Borderline Personality Disorder (BPD)

It used to be thought that people with BPD were at the "border" between:

neurosis – where a person is mentally distressed, but can still tell the difference between their perception and reality

psychosis – where a person is unable to tell the difference between their perception and reality, and may experience delusions and hallucinations

Now it's known that this is not an accurate description. BPD is best understood as a disorder of mood and how a person interacts with others.

BPD is a common personality disorder seen by healthcare professionals. Although BPD is said to be more common in women, this is probably because it is recognised less frequently in men, who may be less likely to seek treatment.

The causes of BPD are unclear. However, as with most conditions, BPD appears to be due to a combination of genetic and environmental factors.

Traumatic events that occur during childhood are associated with developing BPD. An estimated 8 out of 10 people with BPD experience parental neglect or physical, sexual or emotional abuse during their childhood.

BPD can be a serious condition, and many people with the condition self-harm and attempt suicide. It is estimated that 60-70% of people with BPD will attempt suicide at some point in their life.

However, for many with BPD, the outlook is reasonably good over time, and psychological or medical treatment may help.

Treatment may involve a range of individual and group psychological therapies (psychotherapy) carried out by trained professionals working with a community mental health team. Effective treatment may last more than a year.
Read more about treatments for BPD.

Recent studies have suggested that the majority of those with BPD do well over time, with most experiencing sustained relief from symptoms, and around half being completely free of symptoms and able to function well.

Additional treatment is recommended for people whose symptoms return.

I've just read about histrionic personality disorder.  I'd never heard of it before, but I've definitely refered to MIL's behavior as "histrionics."  Interesting . . .


Symptoms
Constantly seeking reassurance or approval
Excessive dramatics with exaggerated displays of emotion
Excessive sensitivity to criticism or disapproval
Inappropriately seductive appearance or behavior
Overly concerned with physical appearance
Tendency to believe that relationships are more intimate than they actually are
Self-centeredness, uncomfortable when not the center of attention
Low tolerance for frustration or delayed gratification
Rapidly shifting emotional states that appear shallow to others
Opinions are easily influenced by other people, but difficult to back up with details

I see that borderline and histrionic personality disorders are placed in the same category.

Things that jumped out at me that we talk about regularly as behaviors our BPD have but which are not stated directly in the criteria for diagnosing BPD are:

Self-centeredness, low tolerance for frustration, excessive sensitivity to criticism (which I guess could fall under the BPD's fear of rejection)

My MIL's behavior with her sons is not what I'd call overtly sexual, but she has always behaved in a, "Look at how silly I am and giggle at me" kind of way, like she is a flirty school girl.  She definitely has "excessive dramatics with exaggerated displays of emotion."  I wouldn't say she is overly concerned with her physical appearance.  

Some of the descriptions I've read fit my BIL more than my MIL, and I would say he is definitely concerned with his physical appearance.  When his brother was describing a nearly-fatal surgery gone wrong, BIL interrupted to change the subject back to his newly acquired job.  BIL also suffers from undiagnosed physical symptoms, and from what I've read, somatoform disorders are linked with histrionic personality disorder.

I haven't read anything mentioning that personality disorders can coexist.  


Borderline personality is marked by unstable self-image, mood, behavior, and relationships.  (MIL + BIL)

Affected people tend to believe they were deprived of adequate care during childhood and consequently feel empty, angry, and entitled to nurturance. As a result, they relentlessly seek care and are sensitive to its perceived absence. (MIL + BIL)

Their relationships tend to be intense and dramatic. When feeling cared for, they appear like lonely waifs who seek help for depression, substance abuse, eating disorders, and past mistreatments. (MIL)

When they fear the loss of the caring person, they frequently express inappropriate and intense anger.
These mood shifts are typically accompanied by extreme changes in their view of the world, themselves, and others—eg, from bad to good, from hated to loved. When they feel abandoned, they dissociate or become desperately impulsive. (MIL)

Their concept of reality is sometimes so poor that they have brief episodes of psychotic thinking, such as paranoid delusions and hallucinations. (MIL)

They often become self-destructive and may self-mutilate or attempt suicide.

They initially tend to evoke intense, nurturing responses in caretakers, but after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, are viewed as help-rejecting complainers.  (MIL)

Borderline personality tends to become milder or to stabilize with age.  (Really?)

(See also the American Psychiatric Association's Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder.)

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Histrionic personality involves conspicuous attention seeking. (MIL + BIL)

Affected people are also overly conscious of appearance and are dramatic. (MIL + BIL)

Their expression of emotions often seems exaggerated, childish, and superficial.  (MIL + BIL)

Still, they frequently evoke sympathetic or erotic attention from others.  (MIL + BIL)

Relationships are often easily established and overly sexualized but tend to be superficial and transient.  

Behind their seductive behaviors and their tendency to exaggerate somatic problems (ie, hypochondriasis [see Table 1: Personality Disorders: Coping Mechanisms]) often lie more basic wishes for dependency and protection.  (BIL)

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It's all interesting.  I know I am not fit to diagnose anyone, but does anyone know if these disorders can coexist?  BIL definitely has somatic problems (remember his "bruised rib" that made him lie on the couch moaning), including some with physical manifestations.  His opinions are easily influenced by others, whereas MIL's opinions warp reality to suit her needs and cannot be changed with reason.

If I had to pick, I'd say MIL has BPD and BIL has HPD, although he does have the problems with substance abuse and intense anger that are characteristic of BPD.  I believe that he does overly sexualize things and place too much importance on physical appearance.  He has always made me uncomfortable in the way that he praises my appearance with too much familiarity and too much enthusiasm.  It's as though he doesn't know how to interact with a female other than being charming (in his mind).  This seems to have lessened in recent years, either because his girlfriend has been present and he knows on some level he shouldn't check out his brothers' wives, or maybe because he's grown up some.  As a teacher of teenaged boys and as a stoic, no-frills woman, I know I exude a certain anti-femininity that usually keeps me safe from uncomfortable situations with or unwanted attentions from chauvinistic students, so the fact that BIL doesn't pick up on what is obvious to 99% of my students is interesting.  I even had a suave male student offer to extract a favor from a teacher "if it's a female, because all the female teachers like me.  Well . . . except for you."