Okay all you armchair psychiatrists...

[klmno]

What happens if it's mis-diagnosis'd? Many, many people who have anxiety & depression would behave in a way that would fit this criteria. I'm only guessing here, but I would think that the direction of therapy would be a lot different. I would think it would take a lot of history given to the therapist/psychiatrist to diagnosis this correctly and make sure that there isn't something else causing the behavior and pattern.

 

[DammitJanet]

K...it also could be that you got therapy and are still borderline but have just dealt with it and are no longer symptomatic. Kind of like cancer or alcoholism. These things kind of stick around but you can be in remission.

 

[klmno]

Well, no one ever even mentioned this as a possible diagnosis for me. I would have assumed that this diagnosis (borderline) would be one that a person must fit the crieria and have no other reason for it- kind of like for BiPolar (BP)- there is not supposed to be any other reason for mania (like medication-induced).

Look at symptoms and behavior of a person with depression alone- it can result in broken relationships, self harming/suicide attempts, impulsive behavior, bad sense of self, and a sense of emptiness. Does that mean that a depressed person automatically has borderline?

I'm not trying to be facetious here- it just seems too similar to the ODD diagnosis conceptually- it's really a diagnosis of symptoms that point to a bigger problem. Maybe sometimes it stands alone and is really a personality disorder, but usually not.

 

[DammitJanet]

K....borderline is CAUSED by extreme emotional trauma of some form or other. It really doesnt matter what that trauma is. Each persons trauma can be different. My trauma is so totally different than Flutterby's dtr and different than MWM's. But we all share a same disorder. What we dont share is the same treatment plan. None of us are on the same medications, none of us get the same exact forms of therapy, none of are in the same exact place in our journey with this disorder.

One of the things that can be said about borderline is that is said to be is that it is more like an emotional disregulation. It feels more like our emotions are worn on the outside of our skin so that the slightest breeze or touch or word can set our emotions going in a painful way just like it would you if you had no skin over your exposed nerve endings. Everything in our world hurts us so we avoid everything even though we want nothing more than people in our lives to cling to and love and share things with. Because our world hurts us and scares us so badly, we push the world away before they can hurt us which makes everyone around us batty. They cant understand why we cry for them to come be with us but when they come we scream at them to just leave us alone. We simply cannot understand that internal struggle ourselves.

 

[DammitJanet]

K....trust me here...Borderline is a very real and a very stand alone diagnosis. It is one of the truly horrible things to have to live with and one of the hardest things to have to attempt to overcome.

All of the personality disorders are extremely hard to treat. Borderlines do not want to comply with treatment because not only do they manipulate but the fear of trusting someone goes against everything they believe in. You have to put trust into a therapist and that really is a hard thing for a borderline to do. It took me at least six months.

 

[flutterby]

Borderline is nothing like ODD in the sense of it being merely a pattern of symptoms. If you read the diagnostic criteria, it says:

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,...

(bold added by me)

It is 70% biological. There are actual changes in the brain as viewed with various imaging techniques. I posted a thread on the General board earlier in the week on Borderline (BPD) info.

A person with depression gets help - medications and therapy - and the symptoms go away. Borderline doesn't. A borderline patient learns to control the symptoms and learns to make better choices, but it is always there.

by the way, most people who are abused are not borderline, but most patients who are borderline are abused. Not all are abused, obviously, because my daughter has never been abused. However, she had emotional needs - a void - that couldn't possibly be met no matter how hard I tried and that fed into it. Her father disappearing on her, my depression and hospitalization, my illness - all factors, I'm sure.

 

[klmno]

I was told mine was along the lines of PTSD, with depression and anxiety being symptommatic problems- my treatment worked very well, although of course, I still have anxiety at times but it runs in both sides of my family and mine is no where as bad as it was- I usually know how to "treat" it myself. I do trust you and understand it's a real problem, not fabricated, just like our difficult child's and their issues. I'll just have to read more about it, I guess, in order to get why this really isn't something else.

 

[klmno]

Heather- I realize that borderline and ODD are not the same- I meant that just like ODD is usually not stand alone and is indicative of a bigger or another issue in our kids, it appears to me (as a layman) that the list of symtoms for borderline would fit other diagnosis's as well and might not be a stand alone diagnosis.

I read your last post again- that helped me more. Still, I would want a therapist/psychiatrist to spend some time going over my history and getting to know me (or any patient) for a while before making this diagnosis- or any for that matter. That is one thing that scares me about some of them- they want to spend 45 mins at most and give you a treatment plan. LOL!

 

[flutterby]

I have to say that this is why I started my own blog on raising a child with Borderline (BPD). As far as I can tell, my daughter is the only minor child on this board with this diagnosis and there isn't a lot of knowledge. I'm not leaving the board by any means, I am thankful everyday for you all, but I need an outlet where it is understood.

That said, this is becoming too emotional for me in my depressed state - and the fact that my daughter has this diagnosis is still too raw - and I'm stepping away from this thread.

K - if you want to learn more about borderline find my thread on General titled "Good Info on Borderline PD".

 

[DammitJanet]

Thats why I said trauma. What happened with your dtr heather was a trauma in her own mind in which her personal needs were invalidated even though they were unrealistic needs. Sometimes the trauma can be something that happens at a daycare or school if a bully does something and no one validates the child that they are in the right. Its tough.

 

[flutterby]

I understood what you meant, Janet. I was just trying to clarify it a bit more because to some, "trauma" means abuse, or something along those lines. Trauma is really subjective according to the person experiencing it and what they may or may not be biologically predisposed to.

 

[klmno]

Janet, that's what Dr. S said about my son- it wasn't trauma like I experienced or like I would define, but in his own mind, he experienced trauma. She said he needed therapy to deal with that and process it it because he was a child who was not old enough to process it on his own. She also said that the big problem would be finding a good therapist who could and would help a child with this kind of issue instead of doing the typical behavioral mod. I had no idea at the time how right she was.

ETA: I apologize for getting to deep into this, Heather. It wasn't meant to cause any pain in anyone- and I feel like I've hijacked the original threaad. I'll go to bed now.

 

[DammitJanet]

K...I think you are picking at a list and not realizing that a therapist and a psychiatrist have a much longer and more detailed description of borderline to understand than that short little synopsis to go by. They do talk to us for quite a while before they slap on a label. In fact, they have gone back and forth on my labels for several months sometimes. The more a therapist knows you the better they can get a feel for what your true labels should be.

 

[rlsnights]

As I understand it, the central issue in Borderline is abandonment. If there is explosive anger, it is provoked by the threat of being left alone (i.e. abandoned). If there are compulsive behaviors like eating, shopping, drinking/drugs those arise from the need to avoid feeling alone at any cost. Often these behaviors are reinforced because they lead to association with other people (think the bar or the mall) who fill the person's need for companionship while keeping the relationships shallow at best. It is the illusion of friendship that the person gets and that is all that the person can sustain. They will interpret these relationships as deeply meaningful despite a great deal of evidence to the contrary.

One of the hallmarks of Borderline (BPD) is suicide attempts. One can view compulsive behaviors like eating or shopping to excess as potentially self-injurious and in the realm of suicidal behaviors. These behaviors are usually impulsive. The person may be hyperfocused but it is not well sustained.

This is because the person with Borderline (BPD) is highly reactive to their environment. The smallest thing - real or imagined - can set them into a frenzy of ego defense. Their emotions are not so much swinging or shifting (as in Bipolar) as in perpetual motion between extremes. The person with Borderline (BPD) is both afraid of being abandoned and afraid of being engulfed and they are unable to inhabit the territory between these extremes.

I have this image of an atom of sorts. The center where the nucleus should be is a black empty space. The electrons are moving around the shell of the atom chaotically because there is no central organizing force (the nucleus). The electrons bounce wildly around, always avoiding the center. The atom cannot join with others more than briefly because the electrons cannot truly bond with another atom. At any given moment the electrons are attracting other atoms only to repulse the other atom when the joining threatens to bring stability and an organizing force to the molecule they will become when joined.

This chaos of feeling is usually expressed very clearly in the life and behavior of a person suffering from Borderline (BPD), at least for the first several years after onset. It is universally devastating to their intimate and familial relationships. They are often unable to hold a job for very long. They may move frequently or get entangled in dramatic squabbles with neighbors or landlords.

The good news about Borderline (BPD) is that it is treatable with DBT and that many people recover from the more severe symptoms within 5-7 years of onset. Borderline (BPD) features are likely to continue to plague the person but may not be nearly as dramatic or disruptive over time.

The latest research on treating Borderline (BPD) suggests that both mood stabilizers and AAP's can improve global functioning. AD's may be helpful with depressive symptoms but don't seem to be very effective in reducing anger and impulsivity.

So... your description of sister in law doesn't seem to fit really well with Borderline (BPD) but it certainly could. Borderline (BPD) has been reported as comorbid with depression in up to 70% of patients. Other comorbidities cited include eating disorders, Bipolar, PTSD, Nacissitic and AntiSocial personality disorders.

She could be alphabet soup.

Over the years my experiences and discussions with therapists and doctors has left me with the realization that the label really doesn't matter a whole lot. For one thing it is very subjective usually. One person's Bipolar is another person's Borderline (BPD). Focusing on the symptoms/behaviors is much more helpful. As I am sure you know, having a hx of a mood disorder of any kind is associated with increased risk of developing a mood disorder - of any kind. Trying to back into a diagnosis based on what medications are effective can be helpful but not conclusive evidence. Since Wellbutrin is a multiple reuptake inhibitor that we know blocks Dopamine and Norepinephrine and Prozac blocks Serotonin, her brain is stewing in all three neurotransmitters (compared to pre-medication). Since we're talking 3 of the major neurotransmitters here, it's a little hard to say what diagnosis to slap on. I agree that bipolar seems unlikely since there is no mood stabilizer on board and she apparently isn't manic on the AD's.

Therefore, I would put my focus on discerning symptoms that may have a heritable basis and that may require different treatment approaches:
1) is there a mood disorder present?
2) is severe anxiety present? phobias, panic attacks
3) is psychosis present?
4) is there severe impulsivity?
5) are there clues suggesting obsessions and compulsions?

I would label the mental health family tree based on these kinds of constructs rather than "diagnoses" per se. You could do a spreadsheet with the symptoms of interest (rage, mood swings, obsessions - whatever) and list the family members then just check each area that you have evidence for that symptom. Might show you a clear pattern but probably won't. It may make you more aware of a trend or the absence of a group of symptoms.

Have fun - you know you will!

 

[gcvmom]

Wow, I'm glad this stirred up some discussion, but sorry it became too overwhelming for Heather It's okay. We're all just trying to understand and share here.

sister in law does have pretty much all the hallmarks of borderline, except the suicidiality, as far as I can see. And my difficult child-dad seems identical in the symptom checklist (he has no friends either). I totally understand the part about emotions being worn on the outside -- that's a perfect description of these two people. husband was like this at home when he was depressed, and I suspect he just did a good job of masking it at work.

Interesting, but when my anxiety was at it's peak and husband and I were having serious issues between us, I found myself compulsively shopping and acquiring things. I DID feel very alone. After about a year or so of therapy and a medication adjustment, I really am much, much better about this kind of thing. There are times when going out to the mall is stress relieving for me, but I am able to "window shop" and still feel better when I get home. Sometimes it's just needing to get away from my stressors (like difficult child's and chaos here in general). But I digress.

I agree with the comment that the label doesn't really matter. It just helps me in understanding what might be going on. I can't do anything about any of it, and at this point, I've detached so much from the whole in-law family and my difficult child-dad that it's only concerning in as much as I want to understand the genetics my kids have inherited so that when the time comes, I'll know how to explain it.

I want to thank everyone for sharing their experiences and information on all this That's what I love about this group!

Gotta run a kid to school now

 

[klmno]

It sounds a lot like my mother to me. Maybe then I do have tendencies- I dunno- I'd never heard any suspicion of diagnosis for it and actually, had never heard of it before coming to this board. I can see tendencies in difficult child that fit this and that made me wonder if when a kid has some difficulties and they aren't adequately worked out in therapy or on their own, so they go untreated, can that turn into borderline? Would that scenario also fit you, Janet? If your struggles as a kid had been treated and helped when you were pretty young, do you think you have this diagnosis?

 

[DammitJanet]

K... we are pretty darn sure that for me in particular that I inherited the gene for bipolar and that I grew up in a home that was particularly invalidating because from the time I was an infant my mother was verbally abusive.

Most mothers sing some sort of silly nursery rhyme or song to their infants and young children to get them to sleep. Quite normal. My mom's song was "Oh she doesnt love her mommy anymore, anymore. Oh she doesnt love her mommy anymore. And the reason that she doesnt love her mommy, is her mommy doesnt love her anymore."

I would cry and cry when she sung that to me even as a young infant and she would laugh and laugh thinking it was funny.

Dont you think it is odd that I even remember the song over 40 years later?

She would run hot and cold on me. Either I was her best friend and she would dress us alike in clothes that she made for us or I was a demon child and relegated to my room to be punished. I never knew from hour to hour which mommy I would have. I dodged items being thrown at me. Phones, kitchen items, food.

This was all before I was 10. It got worse after.

 

[gcvmom]

How horrible for you, Janet

 

[klmno]

OMG, Janet- your mother was worse than miine- and obviously, she had her own MI. I'm so sorry you had to grow up like that. You are much nicer than me- if my mother had gone that far time and time again, there would be no way I'd ever considered helping her when she was in her old age like you did.

I'm aware that Bipolar usually comes from a hereditery predisposition- I was asking about borderline, which I thought you also had a diagnosis of, but I could be mistaken about that. But being treated like that since you were a baby and going on for years, I would imagine that the diagnosis waters are fairly muddied.

 

[rlsnights]

I don't mean to represent myself as an authority on Borderline (BPD). Our oldest has that diagnosis (along with several co-morbid conditions) and I have done some reading about it. It's my impression that, to receive this actual diagnosis, one's symptoms must be fairly severe and prominent. Like a lot of things, Borderline (BPD) looks like an extreme exaggeration of the way many people manage the emotional rollercoaster that is life. Some symptoms, like reactivity, a characteristic of a number of other disorders including bipolar and anxiety.

That said, I think that Janet's description helps bring out the way this mental illness affects people's behavior really well. With my son you are either his best friend (even tho he only met you 5 minutes ago) or you are against him. There is no middle ground and your position as friend or enemy shifts suddenly and extremely from one to the other. You may or may not be able to identify the reason for the shift since it could be as simple as leaving his apartment to go to the store.


When I speak of abandonment in the context of Borderline (BPD) it is way beyond feeling alone and needing a distraction (not to diminish your distress at the time gcvmom). It is not unusual for a person with Borderline (BPD) to interpret a request to call back later because you're busy as a devastating rejection. Based on this simple conversation, they may decide that you don't want them in your life, that you will never again be their friend, that they are unloved by everyone and unwanted. This in turn leads to suicidal thoughts and impulses or self-injurious behaviors. Since no one loves them they will just kill themselves - despair hardly describes the depth of their misery.

I think that you can certainly have "Borderline (BPD) features" without having full blown Borderline (BPD). But if the reason for, say, the rage isn't triggered by the fear of abandonment then it doesn't fit well under the Borderline (BPD) diagnostic rubric as I understand it.

I think that anxiety is under-rated as a cause or co-morbidity of compulsive behaviors and mood swings/reactivity. Severe anxiety can look like Borderline (BPD), it can look like Bipolar, it is a chameleon and it can take a lengthy period of experience for a psychiatrist or therapist to discern the extent to which anxiety is driving certain feelings and behaviors.

The way DBT is intended to help a person with Borderline (BPD) is by teaching them to recognize and manage their extreme emotional fluctuations. The focus is on separating themselves from those emotions and managing the need to act on those emotions in more adaptive ways. Mindfulness is a key skill and integral to successful treatment of Borderline (BPD).

As to the cause of Borderline (BPD), like many illnesses physical and mental, it appears there is genetic pre-disposition and environmental factors. Some research has shown differences in brain structure and function in people with Borderline (BPD). Borderline (BPD) tends to run in families but it is hard to tell whether this is due to genetics or to environment (or both). Invalidating caregivers who tell the child that the child's feelings are wrong or different than what the child is feeling or who create a chaotic, abusive environment are part of the environmental influences thought to contribute to the development of Borderline (BPD).