Mental Health

[River]

I did a "tag" search on "mental health," but didn't find a thread which seemed appropriate for my question. So I'm starting this thread so we have one very broadly conceived location for questions like mine on mental health issues in relationships, generally. I'll put "mental health" in the tag box for this one.

 

[River]

Okay..., somebody mentioned Borderline Personality Disorder (BPD) in the forum recently, and this occurred not long after a friend of mine shared with me her nearly desperate unhappiness in her relationship with her boyfriend.

Her boyfriend (with whom she shares a home) has, she says, a rather extreme fear of abandonment, among other symptoms of BPD. She admits that part of the reason she stays in this relationship is that she feels financially dependent upon him. She's not fully employed and has minimal income. And I want to be supportive and helpful, if I can.

Today, in an email (I don't see her often; she lives somewhat far away), I told her I suspect that her boyfriend may have BPD, and sent her a link to this video as an introduction to the topic of BPD. I did not, and do not, claim expertise in this area. I just thought she might benefit from knowing that it's possible that her b.f. may suffer from the condition. I did not perform a diagnosis, of course! (Nor would I pretend to be able to do so.)

She's likely to have more questions and calls for support of some kind from me in the coming days, and I'd like to discuss this here because I suspect some here may have experience and knowledge which may be of use to me (and others) in my situation.

I'm available for questions and comments, and conversation on the broad topic of helping a friend who is in this sort of a situation. Thank you.

 

[Leetah]

As I understand it Borderline Personality is really hard to treat. Getting someone to recognize it in themselves and be willing to go through the process of change is very difficult. Tam and I had a good friend married to someone with BPD.

Leetah

 

[kdt26417]

I was diagnosed with BPD at one time. I don't consider myself an expert, but I am willing to answer any questions about my own experience.

 

[River]

Thanks KDT -

Mostly I'm interested in supporting my friend as she explores the question as to whether her b.f. might have BPD, and thought perhaps folks in here could offer suggestions about how to relate to my friend as she considers this.

It's pretty clear it isn't something that can be treated with a pill, or which can be expected to change dramatically any time soon. Years of slow, therapy would most likely be required. (If, indeed, the b.f. would be so diagnosed). She's pretty unhappy in the relationship, generally. But I don't want to tell her that it's my opinion that she should pack her bags and move along. I think she should arrive at her own decision without any such suggestion from me. Mostly what I've been doing with her so far is to simply encourage her to accept and honor her own needs and desires and to practice self-kindness and self-compassion.

On a side note, though, KDT, you say you were once diagnosed with PBD. I'm curious to know whether you sought therapy for that and how it went for you.

 

[kdt26417]

I had a self-help book for people with BPD. I didn't get all the way through it, it was hard to read. The author repeatedly wanted me to recognize how much I was hurting other people. Not exactly a boost for my self-esteem. And then my diagnosis changed, from BPD to bipolar if I remember right. I did not get therapy at that time.

 

[River]

I had a self-help book for people with BPD. I didn't get all the way through it, it was hard to read. The author repeatedly wanted me to recognize how much I was hurting other people. Not exactly a boost for my self-esteem. And then my diagnosis changed, from BPD to bipolar if I remember right. I did not get therapy at that time.

Apparently, borderline personality disorder (BPD) and bipolar disorder are frequently misdiagnosed -- one for the other. I'm not sure if this is due to sloppy diagnosis or the very real possibility that one has both conditions, more-or-less (with one perhaps being at "sub-clinical" levels). As the interviewer said in the video I linked to above, most of us exhibit some degree (a sub-clinical degree) of the various symptoms which make up BPD. Abandonment trauma is extraordinarily common among ordinary, everyday people, after all. It's the matter of severity or strength of the symptoms which leads to a proper diagnosis, it seems. Also, it appears to be the whole constellation of symptoms, at a certain severity level, which leads to the diagnosis, done right.

What do you think, KDT? Were you misdiagnosed when diagnosed with BPD?

How's it going with your bipolar, these days? I imagine you are probably on some kind of medication? Therapy?

 

[GalaGirl]

I don't think people with mental health issues are bad people. I do think that people with unmanaged mental health issues could sometimes hurt themselves and/or others.

So my boundary is that I won't hang out with unmanaged people. Dealing with mine and my parents is plenty for me -- I don't need extra.

My father (with his MANY mental health problems, not just Alzheimer) rains down emotional and verbal abuse. My mom totally has fleas but she's determined to stay til he's dead and buried. He has BPD. He also has anosognosia -- a condition where he does not even see that he is sick.

So... if the BF is similar? BPD and cannot see it? Well, don't hold your breath that he's gonna do his therapies and management plan things. Or even go in to be properly dx'd.

Remember your friend might have "fleas" after living with all this.

http://outofthefog.website/what-not-to-do-1/2015/12/3/fleas

And carry a lot of guilt or shame.

Both of these might help you relate to your friend.

http://outofthefog.website/toolbox-intro/

That lists what it feels like, what to do and what not to do.

https://speakoutloud.net/articles

around the middle lists how to support victims of abuse in various stages of leaving or if they want to stay. With tips for friends and family of the person. What to do/not do.

She's pretty unhappy in the relationship, generally. But I don't want to tell her that it's my opinion that she should pack her bags and move along. I think she should arrive at her own decision without any such suggestion from me.

Why not? I think you could be honest and tell her this situation doesn't look so hot and if it were you? You would leave. Like...

"You don't seem happy. If it were me? I would leave this relationship. I get that leaving is a hard choice, and I'm not you. So I'm not going to harp on it. I do think you are better off leaving though. I need to say that to you at least once so you know where I stand.

I want to support you as much as I can. You need to be able to make YOUR own choices.

I am good for things like ______.

I am not good for things like ______.

I cannot and will not support any of _____.

I have a limit on ____. "​

That is honest, and she can know what to expect from you. My friend Sally appreciated that from me. Because at home? She got word salad, changing goal posts, promises not kept, etc. She knew with me? I laid it out plain and what I said is what it was.

I've helped several of my friends leave situations. In my observation? One must physically leave before they can heal enough mentally, emotionally, or spiritually. But they cannot physically leave if they are mentally, emotionally, and spiritually run down. It is a weird circle thing.

So I think one must practice physically leaving "small" so the rest can start to heal when it IS NOT being harangued. So one can think about "leaving medium" and then maybe "leaving big."

I remember one time another friend (call her Jane) was really UPSET with me because I wouldn't tell our friend (call her Sally) to just up and leave.

Jane wanted to say to Sally "He's an asshole! You should leave!"

I would say things like "Well, all couples have problems. Maybe just a little weekend break would be good. Come stay over."

Really I thought the guy was taking his mental health problems out on our friend and she should get the hell out. Sally didn't cause it and could not cure it and he wasn't attending to it. He also grew verbally and physically abusive. So all she could expect there was more of same so getting OUT permanently would be best.

I told Jane to back off and leave Sally be. She was already receiving a hailstorm of abuse at home. She did not need her friends adding a new storm. Or worse -- taking away her agency and her ability to think for herself too. He was already telling her she was stupid, she should do this or that. What would more of same from friends do? That he is an ass and she should leave and she's dumb wanting to stay? That would just make her feel worse.

Sally was also NOT at a place to hear "leave this guy forever." She might be more receptive to "Come stay with me for a weekend. Take a little break." She had a lot of fleas, and she was mourning the relationship and mourning that it had come to this and she wasn't ready to be angry or ready to leave or imagine a whole new life post leaving. Too big.

But she might be able to imagine coming over to dinner, movies or board games, spending the night, brunch and a walk with kids in the park. Then go home. Lower key things.

So I told her I was good for an ear -- like a coffee date for an hour. (Because listening to TOO much made ME ugh.) Taking a walk. Playing board games.

I was good for weekend breaks if she wanted to spend the weekend with us.

I was NOT good for couple things because I wanted no part of being around him so don't even suggest doing a movie together.

I was NOT good for him being around my children. So when I say she could come to dinner or whatever, it was an invitation for just HER, not both.

I did NOT support him keeping her on a tight "phone leash." I had a limit on cel phone boopies. So if she was with me she had to put her cel phone on vibrate. Because I didn't want to hear phone every few minutes with him checking up on her. He knew where she was. Having coffee for an hour down the street from her house. Was an hour on vibrate so I didn't have to hear boopies a horrible request? She agreed no. So she would put her phone ringer to vibrate.

(He buzzed her pants like hell, BTW. But she'd grown SO used to the phone leash ringing and was SO trained to answer immediately she'd stopped seeing it as weird and didn't notice how often it rang in one hour. Having to sit with her pants vibrating most of an hour made her realize how ridiculous it was. It was just an hour and she was down the street having coffee!)

I remember the long process of Sally leaving and waking up. The more time she spent away from him and doing "small leavings" the more she started to "wake up" to the weird and the more she was surprised at all the dysfunction that had crept in. She eventually did a medium leave -- moved in with another friend for a lease and a trial separation. They were supposed to live apart and do counseling to work on being together healthier. Well, he didn't like the counselor and BLEW UP but by that time she'd gotten used to living in peace and what that was like so she could SEE how weird he was.

Which led to leaving big -- the divorce. She had a home, a job, etc by then. She could pay her way.

Mostly what I've been doing with her so far is to simply encourage her to accept and honor her own needs and desires and to practice self-kindness and self-compassion.

That may be all you can do at this time along with inviting her for an "afternoon coffee break" or "weekend break" or "week break." The small leavings.
And read. Starting with

https://speakoutloud.net/helping-women/coercive-control-stage-1

Pay attention to the tips for friends and family of the person.

And look out for YOUR mental health. Don't get over-involved in this situation.

Accept you can only help so much, and point her to professionals for the rest.

I used to drive Sally to "healthy relationships class" at the mall. She refused to go to a women's shelter. We were pretty sure when he stopped ringing so much he was tracking her more quietly by her phone location. I told her she didn't have to go to the shelter. But taking the women's shelter classes at the mall? Was that horrible? I could help with rides. She agreed it might help so we changed the weekly Scrabble/coffee date to a weekly Panera dinner date. She went to class in the mall community room with her Panera to go. I ate Panera at Panera waiting for her to get out of class to drive her back home. The phone showed her at the mall. Problem solved.

So... support may take on that shape too. Keep it in mind.

Galagirl

 

[kdt26417]

I had therapy for awhile, none right now, I just take a medication, namely Zyprexa. My diagnosis has changed several times, for awhile it was schizoaffective disorder, now it is autism spectrum disorder. Before BPD there was clinical depression, even attention deficit disorder at one time. Whatever I have, it is hard to pin down, and maybe it's multiple conditions. Some of my diagnoses were informal, done by Snowbunny who is not a doctor but who did a shitton of research. Some were done by Snowbunny with a doctor in concert. Some were done by a doctor before Snowbunny came along.

 

[River]

I had therapy for awhile, none right now, I just take a medication, namely Zyprexa. My diagnosis has changed several times, for awhile it was schizoaffective disorder, now it is autism spectrum disorder. Before BPD there was clinical depression, even attention deficit disorder at one time. Whatever I have, it is hard to pin down, and maybe it's multiple conditions. Some of my diagnoses were informal, done by Snowbunny who is not a doctor but who did a shitton of research. Some were done by Snowbunny with a doctor in concert. Some were done by a doctor before Snowbunny came along.

I think there are a lot of valid, legitimate places to land on why it's so difficult for even the trained professional experts to come up with the same diagnosis / diagnoses for the same patient / client. But that entirely leaves out the Snowbunny question, since you say she is no such person. It may be that the DMSR is faulty and inadequate, or that the entire program of creating psychological and psychiatric diagnoses is inadequate or worse. There is a long history of controversy on that very question. See, for example:

https://en.wikipedia.org/wiki/Anti-psychiatry

Maybe too many diagnosticians aren't properly or sufficiently 'trained' (or, better, educated).

I'm not ready to throw out the whole DMSR, or to toss out the notion that there really are identifiable "disorders" (most of which are perhaps best defined as syndromes: "a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms").

If you look at the list of symptoms for any given disorder (syndrome), you'll notice that many of the same symptoms appear in many of the various listed disorders / syndromes. In diagnoses, doctors and psychologists are expected to evaluate the strength or severity as well as the presence of whatever the given particular symptoms are ... and if there are enough of the necessary symptoms to the right degree, a diagnoses can be made. Obviously this can get more than a little tricky in some cases, such as in cases of so-called comorbidity.

All of that said, I think what a lot of clients and patients need, whom get medicated instead, is a lot of good fresh air and exercise, a good diet, some herbal medicine and some very good, supportive friends. A lot of what gets diagnosed ought not to have been, and it serves Big Pharma for doctors to hand out just as many expensive pills as possible.

But then there are real traumas with severe consequences, and their associated "adaptive strategies" which are essentially the only way folks know how to cope. And their are some biologically based (organic) conditions at the root of some of this stuff, too. It's complicated!

I think Borderline Personality Disorder (or syndrome) is a pretty real thing.

 

[River]

I don't think people ....

Hi GalaGirl !

Somehow I read KDT's response before even seeing yours. I'm sorry -- I didn't mean to give the impression that I was ignoring your post. I'm reading it now and will respond to it when I'm able to. Thanks!

 

[River]

I don't think people with mental health issues....

Wow! This is exactly the kind of response I was wanting. It's very helpful -- not only for me, as I had hoped it would be, but also for anyone else reading it. As I hoped some of the responses here would be.

Thanks again, GalaGirl!

I haven't looked at the material you linked, yet. But I will; and I have no doubt it will prove helpful as well.


Edit:

G.G. -

Your consistent kindness, generosity, intelligence and wisdom inspires my heart.

 

[GalaGirl]

You are welcome. Glad it helps you some.

Do point your friend to professionals for HER well being. Mental health services can be found for free, low cost or sliding sale. Like training places, universities, local mental health association with interns, etc.

Galagirl

 

[River]

Will do, GG.

I've yet to hear back from her on what I suggested about her b.f.

I call her a friend, 'cause she's more than an acquaintance, but she's more the friend (a somewhat casual friend) of my partner. She also attends the body-centered (somatic) meditation group I facilitate. I have not gotten especially close to her. But I definitely do care about her a lot. So I do want to help.

 

[KC43]

BPD is definitely a thing, but from what I've seen and heard, in my own experience and the experiences of people I know, it has a fair chance of being misdiagnosed. Either someone who *doesn't* have it is diagnosed *with* it, or someone who *does* have it is diagnosed with something else.

There are other diagnoses that share symptoms and indications with BPD, and there's some comorbidity involved as well. So it isn't always easy to diagnose.

I have been (correctly, I believe) diagnosed with complex-PTSD. So has a friend of mine. Both of us were diagnosed years ago with BPD. But the traits and tendencies that led to that diagnosis were, for both of us, defense mechanisms and protections forged during years of verbal and emotional abuse from others. Both of us have since had professionals tell us that we *don't* appear to have BPD, because we lack some of the most common, and most BPD-specific, traits and symptoms.

When we were initially diagnosed, though, complex-PTSD hadn't yet been identified; people who experienced a single traumatic event and people who experienced years or even decades of longterm abuse and trauma from which they had no respite were all diagnosed with PTSD. It's only within the last decade or less, as I understand it, that the mental health community has realized that PTSD caused by longterm, inescapable abuse and trauma has a LOT of differences from PTSD caused by a single traumatic event (e.g. a car accident) or shorter-term trauma. Trauma alters brain chemistry and structure; this has been proven scientifically. Obviously, trauma that occurs over a period of years or decades is going to cause significantly more alteration than a single incident. Complex-PTSD is the name currently given to the alterations, symptoms, and traits in those who experienced longterm trauma.

As Kevin's experience shows, people with Bipolar disorder are sometimes misdiagnosed as having BPD. (It doesn't help that some people use BPD as an abbreviation for bipolar rather than borderline personality disorder...)

I know someone who has Asperger's syndrome who, before they were correctly diagnosed as having Asperger's, were misdiagnosed as having BPD. In their case, the traits and behaviors that were mistaken for BPD were a direct result of not having the understanding and knowledge of "how to human," so to speak. Once they were correctly diagnosed and enrolled in a program designed for people diagnosed as adults with autism spectrum disorders, where they learned the social skills and why their behaviors were problematic, the "BPD" disappeared--because they never had it to begin with.

All of which is a long explanation of why it's important for *anyone* to be very cautious about diagnosing someone with BPD, or even suggesting that they might have it. Given that mental health professionals don't always get it right, it can be unwise for non-professionals to take a guess at someone's possible mental illnesses. The traits and behaviors associated with BPD can be the result of a number of other factors and have nothing at all to do with BPD.

For those who do exhibit these traits and behaviors, or at least some of them, regardless of diagnosis, Dialectical Behavior Therapy (DBT) seems to be a useful tool. It was originally developed for people with BPD, but is equally successful for survivors of longterm abuse, and for people with other disorders and issues that might distort their perceptions of their own and other people's behavior.

 

[River]

Thanks KC43.

I'm likely to see my friend -- with whom I shared my concern -- today. I'll be very clear that I can't diagnose anyone ... and neither can she. I'll even tell her that even expert professionals appear to misdiagnose this one with surprising frequency.

One thing we definitely do know about this guy (her b.f.) is that he shares a number of the symptoms on the list of folks with BPD, including and crucially a severe case of fear of abandonment. This much we do know. It's not a guess. It's clear. And the consequence is that it makes my friend a little crazy being with and around him -- at least at times.

She has a history of getting caught up with abusive or neglectful (or both) men. I hope she will break that cycle, 'cause it's got to hurt. I'm going to encourage her to take good care of herself. And I'll tell her one of the not so hidden secrets of relational happiness that I learned too late in life but none too soon, about half a lifetime ago.: "How other people we're in relationship with treat us is how we're treating ourselves." It came as quite an aha! for me when that notion first blossomed in my consciousness! It seems so obvious; but so many people just don't see it. So some need an explanation. And the explanation is just as obvious as the fact itself. If we're choosing to spend a lot of time with someone who is abusive or neglectful, that's who we're choosing to spend a lot of time with. We're choosing it. Therefore, how he or she treats me is how I'm treating myself. If I want better treatment, that depends upon me -- not "them".

I can choose, of course, to request better treatment from "them" (and be specific in my request). But even that is how I'm treating myself. And if "they" don't change their ways at my request? That's my problem more than it is theirs. I can choose not to hang out with them.

When we are infants and young children, of course, we didn't have that option with regard to our primary care-givers. So we erected all kinds of coping strategies just to hold it together and have food and shelter and other basic needs met. We didn't have the option to choose different parents. So it does come as a major insight when we wake up and realize -- "Oh, yes, I can choose now."

 

[KC43]

I understand what you're saying.

Fear of abandonment is one of those things that *isn't* exclusive to people with BPD. I'm afraid of abandonment to pretty much phobia level, but again, my current medical and mental health care providers have rescinded my 2-decades-old diagnosis of BPD.

In my case, the fear of abandonment is directly tied to attachment disorder. Attachment disorder *can* be a sign of BPD as well-- but it can also be the result of having parents who were neglectful and/or abusive from the time one was very young, in my case an infant. There was no parental bonding, because one of my parents didn't want to bond, and the other was emotionally incapable of it. So for as long as I can remember, I had to mostly take care of myself, couldn't rely on anyone for support or protection in any way.

That's changed now, but only since I met Hubby ten or so years ago. And honestly, Hubby hasn't helped a whole lot, between his general indifference to interacting with me and his tendency to say he'll do things and then not do them, or only do them after I've reminded him half a dozen times. So those behaviors from him have reinforced the belief that I can't rely on anyone and have to mostly take care of myself; at the same time, *sometimes* he takes care of me, and *sometimes* I can rely on him, so it's confusing to the disordered part of me.

My fear of abandonment is the result of having been emotionally abandoned by my parents from...well, pretty much from birth. And from having been emotionally and sometimes physically abandoned by others I arguably should have been able to count on in some way.

I don't know your friend or her partner, but his fear of abandonment, even to the clearly unhealthy level you describe, might be due to abuse or other factors, and not to BPD... That, again, is one of those things for a mental health professional to determine, and even they might get it wrong.

 

[Evie]

I'm sorry if this is a tangent, but it's playing on my mind today.

After being in a (comparatively short) relationship with someone last year who probably has Borderline Personality Disorder, I now find myself hyper vigilant, suspicious even, of new people.

e.g. are those texts normal behaviour, or is this love bombing?

And I hate having that nagging little fear when I'm getting to know someone.

Does anyone have sage word about this?

 

[River]

I'm sorry if this is a tangent, but it's playing on my mind today.

After being in a (comparatively short) relationship with someone last year who probably has Borderline Personality Disorder, I now find myself hyper vigilant, suspicious even, of new people.

e.g. are those texts normal behaviour, or is this love bombing?

And I hate having that nagging little fear when I'm getting to know someone.

Does anyone have sage word about this?

I don't have sage words about it, but I can say that, yes, I too am having a similar experience ... not so much about BPD, or even personality disorders more generally, but about forming any kind of connection (platonic or 'romantic') with folks who won't or can't treat me with kindness and respect, etc.

I paused for a long while two thirds into that last paragraph, to try and find the best words to describe my situation. That situation isn't all about mental health at all. It's just that so very many people in my life in recent time, whether it be the landlord, random people on the street, acquaintances ... and yes, even some friends, have hurt or disappointed me in this way. I've become more cautious than I've ever been -- most especially following the brutal deterioration of a friendship / working relationship a couple years back. That fella, it turns out, had narcissistic personality disorder. I didn't live with him, but had a working relationship with him as well as what I thought was a friendship. But I did catch a few "fleas" in the meanwhile, before I ended all interaction with him.

And, lately, I've gone out for coffee and such with folks in a sort of "dating" sort of way, and some of them seemed fine for a while and then I discovered that they're all covered in cuckoos. Folks who appeared basically okay are all of a sudden dumping really nasty words on me and showing me the nasty and dangerous snakes in their hair. It gets a bit tiring.

 

[River]

I don't know your friend or her partner, but his fear of abandonment, even to the clearly unhealthy level you describe, might be due to abuse or other factors, and not to BPD... That, again, is one of those things for a mental health professional to determine, and even they might get it wrong.

I majored psychology at the undergrad level in college, long ago. I was a damn good student, too, usually topping the test scores in my classes. I've also read psychology off and on through my life after. And I'm still not so clear on the precise distinction between a DSM classified disorder and run of the mill (even if severe) symptoms of, for example, relational / developmental trauma. I think it may be that I'm unclear because there really isn't much clarity on the topic. I mean, aside from checking boxes on a list of diagnostic symptoms.

Anyway, yeah, I can relate to the abandonment trauma thing. It scarred me quite a lot as a young person and I continue to grow and heal (recover) to this day. It didn't help that I spent the first six weeks of my life in an incubator, of course. This was back before they knew to provide a lot of touch for incubator babies. But that was only the start!