BPD-related cognitive-perceptual difficulties and challenges in their diagnosis and treatment

BPD-related cognitive-perceptual difficulties and challenges in their diagnosis and treatment

We’re, at some point in our lives, introduced to concepts like “Born Leader”, “Natural Talent”, “Winner”. I’m sure these terms sound familiar. I’m also sure that the concepts they hold are multi-faceted, or perhaps they hold more than one concept. The intention of these specific concepts is to be something to which we might aspire, and I have picked them specifically for a reason. They also hold an underlying message, or rather, how they are applied by an individual may make what is intended to be “aspirational” and turn it into something which creates a division. They’re usually used fairly lightly, and it’s difficult to see how they may be in any way harmful. But for some small percentage of the population, based on the interpretation, their implication is fundamental, defining and to some degree final. I think we all know that when a baby is born they most definitely do not possess leadership skills. Anyone who has had a child is far more likely to describe the first developmental stage of the child as “the grub” stage, in which the child is not particularly interactive, let alone using leadership skills to lead anyone to take any particular action, in fact one of the bigger difficulties in taking care of a newborn child is interpreting their needs and trying to meet those needs. I think it’s clear that no such thing as a born leader exists. The same goes for natural talent, I think we understand that certain physical bodily attributes may allow a person to develop a skill in one direction or another. If I take the example of a runner, we have become aware of the structure of muscle fiber, and we have begun to see a correlation between percentage of one type of muscle fiber over another in runners, who seem to excel either at short sprints or longer, stamina dependent running. I am fairly certain that even the best sprinters started life unable even to walk, and that the skill displayed later in life has been developed through a lot of effort.

You may feel that this is an overly analytical, even pedantic, look at what is clearly semantics. That this level of distinction may easily be overlooked without any affect. You would be correct in thinking that, but to a portion of the population, this level of consideration triggers in them strong emotions. To that portion of the population the concept of “Born Leader” means that they either are or aren’t capable of being a leader of people, they either do or don’t have natural ability, they are either a winner or a loser. If one makes an observation about another person, saying “That person is a born leader”, to them the implication is that you don’t think that they are a born leader, because it stands to reason that if you did, your observation would be about them, rather than the other person. To these people the idea that people are simultaneously good and bad, kind and caring, and simultaneously self engrossed at times, is more difficult to accept than it is for others. Among this group of people are those who suffer from Borderline Personality Disorder (BPD). If one thinks about this from the perspective of an adult and in isolation from other inclinations it may seem fairly easy to overcome, but the truth is that these inclinations don’t usually start to form once we are adult, and never operate in isolation of other inclinations. To somebody who suffers from BPD the emotional responses to a litany of inclinations like this one may feel like noise, an inability to keep things clear, to fully understand what is taking place in the moment or to come to terms with it quickly enough.

Another concept which holds a similar caveat is the concept of coping. We are introduced to the concept of coping, often, also as though it were possible to either be or to not be coping. The reality differs though, we all have coping skills, some adaptive, some Mal-adaptive. This quick coming to terms with things is in itself a description of coping, the only thing which really differs is which specific skill an individual employs in order to come to terms with what is taking place in the moment. in reality we either cope constructively or we cope destructively but generally speaking we are all coping. It is possible to not cope, mental breakdown and in some extreme cases suicide are examples of not coping, things less drastic are generally not examples of not coping. To somebody who suffers from BPD, this practice known as splitting is one of those Mal-adaptive coping skills. We all split from time to time, so to me the distinction is just that Splitting is employed as a coping skill in order to come to terms with something quickly enough to feel settled.

Some speculation:

Consider the above description now from the perspective of a child, who is still forming their coping strategies and skills. They may well come to believe that, given the example of their parents, authority figures, older brothers and sisters, peers and so on, that splitting is a coping skill which works. “Dad is mean because he doesn’t want to let me do this thing” as opposed to dad is being mean, or better yet, dad has given me a good reason to not do a particular thing. Or “teacher said Brian is a bad boy for not doing the task he was asked to do” rather than “Brian did the wrong thing by not performing the task”. These are very simplified examples, but I use them specifically to make the concepts easily understandable. In these examples, once “Dad” or “Brian” have been painted bad the idea can be dismissed or considered understood and dealt with or coped with.

It follows logically that if one happens to have a mother who is “driven” and who, instead of praising a child for the good achievements, simply keeps her “eyes on the prize” or who simply uses negative reinforcement as a technique the majority of the time, the child may well get the idea that they simply aren’t good enough, that their state of being is, with too great a degree of finality or predetermination, not good enough, reinforcing the splitting inclination. Over time a child who has learned Mal-adaptive coping skills may drive people away. without understanding that their coping skills are what is causing the issue. Thus teaching the child that “people always go away” but also introducing fear of abandonment.

Two types psychological of trauma are defined, a “large” sudden trauma, which we all think of as trauma, like being carjacked, or being beaten, abused, having one’s life threatened or worse, such as being threatened to be killed in an extreme way (Petrol poured over a child and the threat to set the child on fire in order to control the adult / parent is an actual example of which I’m aware). This is the type of trauma which often might cause PTSD. Another type, equally if not more common, but less often identified as trauma, is that which comes in the form of sustained “small” acts of abuse. A child having the “you aren’t good enough” concept reinforced by a parent over a long period of time, even seeing this done to another person, especially a parent or sibling, can also constitute trauma, which also can cause PTSD.

Enough Speculation for now, I think we can probably understand how a person may develop a personality disorder although I’m not certain we can fairly say we know for fact how it happens, other factors play various roles in human development also. The development of a personality disorder is likely to differ from individual to individual.

What we do know is that BPD Exists and that it can be described with the following symptoms:

1. Intense fear of abandonment, real or imagined.
2. A Pattern of intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: A 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 about, Binge Eating, reckless driving etc).
5. Recurrent suicidal behavior, gestures, or threats, or self mutilating behavior (Cutting, and possibly bulimic behavior).
6. Affective instability due to a marked reactivity of mood (Eg Intense episodic dysphoria, irritability or anxiety (Which may result in panic attack) usually lasting only for a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness (Which may be visible by way of overcompensation).
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 (Where the stress may be a response to an imagined threat or abandonment, e.g. They may feel that their loved ones are trying to do them harm), or severe dissociative symptoms (People suffering from BPD may appear to not take responsibility for their own actions).

I can only imagine that to suffer from BDP must be an extremely painful way of life, and the fact that it can be treated should be made better known, because a relatively large number of people can be helped to a much better way of life. To react inherently so intensely to the implications of, as with the individual examples I have used (not coping, not a winner) but also, to so many things people say in day to day life must be just as it is described in the following video. Like the reaction to touch if one’s body were covered in third degree burns.

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