Borderline Personality Disorder: addition

There’s an interesting collection of pieces about Borderline Personality Disorder in the yesterday’s NY Times; see here and here (you might want to look at the questions/answers after this second entry).  It raises some questions that might be worth discussing here.

I think of the NYT characterization as falling into two parts.  The first is a general description of perhaps the most visible manifestation of BPD:

People with the disorder are said to have a thin emotional skin and often behave like 2-year-olds, throwing tantrums when some innocent word, gesture, facial expression or action by others sets off an emotional storm they cannot control. The attacks can be brutal, pushing away those they care most about. Then, when the storm subsides, they typically revert to being “sweet and wonderful,” as one family member put it.

BPDers (people with the disorder) can seem to be one of natures tragedies, both needing and longing for close relationships while at the same time destroying them.   And the other, sometimes less social items in the symptomotology:

Moods can change quickly and unpredictably, behaviors can be impulsive (including abuse of alcohol or drugs, reckless driving, overspending or disordered eating), and relationships with others are often unstable [short, impulsive affairs]. Many patients injure themselves and threaten or attempt suicide to relieve their emotional pain.

The first two questions raised for me are (1) what is it?  Is there something like a psychological natural kind here?  Or a constructed category?   Does the category give rise to Hacking’s “looping effects,” as those so diagnosed are drawn into and changed by a way of life.  Why are BPDers largely women?   Is there something pathological in women’s current condition, or is the therapeutic talk a way of pathologizing women.

(2) Given the immense amount of  pain experienced by and  caused by BPDers, what are we to say of disability theorists who tell us to get over our insistance on people being either  neurotypical or unacceptedly diseased.  An alternative example might be obsessive-compulsives, some of whom live with extremely painful anxiety and who are less than able to respond to the needs of family members.  Some OCD suffers have their lives dramatically improved by medications whose side effects are  not so bad; should we regard the medication as relief from pain or as a bad “normalizing”?

I don’t have answers to these questions, and I’d love to hear what people think.  I’m particularly ill-equipped to answer the second.  For the first, I’ve been Googling around and, having found Janet Wirth-Cauchon’s Women and Borderline Personality Disorder and, having gotten a sample of it for my new kindle, I’m on the verge of buying it.  W-C looks at BPD as ‘the new female malady,’ with the ironic distance that  label suggests, I’d bet.

If you are – or think you are – involved in someway with BPD, you might find the NYT  interesting.  The questions,  with many short takes on life  and BPT, is pretty upsetting.


addition:  In comments  Bri mentioned Rachel Reiland’s Get Me Out of Here; an extensive and riveting ‘preview’ is available on Google Books.  I’m not sure about recommending that resource; like MANY authors I’ve signed onto a claim against them for using books without paying.  And if you read it, you might find the first few chapters before the narrator is hospitalized very painful reading.   Still, it is absorbing.  Thanks, Bri!

25 thoughts on “Borderline Personality Disorder: addition

  1. I recently read Rachel Reiland’s books Get Me Out of Here, dealing with her personal experience of living with BPD. It was extremely interesting to say the least.

    I am a therapist and I have worked with several BPD clients. I find those clients to be very challenging to work with and the therapeutic process can be a very long one. It doesn’t seem to be as simple as learning to regulate one’s emotions – there is obviously a lot more to BPD than that. I also think likening the outbursts of a person with BPD to the tantrums of a two year old is somewhat condescending and simplistic, although yes, there are similarities.

    BPD is extremely complex from what I can gather and my own experience with clients. I also think that many mental health practitioners assign a BPD diagnosis to people (primarily women) who are legitimately acting out against the social oppression they are forced to live with. So many women with BPD seem to have sexual or physical abuse in their background (sometimes both and usually in their childhood or adolescence) and as far as I can see, the way they are as adults is a legitimate response to the atrocity they experienced earlier in their life. However as usual, patriarchy likes to label difficult women as being ill and try to find pills to shove down our throats to subdue us.

  2. this is what i’m like when i’m not getting enough sleep. eg, this is probably a pretty good description of what i was like in the two-three months after my son’s birth. (well, except that i don’t think i ever reverted to sweet and wonderful. that could be because i wasn’t sweet to begin with :) does that make me bpd?

  3. Bri, thanks so much for your remarks. I read a couple of chapters of the Wirth-Cauchon and was struck at the difference between what she describes and the much more simple approach in the NYT. I’m glad to get a sense of which approach is better.

    It seems very useful to think about whether women are “allowed” to be emotionally healthy; I think this was a theme in slightly earlier feminism that I’ve seen less of recently. The conflicting and extremely strong societal demands on women could well leave one at least extremely puzzzlied about one’s self identity. I should think the people you see are fortunate to have you as a therapist.

    (Alice Miller’s (?)description of some parents as “soul murderers” might at least capture the awfulness of what some children suffer.)

    I agree about “tantrum”. There does seem to be quite a bit of hostility toward the BPD. Mind you, the remarks in the NYT record a lot of pain on the part of relatives and co-workers, and there are some very angry former children of BPDers.

    There’s been interesting recent research into BPD through the use of fMRI. There’s some evidence that they fail at a very fundamental level to get what’s going on socially in terms of rewarding interactions. We mention the research here.

    elp, I suppose the answer to your rhetorical question is that the condition has to be more persistent. But, assuming you don’t/won’t go in for cutting yourself and brief chaotic affairs, I think you raise a question about the significance of the stormy behavior. I can certainly think of some people who can explode with vindictive nastiness, but it isn’t clear to me that they fit the overall pattern.

  4. i meant to say earlier: i’m glad bri mentions this worry about medicalising/pathologising strong but legitimate emotional responses; i think this gets missed a lot, at least in popular thinking about mental health. eg, years ago my brother and his long-time girlfriend split up. he was devastated, and then down for months, didn’t know what to do with himself, felt lost in forming a new picture of what his life would be, etc etc. my mother insisted that he was ‘depressed’ and should try anti-depressant medication for it. this seemed so shocking to me: she thought that there was something medically wrong with him because he was very sad and thrown off in response to something very sad and disruptive happening in his life. but i don’t think this was just my mother being silly. it seems like a lot of people think this way about emotions these days. i find it very worrying. i like being human, even if it involves some pain now and again! (my brother and the girlfriend, btw, sorted things out and have now been happily married for several years. ah.)

  5. lp, I agree. I do think we need a distinction that I’m not sure how to put. Maybe this:

    1. Responses to current situations which are appropriate, but which can be considered pathological if they last a long time. Somewhere recently I heard or read someone say that if deep grief lasts over 6 months, you should worry that it’s turning into depresssion. Well, I’m not fond of timers, but the idea is that something lasting 6 months is quite different from having one’s life more or less permanently derailed.

    2. Responses to events in one’s more distant past that, while intelligible as responses to the past, are preventing one now from living a reasonable life.

    I suspect Bri was talking about the second, and you are on the first, but I’m not confident that I’ve put it well at all.

  6. women who “acted” in these ways used to be labeled hysterics. i don’t want to bore anyone with an extensive list of literature, but bdp just seems to me to be a language shift in the way about we talk about a certain set of symptoms.

    this would also explain why it’s (typically) more of a women’s disease, as hysteria was. . .

  7. I agree that there is a worry with normalization and medicalization but here is another perspective. I have lived with a bpd mother and she was diagnosed as such only after an unsuccessful suicide attempt when I was well in my twenties. Finding out about the diagnostic was a genuine relief (for me anyways) because as long as you think of this behaviour as normal it can be quite disstressing and it makes you feel like you are the person who is not normal for reacting to it the way you do. I know that I could not tolerate the behaviour, that it was hurtful and yet I could not say these things to people because then I was considered a bad daughter for not putting up with my mother’s legitimate emotions.
    I am glad that she did not take medication for long because it only made her a very different person than she is. However, the fact that we know that she is bpd is incredibly helpful in managing emotional response to her behaviour (which she still can’t and will never be able to control).

  8. RA: Wirth-Cauchon says it’s descended from that (though that’s not her metaphor). I suspect it’s different to the extent that the BPDer seems to target people, which I don’t think was typical of the hysteric syndrome.

  9. Christine, I am so sorry to hear that this was something you couldn’t seek help for as a child. It is awful not just to feel the pain of attacks, but then also to feel one is in the wrong oneself for reacting as one does. Still, even if one can speak out, the pain and disorientation from finding a powerful adult is ready to pounce when they feel like it is very destructive in many cases. You can grow up without that much of a feeling of guilt for being the target of unreasonable reactions, but still very confused about what it is to get things right.

  10. Try telling someone with the scars from having being close to someone with BPD that the disorder is just a patriarchal conspiracy or symptoms of an “emotionally challanging day”. The “extreme anger” you mention is not typical male behaviour, its typical behaviour of someone that needs professional help before they reak havoc in the loves of other, and or land themselves in jail, which is where many undiagnosed males suffering with BPD end up.

  11. I find a lot of these comments condescending and down right ignorant. I have BPD and I object to being referred to as one of THE BPDers or ‘they’ – talk about stigmatising people with mental health illnesses. Did you know that in the UK 1 in 4 people will suffer from mental health illness – that could be any 1.5 of YOU that have left a comment here.

    If you read the article by Jane E Brody I hope you would have noticed this: “The condition appears to have both genetic and environmental underpinnings. Brain studies have indicated that the emotional center of the nervous system — the amygdala — may be overly reactive, while the part that reins in emotional reactions may be underactive.” There are a set of clear, specified clinical criteria that have to be met before a diagnosis is given – it does not apply to just anyone that is ‘over-emotional’. And it’s a myth that the diagnosis is not given to men.

    Most of us have suffered some sort of childhood trauma, usually with primary care-givers, whether that’s emotional, physical or neglect, but there is a genetic component that is present that triggers the emotional response. In childhood you learn to deal with the world and your primary carers in a way that keeps you safe, there frequently isn’t another role model from whom you can learn other ways of coping. As you develop and grow into adulthood you will undoubtedly be confronted by those triggers that set off the signals to the amygdala to ‘keep you safe’, which then triggers the emotional response. If YOU felt threatened or unsafe (you’re in the middle of the road and a car comes recklessly at you, or you think someone’s about to physically hurt you), do you think about your response? No, your amygdala kicks in immediately and you react: fight or flight. Some therapies focus on re-learning those responses – widening the gap between the trigger and the automatic response, but you can’t just change an automatic response overnight and you have to understand and recognise what triggers it in the first place. Only therapy can help you find those answers, but it is often only medication that can keep you on an even enough keel to be able to try.

    I write a blog, my emotional life is often laid bare. I’m always stunned by the amount of supportive and kind people out there in the ether. If you want to know what it’s like in a BPD person’s head come over and read posts in the ‘on the couch category’

    Best wishes, Stephie.

  12. Thanks, Stephie. I was just about to reply to Eoghan that it is a mistake to think that everyone who is called – or calls themselves – “borderline” is the same. I’m not sure you’d agree. In any case, we do try to be careful about how we describe disabilities here, and I’m actually very sorry if we’ve given a different impression. The most important point, though, seems to be the one you’ve emphasized: there is a genuine problem which has a complex etiology, but which does involve an immense amount of pain that comes from a scary and painful past.

  13. Hi JJ, just to say I read this blog regularly and I love it! I think my issues with some of the comments here (not the post) are the stigmatising of people with mental health illnesses, talking about sufferers as ‘other’ and as though everyone else is immune. I think it is interesting from a feminist perspective to question historically why more women than men have been diagnosed with BPD. As Bri mentions many BPD sufferers have experienced sexual abuse and I believe girls suffer more of this type of abuse than boys, might this explain why women have a higher presentation of BPD than men? I don’t know, but I think there are a lot of interesting questions around gender in mental health. Finally I’d just like to say that through all the therapy I’ve had I’ve never been made to feel that the emotional responses I experience are illegitimate, or that I’m simply being an ‘hysterical woman’. Rather, mental health specialists (both men and women) help me to understand where my incredibly intense emotions come from, why they seem to come from out of nowhere and ways of coping with them, modifying them, accepting them, challenging them. Ultimately they are showing me ways to keep myself safe from harm – often from myself.

  14. Yeah, I will have to second that BPD is very real, and not neccessarily acting our against oppression. I had a horribly abusive mother with BPD, and it will take years of therapy to make sure I don’t become that person.

  15. I don’t know if I really believe in the borderline personality disorder although a significant amount of women come to my mind when I think of it including myself in my early 20s. Now, I have never been diagnosed with it despite spending a number of years in counseling and even two mental health stays, one in which I insisted I had it and was told repeatively by different psychologist I did not. Instead I was diagnosed with PTSD. In my early 20s I was diagnosed with a hormone imbalance which seemed to be causing my BPD like behavior.

    My main problem with the BPD diagnosis is that being a victim of sexual abuse is a symptom. Isn’t this the same victim blaming ideology that makes the process of coming out about sexual abuse so difficult for victims? The BPD diagnosis uses this against people that can’t help their past and deflects from the REAL issue of sexual abuse.

    To me, in so many ways the BPD is misogynst gaslighting disgused as psychology. I read one article were it said something along the lines of, “A BPD may become irriate with your for being an hour late to a date.” I was hysterical with laughter. The tone of BPD weather we like to admit it or not is more archaic conditioning that women are not entilted to their emotions, their hurt feelings, their sensitivity, their rage.

    Another feminist pointed out that if this criteria was applied to men that it wouldn’t exist and would of been dismissed as men often participate in promiscuity, drinking, and other reckless behavior (most of my male friends do this on a nightly basis, infact I would diagnos most of the men in my life if not all with BPD ).

    I agree that if someone is suffering from any symptoms of BPD there might be a mental health problem but the issue with BPD is that it’s too vague and like I said previously I can diagnosed just about anyone in my life that is female with BPD.

    The language used in BPD is classic chauvinist degradation, The Hermit, The Witch, The Waif, and The Queen? I feel like I am at the high school jock table and they are labeling use by cheerleader, prude, freaky goth chick, and wannabe.. Sometimes I read stuff on BPD and think why this is a psychologist ode to douchebaggery, avoid the girl with baggage, avoid the girl with a past, and blame her for being sexually abused/raped/abused or just being in pain.

    Another issue I have with it is the eating disorder aspect. Let’s get real: AMERICA has body dysmorphia, the world has it and it’s perpetuated through our media and every aspect of our lives. Not only young girls but women in general have to FIGHT these stereotypes, negative imagery, photoshopping, lies, and unrealistic expectations everyday and sometimes we lose. Sometimes we submit to the world that is mocking our muffin tops, and calling our size 12 jeans fat, sometimes we start to believe our cellulite is disgusting and our love handles our offensive and we teach this, we encourage these unrealistic expectation in magazines and music videos and we our shocked that when we show women women that starve themselves and are in general unhealthy are the ideal that those normal looking, average women make themselves unhealthy to be that ideal? They are the crazy ones?

    BPD to me is a response to a well guised still very sexist world and I see no real dealing with BPD, let’s say it is real ok, how our we to help these women? Because so far all I see is that BPD is used to chastise, blame (and blame victims), shun, label, and mistreat women suffering from symptoms of their world.

    When I was recovering from being raped and reflecting on the abuse I suffered as a child and in general the mistreatments I suffered at the hands of men, what did me the most damage was trying to suppress my rage and anger. I didn’t feel entilted to my feelings, it was being reinforced to me that I was a burden because I was damaged and no one should have to suffer me because I was raped and broken and now either needed to pretend everything was ok for everyone elses sake or stay far away from anyone as my “damage” was surely contagious. I had to learn to not blame myself, I had to learn to be entilted to my feelings about being raped, I had to take ownership of my need for sensitivity from my peers and loved ones at the time of my recovery and I had to ask for friends. I had to ask for understanding, I had to ask people to be there for me. That’s why when I read things like the definition for “The Waif” I think, “Well I needed someone to talk to at the time, I did need someone to be there for me.” I ended up being alienated and pushed away by a lot of people at the time but what I was able to do was build a stronger relationship with my family and my female friends as I was abandoned by almost all of my male friends at the time.

    I think everyone needs to work on their mental health but I think BPD needs a serious, honest, MODERN, female review because as it stands now I believe the diagnosis for BPD can be detrimental to women especial those that are victims of sexual crimes such as abuse and rape.

  16. And if I may add, the definitions for this so called disorder seem to simultaneously contradict each other. Take for example the Waif vs. the Witch, that defines two totally different people or the Hermit vs. the Queen it seems with BDP you are damned if you do, damned if you don’t. Futhermore, I think the biggest problem with BDP and the danger in it is the door it opens for bullying and abuse. We leave in a misogynst culture that rejects feelings, emotion, sensitivity, etc. This all stems from the chauvanist concept of “Boys Don’t Cry” and “Real mean don’t feel” a logic that has women turning into chauvanist because out of fear of coming off as BDP we have women masking and dettaching from their emotions. The result is bullying going unaccounted for, abuse not being reported, etc. Maybe the issue isn’t “being too sensitive” maybe it’s the disconnect in the human conncection and through our society maybe if we were more in touch with our sensitivity we would see a more humane culture. Maybe BDP even being a diagnosis is proof of how we internalized too much in our culture and although how we may have come so far but we still have a while to go.

  17. Bri is full of crap. My mother was recently diagnosed with BPD and no matter what her previous abuse may have been they still do not justify the abuse the BPD aflicts on the young and innocent. Just as if a male victim of abuse who abuses their children is guilty of severe child abuse, so is a female who is a victim of abuse and abuses their children is also guilty of severs child abuse. My mom was severely abusive to me as a child but not so much as to cause any legal intervention which is the definition of borderline personality disorder. To me, personally, this makes BPD abuse even more damaging as there is no line in the sand to stop the abuse. BPD is exclusive the U.S. and is attributed to the women’s liberation movement. This is a huge problem in the U.S. which is yet to be addressed as more and more women raise children without fathers and abuse men in ways that may not be illegal but are far more damaging to the society as a whole.

  18. So many women with BPD seem to have sexual or physical abuse in their background (sometimes both and usually in their childhood or adolescence) and as far as I can see, the way they are as adults is a legitimate response to the atrocity they experienced earlier in their life. However as usual, patriarchy likes to label difficult women as being ill and try to find pills to shove down our throats to subdue us.

    So it would be okay that men who experience sexual or physical abuse in their background would have a legitimate response to the atrocity they experience earlier in their lives by abusing their children just like women with BPD abuse their children?

    Women are capable of evil just like men.

    Just like my mom was incredibly evil to me as a boy and as I grew up in her household.

  19. Scott, your linking bps and women’sliberation is mythical. For claims like you need reliable refernces to back them up.

  20. A large majority of diagnosis of BPD are within the united states where the women’s lib movement occurred. Women’s lib was about equal civil liberties for women. Unfortunately, too many women interpreted the women’s lib movement as having a right to do anything they want no matter the consequences of their behavior. One example is women believing they have a right to have a child outside of marriage without a father as a role model. A large percentage of these children raised by their mom alone wind up unemployed or underemployed, uneducated, and in trouble with the law in some way. A lot of women have also confused their right to individual civil liberties with their right to have rights in a marriage. Marriage is about the union of two people for the greater good of the family and society and therefore there is no division between a married couple where rights are required. So by women declaring they have rights in a marriage they are destroying the unity of family which has been the basis of any strong society. This is the definition of borderline personality disorder. Borderline in the sense that a person’s action is not illegal but still causes great harm to others or society.

  21. “the united states [is] where the women’s lib movement occurred”


    Couldn’t get past that part

  22. Scott, you are not being reasonable, you are blaming your mothers abuse of you on all women, or at least, feminist women who live in the United States. That’s very simplistic black and white thinking and your anger is very unreasonable. Considering you come from a history of abuse, perhaps you too are BPD?

  23. It’s so sad to see what an awful turn the comments section had. It was first a very valid criticism of the diagnosis and the look out of the best interest of women to digressing back into antagonizing anyone diagnosed with BPD. To be offended by the former is ridiculous as psychiatry is not to be free of criticism just like any other field of medicine. I know too well that if you are a women who expresses like a man, yes you will be written as suspected of BPD. Another problem is demonization and denigration of women with BPD. Female BPD is not a synonym for evil. If the difficulty is all your going to pay attention to then yes, ofcourse you are going to see women with BPD as evil. We need to stop victim blaming and individualizing psychological health and look at sociological and anthropological factors as well.

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