Posted by Dinah on December 3, 2003, at 9:32:34
In reply to Re: borderline pd and bipolar, posted by ramsea on December 3, 2003, at 5:03:10
I have a whole complicated theory, and I'm not sure I'll describe it properly, but I'll try.
I think both conditions are mood disorders, although borderlines would have to be ultra-rapid cycling on the bipolar spectrum. And also that they have a number of other conditions that are biologically based, such as rejection sensitivity, that now do not get the recognition they should get as biological conditions. People seem to think rejection sensitivity is a character flaw, when I propose it is a biological tendency. Wasn't one of the main points of Kramer's "Listening to Prozac" that Prozac provided a sort of safety net so that people didn't react so strongly to rejection? And a number of other borderline traits, as a number of other schizoid traits, are probably determined by biology.
Since I find the DSM IV sadly lacking, I prefer Linehan's "arousal in response to emotional stimuli" and "slow return to baseline". Now how those things came to be, I'm not sure. Interplay of genes and environment most likely? But at this point I think they're hardwired. And the results of the physostigmine (sp?) challenge to people with borderline personality theory is interesting.
Then, my theory goes, the "personality disorders" are merely a person's characteristic way of dealing with the biological vulnerabilities. So a person with borderline personality disorder might have the same biology as someone with avoidant personality disorder, but has learned a separate set of tools to cope with their overwhelming feelings.
The personality disorders may be useful as a clinical shorthand to describe a large group of behaviors that often come together. But too often they aren't thought of that way. Too often clinicians forget that they *are* ways of coping with underlying problems, rather than being the problem themself. (Although granted, they can make the problem worse).
My biofeedback psychologist asked me in exasperation how I conceived my problems. I told him my main problem came from easy emotional arousal and slow return to baseline, as described by Linehan in discussing borderlines. Now there was some evidence to that fact right in front of him. He had just remarked on the jump in my skin conductivity merely because the not terribly threatening assistant had entered the room. And it stayed up for some time. Yet he told me not to give myself such unflattering labels!! Unflattering? And this from a professional?
I've never been diagnosed borderline because I don't fit the actions. My relationships are almost pathologically stable. I am the very opposite of impulsive. I show very little anger. And I try very hard not to let others know of my self injury. So the less sensitive practitioners have a hard time understanding that I *feel* borderline. The underlying biological predispositions are the same. I've officially been diagnosed with cyclothymia. And my fear of abandonment is assuaged by forming very few, but lasting and stable, relationships. And I try to regulate my emotions by avoiding situations (as well as by food and self injury and spending). I too have the lack of a good sense of self, because memory is mood state dependent.
So, in long, my theory is that borderline personality disorder is a combination of a mood disorder and some other unrecognized as of yet biological disorders, some temperament variables that influence how the mood disorder is expressed, and characteristic behaviors that have been learned as a means of reducing the pain.
poster:Dinah
thread:286142
URL: http://www.dr-bob.org/babble/psycho/20031202/msgs/286182.html