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Last edit of this page 06/09/2012
'Mental illness' is anything in human mentality greatly disliked by the person describing it.
BPD - borderline personality disorder (or dyslymbic brain function)
According to the DSM-IV, approximately 75% of people diagnosed with Borderline Personality Disorder are female. Prevalence: approximately 2% of the population.
This diagnosis has been used for decades to stigmatize so called untreatable or difficult people who also upset therapists and yet could not be pigeon holed. It was initially a gap filler or wastebasket diagnosis - a person whose behaviour exhibited features both neurotic and psychotic was put in the border between. The resultant label demonstrates the problem of categorization by committee.
Misdiagnosis is now a problem for both children and adults leading to years of wasted treatment down the wrong alley. Bipolar disorder, depression, anxiety and panic disorders, post traumatic stress disorder (PTSD & C-PTSD), and attention deficit hyperactivity disorder (ADHD & ADD) are the usual suspects. Any of these can occur with BPD and may also be part of the underlying problem.
In my clinical experience the left field appearing, incendiary, emotional storms; rapid mood swings and affect dysregulation; fear driven impulsiveness, catastrophic thoughts and obsessions; chronic feeling of emptiness, terror of abandonment real and imagined; habitual self-harm and/or compulsive aggression in relationships, are best explained by one or a combination of:
- a fearful avoidant attachment style usually violated by attachment figures when young leading to
- emotional vulnerability and difficulty modulating emotions.
- Growing up in an invalidating environment: if a child reports that he is hungry he is told that he is not hungry, he just ate. i.e. his inner experience is invalidated.
When a child expresses upset, the family does not pay attention, or tells him he's making a big deal about it.
The child's beliefs, thoughts and preferences and ideas are not sought or taken seriously.
The child's emotions are not considered to be important communications and are not responded to or do not result in the child's needs getting met.
The child is blamed for her painful experiences and such experiences are trivialized.
The child is discriminated against based on arbitrary characteristics such as gender.
Punishment is used to control behavior, from criticism up to physical and sexual abuse. A history of sexual abuse is seen in approximately 75% of people with Borderline Personality Disorder, according to Marsha Linehan. Source
- other early traumatic injuries leading to complex post-traumatic stress disorder (C-PTSD)
- a malfunction of the limbic system in the brain
- interactions with other brain disorders like obsessive compulsive disorder (OCD) or Bi-Polar disorder that have strong genetic footprints
- interactions of nervous system chemistry with food and food intolerances or food allergies
- reciprocal influence of any of the above with over breathing (intolerance for carbon dioxide) and inadequate hydration (i.e. intolerance for water) and lack of earth grounding.
Self-managing the symptoms is half the battle.
Getting to ownership of the problem is a pre-requisite.
Blaming others can only take you so far - eventually you have to claim the injury and its consequences as your own and learn how to manage the legacy of harm.
Getting family and close friends to support a positive action plan is vital - since many have been wounded in the process, some even through vexatious litigation or criminal sanctions.
'Inflamed' could describe someone on fire. Many years ago one of my BPD clients became a serial arsonist. She had set fire to the apartments of two men she dated after they rejected her. Inflammation is also a physical condition associated with a large range of auto-immune, immune deficiency, cardiac and respiratory diseases, with high levels of the stress hormone cortisol, chronic pain, with depression and many other debilitating conditions. So it is worth considering the role of inflammation and its management in a person diagnosed with BPD.
Silent inflammation is below the threshold of perceived pain. It's like a low grade chronic sore head that flares into a crippling migraine.
Try a number of healing modalities, traditional and non-traditional and lifestyle changes in order to deal with the complex and intertwined personality, health and life style issues. For example, two anti-inflammatories that have proved effective with double blind trials, are long chain omega 3 fatty acids (some fish oils) and an earthing or grounding sleeping sheet.
Earthing our bodies overnight may well reduce inflammation and pain and improve sleep, sometimes quite quickly. This is because the earth's negative bio-electric charge works as an anti-inflamamatory and an anti-oxidant in the body.
The first two weeks of sleeping on an earthing sheet can be a bit uncomfortable as the cortisol and melatonin levels return to a healthy diurnal rhythm. It could take up to six months for the physiological changes to be well established with concomitant and necessary changes in lifestyle, exercise, diet and sleep hygiene!
It is a gentle, soothing process that requires no effort except the initial financial outlay. You just sleep on a sheet with silver threads, connected to the earth. Almost like having your feet touching the ground all night long.
The soles of the feet have more sweat glands and nerve endings per square inch than anywhere else in the body. Our foot is designed to connect bio-electrically with the ground. It's a rare shoe these days that has a conductive, leather sole. Most are made of insulating material such as rubber, which blocks bio-electrical grounding.
Yet almost all our appliances and computers at home only work efficiently when grounded via the earthing cable buried in the ground on a corner of your house or apartment building. Our body is a bio-electric conductor. Remember the shocks you get from door handles or from a child on a trampoline.
Our body needs an earth reference as well, a zero on a scale, in order to operate efficiently. Most of us sleep on non-conductive surfaces so we have no contact with the ground over night. This has consequences at the cellular level of our body.
The book "Earthing" by Clinton Ober is a good place to start, or listen to these audio chapters. Start with this article and visit the Earthing Institute where you can also buy a range of grounding products. Here is the Australian distributor - bare foot healing.
You may think dehydration is an odd symptom to include but consider any list of symptoms caused by the body's drought management system. A racing heart rate and rapid breathing are symptoms of dehydration.
Here is a list of body symptoms exacerbated or caused by dehydration, any of which can act as otherwise inexplicable internal triggers of distress for a person with borderline personality, provoking fight-flight-freeze reactions.
Many breathe enough for 3 people, resulting in over exhaling CO2. Normal breathing sufficient for the body at rest is through the nose (not the mouth) at around 8 to 12 breaths per minute of about 500 mls of air per breath. At that rate and volume your breath will be silent. Hold a finger near your nose and it will register a very light air flow. This page is a sensible source of info about breathing.
Rapid breathing and the less obvious, over breathing result in too little carbon dioxide in the blood.
CO2 is a smooth muscle relaxant (blood vessels, airways, gut) and is one of the body's main metabolic regulators, not just a waste product of breathing.
Insufficient CO2 can provoke anxiety, panic attacks and other psychological symptoms.
Carbon dioxide plays essential roles in the take up and availability of oxygen by the body, regulation of the acid/alkaline (pH) balance of body fluids, ability of smooth muscle (eg blood vessels, airways, gut) to relax, and normal functioning of nerve cells. It is also involved in biochemical pathways involving nearly all minerals, vitamins and enzymes and in the biosynthesis of amino acids, carbohydrates and fats. Low levels of carbon dioxide caused by over-breathing can therefore impact on a huge range of symptoms or poor physiological functioning. Source
One would only need to add caffeine to over breathing and dehydration for an explosive mix. Common sources are soft drinks, dark chocolate, coffee, tea and some analgesics. Individuals with panic and anxiety disorders are especially sensitive to the effects of caffeine. Source
2.0 Triggers for distress
2.1 External triggers
There are external triggers (e.g. painful rejection, repetition of a traumatic event, job loss) and internal triggers (e.g. impending illness, symbolic rejection or something symbolic of a past trauma). Each can take on a life of its own and can set up a damaging self-reinforcing cycle of distress.
Trauma triggers are usually from both sources - i.e. the body responds to a real event with alarm releasing stress chemicals that trigger a a fight-flight-freeze response; then perception and interpretation of the physiological arousal leads to further alarm.
Habitual and catastrophic thinking starts ('this is never going to end') and builds an escalating positive feedback loop. The fear of fear itself becomes a greater threat to coping than the originating fearful event. The person's process of self-soothing is overwhelmed, believing this reoccurrence is unbearable and then attempting to manage the overwhelm by acting out eg with alcohol, self-harm or aggression to others.
To become aware of the triggers early and catch the arousal process before it takes over is half the battle. This requires agency and extraordinary skillfulness in body and mind. It can take decades to learn and apply those skills to catch this explosive process before it starts.
The willingness to be aware of these internal events and to self-manage them is a significant challenge in self-ownership. Blaming others is easier but less effective.
In an intimate relationship the triggers can be quite subtle, nuanced and apparently unintentional and yet follow a well worn path leading to: 'you're too sensitive - it was a joke', or 'you're paranoid' or 'crazy' or 'sick' or 'if you keep on behaving like that I'm leaving'.
2.2 Internal triggers
Internal symptoms of dehydration and of low carbon dioxide in the blood stream (from over breathing) may act as internal triggers for catastrophic fears and emotions. Some describe this as claustrophobia; or a feeling of unreality; tingling or numbness, or of starving for oxygen. Even a mild symptom such as a blocked nose, chest pain, faintness or dizziness may be perceived as ultimately life threatening.
This produces a desperate cascading of other thoughts, affects and body symptoms in the person diagnosed with bpd. They attempt to block out or dissociate from these experiences and/or self-medicate with alcohol or drugs.
'Even a slight fall in overall levels of carbon dioxide will stimulate nerve cells, which then prime the body for action. Muscle tension is increased, sensitivity and perception heightened, the pain threshold lowered and adrenaline released into the blood - the fight-flight-freeze mechanism in action.' Source
Some or all of these symptoms will arise in anyone who consistently over breathes. As an experiment breathe 30-40 breaths per minute for 2-3 minutes. and check which symptoms you get during and after the experiment.
Many of my clients, their partners or parents have just read right over the top of this information, discounted it and then later when I have repeated it to them in the office in the context of their own lives, they get it. Hearing in context is often more influential than just reading it on a web page, so maybe read it again and perhaps read this PTSD forum thread.
There is more info here on caffeine toxicity and scientific evidence of food intolerance in case your psychotherapist thinks the food link is crackers.
These issues are important if your self-harming child has been diagnosed with BPD.
Sydney's Royal Prince Alfred Hospital Food Allergy Unit is a world leader in food intolerance reactions, some of which can mimic psychological disorder in children and adults.
The enteric nervous system in our guts is a small independent brain of enormous complexity. It operates separately to the central nervous system, the limbic system and the neo cortex and produces 85% of the body's serotonin. It is crucial to our emotional and mental well-being. Managing this part of the anatomy with consciousness of gut feelings requires considerable self-discipline and awareness of enteric events.
It's a good idea to facilitate this with a food approach in adults using both a dietitian and somatic psychotherapist, both attuned to the guts of mental health. One such somatic psychotherapy is that devised by the late Gerda Boysen.
Here are useful neurobiological views of bpd and one linking brain organization with psychodynamics, and the psychopharmacology of personality disorder and a fourth on the effect of depression on the brain.
Science daily's is a source of up to date research news.
3.0 The experience from inside and out
Here is a list of experiences from bpd central that might help you work out if you or another are struggling with BPD.
Take care making judgments based on anecdotes and first impressions. We have an automatic tendency to pay attention to or seek out information that agrees with our preconceptions and to ignore, avoid or distort information that contradicts them. My notes on jargon and in therapy.
Nietzsche observed that a society ruled by priests needed sin, because sin is the "handle" and grip for power. Szasz indicated a similar function of mental disorders in the psychiatric industry. In my experience, people identifying with BPD are NOT untreatable, difficult patients rather they are people in difficulty, heroes and villains at the edge of sustainable frailty and dignity.
- BPD central
- A description with experience of a clinician familiar with child abuse and PTSD
- Helen's World particularly her film and fiction list with exaggerated BPD characters like that in 'Fatal Attraction'
- My trip to oz and back - a heart wrenching open letter to a former bpd lover
- Cognitive training program at the Moodgym, ANU, Canberra
- A list of maladaptive schemas or core beliefs that structure thoughts and perceptions
- Scholarly view of recovered memories especially if your self-harming child has been diagnosed with BPD
- Children and adult children of BPD parents
- Joan Lachkar article on mediation with the narcissist borderline couple where one is dominated by mirroring needs and the other by fears of abandonment
- Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries, and Self-Esteem by Kimberlee Roth, Freda B. Friedman, Randi Kreger.
- The Angry Heart: Overcoming Borderline and Addictive Disorders : An Interactive Self-Help Guide by Ph.D. Joseph Santoro, Ph.D. Ronald Cohen, Ronald Jay Cohen
- Stop Walking on Eggshells; Coping When Someone You Care about Has Borderline Personality Disorder by Paul T. Mason, Randi Kreger
- Lost in the Mirror, 2nd Edition : An Inside Look at Borderline Personality Disorder by Richard Moskovitz
- I Can't Get over It: A Handbook for Trauma Survivors Aphrodite Matsakis Editor: New Harbinger Publications 1996
- Skills Training Manual for Treating Borderline Personality Disorder, Linehan, Marsha M. New York: The Guilford Press, 1993.
5.0 Anger management links
Below is the beginning of an interview with Kelly Anderson from the point of view of family members of a person with BPD.
Q: Could you first of all talk a little about you and your experience in mental health research and / or in the BPD treatment?
Thank you for talking with us here at BPD411. At BPD411, we don't work with people who have the disorder, rather we work with the other members of their families and other close associates. While there are many organizations focused on the needs of those with the disorder, there are only a few groups, all online, that focus on the needs of the other family members. When we can help the family members to understand the disorder, this often creates a situation where they stop enabling the poor behaviour of those with the disorder. This results in the borderline getting help, or more commonly, it results in the family member getting the help they need.
In a few words very simple to everyone (not DSM)
Q: "What is the Borderline personality disorder ?"
In our minds, there are actually two things called borderline personality disorder. There are the low functioning borderline patients that are hospitalized, that cut themselves, and who are the primary focus of many of the studies and more effective therapies.
Then there are the high functioning borderline patients that to all the world seem normal, or even saintly. Princess Diana is reputed to be one of these high functioning borderlines as is Martha Stewart. High functioning borderlines are seldom hospitalized, and create a situation of unbearable suffering for their families. The reason for this is that the families are not believed when they tell friends about the suffering they go through. This leads to further isolation and an unbearable feeling of being alone. In addition, since it most often goes undiagnosed, there is no therapeutic support in most cases for high functioning borderlines, so they most often never get better.
The online groups have found a niche in helping the family members of the high functioning borderline. That's because online, you can get validation, and share the experience of living with someone with traits of the disorder without the judgment that so often faces these people in the real world. Online, your friends are not subjected to the distortion campaign that so often is part of the disorder. Go to www.aapel.org for the whole interview.
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