Chroniques d'une Névrosée

What is Borderline Personality Disorder (BPD)?

A borderline writes:
"Being a borderline feels like eternal hell. Nothing less. Pain, anger, confusion, hurt, never knowing how I'm gonna feel from one minute to the next. Hurting because I hurt those who I love. Feeling misunderstood. Analyzing everything. Nothing gives me pleasure. Once in a great while I will get "too happy" and then anxious because of that. Then I self-medicate with alcohol. Then I physically hurt myself. Then I feel guilty because of that. Shame. Wanting to die but not being able to kill myself because I'd feel too much guilt for those I'd hurt, and then feeling angry about that so I cut myself or O.D. to make all the feelings go away. Stress!"

Therapists use a book called "Diagnostic and Statistical Manual" (DSM) to make mental health diagnoses. They've outlined nine traits that borderlines seem to have in common; the presence of five or more of them may indicate BPD.

However, please note the following:

• Everyone has all these traits to a certain extent. Especially teenagers. These traits must be long-standing (lasting years) and persistent. And they must be intense.
• Be very careful about diagnosing yourself or others. In fact, don't do it. Top researchers guide patients through several days of testing before they make a diagnosis. Don't make your own diagnosis on the basis of a WWW site or a book!
• Many people who have BPD also have other concerns, such as depression, eating disorders, substance abuse - even multiple personality disorder or attention deficit disorder. It can be difficult to isolate what is BPD and what might be something else. Again, you need to talk to a qualified professional.

DSM-IV Definition of BPD

1. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
2. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
3. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."

Following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10:

The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area....people are idolized one day; totally devalued and dismissed the next.

Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely unaware of one feeling state while in the other.

When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in other to preserve the all-good image of the other person.

Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.

1. Identity disturbance: markedly and persistently unstable self-image or sense of self.
2. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
3. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
4. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
5. Chronic feelings of emptiness.
6. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
7. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.

There is no "pure" BPD; it coexists with other illnesses. These are the most common. BPD may coexist with:

• Post traumatic stress disorder
• Mood disorders
• Panic/anxiety disorders
• Substance abuse (54% of BPs also have a problem with substance abuse)
• Gender identity disorder
• Attention deficit disorder
• Eating disorders
• Multiple personality disorder
• Obsessive-compulsive disorder

Statistics about BPD

BPs comprise:

• 2% of the general population
• 10% of all mental health outpatients
• 20% of psychiatric inpatients
• 75% of those diagnosed are women
• 75% have been physically or sexually abused

Source: bpdcentral

Are bipolar and borderline personality disorder related?

Borderline personality disorder (BPD) has been a controversial diagnosis since it was first recognized in the Diagnostic and Statistical Manual of Mental Disorders in 1980. One controversy that still has not been resolved is whether BPD is actually just a variation of bipolar disorder.

How are Bipolar and Borderline Personality Disorder Similar?

The primary reason that some experts have proposed that BPD and bipolar disorder may be related is that they share the common feature of mood instability. Bipolar disorder is associated with mood shifts from depression to mania (a mood characterized by elation, decreased need for sleep, and an increase in activity) or hypomania (which is similar to mania but less severe). BPD is also associated with mood changes (sometimes called "emotion dysregulation" or affective instability). People with BPD can frequently change from feeling fine to feeling extremely distressed in a matter of minutes. Impulsive behavior is also frequently experienced both by people with bipolar disorder and by people with BPD.

How are Bipolar and Borderline Personality Disorder Different?

What is the difference between BPD and bipolar disorder, then? Some major components separate the two. While the disorders are both characterized by mood changes, the quality of the mood changes can be very different. In BPD, mood changes are often more short-lived -- they may last for a few hours at a time. In contrast, mood changes in bipolar disorder tend to last for days or even weeks. Also, mood shifts in BPD are usually in reaction to an environmental stressor (such as an argument with a loved one), whereas mood shifts in bipolar disorder may occur out-of-the-blue. Finally, the mood shifts typical of BPD rarely involve elation -- usually the shift is from feeling upset to feeling "OK," not from feeling bad to feeling a high or elevated mood, which is more typical of bipolar disorder.

Are Bipolar and Borderline Personality Disorder Related?

Although it is not yet clear-cut, research has not found a strong relationship between BPD and bipolar disorder. There is some evidence that people with BPD are diagnosed with bipolar disorder at higher rates than individuals with other personality disorders. One study found that about 20% of individuals with BPD are also diagnosed with bipolar disorder, whereas only about 10% of people with with other personality disorders are also diagnosed with bipolar disorder. This could mean there is some relationship between BPD and bipolar, but it could also be attributed to imprecision in diagnosis, or in the individuals making the diagnosis.

Bipolar and Borderline Personality Disorder: The Bottom Line

So far, there is not enough research to suggest that BPD and bipolar disorder are related. Although there are definitely some shared features, there are also some marked differences between BPD and bipolar disorder. Also, the co-occurrence of BPD and bipolar disorder is not large enough to suggest that the two disorders are related. However, more research is needed on this topic. It may be that future research, for example on the genetic and biological causes of BPD and bipolar disorder, may reveal some undiscovered elationships between the two conditions.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision. Washington, DC, Author, 2000.

Gunderson JG, Weingberg I, Daversa MT, Kueppenbender KD, et al. "Descriptive and Longitudinal Observations on the Relationship of Borderline Personality Disorder and Bipolar Disorder." American Journal of Psychiatry, 163:1173-1179, 2006.

Paris, J. "Borderline or Bipolar? Distinguishing Borderline Personality Disorder from Bipolar Spectrum Disorders." Harvard Review of Psychiatry, 12:140-145, 2004.

Avant tout, je suis une personne comme tout le monde, je travaille, j'ai ma famille, mes amis, mes loisirs, mes passions.

J'adore la musique, la lecture, la géopolitique, je fais du sport, je parle plusieurs langues, je voyage, j'élève mon fils qui a 5 ans et demi. 

Je vis comme tout le monde, avec des hauts et des bas plus aigus et plus fréquents.

Et de quelle façon se manifeste ces maladies ?

La bipolarité se manifeste dans ma vie par intermittence et en pointillés.

Je passe par des phases d'excitation, (je dors moins, je suis hyperactive, je dépense plus , je me sens bien, je parle très vite, j'ai envie de séduire...) et il peut suivre des phases dépressives (je suis triste , je reste au lit, rien ne m'intéresse, je suis mal, j'ai des idées noires...).
Certaines périodes, je retrouve une "vie normale".

Les cycles dans le trouble bipolaire sont d'assez longue durée, parfois quelques mois ce qui n'est pas le cas dans le trouble borderline.

Le trouble de la personnalité limite (borderline) me gêne parce que je suis très très sensible, je mets beaucoup trop de temps à me remettre de mes émotions. J'ai tendance à vivre les choses plus intensément que les autres.

Ma drogue c'est les montées d'adrénaline, les sensations ultra fortes, l'excès d'émotions, qui, me font du bien (ou du mal) sur le coup, et me désarçonne sur le long terme.

Je subis mes cycles de bipolarité quoi que je fasse et indépendamment des facteurs externes, alors que mes troubles borderline sont le fruit de mes émotions et de mes impulsions, ou plutôt mon vécu du moment ce qui explique la rapidité de changements et le sentiment trompeur que j'ai plusieurs personnalités (je peux bien démarrer une journée de façon relativement euphorique et il suffit que dans ma voiture, un feu passe au rouge alors que je pensais qu'il resterait au vert pour que la mauvaise humeur s'installe et la journée devienne un enfer).

Le troubel borderline me rend impulsive, instable un peu dans tous les domaines comme la vision que j'ai de moi-même, mes relations avec les autres, mon mode de pensée souvent noir et blanc, mes émotions que je subis de façon anarchique, ... ce qui n'est pas le cas du trouble bipolaire.

Comment  es-tu soignée ?

Je prends un traitement à base de thymo-régulateurs, parfois associés à des anxiolitiques.

Je suis suivie par un psychiatre pour une psychothérapie et pour la prescription du traitement.

Il est important de respecter une bonne hygiène de vie :

- le sommeil (difficile parce que je n'aime pas dormir tôt la nuit, mais il faut s'auto-discipliner)
- les repas équilibrés
- les activités, le sport (qui me remonte le moral dans les phases "down")
- d'éviter les conduites addictives (alcool, tabac, drogues, etc...)

Enfin, une harmonie familiale et sociale contribue à la stabilité de la maladie.

  Guérit-on de ces maladies ?

OUI. Après avoir accepté le diagnostic, la volonté et la détermination des patients peuvent mener à la guérison.

Grâce à l'observance du traitement et au soutien de mon psy, j'ai espoir de me stabiliser.

Qu'est ce que ta sensibilité de borderline et bipolaire t'apporte ?

Une attirance pour l'art en général, une meilleure acuité de perception, un esprit de créativité, une curiosité exacerbée, un réel besoin de mettre en oeuvre des projets et un sens aigu de l'empathie.