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The rebrand of BPD as emotional dysregulation syndrome or something similar does a lot of work in capturing the much of the practical matter of the illness.
I think a lot of people also miss that most people with APD aren't true sociopaths and are also rendered miserable by the illness (especially later in life).
...and both seem to be mostly caused by a combination of genetics, trauma, and other shit you aren't in control of.
Man I miss free will.
Yeah, I completely agree, although I think that the "borderline" aspect of BPD conveys important information, namely that the sufferer's emotional distortions can be indistinguishable from psychosis.
And on the genetic front in particular, the evidence from my n=1 family is damn sobering. Maternal grandmother? Check. Maternal aunt that share's my mother's father? Also check. Sister? Check? Her first daughter? Also check. That's 66% of the daughters from mom's immediate family, with the non-BPD aunt having a different father, and 50% of my sister's daughters, with the younger one also having a different father. And none of the men in my immediate family have fathered a daughter.
You aren't wrong but I don't think anybody really knows this these days except for die hard psychodynamicisists and I can't even spell that.
Wish people knew that though, same for "mood swings are not manic episodes." Every fucking doctor needs to know that one.
In any case my understanding of the state of the research is that it is a two hit situation - you mostly need the genetic predisposition AND the environmental stimulus. However as I suspect you know from past convos - cluster-b coping mechanisms from cultural heritage or family dynamics aren't necessarily the true disorder.
Again, I agree on all counts! I actually didn't know that borderline referred to borderline psychosis either, in fact. Initially, I took it to mean that BPD meant that the individual didn't have much of a personality of their own and adapted the personality of their friends a la Single White Female because that was my sister's behavior. And not only do I agree that there's waaaaaaaaaaay too much equivalence between mood swings and bipolar in general, I'd also add that I've heard people at work say that they deliberately diagnosed a BPD client with bipolar to get them access to services that they would otherwise be ineligible to receive because personality disorder.
On the final front, I can't help but wonder if the environmental chaos that surrounds the BPD individual plus the individual genetics just make it that much easier for BPD to emerge from the witches' brew of the home. I know, for instance, that my mother would often go back to her ur-trauma of losing her father at a tender young age, compounded by her mother quickly marrying another man to re-make the family, and I do ultimately believe that there's a lot of truth there in her specific case. Likewise, when my sister and I were young (she would have been 4), mom was in a serious car accident and almost died, so that or perhaps going through with a planned move to another state on the heels of that could have done it for her. Regardless, I can only speculate.
I've actually heard it described two very similar but subtly different ways - the "borderline between psychosis and neurosis" (as in pathology in those gaps) and as "borderline level of functioning" in contrast to psychotic or neurotic level of functioning (hardcore psychodynamics). I don't know which is more true, but the clinical pearl is the same for both - experiences (including negative self-talk) can become so overwhelming they approach the character of delusion and hallucination, but of course the actual effect on the substrate and underlining biology is radically different.
Still, it is a great teaching point lol.
It's useful you point out the "didn't have much personality of their own" because that is a significant feature in the severe cases - you can see them simply not have have preferences or wants in the way a normal and healthy person does.
A tip I've seen good physician diagnosticians lean into is simply "how long do your mood swings last" if they aren't in the 5-7 day range it's unlikely to be Bipolar (I, anyway). Another good rule of thumb is that if you don't have an inpatient stay (and likely an involuntary one at that) then you probably haven't had a manic episode.
But yes diagnosis for purpose of insurance coverage and other things like that does happen.
I'm not an expert on this but I think it's often driven by attachment dynamics - mother/daughter and mother/son relationship are fundamental different as are male patterns of reality and independence exploration.
I do know some thing you can rule of thumb it as APD=male BPD= female with that being the majority of the cases, but I've noticed plenty of men who are really just BPD instead of APD.
Less so the other way around.
The borderline between neurosis and psychosis is the one that I learned and I personally think it's a better fit overall, though "borderline functioning" does fit a lot of BPDs as well. Thinking about it a little more, most of the higher functioning BPDs that I know of have/had some outside support that contributed to their stability, though the drama in their lives was also more manageable and lower stakes as well. Either way, I suspect there are always the go-to delusions that are close at hand, and that level of functioning probably correlates pretty closely to the BPD's level of investment/preoccupation with their personal delusions. Similarly, IME the higher functioning BPDs seem to have more of a core personality, although even in the higher-functioning BPDs that I've known, I have seen them take radical departures from their default personas, which can be pretty wild when a middle-aged person comes off like a teenager that started hanging out with a different crowd!
As for attachment dynamics, that makes a lot of sense, although I would also say that basic gender and hormonal differences play a large part there; I flirted with Behavioralism as a teenager (as one does) but time, newer research, and personal experience have all led me to firmly disbelieve that humans are little blank slates at birth. Sorry, Skinner! And yeah, I also think that there is a significant subset of men that are BPD and misdiagnosed for various reasons, one of which seems blindingly obvious to me, but only on the BPD side. APDs, almost all male, for sure.
Sometimes I get so frustrated with clinicians, just because this dude is male and violent does not mean APD, listen to the rest of the situation yo.
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One of which?
I was deliberately vague because my answer has CW implications but I suppose putting it in spoiler tags is a decent compromise:gender dysphoria, specifically of the Mr./Ms. Garrison, Jonathan/Jessica Yaniv flavor.
Tell me what you think about this:
I've long conceptualized trans thought content as a combination of:
When I think about item 4. my model is more women who seems to be trans while having a borderline breakdown or are just chronically severe.
It sounds like you spot more often in men, in comparison to me. I think my blind spot here is that my personal life people I know who are MTF seem to not be borderline - mostly dissatisfied with the world, lonely, looking for ego sources, which writing that out sounds borderline adjacent but I don't get the vibe from knowing them (?compromised objectivity?).
You point out your high profile types though and I go oh yeah shit sounds right.
I think this may just be my pot of MTF based off of my background however.
Really interested in your thoughts because no fucking way in hell can I have a convo about this in an academic hospital.
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