I'm a psychiatrist, and I'm heartened to see this show up in the HN top-10. Lots of people have someone in their life with Borderline PD (or at least features). It's a serious impairment that sometimes gets vilified or downplayed as "just a personality disorder." If people could "just stop doing it," they would.
It can be hard to maintain steady, honest empathy for people with Borderline PD, but their suffering is very real.
I was diagnosed in college. I went through a few relationships and got attached like crazy, early. That drove the person away and I'd get desperate/angry. Rinse, repeat.
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.
From my anecdotal experience, this kind of intrusive thoughts stems from being afraid of your emotions. Being afraid that anger of frustration overpowers you and you'd do things that would destroy your life.
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.
Soon after I moved I also started working out. I've gained about 50 lbs (mostly muscle), and have much better self-confidence. I would also say that helped.
My diet has also changed a lot, like another commentator mentioned.
Glad that you are doing better!
I hope you are also able to unlearn the thought patterns that are learned during an emotional crisis. "Emotions are dangerous and I have to control them" is one of them.
While these thought patterns subside when everything is fine they may come back when life goes into hard mode.
There is a great comment in a psychologists AMA on reddit regarding thought patterns: https://www.reddit.com/r/AskReddit/comments/4vwsqc/psycholog...
Diet (especially getting enough omega 3s and fruits and vegetables) -- as well as other lifestyle issues and stresses -- can have a big effect on mood. So moving to a new situation may have helped -- like perhaps you spouse is a good at cooking healthy food? See for example my comments here on many factors of psychological health: https://news.ycombinator.com/item?id=15455259
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."
> 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
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.
> I am still contemplating whether I should mention it to my spouse. She knows about my diagnosis in college but not these intrusive thoughts.
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.
Perhaps this type of information can be shared in a setting with the two subjects plus a professional such as their psychiatrist. I mean, isn't this what e.g. psychologists, psychiatrists, and mediators are for?
That is what I was getting at with "unless you have a specific setting that allows it to be digested by her slowly, and with professional help to put it into context".
My favorite viruscomix [1] (by Winston Rowntree) deals with intrusive thoughts, by having a homeless character meet her alternate reality self. The conventionally successful self had a better support network, but is still desperately afraid that she will heed her reclusive, despairing aspect. I want to give away the emotional climax, but shouldn't; I cried when I first read it.
A close relative suffers from a PD. Borderline with likely schizophrenic co-morbity, he's not cooperative to diagnostics.
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.
This is a fab short explanation. It is the understanding I have come to after battling complex trauma myself. Recovery for me has been a long process of discovery. To find a better life you need to first learn to feel your emotions and secondly to retrain them. Learning to feel took me years. Meditating helped tremendously because it gave me the ability to focus. And i could turn that focus towards feeling. I have learned to hold my attention on a feeling. Which allows me to calm myself when I am frightened and gradually over time my fear of daily life - which was mostly invisible to me as a younger man - has diminished.
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.
Hearing that you've reduced your fear of daily life since your younger days is exactly what I needed to read right now, and I didn't even realize it. Thanks for the optimism.
I think you seem to be confusing "lack of insight" (the clinical term, as a manifestation of a severe mental disorder) and "lacking insight" in a more general sense. The latter may well be cured by therapy or reflection on childhood problems. But as someone with a schizophrenic brother who, like the parent poster's family member, totally lacks insight into their own illness, I can say that the former really is not curable in the way you imply. It's a terrible thing to witness, and as far as I can tell, there are no simple solutions.
They're both connected in this instance. A person with a personality disorder is really on a continuum of insight in which schizophrenia is the most extreme example and represents a complete dissociative break with self-awareness.
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.
>> 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.
I think what you describe is the main reason for a lack of sympathy for people with BPD. For people with other mental disorders, it's much easier to see how the person is suffering or negatively impacted by their illness. But it's often too difficult to see past one's own anger, frustration and annoyance to recognize that suffering in people with BPD.
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.
>I think what you describe is the main reason for a lack of sympathy for people with BPD. For people with other mental disorders, it's much easier to see how the person is suffering or negatively impacted by their illness. But it's often too difficult to see past one's own anger, frustration and annoyance to recognize that suffering in people with BPD.
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.
> 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.
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 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.
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.
> 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.
> All untreated BPDs experience splitting. For me, that isn't up for debate
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.
>People suffering from borderline are still individual humans.
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.
Yes, I was the same, and I thought it was for no apparent reason. To give an example, I'd have a friend at my place, and we'd have a lot of fun playing for example computer games together, until the morning after where I wake up grumpy and don't feel like socialising at all. All I wanted to be, was alone on my own. I thought it was BPD as it fitted the bifurcation black/white thinking and I self-diagnosed as such until I figured many years later that the reason why it is occurring was that I suffer from autism, and this is a sign of overstimulation.
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.
They make me feel like I'm living in some emotions-cranked-to-11 stage play. Everything is overly intense and saturated. Things that I encounter rarely, uncontrollable love/lust! rage! betrayal! us-against-the-world loyalty! new soul-mates! malicious negligence! manipulation! conspiracy! jealousy! suddenly become the stuff of everyday life. I've only ever been on the periphery of one of these people, and I was already exhausted.
Just to add on, speaking from experience, many insurance companies in the US will not cover things like Borderline Personality Disorder since they see it as not curable. Most of the personality disorders are not covered.
BPD comes in two flavors. The first, acting out, is the stereotypical BPD that is the better known variety. The second, acting in or quiet BPD, is less well known.
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.
I try to hear that. I succeed a little. Mostly I think about the incalculable cost to the rest of us. I have two children who are suicidal from time to because of a person close to them who is borderline. Me too.
Well, there are. I'm studying philosophy, for example and while I'm interested in tech I can't say I understand much of it. I come here for the interesting mix of news and refreshingly critical points of view.
Read the DSM description. If you are a technologist you will recognize the format, it is a set of tests that you can likely apply yourself. While I recommend leaving it to a professional, your own curiosity can lead to quite a bit of learning.
What is treatment for BPD, if you don't mind me asking?
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.
The gold standard is DBT for BPD, and treating other co-occuring conditions. It's hard to find somewhere that does by-the-book DBT, and other approaches can also help, but I might recommend starting with an academic center if possible.
Many times people with BPD see it as a problem with the people around them, and have a hard time connecting the dots that their behavior is the common thread. Not seeing it as their problem, they often avoid treatment, but certainly not always. Particularly as time goes on, many are hopeful for some relief.
I just broke off contact with someone I suspect having BPD after the second time they did a complete 180 from the friendly 2 hrs we had before to zooming into a angry, paranoid state over something trivial that was frightening for me.
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.
It can be hard to maintain steady, honest empathy for people with Borderline PD, but their suffering is very real.