Friday, December 30, 2011

More About Epilepsy and BPD

I previously posted about some theories that there may be a link between having epilepsy in one's family and having borderline personality disorder (BPD).

Recently a very wise person who has been diagnosed with BPD and is recovering from it brought up the possible BPD-epilepsy connection with me.  This person pointed me to the website of Dr. Leland M. Heller.

According to Dr. Heller, "The most severe BPD symptoms are likely a form of epilepsy and include 'dissociation' (unreality, body parts going numb, deja vu, etc.)..."

Of interest to me was the page where Dr. Heller stated,
Epilepsy means nerve cells firing inappropriately and out of control. Some individuals have a genetically unstable neurological system that can cause epilepsy in different areas.  This instability in the instinctual "trapped, cornered, wounded animal" response causes the BPD. Some other common disorders are likely epileptic in origin including bipolar disorder...
Dr. Heller also addresses the possible BPD-epilepsy connection here.

Saturday, December 17, 2011

I Will Always Care

I told someone, "The only way I will ever again feel safe in your presence is if you return to seeing a mental health professional on a regular basis." Should this person ever visit this blog, I want something to be understood.

I said that not because I do not care about you, but exactly because I do.  You can go on looking very confident and outwardly successful to everyone else and, as you well know, I have never had any objections to that.  But it's simply not enough; you are due for so much more and so much better.  What you deserve is that lasting happiness that Aristotle called eudaemonia -- Greek for "good spirits."  It refers to an ability to feel at peace within the confines of your own psyche, to be comfortable in your own skin and in the body that Nature gave you, to accept yourself and see in yourself the charm and beauty and compassion that others have seen in you on those occasions when you let them.  To know that there is nothing unnatural or uncomfortable about one day having children and starting a family of your own.  No, starting a family is not any kind of duty or moral obligation; it is simply something very rewarding, an enterprise grander and more challenging than any business scheme I could cook up. So much happiness is possible to you, and just begging to be allowed entry into your life.  And, as you are cognizant, that happiness reaching you is incumbent upon the hard and disciplined choice to accept it.

Contrary to your fears, no one sees you as some specimen to be put in a laboratory, poked or prodded.  You are never on some stage to be judged harshly by anyone.  And no matter how strangely you may look or dress, no one is staring at you; people are much too consumed by their own worries or insecurities to project negative thoughts upon you.  No one plots against you, no one conspires against you, no one is trying to outsmart you, no one wants to use you. On the contrary, everyone believes in your greatness as a person and is rooting for you to win at life. 

A return to psychiatric care does not have to be a prison sentence.  Nor must it feel like one.  In Hawaii, it would be you -- and no one else -- who would ultimately be in control.  You could fire any mental health professional who did not meet your standards of competence and care.  As far as American mental health professionals are concerned, it is the patient who is the boss.  Getting the care that you need is a form of self-determination and self-empowerment.  Far from submitting to the dictates of anyone else, receiving quality care is a form of psychological liberation, no less important than political and economic freedom.  I want you to be happy.  But far more important than that is that I want you to want you to be happy.

You told me that I cannot force any of this upon you, and of course that is true.  I was the one who first told you, "I cannot persuade anyone to do anything.  I can only encourage you to persuade yourself to do something."  That applies here.  I force no one's hand.  I wish happiness for you.  And I unabashedly plea that you put at least as much priority as I do upon the joys and sense of serenity just waiting to be experienced. 

Whatever you do, I will always give a damn, irrepressibly.   I have no regrets about knowing you; I only have gratitude for it and I face no qualms in expressing that.  Just as you have every right to your own choices, I have a right to mine.  Of course I can move on and put the emphasis on my writing projects.  My doing so will never mean that I have forgotten anything.  I will continue to remember and to care.  That is my own prerogative.  :'-)

Friday, December 16, 2011

Identity Disturbances

Among the nine criteria for diagnosing Borderline Personality Disorder, another is the presence of "identity disturbances."  As Psych Central phrases it,
There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support.
I don't thinks Psych Central means that a BPD sufferer's entire outward persona will completely shift from minute to minute or day to day (although some mood swings can be like that).  Rather, it's more along the lines of someone "searching for identity" the way a high-schooler would.  One would can have certain career goals in mind and have a certain type of fashion for some months or some years.  Then some stressful triggering event can cause this person to immediately switch all of this around so that the clothing choices and career goal will be completely different.  Those who do not have BPD can also sometimes make sudden changes.  However, those with BPD often make sudden changes in manner that those around them finding more jarring and confusing.  

A helpful article on this subject is found here.

As recovered Borderline Rachel Reiland has pointed out, sometimes this identity confusion can manifest in the BPD sufferer wearing a sort of mask, trying to always appear confident and friendly to mask a gnawing self-doubt and extreme predisposition to being bothered by what other people say.

Someone suffering from BPD identity disturbances will not have an integrated, consistent personality, but instead have a highly fragmented personality, switching back and forth. The true self will emerge when one feels safe. However, once one feels threatened in some way, the impervious false self emerges as a form of "protection." Sadly, this "confident" false self happens to wall off the person from true emotional bonds, thus becoming a maladaptive obstacle to finding true lasting happiness. :'-(

Some psychologists can mistake this phenomenon for Multiple Personality Disorder. However, there is an important difference. When someone with Multiple Personalities switches from one personality to another, the switch is unconscious; the person doesn't know it is happening. By contrast, the Borderline with a disturbed, "fragmented" personality does have some conscious awareness of when she or he is changing personalities as the result of some emotional trigger. Again, Rachel Reiland explains that.

The identity confusion can even come in the form of changes in perceived sexual orientation.

But you are not cursed to permanently suffer with this. A return to psychiatric care can be of enormous help with the proper diagnosis and committed mental health professionals. Please take your happiness very seriously. :'-)

Monday, December 12, 2011

Wearing a Mask of Confidence on the Outside, Feeling the Opposite on the Inside

The blog Beyond the Borderline Personality presents this interesting excerpt from an article in Scientific American Mind (the article itself is not fully Web-accessible):
BPD is also characterized by a disturbing, but fascinating, dual nature: when people with the disorder are not experiencing flagrant symptoms, they often appear highly functional. “You could meet a patient with BPD in a social setting and not have an inkling that the patient had a major psychiatric disorder,” says psychiatrist Glen O. Gabbard of the Baylor College of Medicine. 
On the bottom of that page, there are many insightful comments from sufferers of BPD and/or Bipolar Disorder who  discuss how they appear very confident and composed in public -- such as, say, boasting about being some great real-estate investor -- but are tormented by insecurity on the inside:
*"in many ways I appear 100% [fine in public] but it's just an act..I can only keep up the appearance for so long before I snap..even when I snap I can usually manage to contain it somewhat.."

* " I understand the facade all too well, but it's only a facade. So many times I feel I could fall apart at any moment. I try not to let people on to that little tid bit, but I certainly know what you're talking about."

* From the blog writer herself:  "This is actually one of the reasons my Roommate was not convinced I'm Borderline because when she first moved in with me she'd never seen me dissolve from one minute to the next. I'm so good at portraying a fairy tale version of myself that no one quite catches on"
Also, there is a sad follow-up to my previous post mentioning Amy Winehouse's tragic death. The Daily Star reports that a family member of Amy Winehouse has made the educated guess that Ms. Winehouse suffered from BPD symptoms. Unfortunately for Ms. Winehouse, this would not and cannot be corroborated by a mental health professional. As one article elaborates,
According to the [Daily] Star, a family member said that the Grammy award-winning singer may have suffered from Borderline Personality Disorder. "It was never diagnosed, because unfortunately she would never agree to a proper diagnosis," the Daily Star quoted a family member as saying. "I'm not an expert, but from what I've read on Borderline Personality Disorder it kind of fitted with her."

Meanwhile, Winehouse’s father, 61-year-old Mitch Winehouse, told the Star he wished Amy would have sought counseling. 
If you are experiencing inner pain like that described in the quotations above, then -- even if your symptoms are not as severe as Ms. Winehouse's -- it would be prudent to make sure that you are currently receiving professional help on a regular basis. No one should have to experience such consistent pain. Your true, inner happiness -- not your outward public success -- is what is most important, and there are people in your life who care about you. :'-)

Tuesday, November 29, 2011

Paranoid Delusions

Suppose I repeatedly insisted to you that all of the men who walked past me in Waikiki leered at me and wanted to sexually assault me.  Then suppose that, when we walk in Waikiki side-by-side, you notice that the men who walk past me simply mind their own business; you catch no leering.  If I repeatedly make this distrustful insistence to you about men -- that they're all ogling me -- it might be the case that my claim amounts to a paranoid delusion.

Paranoia is often associated with Paranoid Personality Disorder (naturally) and schizophrenia.  However, there are cases where it is also found in Borderline Personality Disorder (BPD).  In fact, the presence of paranoia is one of BPD's nine main diagnostic criteria.

Wednesday, November 23, 2011

What Is 'Suicidal Ideation' (Warning: Post Has Disturbing Contents)

This blog discusses what are already difficult subjects (BPD and Body Dysmorphia), but this post is about something I find particularly uncomfortable.  However, I find it necessary to clarify the distinction between suicide and "suicidal ideation."  The topic of Borderline Personality Disorder is difficult to begin with, and I already had to tread carefully to begin with.  However, I have to be even more careful with this one.

One of the nine criteria for diagnosing Borderline Personality Disorder (BPD) is the presence of "suicidal ideation." Now, most of us know what suicide is, but ideation is not a very familiar term.  What is suicidal ideation? explains, "Strictly speaking, suicidal ideation means wanting to take one's own life or thinking about suicide without actually making plans to commit suicide. . . . Suicidal ideation is one of the symptoms of both major depression and bipolar depression."

About.Com gives this example:  "Alice often imagined ending her own life in some dramatic way, like jumping off the highest bridge she could find - but it was only suicidal ideation because she really had no intention of actually doing any of the things she imagined."

Thus, to consider the possibility that someone possesses suicidal ideation, it is not necessary that this person actually sincerely plans to commit suicide.  If this person repeatedly contemplates how much sadness or pain would be ended by death or suicide, that is enough grounds to consider the possibility that this person suffers from suicidal ideation.  That applies even if you have a hard time imagining that this person actually would go through with killing her- or himself.

Now suppose that you know someone who has repeatedly and seriously mentioned, "I have a strong feeling that I am not willing to exist."  Suppose this person has made very visible self-destructive gestures, such as having a past of cutting her or his own wrists with a blade.  Suppose this person envelopes her- or himself in morbid imagery and -- absent of giving you any sort of coherent context for the behavior -- puts up self-disfiguring self-portraits in which this person is made to look like a pallid, gray-skinned dead body.  Now imagine that, when you talk with this person and people who know this person, it seems very hard to imagine this person would actually go through with suicide.  That last factor -- that it's hard to imagine the person going through with suicide -- does not preclude the possibility that the person in question is experiencing suicidal ideation.

In short, if someone continually fixates on morbid, self-destructive, self-disfiguring, or suicidal imagery, there is a chance that this person fits the "suicidal gestures" criterion of the BPD diagnosis, even if everyone in this person's circle finds it unlikely that this person would actually commit suicide.  (Of course, only a trained mental health professional can offer an official diagnosis.)  Should someone have suicidal ideation, that might fit one of the nine diagnostic criteria for BPD.

Now I will explain why this blog post requires even more caution than usual:  I must emphasize that I do not want to downplay the suicide risk of those who have BPD.  Out of those diagnosed with BPD, 1 in 10 actually do commit suicide. I neither want to overstate nor understate such dangers.  That rate is significantly larger than that of the general population. 

Even if you find it unlikely that you would ever commit suicide, I have the strong conviction that if you experience suicidal ideation -- or have experienced suicidal ideation over the past nine years -- it could be very important to return to psychiatric care.  Your life and long-term happiness are of profound significance.

Wednesday, October 19, 2011

Helpful Online Exchange About BPD, Gender Identity Confusion,and Confusion on Sexual Orientation

On my Facebook page about BPD, I had a helpful exchange with someone back on March 16, 2011, on the subjects of Borderline Personality Disorder, gender identity confusion, and confusion on sexual orientation. That specific exchange is over here. Of course, it is important to bear in mind that someone confused over gender identity is not necessarily undecided on sexual orientation, and someone undecided on sexual orientation is not necessarily confused about gender identity. Moreover, someone can have BPD and not be confused in either area.

Wednesday, October 5, 2011

'Non-Bizarre' Delusions

Among the diagnostic criteria for BPD, one is the presence of "transient stress-related paranoid ideation, delusions or severe dissociative symptoms." I am going to clarify that "delusions," in this context, refers almost exclusively to what psychologists term "non-bizarre delusions," as opposed to "bizarre delusions." This, of course, raises the question, "What is a 'non-bizarre delusion,' as opposed to a 'bizarre delusion'?"

A delusion is a paranoid, frightful belief one holds in the absence of evidence and even in defiance of all evidence.

A "bizarre delusion" is an implausible delusion that defies all laws of science. If I insisted to you that dove feathers were sprouting from my face, when you could clearly see that that wasn't happening, that would be an example of my holding a "bizarre delusion."
By contrast, a "non-bizarre delusion" is a delusion that is not necessarily implausible -- and which actually comports with the laws of physics and science -- but still lacks evidence. For instance, if I said that everyone ogled me and wanted to rape me, that would not defy the laws of physics; that's not impossible. But if you observe that, in fact, people interact with me all the time without ogling me, then you may be observing my having a non-bizarre delusion.

Wednesday, September 14, 2011

I Made a BPD Awareness Pic Badge for Facebook

You know those weird "pic badges" that people are putting on their profile pictures on Facebook? Those are usually to raise awareness about an issue like prostate cancer or remembering 9/11.

I immediately decided to make a pic badge for propagating awareness of Borderline Personality Disorder.

If you want to put that pic badge on your own Facebook profile picture, you can go here.

It turned out, though, that there were already several other BPD Awareness pic badges available.

Friday, August 26, 2011

A Connection Between BPD and Epilepsy?

If I have epilepsy, then is it possible that my future children could inherit genes that make the preponderance of Borderline Personality Disorder symptoms more likely?

Not a lot of research has been done in this area. However, some patients with BPD, as well as their family members, share some interesting anecdotes on this topic over here.

It turns out that one medication used to treat epilepsy is also used to treat Bipolar Disorder and BPD.

Sunday, August 14, 2011

'Having an Empathy Problem' Versus 'Having Zero Empathy'

Stuart K. Hayashi

What I am about to say is a generalization about persons suffering from currently-untreated Borderline Personality Disorder (BPD; borderline personlighetsforstyrrelse). Naturally, these generalizations do not necessarily apply to all people with BPD at all times. This assessment is based on what I have observed in my own experiences, plus what some persons diagnosed with BPD have written to me. Bear in mind that those persons do not necessarily agree with everything written on this blog. Anyhow, I will sometimes refer to persons with currently-untreated BPD as "Borderlines." This should not be taken as a pejorative; the locution is used for the purpose of making my blog post easier to read. Likewise, the loved ones of Borderlines will sometime be called "Non-Borderlines," "Nons" for short. When discussing a Borderline, I will switch between the pronouns "him" and "her."

Their Aloof Pose Does Not Prove That They Never Think About You
Love ones have often been on the receiving end of very inconsiderate treatment from the Borderlines in their lives. And when currently-untreated Borderlines are confronted with this fact, their loved ones are often horrified by the currently-untreated Borderlines' evident refusal to show remorse for this treatment, or to even make any sincere promise to change it. Based on the Borderlines' blase-at-best reaction, many loved ones often conclude that Borderlines are sociopaths who have zero capacity to empathize. I can see why such loved ones would infer as much. However, such a conclusion is misleading. If you have someone in your life who has undiagnosed, untreated BPD -- and refrains from exhibiting any real remorse for mistreatment of you -- chances are that this person does have genuine remorse for this mistreatment . . . but would be loathe to admit it to you.

Even as prestigious a research psychologist as Simon Baron-Cohen (cousin to the famous actor who plays Borat and Bruno) grievously equivocates Borderlines with sociopaths. A news article about Baron-Cohen's latest book summarizes Baron-Cohen's conclusion this way:
...the pathological group. These are people with borderline personality disorder, antisocial personality disorder and narcissistic personality disorder. They are capable of inflicting physical and psychological harm on others and are unmoved by the plight of those they hurt. Baron-Cohen says people with these conditions all have one thing in common: zero empathy.
The news article's author is not putting words into Baron-Cohen's mouth. Direct quotations from Baron-Cohen indicate the accuracy of the prior paragraph's description of Baron-Cohen's view. Baron-Cohen himself says that he equates every "personality disorder" with "a lack of empathy because many of the personality disorders, like the psychopath, or people with borderline personality disorder are just operating on a totally self-centred mode."

Both Simon Baron-Cohen and the newspaper writer fallaciously equate ethics with "social interaction," the implication being that you would have no need for morality if you were stranded on a desert island all by yourself. As you know that I support a humane and considerate Ethical Egoism, you know I reject the "zero-empathy-equals-evil" presumptions of Baron-Cohen and that newspaper writer. But as this blog concerns itself merely with explanations of BPD and Body Dysmorphia (dysmorfofobi), I will not digress into a long discussion about the ethics of rational self-interest. I will merely continue about BPD.

This ABC News piece likewise cites a psychologist as it equates BPD with a sociopathic paucity of empathy:
Two of the potential issues [Casey] Anthony could suffer from are borderline personality disorder and psychopathology, the experts said. The main thing these issues have in common is a total lack of empathy, according to LeslieBeth Wish, a psychologist and licensed social worker in Sarasota, Fla.
Once, a person with a beautifully high level of empathy had seriously told me, "I wonder if I'm a sociopath. When other people want me to cry about the things I do to them, they get no such response. I just go numb; I don't have an ability to feel."

Knowing this person very well, I replied, "I don't think you lack such a capacity; I have seen and felt your warmth and caring. I think what's really going on is that you feel so strongly, that it it causes a strain and hurt more severe than that experienced by others. It's not that you feel less than they, but more. To defend you against too much pain, the emotional parts of you go numb so as to protect you."

Then this person made a really weird blank look (more of this will be described later). The person then said something very quickly, and the tone would have sounded cocky if it weren't full of obvious defensiveness. What was said was, "No, I don't go numb at all. I'm just logical."

At the time, I scoffed at the notion that this person could be a sociopath; this person had -- and has -- a highly empathic nature. I now understand why this was said, and why very sane, normal people would accuse this person of being lacking in empathy. They would make this accusation because they do not fully understand this person's psychiatric condition. The most tragic part is that this person, too, misunderstood this person's own issues with empathy. :'-(

Two Forms of Empathy
First we should clarify that there are two types of empathy -- cognitive empathy and affective empathy. You are engaging in cognitive empathy when, on an intellectual level, you understand how someone else is feeling. By contrast, you experience affective empathy when you observe someone else's emotion and, as a direct consequence of this observation, experience the very same emotion.

If I observe that someone else is sad, but I myself do not feel sad about this, then I am experiencing cognitive empathy but not affective empathy. Conversely, if I see someone is sad, and I consequently feel sad myself, then I am having empathy on both the cognitive and affective levels.

In many cases, a functioning autistic is low on cognitive empathy but is still capable of experiencing affective empathy. That is, if your body language gives off the subtle cues about your feelings that are normally given off, the functioning autistic will comprehend none of it; he will not know what you are feeling. However, if you make it very obvious that you are sad or frightened to an extreme degree, the functioning autistic will probably likewise become sad or frightened as well.

A sociopathic con man pretty much operates in the opposite fashion -- he has high cognitive empathy but low affective empathy. He is able to manipulate and con you precisely because he can carefully read your body language and tone, and therefrom accurately infer what you are feeling. However, when he sees the pain that his actions have caused you, he is genuinely unable to feel bad along with you, or to experience authentic remorse. Insofar as he is remorseful, that remorse is shallow and will be soon forgotten.

Many people with currently-untreated, undiagnosed BPD have issues with empathy that are similar to those of functioning autistics and sociopaths. However, there are important differences.

Why Do Borderlines Appear Unsympathetic to Your Distress?
An astonishing number of currently-untreated, undiagnosed people with BPD symptoms like to pride themselves on their ability to read people; they see themselves as having high cognitive empathy. However, in my experience, the same people-with-BPD-symptoms have actually made some glaring social gaffes, oblivious to their own outlandishness. I know of one case where this person thought that she had impressed everyone in the room when, in actuality, her eccentric behavior made most of the people in the room feel awkward and uncomfortable. Sometimes this person had high cognitive empathy, but there were commensurate occasions on which her cognitive empathy was low.

When it comes to the matter of affective empathy, consider the emotional instability common to Borderlines who are currently not in treatment but ought to return to it. When the currently-untreated Borderline is feeling safe and secure, it is very easy for the Borderline to emotionally bond with you and to feel as you do. However, it may be the case that this Borderline can easily be "triggered" by some stimulus -- such as by some type of mention of sex or reproductive anatomy -- that elicits a panicky anxiety attack from the Borderline. During these panic/anxiety attacks, the Borderline is often caught in a fight-or-flight response. Even though, to you, the Borderline is getting upset about nothing, the Borderline can seriously feel something like, "Aaaaaauuuuuckk!! I'm dying!!!" (This is not hyperbole. The distress is that severe.)

BPD Anxiety
When the Borderline is triggered, the Borderline will interpret the trigger as some kind of life-or-death emergency. In those moments, the currently-untreated Borderline's concern for anyone else's feelings or well-being goes out the window. During moments of panic -- triggered by rather harmless stimuli -- the Borderline will be low on both cognitive- and affective empathy.

Recall that among the main symptoms of BPD are emotional instability, chronic emptiness, a proneness to anger, self-destructiveness, suicidal thoughts, and general anxiety. As emotional pain is something of a norm for Borderlines, too many of them develop the maladaptive practice of suppressing their emotions and trying to become emotionally numb. I recall someone very dear to me who learned to repeatedly become stoic in this way. This person often became upset at the slightest provocation. It was not initially obvious when this person became upset. When this person was triggered and became upset, this person's face suddenly became weirdly blank, with this person's mouth stiffening. It looked like some kind of "poker face," but with some resignation and tiredness, too. Although the person had learned to hide the discomfort by putting on a blank, stoic expression, you could still detect the tension at the temples.

The point is that even when this person had those panic/anxiety attacks, the person developed this blank, stone-faced expression. I suspect it is because the person misapprehends that admitting her own vulnerabilities would be some kind of show of weakness. My educated guess is that some currently-untreated Borderlines misperceive that confronting and accepting this vulnerability would be some sort of relinquishment of power and control. In fact, the opposite is true -- to let the vulnerabilities show would be the manifestation of true confidence and courage and strength. Moreover, it would not be giving up control and power but gaining the only forms of power and control that matter -- the power and control over oneself that comes with taking responsibility for one's own mental well-being.

Yes, this person easily became upset. As a maladaptive -- and ultimately unhelpful -- attempt to manage the anger or hurt, this person had become accustomed to numbing and repressing such emotions so as to not "lose cool" in public. The long-term negative effects of this emotion-suppression technique are explained by a psychologist here and by a recovered Borderline here.

And one big, panic-inducing "trigger" for many currently-untreated Borderlines is any attempt on your part to confront them on how their inconsiderate behavior is hurting you and of how you wish they would see the situation from your vantage point. When you try to very gently discuss this matter with the currently-untreated Borderline, the currently-untreated Borderline might react in one or both of these ways:
1. Become triggered and experience that sense of panic and emergency. In this very moment, the currently-untreated Borderline will only worry about her own feelings -- as if her life is on the verge of ending -- and will have low regard for your decision to express your own feelings. This definitely makes the currently-untreated Borderline appear generally non-empathetic.

2. Become triggered and upset, and then immediately cope with the panic by getting all numb. To the degree that the currently-untreated Borderline succeeds in becoming numb, she will honestly be devoid of any interest in your plea that she take your feelings and well-being into account. This, too, makes the currently-untreated Borderline appear generally non-empathetic.
In those moments of confrontation, the currently-untreated Borderline probably does show a deficiency in empathy. It would be a mistake, however, to conclude from this that the currently-untreated Borderline has never felt any authentic affective empathy for you.

A sociopath is someone perpetually incapable of experiencing strong affective empathy. This applies all or at least most of the time. By contrast, a currently-untreated Borderline will very easily feel affective empathy for you when she is relaxed. But this currently-treated Borderline will, in times of stress, experience momentary -- but very brutal and crushing -- lapses in empathy for you. Simon Baron-Cohen is all mixed up. A currently-untreated Borderline's momentary lapses in affective empathy -- and stubborn refusal to be contrite with his or her victims -- should not be conflated with a sociopath's continuous and persistent absence of affective empathy.

A Vicious Cycle Going in . . . A Perfect Circle . . .
If you're a Non, and have tried to maintain a close social bond with a currently-untreated Borderline, then you might have gone through this painful cycle:
1. The currently-untreated Borderline does something to the Non that is horribly inconsiderate . . . maybe even cruel.

2. The Non very gingerly, calmly, and gently tries to explain to the currently-untreated Borderline how the Borderline's behavior has been harmful and/or disrespectful to the Non. The Non compassionately asks the Borderline for a very deliberate changes -- an improvement -- in behavior.
3. This confrontation triggers the Borderline. The currently-untreated Borderline gets that panicky fight-or-flight response -- even if he or she continues to look calm on the outside -- and gains the inaccurate-but-strong emotional sensation that it's an emergency to completely ignore and disregard the Non's tearful entreaties. The Borderline will rebuff the Non's entreaties, as if only the Borderline's feelings are important whereas the Non's feelings are immaterial.

4. The Non interprets the Borderline's rebuff as a general lack of empathy and remorse. This is offensive, horrifying, and disgusting to the Non. He now sees the Borderline as cold-hearted, and this cold-heartedness as immoral. The Non desperately pleads with the Borderline to be more caring (i.e., more moral).

5. This further aggravates the Borderline, thus impelling the Borderline to further numb him- or herself. Whether by conscious intention or by automatized practice, the Borderline refrains from making any remorse visible to the Non. (In truth, when the Borderline is out of the Non's sight, the Borderline will reflect on the matter in secret and feel guilty about it.) The Non then tries harder, further admonishing the Borderline to change.
This cycle pretty much repeats itself -- getting worse and angrier with every repetition -- until the Non finally gives up and cuts the Borderline out of his life. Years later, the Non probably believes that the Borderline still feels no remorse. In truth, when the Borderline looks back on these events -- and refrains from evasion -- the Borderline probably does regret his or her behavior . . . but he or she delusionally believes it important that the Non never learns this.

If you're a Non, then it's not realistic for you to expect your entreaties to ever be enough to persuade the Borderline to change, no matter how gentle or heartfelt or justified your entreaties are. The entreaties almost always fail because this approach is one that many currently-untreated Borderlines find intolerable.

You are, however, morally justified in your wish that the Borderline would change, if only because it would be more conducive to at least his or her own happiness. :'-(

I recommend this alternative approach. Inform the Borderline that you will always care about him or her, no matter what. To always care about and love the person, however, is not the same as tolerating all of the abusive behavior, all of the devaluation, and all of the inconsiderateness and disrespect. Make it clear to the currently-untreated, undiagnosed-person-with-BPD-symptoms that, though you will always care about this person, you will tolerate no disrespect or devaluation. Any time the person unjustly devalues or disrespects you, withdraw yourself from the interaction, and do not comply with any irrational requests. If the inconsiderateness is very severe and persistent, you can communicate to this person that these two principles are both true at the same time and do not contradict:
1. You care about this person's well-being, and probably always will.

2. You will not interact with this person again until such time that this person is able to provide you creditable evidence that she has resolved to change for the better and is getting the professional psychiatric care that she needs.
My alternative approach cannot guarantee any change at all in the currently-untreated Borderline's behavior. However, it will spare you -- the Non -- a lot of hours or years of fruitless entreaties to the currently-untreated Borderline to change.

Perhaps you can take some small consolation in the knowledge that the currently-untreated Borderline often did have authentic affective empathy for you, and that this person's exhibitions of indifference to you do not necessarily prove that, deep down inside, this person has zero regrets about mistreating you. :'-(

Wednesday, August 10, 2011

Fragmented Personalities

As the mental health vlogger and recovering BPD patient MeAndMyBlackTable helpfully explains, "Borderline Personality Disorder is not a Multiple Personality Disorder. However, when you are having a conversation with someone who has BPD, it can feel like you're having a conversation with more than one person." I do know of at least one case where a psychiatrist was tempted to diagnose someone with multiple personality disorder (now known as the Dissociative Identity Disorder) when the symptoms much more closely matched BPD and Body Dysmorphia.

There are reasons for why someone with BPD would act as if he or she has multiple personalities. To some extent, it makes sense that people would somewhat adjust their behavior according to different situations. A normal man is expected to be solemn at church, and more jocular at a party. You wouldn't expect him to be loud and raucous at a church. . . . Well, actually, I would be, but I'm not normal. And thank goodness for that! Hee-hee! ^_^ Anyhow, that sort of adjustment is normal to some degree. However, in many cases of someone with BPD, the personality changes are often much more extreme -- to the point where they greatly interfere with domestic life.

In public, someone with undiagnosed, partially-treated, currently-untreated BPD symptoms may appear to be a tough, unemotional, invincible businessman or -woman. But when the guard comes down, he or she might start sniffling over something that you wouldn't ordinarily expect someone to cry about -- such as about someone tastefully complimenting him or her -- and talk to you in the voice of a lost, little child. And this change can sometimes be very sudden and happen at the slightest provocation. If you're unfamiliar with BPD symptoms, this can seem very surprising. You may feel tempted to ask the multiple-persona person, "Which of your personalities is 'the real you'?" The truth, whether that person recognizes it or not -- is that all the different personality facets are the "real" one; it's just that they haven't been as smoothly integrated as you would expect with most people.

This is related to the identity disturbances, wherein someone can take on a certain persona for several months and then "change" again, or might even change self-identified sexual orientation every few months or years (see here for an example of changes in sexual orientation). Though someone with undiagnosed, currently-untreated BPD might stress his or her repeated personality "c-h-a-n-g-e"s throughout life, there is a factor that will sadly remain constant if psychiatric care remains absent: the presence of these life-thwarting symptoms. Insofar as someone with severe, untreated, undiagnosed BPD refuses any return to psychiatric care, a very beneficent, happy, authentic change is exactly what is missing. (For a good description of the identity issues, see this essay.)

This seems to be related to the issue of "splitting." If someone is "splitting," it means he or she has very unbalanced, whim-based, polarized, and completely nuance-free shifts in her evaluations of other people. With greater emotional attachment to a person comes more intense shifts in these evaluations. Consider a boy ranging in age from newborn to about seven years old. When a mother is nurturing her newborn baby boy, who is confined to his cradle, he sees her as all-benevolent. But when she walks away from his cradle, it's not as if he can go after her. He cannot be sure that she will ever return to his side -- as far as he can understand it, she is abandoning him, perhaps forever. In these periods, the mother is not seen as all-benevolent but infinitely neglectful, infinitely cold-hearted, and ultimately undependable.

Likewise, consider this same boy when he is four years old. Again, when his mother is lavishing attention on his adorableness, he sees her as all-good, all-nurturing, all-loving. But when she scolds him or disciplines him, he feels humiliated. At this particular juncture, she switches to all-malevolent, all-hateful. There is no nuance in this; for many children this age, it's hard to comprehend the idea that you can approve of some aspects of your mother's personality and disapprove of other parts of her while loving her overall.

For many people with undiagnosed, currently-untreated BPD, there is a similar phenomenon at work. This person can become fixated on you and lavish you with adulation, as if you are the all-nurturing mother this person has always wished for. You can be the most masculine man in the world, and you can still be regarded, on some level, as that much-yearned-for mother figure (I repeat: you, as a man, can be seen as a strong mother figure, not father figure). But when you disappoint this person, that vision is shattered. No matter how much this person proclaimed your supreme value, you can then instantly be cast into the dog house. In his or her eyes, you become something that deserves zero attention or respect. To this person, you become something beyond contempt, a speck of dust.

When you have first been idolized by such a person, and then, soon afterward, given the cold-shoulder by this same person over nothing, it can make you wonder if the prior idolization was genuine. It makes the person look shallow at best, insincere at worst. But in such cases, what often happens is that, in those moments of adulation, that person meant it. Likewise, when that person was treating you like garbage, that was what was meant, too.

It's not that the person is consciously being dishonest in either case; it's that the person is acting according to strong whims with the same psychological complexity as a four-year-old boy would react to you. It's very easy for a four-year-old boy to instantly shift from seeing you as all-great to all-crummy. The same principle can apply to the emotional reactions you receive from someone with undiagnosed, currently-untreated BPD. You can find a helpful description of this "splitting" over here. And now I will quote another accurate description of "splitting":

Devaluation is when they suddenly behave as if they don't value you anymore. They become inexplicably cool toward you for no discernible rhyme or reason. And they seem to have no memory of how much they adored you yesterday.

They may be doing this as a reaction to feeling abandoned. And they may feel abandoned at the *slightest* sign of rejection from someone. It may be something as inconsequential as you showing up 10 minutes late for a date. Or they might imagine you were paying attention to someone else in a sexual way, etc. Many things can trigger their fear of abandonment.

They also typically devalue their partners at times when a relationship is becoming especially close or is about to move to a new level... this also triggers their fear of abandonment. Things have become too close, they become frightened, and they push the partner away. Often, this response is an automatic reaction, more of a reflex, and not something to which they give much conscious thought. And they truly can forget how much they cared about you yesterday... they live very much in the moment... and their mood of the moment is all encompassing, they can forget everything else.

Devaluation is usually a part of a cycle of Idealization and Devaluation. They go back and forth between these two extremes of feeling for their partner. This is the push/pull dynamic of BPD. They devalue and push the partner away until there is too much distance...

Perhaps you know someone who has symptoms of undiagnosed, currently-untreated BPD. Perhaps this person repeatedly proclaimed undying love for you. Then this person went through a scary phase and, a week later, started treating you like dirt. Was this person's prior declarations of love all a lie? I think you will find that, when proclaiming love, this person believed it at the time. Likewise, when this person was treating you like dirt, this person assumed it emotionally justified, at the time. This is how someone with treated, diagnosed BPD describes it [when you go to the link, it's in the margin on the right]:

Some partners of people with BPD worry the relationship was just a game, that their SO [significant other] was using them and felt nothing for them. That's not true.

I am a recovering BP [Borderline Personality].

Before, when I was in a relationship, my feelings felt genuine. I didn't have a conscious ulterior motive. There was an authentic connection; and while it may have been unhealthy and for the wrong reasons, it was, in my mind, real.

I acted as if I was in love because I thought I was.

The bond that occurred in the beginning of a relationship was incredible: there was a deep (false) sense of knowing the other person intimately, intuitively. He became my whole world and it was wonderful, rapturous. When my boyfriends left – and they invariably left – that world was anhiliated; everything fell to ashes. . . . The saddest thing about the situation was that I was the cause of my pain, yet had little idea then that it was due to my own behavior.

So yes, the love is “real”, but only in the sense of how it feels to the person with BPD: the feelings seem real, they feel like love.

This is a video that describes a more severe (to me) version of the "fragmented personalities" phenomenon.

Below is a video from the mental health vlogger and recovering BPD sufferer Dani Z. She is much more chipper and more self-aware than those whom I have known who have shown symptoms of what looks like untreated, undiagnosed BPD. But Dani Z being more chipper and self-aware is part of the fact that there is individual variation among different cases of people who have BPD.

Sunday, August 7, 2011

More Treatments for BPD Available on Oahu

Earlier I blogged about BPD treatment practices in Honolulu, and noted that within Psychology Today's index of mental health care professionals on Oahu, only one was listed as a specialist for treating Borderline Personality Disorder and gender identity issues (see here). I thought there was only one such specialist on Oahu, but there is another in Kailua.

And it turns out that there is a Dialectical Behavior Therapy (DBT) clinic on Oahu. Its website's very front page mentions that the clinic's practitioners specifically aim to treat BPD symptoms.

UPDATE from Monday, January 16, 2012: Today I found another website providing contact information for other clinics and therapists in Honolulu who provide DBT. Among those professionals, though, only one mentions having a strong focus on providing DBT.

I know that, deep down, you know that it's a good idea to return to getting the help you need. Have courage. The long-range happiness possible to you is within your grasp; you only need to courageously commit to making it a reality. :'-)

UPDATE from Sunday, June 7, 2015:  Oh, wow; now this blog post is really outdated.  A good resource is the University Hospital of Northern Norway, also called Universitetssykehuset Nord-Norge in Tromsø, particularly the psychiatric center. What is not outdated is the importance of your long-range well-being. Regular psychiatric care is worth it for your happiness. :'-)

Sunday, July 24, 2011

Another Description of BPD

These two videos provide a good description of Borderline Personality Disorder (BPD). Remember that not all nine criteria need to be present to warrant a psychiatrist's diagnosis of BPD.

I have a few comments to add. When the vlogger discusses impulsive and self-sabotaging behavior, she mentions the usual suspects, like reckless promiscuity and gambling. Another behavior that is seldom cited, but could also equally qualify, is self-described "video-game addiction." This could involve playing an online video game like World of Warcraft for hours and hours on end (e.g., 18 consecutive hours) at the expense of necessary life activities.

Also, when the vlogger discusses anger, what is mentioned is the extreme exhibition of aggression. That has been documented in diagnosed cases of BPD, but it is not the only form of intense anger that can be felt by someone with BPD. What is also possible is that the person with BPD holds everything inward and refrains from expressing the aggression, but nevertheless feels it on the inside. Anger toward another person can manifest in an extreme withdrawal of affection from that person. This phenomenon still fits the "intense, inappropriate anger" criterion for BPD. It comes with what is called "the quiet version of BPD."

Anyhow, I find these videos helpful and recommend them.

Wednesday, July 20, 2011

Monday, July 18, 2011

BPD Treatments on Oahu

Psychology Today has a website that helps readers search for therapists in their region who are specialized in treating their particular condition. I ran such a search for Oahu. To my chagrin, there is only one psychotherapist in Honolulu who lists herself as being able to treat BPD (see here). I wish there was a whole lot of psychotherapists competing to treat BPD patients. The one therapist listed also treats issues relating to gender identity.

UPDATE from July 31, 2011: Earlier I blogged about BPD treatment practices in Honolulu, and noted that within Psychology Today's index of mental health care professionals on Oahu, only one was listed as a specialist for treating Borderline Personality Disorder and gender identity issues (see here). I thought there was only one such specialist on Oahu, but there is another in Kailua.

And it turns out that there is a Dialectical Behavior Therapy (DBT) clinic on Oahu. Its website's very front page mentions that the clinic's practitioners specifically aim to treat BPD symptoms.

UPDATE from Monday, January 16, 2012: Today I found another website providing contact information for other clinics and therapists in Honolulu who provide DBT. Among those professionals, though, only one mentions having a strong focus on providing DBT.

I know that, deep down, you know that it's a good idea to return to getting the help you need. Have courage. The long-range happiness that you deserve is within your grasp; you only need to courageously commit to making it a reality. :'-)

UPDATE from Sunday, June 7, 2015:  Oh, wow; now this blog post is really outdated.  A good resource is the University Hospital of Northern Norway, also called Universitetssykehuset Nord-Norge in Tromsø, particularly the psychiatric center. What is not outdated is the importance of your long-range well-being. Regular psychiatric care is worth it for your happiness. :'-)

Saturday, July 16, 2011

Additional Comments on Borderline Personality Disorder

This blog post won't be the usual integrated essay that I normally write. It is just a series of comments pertaining to BPD.

Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD, or "body dysmorphia"; or, as it is called in Norge, dysmorfofobi) is a condition in which the sufferer frequently feels a very painful or disorientating sense of alienation from one's own natural-born physical features. One can look in the mirror and think, "Who is that? This is wrong. This is all wrong." One can even see oneself as ugly, no matter how much others assure one that one is the opposite of ugly.

When 70 patients diagnosed with BPD were surveyed, 54.3 percent of them reported also having Body Dysmorphic Disorder.

Gender Identity Confusion
Moreover, this other survey was given to both patients diagnosed with BPD and psychotherapy patients not diagnosed with any personality disorder.

The applicability of various categories of identity confusion to their own lives was rated on a scale of 1-7, 1 meaning hardly applicable.

Gender identity confusion refers to frequent and distressing uncertainty over which gender one wants to be. This does not refer to someone being born one sex and always or even consistently desiring to be the opposite sex. Rather, gender identity confusion refers to persistent indecision on the matter.

When it comes to the prevalence of gender identity confusion, the average of the answers for the BPD patients was 2.42, whereas the average of the answers for the psychotherapy-patients-not​-diagnosed-with-any-person​ality-disorder was 1.66. That means that the prevalence of gender identity confusion is low for both groups. However, note that this suggests that those with BPD are 45 percent likelier to experience gender identity confusion than the general population.

Indecision on Sexual Orientation (Same Survey)
Moreover, the presence of uncertainty about one's own sexual orientation (heterosexual, homosexual, or bisexual) is low for both those with BPD and those who do not have it. However, the survey suggests that those with BPD are about 31 percent likelier to have this uncertainty than those without BPD.

YouTube Cartoon About BPD Symptoms
Here is an eccentric cartoon on YouTube that describes some of the symptoms.

Concluding Remarks
Naturally, there is nothing inherently wrong -- in either the psychological or moral sense -- about experiencing uncertainty about one's gender identity or sexual orientation. Nor should one feel ashamed about having body dysmorphia.

To the degree that one is distressed by having any of these conditions, a return to psychiatric care can be very beneficial. It's worth it. :'-)

UPDATE from Wednesday, October 19, 2011: On my Facebook page about BPD, I had a helpful exchange with someone back on March 16, 2011, on the subjects of Borderline Personality Disorder, gender identity confusion, and confusion on sexual orientation. That specific exchange is over here. Of course, it is important to bear in mind that someone confused over gender identity is not necessarily undecided on sexual orientation, and someone undecided on sexual orientation is not necessarily confused about gender identity. Moreover, someone can have BPD and not be confused in either area.

One's Outward, Public Success Doesn't Preclude a Need to Return to Psychiatric Care

Stuart K. Hayashi

There are some people who achieve a form of professional or academic success, and yet their inner, private lives are full of emotional self-sabotage that could be prevented if only they sought -- or returned to -- psychiatric care and stuck with it. Sometimes such a person might rationalize, "My very success in public proves that I don't need help!"

But if that were the case, then their public successes would prove that John Belushi, Chris Farley, Michael Jackson, Charlie Sheen, Marilyn Monroe, and my own childhood idol, innovative entrepreneur Howard Hughes, were never in need of having -- or returning to -- professional help.

In other cases, one might focus on the public enterprises in order to distract oneself from facing or acknowledging the deeper insecurities that plague him or her. But that is not tenable. In the long run, one can hide the truth, but one cannot hide from the truth. The personal demons cannot be evaded, only confronted head-on with the assistance of an expert at psychiatric care.

It's not the case that success in public can ever substitute a truly fulfilling private inner state. Both one's private and public lives are important.

One might say, "John Belushi was already great the way he was." Should that be conceded, one can still consider how much more he could have gotten out of life had he stuck with treatment enough to reach full recovery.

Consider Nina (Natalie Portman's character) in Black Swan. She strove to excel in her line of work, but her mental health -- her ability to have a true inner happiness -- went woefully neglected.

It doesn't have to be that way. Private, inner peace and long-run contentment in life can be achieved, even in the absence of public success. The inner peace that come with returning to psychiatric care is really the most important success of all. It is worth it. :'-)

Lindsay Lohan (b. 1986)

Lindsay Lohan (b. 1986) yet again

Lindsay Lohan (b. 1986) yet again

Michael Jackson (1958 - 2009)

Howard Hughes (1905 - 1976)

John Belushi (1949 - 1982)

Chris Farley (1964 - 1997)

Charlie Sheen (b. 1965)

Marilyn Monroe (1926 - 1962)

Friday, July 15, 2011

Stu-Art's Art Stu-dio

At Jan Bussieck's excellent suggestion, I am contemplating opening an art studio with a big sign saying



Thursday, July 14, 2011

There Is More to Her Than Her Looking Like a Confident, Take-Charge Person in Public...

Of all the books I have read on BPD, the one that has most emotionally affected me is Get Me Out of Here: My Recovery from Borderline Personality Disorder by Rachel Reiland (this is a pseudonym). Almost all of the book is available for viewing on Google Books over here.

Naturally, every case of BPD is unique. The problems that Ms. Reiland wrote about in her memoir are not necessarily applicable to the case of anyone else with BPD. However, dear reader, I think it might be prudent to consider reading this book if the phenomena described sound familiar or in some ways mirror your own experiences and encounters.

Ms. Reiland is an accountant who presents a very tough exterior, coming across as someone who is emotionally impervious. Upon reading, I thought, "Oh, she's like The Terminator!" It turns out, though, that the subconscious purpose of this persona was to hide a deeply ingrained insecurity. She still felt like a vulnerable baby girl, and felt the need to put on this seemingly mature "emotionless businesswoman" front as a maladaptive method for coping with the inner pain. Bragging that one is supposedly a big-shot investor in real estate is no substitute for self-acceptance.

I was also very much struck by how, in the early stages of treatment, she had to confront her own latent misogyny. She considered women to be congenitally weak and inferior to men, and thus felt ashamed of being female and of having female anatomy.

This blog post is actually not a review of the book; you already know that I recommend it. Rather, my intention here is to quote from some of the passages that most affected me. I hope that the extent to which I am quoting excerpts falls within Fair Use. If the excerpts are too long, I will remove this post.

Regarding the online Google Books version, the sections from the printed version missing from this online version are:

* Note from the original publisher (Randi Kreger)

* Foreword by BPD expert Jerold J. Kreisman

* Acknowledgments section

* Epilogue

* Section on books and websites that have more info on BPD

* "About the Author"

* Pages that were blank anyway

Other than that, so far it looks like the rest of the entire book is on Google Books.


Tough Persona

On the tough, numb, emotionally invulnerable face that one presents to the outside world. Pages 193-94:

I was far more familiar with the tough half of the inner child, whom in my writings I'd dubbed Toughie or TC for Tough Chick. This was the hardened facade I had maintained for years. TC was the swaggering presence the sisters [of the Catholic school] ousted from the classroom and remained in the hallway. TC lived by an I-don't-give-a-shit credo, too tough to be hurt, too independent to care, and too streetwise to ever trust a soul. To TC, trust was an open invitation to be screwed.

TC was male in every way but one. He had somehow been trapped in a female body. He was the portrait of manhood as I saw it in my childhood, one who loathed weakness and sentiment, as my father did.

The other fragment was the vulnerable one, whom I dubbed Vulno in my writings. I was not nearly as familiar with this one, whose presence seemed to have been given life through therapy. Where TC had erected a barricade of walls in self-protection, Vulno was the antithesis, a fount of raw openness. Vulno trusted everyone and could not make sense of those who would not return such trust with love. It was as if the vulnerability itself, the willingness to be screwed over, would somehow protect her. She was ruled by emotion, always thirsting for love, seeking it everywhere with anyone and suffering great pain if it weren't forthcoming.

Vulno was intimidated by power. She would not seek it. She was content to be a follower if that would gain acceptance and love. . . .

Neither fragmented identity was admirable. Both were extremes. Neither appeared very worthy to me or, for that matter, lovable. But at least I could respect the tough side, which is, perhaps, why that side openly manifested itself far more frequently than the vulnerable one.


Resentment of own femininity. Pages 207-08:

[Dr. Padget, the psychotherapist:] "And because you're a woman, somehow I think you're a pushover? You're saying I think you deserve less respect?"

[Rachel:] "Yes!"

"Why can't you be a strong person and a woman, too?"

"Don't patronize me, okay? You wouldn't get it. You can say all you want to, but you don't know what it's like to be stuck being a woman. You have no idea. You're a man."

Dr. Padget redirected the focus, "What is it precisely that you hate about being a woman?"

I countered with a litany of reasons. . . .

"Boys who stuck to their guns were assertive; girls who did so were pushy little bitches. Boys were steady and strong, while girls were overemotional and oversensitive." . . .

"That's your father talking again," he sighed.

"No, not just my father. My mother too. My mother thought the same things. I know she did."

Hating One's Own Reproductive Anatomy

Disturbed by physiological reminders of her own femininity. Pages 271-74:

Here, Rachel resents herself for having her period.

"Quit using those words!" I demanded [to Dr. Padget].

"Menstrual period?"

"Damnit! You're doing it again. Quit rubbing my nose in it, will you?" . . .

"I know the shame doesn't come from you," he said gently, softening the blow. "It's sad to think that something so natural could be given such distorted connotations. You feel the shame because your parents were ashamed of your femaleness. Nature's sign of maturity became a curse you felt you had to hide. But that's not the way it's supposed to happen."

"Oh, yeah?" I asked, wounded pride still stinging. "So I guess you threw a party when your own daughter started."

"No party," he said, ignoring my sarcasm. "But I was proud."

"For having her first period?" I asked, surprised to hear the words come so easily off my tongue.

"For being a woman. For growing up."

I contemplated the notion for a minute, then asked him, "If I'd been your daughter, would you have been proud of me?"

"Of course," he replied gently, his tone soothing, bonding me to him. "A good and loving father is naturally pleased to see his daughter blossoming into womanhood. Proud to see his little girl growing up."

"Dr. Padget, did you ever talk to your daughter when she wasn't a little girl anymore? You know, about feelings? Did she ever cry in front of you?"

"Sure," he smiled. "She cried; she laughed; she got angry at me sometimes. Some things she felt more comfortable discussing with her mother, but we talked about things too."

Fragmented Personalities

Rachel talks about acting as if she has more than one personality. She summons a specific personality for a specific situation. This is not merely the case of someone behaving formally in formal situations and informal in informal situations; her demeanor changes to an extreme degree as a method of coping. Pages 97-98:

"[ . . . ] "What's wrong with me? Am I really crazy? She's taking over.' [Rachel says this to her therapist, Dr. John M. Padget.]

"Who is taking over?" he asked gently, as if to a child.

"The other one. The mean one. The one that always says terrible things and gets me in trouble. That part of me. . . ."

[ . . . ]

There's only one you, Rachel. Just one. You're fragmenting here. Dissociating."

"What does that mean?"

Dr. Padget went on to explain the terms. Fragmenting, or dissociating, occurred when a person did not have a fully integrated personality. Different aspects of the personality would emerge, depending upon the situation. It was a patchwork means of coping."

When gripped by fear, the abusive tough-acting persona would come to fend off the threat and reduce the feelings of helplessness and vulnerability. When she was overwhelmed by the need to be close to someone, the pleading, begging little girl emerged. In many situations, the adult sensibilities and rationality were present, and thus the personalities would be somewhat integrated and subdued. But in times of intense feelings, one of the other two personas would step in, overwhelming me.

It wasn't a multiple personality disorder type of dissociation, he explained, because I was always conscious, at least on some level, of what I was doing and saying. A person with multiple personality disorder, like Sybil [the protagonist of the eponymous Sally Field movie], would not have the conscious awareness I did.

But the dissociation set the stage for a fierce internal conflict as the two inner-child personae, like oil and water, battled each other. One clearly female, one clearly male.

Body Dysmorphia

Throughout the work she also ruminates over her Body Dysmorphic Disorder. This refers to one having a long-term, pathological discomfort with one's own body and natural physical features, often feeling alienated from them. As she says on page 99, "My bedroom mirror was like the fun house variety."


I do not want to give the impression that this book only makes one feel very negative, emotionally. Rather, Ms. Reiland documents her struggle to come to grips with her condition. It is ultimately an uplifting read.

Groundhog Day Curse Can Be Broken

Stuart K. Hayashi

In 1994, Bill Murray starred in the excellent comedic fantasy Groundhog Day. In the movie, Murray's character is cursed to keep re-living the same day, February 2, over and over again. When he wakes up every day, it's February 2 and everyone acts exactly the same. Only Murray is aware that the same disastrous events are repeating.

Murray's character is not a bad person (though some people, who do not understand him, tell him that he is bitchy); he doesn't seek to hurt anyone. However, he is caught in a dysfunctional behavioral pattern that is emotionally damaging to both himself and others. Fortunately, he finally comes to understand that he does have control over his own choices. Rather than be changed by external factors impinging upon him, Murray makes a long-term commitment to changing for the better -- choosing to celebrate life and sunny happiness. By making better choices, he is able to break the curse and end the time loop.

A similar pattern sometimes occurs with those experiencing undiagnosed, currently-untreated Borderline Personality Disorder (BPD). One with this condition can continue a pattern of anxious attachment and self-sabotage, particularly in matters of love and relationships. It starts off so happy, but then one allows one's insecurities and emotional instability to sabotage it. One can then feel so vulnerable to heartbreak that one becomes too debilitated for the relationship to progress to the next stage. Then one can emotionally withdraw from the current partner while turning a lot of attention to some other object of fixation. The process can repeat itself.

The pattern of self-sabotage can change subsequent to someone strongly choosing to change it. This does not happen overnight, of course; it is a progression of baby steps to which one maintains commitment. In the case of someone with undiagnosed, currently-untreated BPD, I do not think this can be done by sheer will alone; it also requires guidance from an expert -- a psychiatric professional. It involves training in gaining a stable sense of identity. One promising sort of treatment is Jeffrey Young's Schema Therapy.

To enter -- or return to -- psychiatric care is not easy. Nor is it easy to look for a proper diagnosis. All this takes a lot of time, energy, and work. The therapy sessions can stir up a lot of unpleasant emotions and memories. It may initially seem easier to try to repress and evade those feelings and memories. Such an evasion is untenable in the long run; one can only vanquish those haunters-of-the-mind by confronting them with the guidance of a mental health expert. In the end, truly lasting happiness can result; loving and trusting relationships can be maintained. In the end, it is worth it. What is at stake is whether one will continue living the rest of one's life in insecurity and self-image instability, or find peace with oneself and others. It is a life-saving decision. Such happiness is the single most important project or enterprise one can work on. :'-) <3

Tuesday, April 12, 2011

BPD and Object Constancy

Stuart K. Hayashi

There is an issue found in some people with Borderline Personality Disorder (BPD) that can be called an issue of Object Constancy. Though I am not a psychologist, I have read enough about this subject for me to feel relatively confident in discussing it in a more public venue. What I am about to explain is my interpretation of the writings on psychology that I have read.

I should state that not all people with BPD necessarily have this objection-relations issue. Many psychotherapists anecdotally relate, however, that this issue often arises when treating patients with BPD.

When a mother physically walks out of her baby's line of sight, that causes distress for the baby.  In the interim where the mother is gone, it's not just a matter of the baby missing his mother in the way that an adult will strongly miss someone.  An adult has an understanding of the context in a way the baby does not.  The baby cannot actually be sure, based on his limited knowledge, that the mother will ever return.  He can easily feel betrayed and abandoned.  It's as if the mother has ceased to exist, leaving him all alone.

There comes a point in a child's development, though, where this separation anxiety gradually begins to mitigate itself.  There comes a point where the following happens.  The parent tells her child that she will leave him alone for a certain amount of time, and promises to return.  There comes a point where the child comes to understand, on both an intellectual and emotional level, that the parent will indeed return.  At that point, the child has achieved a much more mature level of "object constancy" in relation to his parent.

When an adult has object constancy with respect to other people -- a human-relationship constancy -- it works like this.  Jim and Angela become very close.  They share many beautiful experiences together.  But for business reasons, they have to be separated and go to different continents for a few months.  Even for someone who is strong in object/relationship constancy, some affection might fade over time as he remains physically separated from the other person.  For the most part, though, the feeling lingers.  When Jim remembers experiences he shared with Angela, he is able, then, to re-experience, all over again, much of the same emotions he had during those moments with Angela.  The emotional bond remains strong.  Not only does Jim have conscious memories of what happened with Angela.  He also retains an emotional familiarity with Angela.

The situation is different for someone who has not developed a strong object/human-relationship constancy.  Let's pretend now that Jim doesn't have relationship constancy.  Let's also pretend that Angela is completely unaware of the psychologists' Object Relations theory, and unaware that it pertains to Jim.  This would mean that when Jim is separated from Angela for even a short while, he feels as if he cannot be certain that they will ever be reunited -- that feeling arises even if, on an intellectual level, Jim knows that they are supposed to see each other again. If Jim and Angela are separated for a longer period, Jim might go through these two stages:

1. Intensely missing Angela; it's as if a whole part of himself is gone.  He begins to wonder if Angela has chosen to abandon him.

2. If Jim an Angela are separated for too long (maybe a few weeks?), this happens: even if this is contradicted by facts he understands on an intellectual level, Jim emotionally feels abandoned by Angela.  Regardless of his intellectual understanding, Jim emotionally feels that Angela has vanished from his life.  In order to cope and survive, Jim then emotionally detaches from Angela to an extreme degree.  It's as if she doesn't exist for him anymore.  He can still have conscious memories about her, but the emotional familiarity has vanished.

If this case is severe enough, then when Angela and Jim are finally reunited, Jim might behave "politely" but in an impersonal manner that Angela finds jarring.  Jim might be "polite" to her in a way that a flight attendant is expected to be courteous toward his customers -- pleasant and smiley but also still impersonal. Angela will have a difficult time comprehending -- both intellectually and emotionally -- why the emotional familiarity has disappeared.  That will especially be confusing for her if she is someone who has a strong sense of object/human-relationship constancy.

As one website on the topic explains it,

...borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they last interacted with the borderline.

Here is how one BPD patient describes the phenomenon.

When a person leaves (even temporarily), they [people with BPD] may have a problem recreating or remembering feelings of love that were present between themselves and the other. Often, BPD  patients want to keep something belonging to the loved one around during separations. . . . I have an extraordinarily hard time holding onto the thought that people remember me, hold me dear or care for me when I am not in their physical presence. Out of sight, no longer connected. I'm sure to most people this is not how they perceive relationships (be it friendship, dating, familial). I think it should be a consistent progression of emotions and experiences that build together to form a deep bond. I also have a hard time holding onto the strong emotions I feel for those I care about, and when I do manage to I also manage to convince myself that I am the only one that feels this way and no one else could possibly share my depth of emotion though I desperately hope they do. This creates a feeling of panic and loss for something that may actually be there and I need to find a way to reaffirm these feelings in myself and others every time I am back in contact with them. It’s a maddening cycle of doubt, loss, connection and disconnection.

A good explanation (complete with Venn Diagrams) of difficulties in relationships of those with BPD is found here.

Some people try to avoid this problem simply by avoiding making any deep attachments to anyone.  Such a person can be very friendly, smiling, and laughing in public, while still remaining impersonal and detached -- largely keeping one's deepest feelings hidden from everyone in cheerful-but-superficial conversation.   But this position is untenable in the long run.  Much more long-term fulfillment can be achieved when, with the help of trained professionals, one becomes self-aware about the Object Constancy issue and learns to manage it constructively with the love and support of those who care.