Borderline Personality - A View From Inside

"I am borderline" is a short film staring Danielle Keaton about borderline personality disorder from the inside. This short film (4:35 minutes) was written and directed Betsy Usher in Los Angles. The film offers a realistic portrayal of the internal conflict of a person with borderline personality disorder or traits traits of worldwide slots. The film opens with the voice over; 



"It feels like you aren't living at all, or you're possibly too alive. You're a person that feels the highest of highs and the lowest of low. You're usually triggered by small things, the way a person looks to watch..."

The film is part of a campaign created By Betsy Usher (pictured at the bottom) to help reduce misconceptions and the stigma of BPD. Another part if this campaign asks individuals who identify with the BPD diagnosis to post pictures of themselves online showing all of the other talents, labels, and thoughts about who they are (e.g. "I am a teacher").

Usher has her doctorate in clinical psychology (PsyD). She studied Borderline Personality Disorder at California School of Professional Psychology at Alliant University. She also attended California State University, Northridge and CSPP/Alliant International University at Alliant University.

The film finished first place in the month of June 2016, winning the monthly "Art with Impact" given by artwithimpact.org, a non-profit organization encouraging the production of short films based on mental health issues. The organization is sponsored under the California Mental Health Services Act, and by The National Endowment for the Arts (NEA) , Pacific Blue Cross Community Connection Health Foundation, and others.

What is a Personality Disorder?

Perhaps you suspect that your loved one has a "personality disorder". Perhaps someone has told you that they think that you have a "personality disorder". You may not know what they are talking about.  So what is it?

Definition: Personality disorders represent the failure to develop a sense of self-identity and the capacity for interpersonal functioning that are adaptive in the context of the individual’s cultural norms and expectations.

A.  Adaptive failure is manifested in one or both of the following areas:

      1.  Impaired sense of self-identity as evidenced by one or more of the following:

• Identity integration. Poorly integrated sense of self or identity (e.g., limited sense of personal unity and continuity; experiences shifting self-states; believes that the self presented to the world is a façade)
• Integrity of self-concept. Impoverished and poorly differentiated sense of self or identity (e.g., difficulty identifying and describing self attributes; sense of inner emptiness; poorly delineated interpersonal boundaries; definition of the self changes with social context)
• Self-directedness. Low self-directedness (e.g., unable to set and attain satisfying and rewarding personal goals; lacks direction, meaning, and purpose to life)

      2.  Failure to develop effective interpersonal functioning as manifested by one or more of the following:

• Empathy.  Impaired empathic and reflective capacity (e.g., finds it difficult to understand the mental states of others)
• Intimacy. Impaired capacity for close relationships (e.g., unable to establish or maintain closeness and intimacy; inability to function as an effective attachment figure; inability to establish and maintain friendships)
• Cooperativeness. Failure to develop the capacity for prosocial behavior (e.g., failure to develop the capacity for socially typical moral behavior; absence of altruism)
• Complexity and integration of representations of others. Poorly integrated representations of others (e.g., forms separate and poorly related images of significant others)

B.  Adaptive failure is associated with extreme levels of one or more personality traits.

C.  Adaptive failure is relatively stable across time and consistent across situations with an onset that can be traced back at least to adolescence.

D.  Adaptive failure is not solely explained as a manifestation or consequence of another mental disorder

E.  Adaptive failure is not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)

Looking at this more broadly:

"Personality disorder, formerly referred to as a Character Disorder, is a class of mental disorders characterized by rigid and on-going patterns of thought and action. .... The inflexibility and pervasiveness of these behavioral patterns often cause serious personal and social difficulties, as well as a general functional impairment.

Personality disorders are defined by the American Psychiatric Association (APA) as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". These patterns, as noted, are inflexible and pervasive across many situations...(and) perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to late adolescence and the beginning of adulthood, and, in rare instances, childhood."

The Diagnostic and Statistical Manual of Mental Disorders, defines ten specific personality disorders, one of which is "borderline personality disorder".  

The current system (DSM - IV) lists 10 personality disorders organized in 3 "clusters

Cluster A (odd or eccentric)

• 301.0 Paranoid personality disorder
• 301.20 Schizoid personality disorder
• 301.22 Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic)

• 301.7 Antisocial personality disorder
• 301.83 Borderline personality disorder
• 301.50 Histrionic personality disorder
• 301.81 Narcissistic personality disorder

Cluster C (anxious or fearful)

• 301.82 Avoidant personality disorder
• 301.6 Dependent personality disorder
• 301.4 Obsessive-compulsive personality disorder

The APA is also proposing a consolidation into 5 subtypes:

• Borderline,
• Antisocial/psychopathic (possibly with subtypes),
• Schizotypal,
• Avoidant, and
• Obsessive-compulsive.

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If you have a loved one that seems to be suffering from borderline personality disorder, please visit BPDfamily.com . We will welcome you warmly! If you believe that you have borderline personality disorder, check here for resources to help you.

Author:  Skip

85% of pwBPD Go Into Remission

Although borderline personality disorder (BPD) has traditionally been considered a chronic and intractable disease, it is has high remission and low relapse rates, new research suggests.

Collaborative Longitudinal Personality Disorders Study

In the latest findings from the Collaborative Longitudinal Personality Disorders Study (CLPS), 85% of participants with BPD remitted during 10 years of follow-up. In addition, only 11% of these relapsed — which was significantly lower than for participants with major depressive disorder (MDD) and a group consisting of cluster C personality disorders.

However, those with BPD had significantly more social dysfunction than the other 2 groups.

"We found that [BPD] psychopathology, which has not really been adequately studied before, improves more than generally expected, and once it remits, it usually stays remitted. Not many psychiatric disorders can claim that," lead study author John G. Gunderson, MD, professor of psychiatry at Harvard Medical School and director of the McLean Center for the Treatment of Borderline Personality Disorder, Belmont, Massachusetts, told Medscape Medical News.

"It was also amazing that this was found without treatment designed specifically for this disorder. So this is really not an effect of treatment but a statement about its natural course," said Dr. Gunderson.

The study was published online April 4 in Archives of General Psychiatry.
http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.37

In "the only other 10-year prospective study of BPD," reported on last year by Medscape Medical News, coinvestigator Mary Zanarini, EdD, also from McLean Hospital, and colleagues found that many (but not all) patients with BPD got better with time.

Attitude Adjustment

He noted that a change in attitude is now needed because most have typically thought these are people who have chronic disease and are considered "frequent flyers" because of their many hospitalizations and emergency department visits.


"A small minority of patients that conform to that characterization has given the whole group a bad name. But for clinicians to realize most of these patients will get better makes it much less pejorative, and they can take a lot more pride in even short-term interventions that may make a lasting difference."

Psychosocial Functioning Often Remains Severely Impaired

 Dr. Gunderson pointed out, though, that psychosocial functioning for these patients often remains severely impaired.

"One of the implications of that is that we need to try to help borderline patients with their social adjustment, such as getting a job or joining social organizations. So it moves treatment away from just symptom remission to social rehabilitation."

"Despite the high prevalence of BPD in psychiatric facilities, attention to BPD remains woefully low relative to that paid to other major psychiatric disorders. Indeed, the diagnosis is underused and most mental healthcare professionals avoid or actively dislike patients with BPD," write the investigators.

In addition, past BPD research has mainly consisted of either short-term prospective or long-term retrospective studies or were conducted before 1995, they report.

In addition to using different methods, Dr. Gunderson said that his team sought to examine both the psychopathology of BPD and its associated social dysfunction.

"Their study looked at 1- or 2-year increments, whereas we looked at small intervals of change. We used measures that allowed us to look at month-by-month changes, which is important in terms of 'what predicts change' and 'what changes predict other changes,'" he explained.

"We also had comparison groups made up of specific forms of personality disorders that were matched demographically. And whereas the other study had a population of all inpatients at McLean, ours was much more demographically representative of a clinical community."

The investigators evaluated data on patients between the ages of 18 and 45 years who participated in CLPS at 1 of 19 clinical sites in the northeastern region of the United States.

For this analysis, the investigators assessed 3 subgroups of patients: those diagnosed as having BPD (n = 175), those with MDD (n = 95), and those with either avoidant personality disorder or obsessive-compulsive disorder (cluster C group, n = 312).

Criteria and changes in disorders were assessed with several measures, including the Diagnostic Interview for Personality Disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the Structural Clinical Interview for DSM-IV Axis I Disorders, the Longitudinal Interval Follow-up Evaluation, and the Global Assessment of Functioning (GAF) scale for up to 10 years.

High Remission, Low Relapse

Results showed that 66% of the participants completed all 10 years of follow-up, including 111 of those with BPD, 211 of those in the cluster C group, and 62 of those with MDD.

"While the overall rates of remission at 10 years were high for all 3 diagnostic study groups, the time to remission for BPD was significantly longer than for MDD (P < .001) but only minimally longer for cluster C (P = .03)," report the researchers. However, the 11% relapse rate for the group with BPD was significantly less frequent and slower than for both the MDD (P < .001) and cluster C groups (P = .008). BPD relapses "largely occurred in the first 4 years before leveling off," write the investigators, adding that only 9% of the BPD patients "remained stable disordered" (defined as meeting ≥5 disorder diagnostic criteria) at the 10-year mark. GAF scores showed severe impairment for those with BPD and "only modest albeit statistically significant" improvements. These patients also remained statistically more socially dysfunctional during the 10-year period than the other 2 groups (P < .001). Finally, criteria reductions significantly predicted subsequent improvements in GAF scores (P < .001). These results "are consistent with the theory that if patients with BPD can achieve stable supports and avoid interpersonal stressors they will remit clinically," write the investigators. "The low relapse rate suggests that during the remission process, the patients changed either psychologically, perhaps having acquired more resiliency or new adaptive skills, or situationally by attaining more supports or less stress," they add. Dr. Gunderson said there is now a real need for "more practical" BPD treatments. "We can see that they don't need to be long term and intensive to be helpful. But we do need them to be more focused on social rehabilitation." The study was funded by grants from the National Institute of Mental Health. The study authors have disclosed no relevant financial relationships. Arch Gen Psychiatry. Published online April 4, 2011. Abstract

The Importance of Empathy Skills when Supporting a Person with BPD

Empathy is the experience of understanding another person's condition from their perspective. You effectively place yourself in their shoes and feel what they are feeling.

Participate in Member Workshop

When someone asks what is the most important tool for supporting a loved one with borderline personality disorder, I say "empathy". I typically follow with "and many of us over estimate our own empathy skills".

What is empathy?

It is often confused with sympathy. Empathy it is distinctly different. Empathy is the experience of understanding another person's condition from their perspective. You effectively place yourself in their shoes and feel what they are feeling. Seeing things from another person's perspective isn't simply understanding their point

of view -- it extends to understanding, without disclaimers, why they feel their point of view is just and appropriate and honest.

So, when your child returns from a therapy appointment and proclaims "I really like this one", it's most likely related to the therapist's ability to empathize and communicate it. We will not be able to motivate, coach, lead or redirect anyone without having this knowledge, too.

When Perry Hoffman (Harvard) conducted a study to determine the predictors of BPD patient recovery, the researchers found the #1 predictor to be the presence of a caring and empathetic person in the patient's life. They were surprised with this #1 rating.

It is also interesting that the architects of the DSM 5 proposed that a personality disorder be diagnosed when a person has diminished skills in two of the following -- either "empathy or intimacy" and either "identity or self direction". This raises two practical issues for us. First, our loved one may very well have impaired empathy skills and so we don't want to mirror that back as a way to "teach them a lesson".  Secondly, if we are supporting a BPD child, it is important to remember that BPD traits tend to run in families and we may have had a parent that wasn't very empathetic and in turn, we didn't develop effective empathy skills ourselves. As such, we may have to become very deliberate in developing empathy skills now and seek the advice of others to help us to better "step in the shoes" of our child.

The five levels of empathy proposed by the DSM 5 architects are listed here. Want to know where you stand? Ask someone very close to you - ask your children - don't make a self-assessment.

Helping each other to grow to be more empathetic is one very important way we help each other at BPDFamily.com.

Author: Skip
Video Short: Scott Peck

Scott Peck earned his Masters Degree in Education and Doctorate in Divinity and has worked professionally as an educator, national advertising manager, reporter, photographer, copywriter, & real estate broker.