What is Borderline type?

Finally a blog that is not theoretical. It feels good to write about science and "real" psychology.

Do you know someone that has a history of relationship problems, anger issues, intimacy issues and intense mood swings? Do you care enough about them to offer help? If so, the first step might be to learn about the personality disorder BPD or Borderline Personality Disorder. A good way to continue would be to identify the symptoms and the criteria for diagnosis and then to discuss treatment.

A good summation of the symptoms seems to be, in some detail, the following list:

Unstable relationships. The person cannot maintain healthy relationships with others.

Unstable self image. Fluctuation between positive and negative self-image, often rapidly.

Self-harm. May be driven to harm oneself both physically or emotionally. Self-destructive behavior may include spending money and risky sex.

Excessive emotion, Often anger, often in the face of abandonment.

Feelings of emptiness And depression.

Paranoia. A lack of trust often of others not being reliable.

Anxiety.

Difficulties with empathy. Often the person has a hard time understanding how others feel.

Childhood trauma

With that said, in my research I learned some ways to talk about the symptoms. The most important sign is an over-investment and then an under-investment in friends and partners. A person with BPD may rapidly see great value in another and then just as rapidly switch and see very little value. During the "value" phase there may be excessive positive feelings and during the "devalue" phase there often is extensive anger. This disorder often manifests as outward and excessive anger at being "wronged" and how "untrustworthy" the other person is. The anger may be out of control and include irrational behavior and irrational beliefs. The second most important characteristic may be what is above called "self-destructive behavior." This is characterized by addictive behavior, spending, sex and other displays that may, in fact, drive others away in such a way that it achieves the very outcome that was feared. Abandonment can be achieved, in BPD, by the very acting-out of the fears related to abandonment. A third important characteristic is mood swings, usually in BPD being shorter lived than in other disorders. Quickly passing moods that may be anxious, depressed, angry, etc. are the problem because they may be seen by others as irrational and unfair. BPD people may also be mad at themselves for excessive amounts of time and to an excessive degree.

So how do we sum up the symptoms?

It is characterized by social issues, anxiety, swings of anger and a sense of betrayal. The hard and visible signs are relationship issues, low or no self-satisfaction with social interactions, and a lack of trust in other people even when it is unjustified.

How do we look at this disorder through the lens of critical thought? One way is to target the core issue, fear. What makes a person this fearful and how does the brain learn this pattern of fear? History can be trauma in life, repeated disappointments, and genetics. But of course many people have these things, even genetic precursors to these things, and don't develop them in such a way that they interfere with life goals. It has always been my position that what most people call "dumb" is really a brain not working. When a brain does not work, it can't self-analyze and it can't progress intellectually. Sending someone with no "thinking" skills to a therapist is like sending someone with a broken bone to physical therapy. It seems clear that early in life (and later as a last choice) people need to be exposed to critical thinking skills that define our interactions with the world and the people in it. The very curiosity present in people predisposed to asking big questions (do we have free will and what does it look like?) has to be seen as an attribute that can be fostered and grown by most people. If not, then a therapist teaching critical thinking skills (if that's a thing outside of what I'm doing) is a moot point. Some people ask at a young age if the tree is there when you don't "see" it. Others think this kind of thinking is useless. What of these two types and is this too big of a question? I would say here that we must assume it can be encouraged in most people (curiousity) and that in some it takes longer than in others to develop. That assumption, though it may not be true, is at least a step that has no negative consequences in therapy.

My position is that when people master their relationship to reality, both through science and critical thought (critical commonsense), they will be in a better position to get what they want from reality. Our society encourages the opposite, the break with reality, the assumption that we live in our own bubble forever (subjectivism); it assumes that there is no thing as absolute truth, that all statements are opinion, etc. Because of this, the job is to survive this training and graduate to a different perspective, that of value and objectivism.

BPD treatment.

"In the past, many mental health professionals found it difficult to treat borderline personality disorder (BPD), so they came to the conclusion that there was little to be done. But we now know that BPD is treatable. In fact, the long-term prognosis for BPD is better than those for depression and bipolar disorder. However, it requires a specialized approach. The bottom line is that most people with BPD can and do get better—and they do so fairly rapidly with the right treatments and support." (helpguide.org)

"People with borderline personality disorder (BPD) tend to have major difficulties with relationships, especially with those closest to them. Their wild mood swings, angry outbursts, chronic abandonment fears, and impulsive and irrational behaviors can leave loved ones feeling helpless, abused, and off balance. Partners and family members of people with BPD often describe the relationship as an emotional roller coaster with no end in sight. You may feel like you’re at the mercy of your loved one’s BPD symptoms—trapped unless you leave the relationship or the person takes steps to get treatment. But you have more power than you think." (ibid)

"Once upset, borderline people are often unable to think straight or calm themselves in a healthy way. They may say hurtful things or act out in dangerous or inappropriate ways. This emotional volatility can cause turmoil in their relationships and stress for family members, partners, and friends." (ibid)

"People in a close relationship with a borderline adult often liken talking with their loved one to arguing with a small child." (ibid)

Though as a critical counselor I don't believe in much of the current therapy bullshit I will include a good list below (from NEABPD):

Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.

Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.

Transference-focused therapy (TFP) is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist. Patients then apply the insights they learn to other situations.

Good Psychiatric Management: GPM provides mental health professionals an easy-to-adopt “tool box” for patients with severe personality disorders.

Medications cannot cure BPD but can help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety. Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective. People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects.

Self-Care activities include: regular exercise, good sleep habits, a nutritious diet, taking medications as prescribed, and healthy stress management. Good self-care can help to reduce common symptoms of BPD such as mood changes, impulsive behavior, and irritability.

Why do I think most of this is bullshit? Simple. I don't believe you cant take an unhealthy brain and apply "techniques" to it prior to real critical training. The very superficial nature of the above suggests shows that there is a lack of critical response to a disorder as prevalent and destructive as BPD. Why aren't there ideas that, when you read them, really ring true about recovery. The answer is twofold: The writers aren't critical and the disorder is misunderstood in the context of it being a consequence of bad overall critical learning for an individual.

It seems obvious that a BPD person needs to be in a trusting relationship in order to learn. This may mean that the person needs to see a therapist first, because that trusting relationship can have better boundaries within that place. A therapist, for instance, is not also a provider or a sexual partner.

From a critical perspective, however, it seems obvious that this is easier said than done. It is also true that a therapist most likely lacks critical thinking training. That means it could end up being the blind leading the blind, which is actually how I view modern therapy. Why am I justified in saying this? I can only say in defense that once you really understand critical strategies that you can become self-reflective enough to gauge what actually is objective improvement and what is merely emotional satisfaction. If a person lacks critical thinking skills they cannot absorb any information. Because of this, merely memorizing information, whether it be math or a list of techniques for curing BPD, is going to result in a person who cannot make decisions about these things outside of a small, controlled event (like a doctor's office).

I'm also not a therapist. That is why I've put these little simple lists up for someone who wants to explore the first step in identifying and recovering from BPD. Below is a specific treatment outline that, in my humble opinion, I can tell you isn't going to work. But it could possibly help and, like with all things "therapy," may open the door for someone to build a cognitive framework to overcome a set of behavior consistent with BPD.

"DBT is a combination of group therapy and individual treatment designed to help therapists offer the best treatment possible. What makes DBT unique and effective is its focus on teaching participants a set of behavioral skills that help them cope with their difficult symptoms. “The skills are what people talk about when they talk about DBT; they are the active ingredient in DBT,” explains the creator of DBT, Dr. Marsha Linehan. These skills include:

1. Mindfulness: Being fully aware and present

2. Distress Tolerance: Tolerating difficult or uncomfortable situations

3. Interpersonal Effectiveness: Asking for what you want and saying no when you need to (while still maintaining self-respect and healthy relationships)

4. Emotion Regulation: Changing emotions that you want to change

Each skill is a separate module of DBT and it takes a full year to go through all four modules in group therapy. Some may choose to repeat a module to help make those specific skills stick—like Randy, who repeated all the modules twice and the distress tolerance module three times because that’s the skill he struggles with the most. It takes a lot of time and energy to learn these coping mechanisms and implement them when symptoms flare.

Everything in DBT is connected and works together to help people manage their symptoms. Skills are introduced in group therapy lessons and are learned through practice and homework. “We have a handbook,” Randy says. “It ranges from things like how to talk to someone you don’t agree with without getting emotional to ‘I’m freaking out, what do I do?’” This is followed with individual therapy that includes lessons tailored to each person so they can apply what they’ve learned to everyday life." (NAMI.org)

So, what does it all mean? How does one control a disorder based on fear that, by definition, sabotages someone's ability to manage fear? I have always said "first things first." The balanced and calm relationship with reality that comes from intellectual growth is, to me, the very trust that someone needs to overcome the natural fear of living a real life (with its rejections and disappointments). It is not firstly the relationship with a partner or a therapist but the relationship to "world" that provides the security needed to take risks as simple as that needed to engage in a real human interaction.

Challenges.

As is often the case the challenge against me and CCS is that we make a thing, in this case BPD, over-simplified. I can understand this and I know that in science that kind of criticism is even more important. I can only say that in my experience I have found that leading people to intellectual development is the only thing that enables them to cure anything, including mental and physical ailment. The first step in critical commonsense is to assume you don't know everything, so going into a treatment plan with a stable of intellectual tools and a natural open-mindedness will inevitably help one decide if in fact it has been oversimplified. The iconoclastic nature of CCS also transcends, for a real thinker, the rote information (especially online) that confuses the line between real information that is helpful and memorized superficiality.

It is clear that a BPD person needs a trusting relationship. Am I wrong to emphasize that it is intellectual and not merely emotional? I can only say that I have always taken this approach and I have found that humans, by nature, respond to the truth inherent in intellectual answers and wallow in the vaguery of emotional ones. I would think one comes from the other, intellectual first and then emotional. Am I right? That could probably be further explored if one feels the need to dive into BPD treatments for real reasons.