ZAWAJ.COM: Editorials

BORDERLINE PERSONALITY DISORDER:

What you Need to Know

We received the following information from a Muslim brother, and we thought it was useful information that is worth sharing:

Dear Zawaj.com Editor,

Thanks for taking the time to read this e-mail.

After several years of marriage and having kids with my wife, I have discovered with the help of a therapist and by my personal study and research, that my wife has symptoms which fit the definition of Borderline Personality Disorder (BPD) in the Diagnostic and Statistical Manual (DSM-IV) (APA 1994), published by the American Psychiatric Association.

However, the problem is that all the therapists agree, due to the nature of BPD, any direct disclosure about the disorder without psychiatric supervision or any attempt to force therapy to the patient may result in denial and possible counter-blame to others. The need for therapy has to come within from the patient.

In other words, I cannot just tell her that she has the symptoms of BPD. I love her very much and I am ready to stand by her.

Therefore, I am writing to you in the hopes that she may read this, and maybe she will decide to go for therapy by herself.

Should you kindly help me by posting, distributing or forwarding this message and the following information to others then I would be grateful.

Sincerely,

Muslim Brother (Please keep my identity anyonymous)

Borderline Personality Disorder (BPD)

Is someone you care about causing you a great deal of pain?
Do you find yourself concealing what you think or feel because you're afraid of the other person's reaction or because it just doesn't seem worth the horrible fight or hurt feelings that will follow?
Do you feel that anything you say or do will be twisted and used against you? Are you blamed and criticized for everything wrong in the relationship-even when it makes no logical sense?
Are you the focus of intense, violent, and irrational rages, alternating with periods when the other person acts perfectly normal and loving? Does no one believe you when you explain that this is going on?
Do you feel manipulated, controlled, or even lied to sometimes?
Do you feel like you're the victim of emotional blackmail?
Do you feel like the person you care about sees you as either all good or all bad, with nothing in between? Is there sometimes no rational reason for the switch?
Are you afraid to ask for things in the relationship because you will be told that you're too demanding or that there is something wrong with you? Are you told that your needs are not important?
Is the person always denigrating or denying your point of view? Do you feel that their expectations of you are constantly changing, so you can never do anything right?
Are you accused of doing things you never did and saying things you never said? Do you feel misunderstood a great deal of the time, and when you try to explain do you find that the other person doesn't believe you?
Are you constantly being put down? When you try to leave the relationship does the other person try to prevent you from leaving in a variety of ways (anything from declarations of love and promises to change to implicit or explicit threats)?
Do you have a hard time planning anything (social engagements, etc.) because of the other person's moodiness, impulsiveness, or unpredictability? Do you make excuses for their behavior or try to convince yourself that everything is okay?
Right now, are you thinking, "I had no idea that anyone else was going through this?"

Does This Person Display the Following Behaviors?

Alternate between seeing people as either flawless or evil? Have difficulty remembering the good things about a person they're casting in the role of villain?
Find it impossible to recall anything negative about this person when they become the hero?
Alternate between seeing others as completely for them or against them?
Alternate between seeing situations as either disastrous or ideal?
Alternate between seeing themselves as either worthless or flawless?
Have a hard time recalling someone's love for them when they're not around?
Believe that others are either completely right or totally wrong?
Change their opinions depending upon who they're with?
Alternate between idealizing people and devaluing them?
Remember situations very differently than other people, or find themselves unable to recall them at all?
Believe that others are responsible for their actions-or take too much responsibility for the actions of others?
Seem unwilling to admit to a mistake-or feel that everything that they do is a mistake?
Base their beliefs on feelings rather than facts?
Not realize the effects of their behavior on others?

Does This Person Also:

Feel abandoned at the slightest provocation?
Have extreme moodiness that cycles very quickly (in minutes or hours)?
Have difficulty managing their emotions?
Feel emotions so intensely that it's difficult to put others' needs-even those of their own children-ahead of their own?
Feel distrustful and suspicious a great deal of the time?
Feel anxious or irritable a great deal of the time?
Feel empty or like they have no self a great deal of the time?
Feel ignored when they are not the focus of attention?
Express anger inappropriately or have difficulty expressing anger at all?
Feel that they never can get enough love, affection, or attention?
Frequently feel spacey, unreal, or out of it?

And Does This Person:

Have trouble observing others' personal limits?
Have trouble defining their own personal limits?
Act impulsively in ways that are potentially self-damaging, such as spending too much, engaging in dangerous sex, fighting, gambling, abusing drugs or alcohol, reckless driving, shoplifting, or disordered eating?
Mutilate themselves-for example, purposely cutting or burning their skin?
Threaten to kill themselves-or make actual suicide attempts?
Rush into relationships based on idealized fantasies of what they would like the other person or the relationship to be?
Change their expectations in such a way that the other person feels they can never do anything right?
Have frightening, unpredictable rages that make no logical sense-or have trouble expressing anger at all?
Physically abuse others, such as slapping, kicking, and scratching them?
Needlessly create crises or live a chaotic lifestyle?
Act inconsistently or unpredictably?
Alternately want to be close to others, then distance themselves? (Examples include picking fights when things are going well or alternately ending relationships and then trying to get back together.)
Cut people out of their life over issues that seem trivial or overblown?
Act competent and controlled in some situations but extremely out of control in others?
Verbally abuse others, criticizing and blaming them to the point where it feels brutal?
Act verbally abusive toward people they know very well, while putting on a charming front for others? Can they switch from one mode to the other in seconds?
Act in what seems like extreme or controlling ways to get their own needs met?
Do or say something inappropriate to focus the attention on them when they feel ignored?
Accuse others of doing things they did not do, having feelings they do not feel, or believing things they do not believe?

What is the Diagnostic and Statistical Manual (DSM-IV)?

Quote from book published by the American Psychiatric Association:

"The DSM IV provides the only comprehensive classification of all recognized psychiatric disorders in print. This edition features increased emphasis on multicultural influences, development across the lifespan, and substance abuse disorders. More than 1,000 clinicians and researchers have contributed to the revision of this classic reference".

Please note that only five of the nine listed symptoms are required to make a diagnosis.

Borderline Personality Disorder Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3- Identity disturbance: markedly and persistently unstable self-image or sense of self.

4- Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self- mutilating behavior covered in Criterion 5.

5- Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior.

6- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7- Chronic feelings of emptiness.

8- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9- Transient, stress-related paranoid ideation or severe dissociative symptoms.

- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC

Associated Features:

Borderline Personality Disorder frequently co-exists with the following:

Depressed Mood
Addiction
Dramatic or Erratic or Antisocial Personality

Differential Diagnosis

When you visit a GP with a sore throat she may take a couple of tests, maybe test for a virus and possibly take a blood test. Based on these results she will be able to diagnose you. In the course of that diagnosis she may be presented with two possible alternatives (a common cold and/or strep throat for example), it is now her job to diagnose the most probable of the two. This is a differential diagnosis. On psychiatric evaluation a patient may present with symptoms of possibly two or more illnesses. It is the psychiatrists role to differentiate which is the most probable and take action based on that decision.

Here are a list of the possible other diagnoses on the mood disorder and personality disorder spectrum. These must be carefully considered and ruled out before a definite diagnosis is made. It is also likely that those with borderline personality disorder will be carrying another, possibly equally debilitating disease and this also has to be taken into account.

- Mood Disorders
- Histrionic Personality Disorder
- Schizotypal Personality Disorder
- Paranoid Personality Disorder
- Narcissistic Personality Disorder
- Antisocial Personality Disorder
- Dependent Personality Disorder
- Personality Change Due to a General Medical Condition
- Symptoms that may develop in association with chronic substance use
- Identity Problem

BPD Online Resources:

What is BPD?
http://www.bpdcentral.com/resources/basics/main.shtml

Indicators of BPD:
http://www.bpdcentral.com/resources/basics/indicators.shtml

Additional Traits Common to People with BPD
http://www.bpdcentral.com/resources/basics/additional.shtml

Types of BPD
http://www.bpdcentral.com/resources/basics/types.shtml

Assumptions held by BPD sufferers
http://www.bpdcentral.com/resources/basics/assumptions.shtml

Myths and Realities about BPD
http://www.bpdcentral.com/resources/basics/myths.shtml

Common "games" between BPs and Non-BPs
http://www.bpdcentral.com/resources/basics/games.shtml

BPD Central - Frequently asked questions (FAQs)
http://www.bpdcentral.com/faqs.shtml

Learn More

BPD Central - Message Board
http://www.bpdcentral.com/nookboard/index.php

Causes and Treatment for BPD
http://www.bpdcentral.com/resources/mediakit/causes.shtml

Dialectical Behavior Therapy
(An evidence-based, cognitive-behavioral treatment)
Frequently asked questions (FAQs)
http://www.behavioraltech.com/downloads/DBT_FAQ.pdf

Media Kit
http://www.bpdcentral.com/resources/mediakit/main.shtml

Books for Non-BP:

"Stop Walking on Eggshells; Coping When Someone You Care about Has Borderline Personality Disorder"
by Paul T. Mason, Randi Kreger, Larry J. Siever
ISBN: 157224108X
http://www.amazon.com/exec/obidos/tg/detail/-/157224108X/

"The Stop Walking on Eggshells Workbook: Practical Strategies for Living With Someone Who Has Borderline Personality Disorder"
by Randi Kreger, James Paul Shirley
ISBN: 157224108X
http://www.amazon.com/exec/obidos/tg/detail/-/1572242760/

"I Hate You, Don't Leave Me: Understanding the Borderline Personality"
by Jerold J. Kreisman (Author), Hal Straus (Author)
ISBN: 0380713055
http://www.amazon.com/exec/obidos/tg/detail/-/0380713055/

More Books:
http://www.bpdcentral.com/books/more_books.shtml

Further Resources / web-sites:

- http://www.bpd.net.nz/
- http://www.bpdcentral.com/links/general.shtml
- http://www.bpdcentral.com/links/related.shtml
- http://www.BPDresources.com

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