note.  “The possibility of a link between childhood sexual abuse and later psychotic disorders, however, remains unresolved despite the claims of some that a causal link has been established to schizophrenia,” the authors write.

Many cases of childhood sexual abuse never come to light, and the overall population of abused children may be significantly different from those whose abuse is detected by officials.

“Establishing that severe childhood sexual abuse is a risk factor for schizophrenia does have important clinical implications irrespective of questions of causality and irrespective of whether those whose abuse is revealed are typical,” the authors conclude.

“Children who come to attention following childhood sexual abuse involving penetration, particularly in the peripubertal and postpubertal period, should receive ongoing clinical and social support in the knowledge that they are at greater risk of developing a psychotic illness.”

“Such treatment in our opinion should focus on improving their current functioning and adaptation to the demands of the transition from adolescent to adult roles rather than primarily on the abuse experience itself.

“Such an approach should benefit all victims, irrespective of whether they have the potential to develop a psychotic illness.”

The study is found in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Schizophrenia and Other Psychotic Disorders in a Cohort of Sexually Abused Children
Margaret C. Cutajar, DPsych, MAPS; Paul E. Mullen, DSc, FRANZCP, FRCPsych; James R. P. Ogloff, PhD; Stuart D. Thomas, PhD; David L. Wells, MA, FACLM; Josie Spataro, PhD, MAPS  Arch Gen Psychiatry. 2010;67(11):1114-1119.

Author: Skip 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

Extinction Bursts - Important to Understand when your Partner has BPD.

We all know that life is a journey and that it’s important to have focus and objectives. This can become difficult if the person "traveling" with us has Borderline Personality Disorder (BPD).  Because of the associated impulsiveness, hypersensitivity, and dysfunctional coping, people with this disorder often "wander off the path". And we often feel compelled to chase after and cater to them, which, in turn, diverts our focus and often results in anxiety, abuse, and dysfunction for everyone.

According to BPDFamily.com, extinguishing this pattern isn’t easy, yet it is an essential first step in having a healthy relationship.  Taking care of ourselves may feel like a selfish focus - but as the emotionally healthier one, it’s important  that we not get bogged down in BPD induced dramas.  And it's important that we understand that our BPD loved ones aren’t mentally fit to be leading the relationship.

So what do we do?   When the person with Borderline Personality Disorder becomes dysregulated or depressed. BPDFamily.com recommends that you give them the space to self sooth - not try to do it for them.  Take a deep breath and politely and non-aggressively disengage. It’s not easy to block out the distraction and emotional pleas for our attention, yet it is only with a critical pause that we can really stay on a constructive and healthy pathway.

This act is called extinction. We essentially remove our reinforcement in an attempt to stop the  behavior. We simply stop rewarding the behavior.

When our partner doesn’t get the expected response (reinforcement by us) it may scare or anger them and they may try harder to  engage us using threats, violence, destruction, intimidation, name calling, belittling, promises of withholding necessary things, retaliation, or any other painful thing they can think of to get us to engage.   This escalation is know as an extinction burst.

Extinction Burst - The term extinction burst describes the phenomena of behavior temporarily getting worse, not better, when the reinforcement stops. Spontaneous Recovery - Behavior affected by extinction is apt to recur in the future when the trigger is presented again. This is known as spontaneous recovery or the transient increase in behavior. Be aware of this eventuality. It is a part of the extinction process. Don't be discouraged.

This is OK, as long as we anticipate it, understand it, and are prepared for it.  The same is true for spontaneous recovery.


They won’t like this, but it is a necessary for them to experience and to learn to self sooth their own frustrations in life.  It is what will bring on the opportunity for change.   When we do it, we block this opportunity for change and we subvert our own emotional health.

We can not allow others to lead us astray on our journey. In time, if we stay committed to our path our partners will adjust.  And we won’t be subjecting ourselves to as much pain.  

Authors: United for Now, Skip 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

Borderline Personality Disorder Prevalence 5.9%

BPDFamily.com reports that Borderline Personality Disorder is three times more prevalent than previously thought and is possibly the most common of the personality disorders.

A recent study by the National Institute of Health projects that BPD affects more individuals and their families than previously believed. See member discussion here:

A sample of findings:

• the prevalence of the disorder is 5.9%;
• that prevalence in men is the same as women;
• BPD was more prevalent among Native American men, younger and separated/divorced
  /widowed adults, and lower income and education;
• BPD was less prevalent among Hispanic men and women, and Asian women;
• BPD prevalence was greatest among people with bipolar disorder (50%), panic disorder, or drug dependence. Smokers were also more likely to have BPD'
• 24% had comorbidity with another personality disorder. The rates of NPD/BPD and ASPD/BPD were higher among women;
• lower incidence was seen in adults over 44 years of age.

There are many family members who are hurt by their loved one’s disorder. A person who suffers from a personality disorder can often be rigid and exhibits heightened emotions and responses, leaving them highly distressed in their life. This ultimately affects most of the relationships closest to them. BPDFamily.com estimates that 18 million individuals are struggling in their relationships with their husbands and wives, romantic partners present and past, friends, coworkers, their parents, siblings, children, in-laws, etc.

Are you in love with someone with borderline personality disorder? Do you think your mother, child, friend, neighbor or coworker has BPD? Can we help you to untangle the mysteries, dissolve the chaos and reclaim your life? Please leave a comment if any of this sounds like a situation that you are or have been in you may want to visit the BPDfamily support group.

Authors: DreamGirl, Skip 

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com

Can it be Borderline Personality if There is No Cutting or Substance Abuse?

Borderline Personality Disorder (BPD) is widely associated with self harming, suicidal ideation, substance abuse, and difficulty holding employment or staying in school. However there are many people with clinical BPD or BPD traits that are not self destructive and are very productive in school and the workplace. The later are often missed by family or physicians as having BPD traits - but are seen as difficult or "characterless" people. When this happens, the family and clinical responses can exacerbate the problems rather than help.

To support a difficult loved one and to make appropriate family decisions it is important to understand what is affecting your family member - are they mentally ill or are they just troubled? BPDFamily.com is a support group for family and friends to explore issues like this.

20 percent of all psychiatric inpatients have BPD, as do 10 percent of all mental health outpatients according to the American Psychiatric Association.  Their characteristics of low functioning borderlines include:

1. They acknowledge they have some behavior problems (not necessarily BPD, however)

2. They cope with pain through self-destructive behavior, such as self-injury and actions that put them in harm’s way. The term for this is “acting in”

3. They (often desperately) seek help from the mental health system. Some are hospitalized for their own safety. They may often become very attached to their professional caregivers

4. They have a difficult time with daily functioning and may even be disabled. This is called “low functioning”

5. If they have overlapping (“comorbid) other disorders, they tend to be the kind that require intensive professional treatment, such as Bipolar, Clinical Depression, or an Eating Disorder

6. Family members’ greatest challenges are keeping their loved one alive and functioning. Other concerns might be their inability to, earn their own living and adequately parent their child.

In a discussion on BPDFamily.com, Randi Kreger, co-author of Stop Walking on Eggshells, says the situation with high functioning borderlines will look more like this:

"1. Denial is their primary characteristic. They disavow having any problems and see no need to change. Relationship difficulties, they say, are everyone else’s fault. If family members suggests they may have BPD, they almost always accuse the other person of having it instead. (This is why I strongly advise non-BPs to leave this disclosure to a trained professional)

2. They cope with their pain by raging outward, blaming and accusing family members for real or imagined problems (“acting out”)

3. They refuse to seek help from the mental health system unless someone threatens to end the relationship. If they do go, they usually don’t intend to work on their own issues. In couples therapy, their goal is often to convince the therapist that they are being victimized

4. They may hide their low self-esteem behind a brash, confident pose that hides their inner turmoil. They usually function quite well at work and only display aggressive behavior toward those close to them (high functioning). But the black hole in the gut and their intense self-loathing are still there. It’s just buried deeper

5. If they also have other mental disorders, they’re ones that also allow for high functioning such as Narcissistic Personality Disorder (NPD) or Antisocial Personality Disorder (APD). (These mostly appear concurrently in men—especially APD)

6. Family members’ greatest challenges include coping with verbal abuse, protecting children, trying to get their family member to seel treatment, and maintaining their self-esteem and sense of reality. Partners, especially, are in relationships with Cluster Two BPs. "

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BPDFamily.com provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here. www.bpdfamily.com