fbpda

My Friend Has BPD: Our Journey Together
By Catee Baugh, Eckerd College, ’10

My best friend Annabelle.* and I met at acting camp right before sixth grade. We talked casually then, but when we saw each other on the first day of middle school, we screamed. We were so glad to have one person we knew. And that’s how our friendship began.

It was rocky, to say the least. Annabelle would often say things that crushed my self esteem to pieces, like calling me fat or crybaby. One small, stupid thing I said could get her mad at me for weeks. Sometimes I just wanted to get away from her.

When we went to separate high schools, our friendship grew. We talked weekly, sharing the details of our lives. I didn’t approve of what Annabelle was doing at the time. She went from boy to boy to see what each of them could give her. She cheated on them, then acted like it was no big deal. She was drinking and taking medicine she didn’t need, like Vicodin. At the time I didn’t really know what to make of it all. It wasn’t until our junior year that I found out what was happening.

Annabelle and I were on the phone, and she consoling me after my first breakup. I was complaining about things my boyfriend had done and his excuses for how he treated me. He had depression and schizophrenia and when he went off his meds, he would stop being kind to me.

“What a crock,” Annabelle said. “I have BPD and I still don’t act that way.”

“Wait, what? BPD? What’s that?”

Annabelle told me about her symptoms—how she had trouble with stable relationships, how she always looked over her shoulder to see if there was someone better for her or someone better than her, how she cut herself to deal with pain and to punish herself. When one thing went wrong, it felt like the world would end. Annabelle got worse in the next couple of years. She called me several times, having cut or feeling worthless because of one small failure. Then I remember her turning point. Right before college, she met a guy, and for the first time, she opened up and told him what she needed. She’s been with him now for over a year and a half. She hasn’t cut herself in months. Her self-loathing episodes are less frequent, mostly when she’s exhausted or not feeling well. In all, she’s more stable.

It can be hard to be friends with Annabelle. She can be explosive and even hostile, and my temper’s not so great either. If I have a criticism or an issue with something, I have to find an extremely delicate way to put it. But it’s worth it. I can tell her about anything and everything, and even if I might not like her advice, I know it’s what she thinks is best for me. She has the classic fear of abandonment common in BPD, but it’s made our friendship stronger. Annabelle deeply appreciates everyone who stood by her. She’s incredibly loyal, and sometimes she’s been the only person to really stand up for me. Annabelle has never used her illness as an excuse for her behavior. She consistently strives to be a better friend, girlfriend, daughter, and person. She constantly pushes through her diagnosis to get to who she wants to be.

If you have a friend with BPD, you might wonder, “Where do I go from here?” Here’s my answer. Stick by your friend, even when it’s hard. People with BPD are afraid of losing you; if you want to be a good friend, don’t justify that fear. Remind your friend that she is a good person. That everyone makes mistakes, and one small error doesn’t ruin your life. Tell them how you feel—a gentle, objective opinion might help their viewpoint.

And get them help if they’re being self-destructive; they may hate you for it at the moment, but they need it more than you realize.

Finally, just listen to them. It’s the most important thing. You don’t need a psychology degree or a big guidebook. Try to understand where they’re coming from and what’s happening to them. Listening, with your mind and your heart, can get your friend to open up and tell you what they need. They don’t need therapy from you; they need love.

Don’t treat BPD like a character flaw. Treat it like the illness it is. Some may see Annabelle as a head case, a tramp, or a bitch. But she’s just a person who needs a little help sometimes. And she’s more than that. My best friend. My sister.

*Name has been changed

April 2008

 

A Clinician’s Guide to BPD vs. BAD
Emily E. Lazarou, MD, MS, RD, LD

When I was invited to write a clinical article for FBPDA, I was excited. Then my mind starting working feverishly. Borderline Personality Disorder (BPD) and its treatment is a vastly complex venture and should be approached as such. To open the “Pandora’s Box” of such complexity must be done with care, in order to get the most out of it. A recurring clinical section in this newsletter is a positive step that helps educate everyone about BPD. I’m proud to start the discussion.

Personality disorders fascinated me even before I knew what they were. Not surprisingly, I use my knowledge of personality disorders to empathize with patients. When you start to look at a patient’s world through his or her eyes, it’s easier to determine the etiology of the situation and hence the direction of treatment.

Borderline Personality Disorder is the most commonly diagnosed of all personality disorders and one that evokes a lot of counter-transference on the part of the clinician. As a result, not all physicians are open to treating clients with BPD. Additionally, insurance companies tend to discriminate against Axis II Disorders and so, to add insult to injury, clinicians don’t get paid to treat patients with such conditions. Put these facts together and the situation is clear: When you as a clinician witness a distraught Borderline patient and his or her family enter your office, you are usually already starting at a disadvantage, one emphasized by misinformation and an unaccommodating health care system.

The term “Borderline” was employed to characterize BPD’s multifaceted nature. When the multiple symptoms inherent in BPD manifest, they can mimic the symptoms of many other disorders. In turn, this becomes a diagnostic conundrum for the busy, time-strapped physician. With this in mind, I’d like to examine Borderline Personality Disorder (BPD) vs. Bipolar Affective Disorder (BAD) and suggest how professionals can distinguish the two clinically. First, when I look at a patient, I take into account my counter-transference. Since counter-transference reflects the same feelings that the patient evokes in others in their environment, initially it’s your only gauge of how your client interacts with others. This is an important clinical finding that physicians need to pay attention to. Listen to your counter-transference. Is it positive? Negative? Generally speaking, BPD tends to produce negative vibes whereas BAD gives positive vibes. Briefly imagine a patient in a manic state rambling, giggling, and telling you about all the things they did during that short day. I smile just thinking about it.

Next, get down to basics. It is essential to actually know the criteria for each disorder. I find when I see one of these “diagnostic dilemmas” come into my office saying “I’m bipolar, schizophrenic, ADD, and PTSD” I pretty much know where it’s going. So sit down and look at the criteria. One person does not fit the diagnostic criteria for all of these disorders! I am all for getting a feeling for a patient and going with it initially until you can clarify the diagnosis. But when you take it to the next level and actually start treating a patient unsystematically based upon a hunch, that’s taking it too far. It doesn’t help the patient and both medically and legally, it doesn’t help you in the long run. You must take the time to check the criteria in order to diagnose and treat accordingly.

Since mood swings can be exhibited by patients with BPD and patients with BAD, this can be a source of misdiagnosis. BPD patients do have mood swings, but their duration and intensity are different than those experienced by persons with BAD. As I see it, this is really the only connection between BAD and BPD. In BAD, mood swings are circumscribed. In BPD, they can be happy, then sad, then back again—appointment to appointment or even within one appointment. Other differences are evident. Bipolar patients tend to not have the abusive history that is regularly seen in those with BPD (BPD patients often have sexual trauma in their past). Further, those with BPD exhibit a fear of abandonment, splitting, lack of sense of self, and self-harm behaviors that are not inherent in BAD. BPD patients also tend to have explosive relationships, while those who are bipolar typically have good relationships (with the exception of hypersexuality in manic episodes). And while bipolar patients do have suicidal thoughts, these appear during depressive states. In contrast, BPD patients have a chronic feeling of suicidality.

Clearly there are significant differences between BPD and BAD, yet misdiagnoses are not uncommon. Both conditions are treatable, but it is essential to know the criteria for both and the differences between these personality disorders in order to better serve patients.

Bottom line: Get back to basics. Listen to your gut. Empathize. Look through the eyes of your patients; they will tell you the diagnosis.

March 2008