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A few of you may be aware that I am diagnosed with Borderline Personality Disorder. As May is BPD Awareness month I wanted to take this opportunity to spread the awareness of this disorder here on The Ant Hill
BPD is a severe, chronic, disabling, and potentially lethal psychiatric condition. People who suffer with this disorder have extreme and long standing instability in their emotional lives, as well as in their behavior and their self-image. This is a common disorder affecting 2% of the general population. The best evidence indicates that about 11% of psychiatric outpatients and 19% of inpatients meet diagnostic criteria for BPD.
These instabilities of emotion, behavior, and self-image have devastating and sometimes deadly consequences. People with BPD have repeated and frequent difficulties in their relationships and work lives and they feel alternating extremes of anger, depression, and emptiness. All too frequently, 69% to 75% of individuals with BPD resort to self-destructive behaviors such as self-mutilation, alcohol and drug abuse, serious over or under eating, and suicide attempts to attempt to escape from their emotional turmoil. The completed suicide rate for BPD individuals is 3% to 9.5%, which is comparable to the other serious psychiatric disorders such as depression, alcohol dependence, and schizophrenia.
Compounding the seriousness of Borderline Personality Disorder is that it is difficult to treat. The very characteristics of the disorder, such as unstable relationships and intense anger, interfere with establishing the therapeutic relationship that is necessary to any treatment, whether psychotherapy or medication. Further, mental health professionals often are reluctant to treat these individuals because they exhibit two characteristics likely to lead to clinician “burnout” : the BPD person’s hostility towards the clinical professional and their persistent suicidal thoughts and feelings.
Despite the devastating nature of this disorder, it has not received the scientific and clinical attention that other health and psychiatric problems of equal, or even lesser, level of disability have received.
What is Borderline Personality Disorder?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an American handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them. It is published by the American Psychiatric Association, and used worldwide by clinicians and researchers as well as insurance companies, pharmaceutical companies and policy makers.
According to the DSM-IV, Borderline Personality Disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
What is Emotional Dysregulation?
The mind of an individual with BPD does not correctly process emotions, and is triggered by a wide range of seemingly normal events and circumstances–a look, a sound, a physical touch, or something that evokes a memory of a past event. This trigger creates an environment that is perceived as unsafe and chaotic, resulting in the BPD responding in a dramatic ‘fight or flight’ manner, often leading to either intense fear and social isolation or ‘acting out’ through impulsive, maladaptive behaviors.
The tendency of individuals with BPD is to actively avoid threatening situations.
The result of avoidance is isolation and denial, which leaves the individual feeling more alone, hopeless, and ’stuck’ in a self-destructive cycle of out-of-control emotions. The confusion and pain is experienced not only in the mind of the individual with BPD, but also in the lives of their family and loved ones who are equally impacted by the devastating consequences of this mental illness.
Why is the Ability to Regulate Emotions So Crucial?
The ability to regulate the experience and expression of emotion is crucial because its absence leads to the disruption of behavior, especially goal-directed behavior and other prosocial behavior.
The inability to regulate emotional arousal also interferes with the development and maintenance of a sense of self.
What are the Effects of Emotional Dsyregulation?
The numbness associated with inhibited affect is often experienced as emptiness. The individual’s sense of events is never ‘correct’ or unpredictably ‘correct’, which leads to the development of an overdependence on others to determine how they think, feel, and act. This further leads to a lack of identity or complete absence of a sense of self.
The difficulties in controlling impulsive behaviors and expressions of extreme negative emotions wreak havoc in many ways with their relationships; in particular, difficulties with anger and anger expression preclude the maintenance of stable relationships.
What Causes Emotional Dysregulation?
Emotional invalidation is an interaction style characteristic of societies that put a premium on individualism, including individual self-control and individual achievement.
An invalidating environment contributes to emotion dysregulation in a number of ways:
Painful experiences are trivialized and attributed to negative traits such as lack of motivation, lack of discipline, and failure to adopt a positive attitude.
It fails to teach the child to label and modulate arousal, to tolerate distress, or to trust her own emotional responses as valid interpretations of events.
It actively teaches the child to invalidate her own experiences by making it necessary for her to scan the environment for cues about how to act and feel.
It punishes the expression of negative emotion and erratically reinforces emotional communication only after escalation by the child. In doing so, the family shapes an emotional expression style that essentially cuts off the communicative function of ordinary emotions.
Why is BPD More Misunderstood, Stigmatized, and Under-Funded Compared to Other Mental Illnesses?
Famous personalities who are thought to have suffered from Borderline Personality Disorder include Marilyn Monroe, Princess Diana, Adolph Hitler, the character portrayed by Winona Ryder in the film Girl, Interrupted, the roommate in the film Single White Female, and the character portrayed by Glenn Close in the film Fatal Attraction, among others.
Media stereotypes have enhanced the most severe symptoms of BPD and increased the stigma rather than promoting education and providing support for those who struggle to cope in real life. Without the emergence of a celebrity or well-known and highly-respected individual who is diagnosed and functioning with BPD to spark a more positive and hope-inspiring media campaign to generate awareness and support, individuals with BPD will likely continue to be considered ‘untreatable burdens’ by the public, given lower priority for research funding within the mental health community, and denied coverage for treatment by the healthcare industry.
http://bpdawareness.org
May 1, 2008 |
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trysh, Crafting May 1, 2008 2:53 pm
You have taught me a lot I did not know about this. It’s a shame that it takes a ‘celebrity’ to bring enough positive reaction to set things in motion to get help. Hopefully this will change soon.
Thank you for sharing this with us.
Bad Momma, Moms May 1, 2008 7:48 pm
Thanks for sharing! This is a very well written piece. I learned something new today. Hope you are doing o.k.. It’s a shame that illnesses like this are not covered by insurance.
yemmas, Multiple Sclerosis May 1, 2008 7:49 pm
Thank you for sharing this. Awareness is good.
Joeprah, Dads May 1, 2008 9:14 pm
I like the rest here enjoy this post because it is an eye opener. Good work and a very well written post.
RealWorldMom, Moms May 2, 2008 9:51 am
Thank you for sharing this important information, Jackal. Hugs to you!
missheathyrmarie May 2, 2008 12:09 pm
jackal, thank you so much for sharing this awareness with us all. hugs to you!
Jackal May 2, 2008 1:55 pm
Thanks everyone for taking the time to read. Much appreciated.
Maureen, Painting/Drawing May 4, 2008 7:48 am
Wow. Thanks for bringing this to our attention. I knew a little, but not nearly enough, it seems.
I hope more can be done for people suffering from this… thanks again and take care.
SystemsThinker May 5, 2008 9:34 pm
Thanks for being so open about your situation and helping raise awareness. I really hope this month can indeed be a spur to help people understand this really important condition.
I’m doing my part to spread the word too. I just wrote:
Borderline Personality Disorder Awareness Month: Discussing, Understanding & Publicizing an Under-Recognized Epidemic
I’m really glad to see people starting to talk about BPD more and more. Thanks for your blog!
Jackal May 6, 2008 4:04 am
Thanks Maureen and SystemsThinker for taking time to read - much appreciated.
With more understanding comes acceptance - well that is my hope. It seems a double battle to struggle with the disorder and to battle with the stigma of it. I read it is considered in the mental health circles as the ‘leprosy’ of mental illness. Doesn’t make it easy knowing as sufferers we also have to suffer prejudice from the ones we look to for help.