Borderline Personality Disorder: High and Low Functioning Subtypes

    en-usSeptember 18, 2023

    Podcast Summary

    • Understanding Borderline Personality DisorderBorderline personality disorder is a real and treatable mental health condition. With the right diagnosis, motivation, and willingness to change, individuals can receive effective treatment and improve their lives.

      Borderline personality disorder (BPD) is a real and treatable mental health condition, deserving of respect and proper diagnosis. Dr. Nigro, in his podcast, expressed his frustration with the dismissive attitude towards diagnosing BPD in adolescent girls, stating it as a ridiculous comment without factual basis. He emphasized that the disorder, with the right level of insight, motivation, and willingness to change, can be treated and cured. Dr. Nigro also acknowledged the work of authors who have contributed to the understanding of BPD through books like "Stop Walking on Eggshells." He clarified that the framework of "witch, queen, waif, and hermit" is a working model to understand different types of individuals with BPD and not a definitive diagnosis. Overall, Dr. Nigro emphasized the importance of acknowledging and respecting the gravity of mental health conditions like BPD and the role of proper diagnosis and treatment in improving people's lives.

    • Understanding BPD's Manifestations: High vs. Low FunctioningHigh functioning borderlines exhibit outward behaviors like rage, while low functioning ones engage in self-harm and self-blame. Not all self-injurious behaviors indicate BPD, and effective treatment involves specialized approaches.

      Borderline personality disorder (BPD) manifests differently in individuals based on their functioning levels. High functioning borderlines exhibit outward acting-out behaviors such as rage, which can take various forms including physical and verbal aggression. On the other hand, low functioning borderlines engage in intra-punitive behaviors, which involve self-harm and self-blame. It's crucial to understand that not all individuals with self-injurious behaviors have BPD, and it's essential to avoid diagnostic overshadowing. Self-injurious behaviors can serve multiple purposes, including transferring emotional pain to physical pain, self-punishment, seeking numbness and a release, and attention-seeking. As a reminder, BPD is a complex disorder, and effective treatment often requires specialized approaches, such as cognitive-behavioral therapy or EMDR.

    • Understanding the Variability of Borderline Personality DisorderHigh functioning borderlines can hide their condition, requiring thorough evaluation. All individuals with BPD may exhibit suicidal behaviors, necessitating safety measures and professional help.

      Borderline personality disorder (BPD) manifests differently in individuals, with high functioning borderlines able to maintain jobs, friendships, and a relatively normal exterior, while low functioning borderlines struggle with daily living responsibilities and have more noticeable symptoms. High functioning borderlines can hide their condition well, making it crucial for proper testing and evaluation to understand the complex interpersonal dynamics at play. Furthermore, individuals with BPD, regardless of functioning level, may exhibit threats or attempts of suicide, and it's essential to prioritize safety and seek professional help when concerned.

    • Differences in Hypersexuality between BPD and Bipolar DisorderHypersexuality in bipolar disorder occurs during manic episodes, while in BPD, it's used to fill emotional voids and seek validation. High-functioning borderlines push others away, while low-functioning ones may harm themselves or others if abandoned.

      Understanding the differences between hypersexuality in borderline personality disorder (BPD) and bipolar disorder can be crucial for accurate diagnosis and effective treatment. Hypersexuality in bipolar disorder often occurs during manic or hypomanic episodes, leading to pleasurable but potentially harmful behaviors. In contrast, hypersexuality in BPD is more about filling emotional voids and seeking validation. Additionally, high-functioning borderlines tend to push others away when their fear of abandonment is triggered, while low-functioning borderlines may threaten self-harm or harm others if they feel abandoned. It's essential to recognize that individuals with these disorders can be dangerous and unpredictable, and proper diagnosis and treatment are vital for managing their symptoms and ensuring their safety and the safety of those around them.

    • Understanding Borderline Personality Disorder's Masked InstabilityPeople with BPD mask deeper emotional instability, seeking validation and control, and require skilled clinicians for accurate diagnosis and self-control development.

      Individuals with borderline personality disorder (BPD) often seek validation and approval from others, leading to a loss of self-control. This disorder, which includes traits of antisocial, borderline, narcissistic, and histrionic personality types, is characterized by a facade that masks deeper emotional instability. Lower functioning individuals with BPD are more likely to seek therapy due to their pain and desire for control, while high functioning individuals may avoid it due to the perceived stigma. Neuropsychological evaluations are crucial for accurate diagnosis and understanding how symptoms manifest specifically for each person. It's essential to work with skilled clinicians who can help individuals with BPD regain independence from the opinions of others and develop self-control.

    • Understanding the Mindset of High-Functioning BPDHigh-functioning BPD individuals prioritize their needs, view others as extensions, and blame others for their circumstances, making relationships unequal and challenging to navigate.

      Individuals with high-functioning Borderline Personality Disorder (BPD) often view others as extensions of themselves, prioritizing their own needs above others. This mindset, which can resemble narcissistic, histrionic, and antisocial behaviors, leads to an unequal exchange in relationships. These individuals also exhibit a high external locus of control, blaming others for their circumstances and refusing to take responsibility for their actions. It's crucial to recognize that therapy and change are not always within our control, and we cannot force individuals to seek help or change for their own benefit. Additionally, mistakes or setbacks for those with low-functioning BPD can lead to feelings of failure and increased risk for suicidal ideations or attempts. Understanding these patterns and the unique challenges of each BPD subtype can help us provide more effective support and care.

    • Understanding the Complexity of BPDBPD can present differently in individuals, from high to low functioning, and recovery is possible with the right treatment and support.

      Borderline personality disorder (BPD) can present in various ways, ranging from high functioning to low functioning. High functioning individuals with BPD may come across as polished and put-together, while low functioning individuals may present with more obvious signs of instability. However, these categories are not mutually exclusive, and individuals can move between them. Some people with BPD may wear their disorder like a comfortable coat, complaining about it constantly but unwilling to let go. These individuals may require more frequent interventions, but they are not necessarily resistant to change. Change occurs when individuals become tired of their current way of thinking, feeling, and acting. Despite the challenges of treating BPD, it is important to remember that with the right treatment and medication, recovery is possible. The speaker, who has worked with many individuals with BPD, has seen miraculous transformations. While it may not be an easy journey, the rewards of helping someone overcome BPD can be significant.

    • Signs of borderline personality may indicate a need for earlier diagnosis and treatmentIf medications aren't working, it might be borderline personality. Seek earlier diagnosis and treatment for better outcomes. Communicate openly with healthcare providers.

      If your medications aren't working, it may be a sign that you're dealing with borderline personality, and early diagnosis and treatment are crucial. The speaker emphasizes the importance of communicating with your healthcare providers if you're not seeing progress with your medication. They also mention that while the typical age for diagnosis is 18, earlier diagnosis and treatment can be beneficial. The speaker encourages a shift in perspective, viewing borderline personality as a way of moving through life rather than a disorder or pathology. They also emphasize the importance of destigmatizing this condition and encourage open communication with providers. If you're struggling with symptoms and aren't seeing progress with medication, consider discussing personality disorders with your healthcare team.