Monday, March 26, 2012

On the Borderline.

I was gone last week. Sometimes that happens. Between the day job and the writing and the family ... blogging sometimes gets relegated to the things I wish I could do but can't. Only sometimes, though. But! I have a few updates:
  • I am working on Book 3 in The Guards of the Shadowlands series! My editor loved Book 2, and I'll be doing revisions on it soon, but for the moment I'm trying to crank out a first draft of Book 3. I'm hoping to have that draft by the beginning of June, but with everything else that's happening,  I wonder if that's too ambitious. I'll let you know.
  • I received cover proofs for SANCTUM and oh, oh, oh, they are gorgeous. I can't wait to show you guys the cover. When I first opened the file, I started crying. There was just something incredibly emotional about seeing a visualization of my story concept. More updates on that very soon!
And now ... today I thought I'd discuss yet another personality disorder. I've already posted about Schizoid Personality Disorder and Obsessive Compulsive Personality Disorder, and you can find my quick-and-dirty primer on personality disorders here.

Borderline personality disorder can be found in approximately 5-6% of the population (that's from the study I link to in this paragraph, which was a pretty thorough one, but other estimates put the prevalence at only 1-2%). A relatively recent epidemiologic survey study (of over 35,000 people) found that there's no gender difference in the prevalence of this disorder, which was previously thought to be more common in women. The study did show that the disorder is associated with more general mental and physical impairment in women, however.

The symptoms, according to the DSM-IV: Like with all personality disorders, BPD is a pervasive pattern (meaning it occurs across relationships, situations, and settings) of impairment. With BPD, that impairment occurs in interpersonal relationships, with self-image, emotion, and impulsivity. To be diagnosed with the disorder, someone must show five or more of the following symptoms:
  1. "Frantic" efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships in which the person alternates between idealization and devaluation (often referred to as black-white thinking or splitting)
  3. Markedly and persistently unstable self image or sense of self (in other words, you like yourself one hour, and despise yourself the next, in a really extreme way)
  4. Impsulsivity in at least two areas that are potentially self-damaging (like spending, sex, alcohol/drug use, binge eating, or reckless driving)
  5. Recurrent suicidal behavior or self-mutilating behavior
  6. Intense mood reactivity (extreme emotions in response to situations)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger
  9. Stress-related paranoia or dissociative symptoms
Individuals diagnosed with this disorder account for a disproportionately high percentage of mental health care dollars. In other words, BPD causes a lot of impairment and suffering. Research shows that people who have been neglected or abused (particularly sexually abused) in childhood are more likely to be diagnosed with this disorder, especially if they have a problematic home environment and/or a certain kind of temperament (e.g., high levels of negative emotion).

Interestingly, a few psychiatrists have diagnosed fictional character Anakin Skywalker as having BPD, and even used him as a teaching example. There's a great article on that by Dr. Carolyn Kaufman here.

There is an effective treatment for BPD called Dialectical Behavior Therapy (there's no drug that helps, not really).The developer of DBT, Dr. Marsha Linehan (who, by the way, has had a long and productive career in psychology, and has helped a lot of people), disclosed recently that she was actually diagnosed with this disorder as a teenager--and if you want to read a truly inspirational story, go read this article about her. I promise you will not regret the time you spend on it.

Just a note about this disorder: the label "borderline" comes with a whole lot of stigma, so when I hear "I think this person has borderline personality disorder" (or worse: "I think this person is borderline"), I tend to interpret it as code for "I'm not sure how to help this person, so I'm using a label to neatly categorize him/her in a way that allows me to feel less guilty about it." (Hey, it's a complex code.) I'm definitely not saying all mental health clinicians do this, and I certainly don't believe any do it on purpose. But I am saying that my ears perk when I hear the phrase, and I start asking A LOT of questions.

In general, I think our diagnostic system is really useful, and helps us develop more effective treatments for problems that cause a lot of suffering. However, I think these terms are always at risk for being used in ways that dismiss complex human beings or add to the stigma, and of course, that bothers me. <end of rant>

Aaand because it's Monday, go check out Lydia's Medical Monday post, and Laura's Mental Health Monday post (zombies! yipes!).


  1. Ooh, you received proofs. So cool. And I missed the reveal of your author photo the other day. I must say...very nice!!

  2. Congrats on your proofs!

    Didn't know that about Anakin's character. Just thought it was more of Lucas's bad dialogue and screenwriting (with some bad acting in there too.)

  3. I would make the claim that Anakin had AAD (Absolute Asshat Disorder), but I suppose he gets some sympathy for what those Aliens did to his mom.

    Disorders like this, when then is no clear chemical or biological reason, can be hard to wrap your head around. Sometimes it makes you wonder, what is is that makes this a disorder, rather than: this person is simply emotionally damaged beyond repair because they've experience so much suffering in their life.

    I always like your attitude about these things. That nothing is clear cut, and there are so easy, simple answers.

  4. That's so odd--and terrible, of course! I'm only saying odd because when I read "borderline," I think of it as being "almost." Like they've just got a little problem. But holy smokes. These are terrible and big problems. And I can totally see that in Anakin! :D

    Super-congrats on the cover. I bet I'd cry, too. Yay!!! Can't wait to see it. <3

  5. Anakin is classic schizoid! You probably saw that from miles away. I was just like, "Personality disorder, not sure which one though." I have to pay you so I can see those proofs? Hmmm? I'll send you candy. :)

  6. Congratulations on the cover!

    Re: Borderline - Pat Conroy has a character in South of Broad who suffers from it. Otherwise, my first thought was Madonna- her song, not her personality. I'll have to listen to that song again, now that I've got a better grasp of the true meaning of the word. :)

  7. Love the rant. I've heard that this disorder is overdiagnosed, and it does seem like everyone I know knows someone with BPD, or thinks they do. I can see why. Reading the criteria, I could easily put a long-time acquaintance of mine in that category from my superficial understanding of the symptoms if I didn't know a lot of cross-referencing and other nuances are needed! Thanks for another fascinating post, and WOW, I can't wait to see the cover of SANCTUM! Congratulations!!

  8. Really informative, as usual! I appreciated seeing it laid out like that. I suspect there are many over-diagnosed disorders though. Humans are so complex, it's hard to find a clear cut case. In other news - I'm so excited for your cover reveal! :D

  9. Very interesting about Anakin. I love Star Wars, even the new ones, and I think Lucas did a good joy showing how Anakin turned to the dark side. I'm so glad you like the cover proofs!

  10. Anakin? Hmm. Hadn't thought of that.
    Congrats on your cover proofs--so exciting!

  11. Interesting to read your take as a professional on the diagnosis (or over-diagnosis) of borderline personality. As a lay person, I must admit, when I hear that diagnosis, I've sometimes considered it a cop-out attempt by the psychiatrist to cover his butt. Kinda like, years ago, when it was so common for doctors to attribute way too many women's symptoms to "nerves."

  12. Anakin's a borderline? Interesting...

    Good luck to you on finishing your draft. Can't wait to see the cover!

  13. Congrats on your proofs! This is a great post.

  14. How accurate is that list? And is this something that one could grow out of?