Should I (32/M) divorce my emotionally unstable wife (34/F)?

[salparadise]

I'm sorry, but isn't "in sickness and in health" somewhere in marriage vows? I mean maybe if people didn't look at marriage vows as stick-in-the-mud there wouldn't be so many affairs.

 

To be fair, I think that OP is obviously in a lot of hurt and mental health is a serious issue. But he then mentioned that he has an attraction to a co-worker. I don't really care how emotionally abusive your wife is or how much hurt there is in your marriage, that is not an excuse to start an affair with another woman. If your marriage is truly over, then do what's necessary to end it before pursuing another relationship. This man is obviously on the verge of having an affair and he is going to use his unhappy marriage as his justification for it.

 

Go back and reread the original post. What he said is that he knows not to get involved with the coworker, but the fact that she is attracted to him makes him realize that someone out there, even an attractive woman, might appreciate and value him for more than an object of distain and a target for rage and abuse. She has made him realize that life could be a positive experience!

[renaissancewoman]

Go back and reread the original post. What he said is that he knows not to get involved with the coworker, but the fact that she is attracted to him makes him realize that someone out there, even an attractive woman, might appreciate and value him for more than an object of distain and a target for rage and abuse. She has made him realize that life could be a positive experience!

 

I summarized his post as:

1) I am a model husband. I provide for my family and spend time with them and help with chores.

2) My wife is terrible. She has a screwed up family. She is fake and I only know her angry nature behind closed doors. She treats me terribly.

3) I am attracted to another woman.

 

His story is so one-sided that I find it hard to believe all of it. Even if it was all true, why on earth would be then still consider working on the marriage. It sounded a lot to me like someone justifying his attraction for another person which is why he is pondering divorce more and now he's looking for validation by describing how awful his wife is. If his wife is so awful, then move on. Everyone deserves to be happy. From what he has described from her nature, he is more than justified to file for divorce. But I just don't think we are getting the full picture here.

[ShatteredLady]

Salparadise. You edited my post. My intent was not "shaming" anyone. I thought I was being constructive. I believe in seeing medical specialists.

 

I thought my conversation with my doc (Internet diagnosis of MANY conditions) was appropriate to share.

 

I understand that you have experience & knowledge of personality disorders. You weren't in my mind when I wrote. I wasn't attacking you or anyone else. I wasn't even talking about LS. I had no intention of offending you so deeply. I'm sorry that you took it that way.

 

Sometimes on forums we end-up 'chatting' on subjects raised & that's all I was doing here. e.g. Throwing out suggestions like how the lady at work 'could' be influencing etc.

 

I apologize to anyone I angered or offended.

[Downtown]

The prevalence of personality disorders in the US population is 9.1 percent according to NIMH, and of BPD specifically 1.4 percent. These are diagnosed. Who knows how many are undiagnosed given their resistance. 10 percent of people who present for outpatient psychiatric treatment have BPD according to NEA-BPD, and 18 million Americans overall (5.9 percent).

Yes, Sal, that is my understanding too. NIMH says that the 12-month incidence of BPD is 1.4%. Importantly, this figure is so small because it represents the percent exhibiting full-blown BPD traits within the past 12 months. It greatly understates the problem because a person satisfying 75%, 85%, or 95% of the defining traits is said to "not have full-blown BPD" -- but likely will be nearly as impossible to live with as a person exhibiting 100% of the symptoms.

 

Hence, to anyone searching for a potential mate, a much more meaningful figure is the 5.9% figure. It represents the "lifetime incidence" of BPD, i.e., is the percent who have exhibited full-blown BPD for an extended period at some point in their lives. This is more meaningful because, when a person acquires a lifetime BPD problem it does not go away when it drops below the 100% level. Granted, it may get a bit less severe in middle age or old age. Yet, as I noted above, a person dropping from 100% of the symptoms to only 90% still will be nearly as impossible to live with -- even though that BPDer will now be said to "not exhibit full-blown BPD." The relevant figure, then, is not what % have full-blown traits but, rather, what % have strong traits.

 

This 5.9% figure has important implications with respect to the incidence of BPD in marriages and other LTRs. If BPDers (those with strong traits) were to pair up only with other BPDers, the share of relationships having a BPD partner would be 5.9% of the relationships. Yet, BPDers rarely pair up with other BPDers. One reason, of course, is that 94% of the available people they meet are nonBPDers. Another reason is that, in the very unlikely event a BPDer should pair up with another BPDer, they would quickly part ways. Because BPDers have a very weak, unstable sense of identity, they have a powerful need to pair up with someone who can supply that missing identity.

 

The result is that nearly 12% of adult relationships contain a BPDer. Moreover, because BPDers tend to attract and push away a lot of partners -- leaving a long trail of ex-partners in their wake -- the percent of R/S containing a BPDer likely exceeds 12% by a substantial amount. And that percent will increase even further when you add in all of the folks having strong BPD traits that never rise to the 100% level (thus causing them to be excluded from the 5.9% figure). I therefore agree with you, Sal, that there is good reason why so many LoveShack members describe their partners and ex-partners as exhibiting BPD symptoms.

[ShatteredLady]

Is it possible to display very few traits mostly (for many years) & then go through 'stages' (even a year or so) of pretty much 100% traits or is that considered something else? Mental breakdown etc?

[salparadise]

Is it possible to display very few traits mostly (for many years) & then go through 'stages' (even a year or so) of pretty much 100% traits or is that considered something else? Mental breakdown etc?

 

Yes. It's called decompensating. Certain stressors, including relationship issues, can upset a fragile equilibrium that allows them to function somewhat normally for a time (apparently). Life has ups and downs. Most people have some resilience, but BPDers can come unglued in response to stressors, or for no apparent reason. Another statistic - 20 percent of psychiatric in patients have BPD.

[WantingToLeave]

I summarized his post as:

1) I am a model husband. I provide for my family and spend time with them and help with chores.

2) My wife is terrible. She has a screwed up family. She is fake and I only know her angry nature behind closed doors. She treats me terribly.

3) I am attracted to another woman.

 

His story is so one-sided that I find it hard to believe all of it. Even if it was all true, why on earth would be then still consider working on the marriage. It sounded a lot to me like someone justifying his attraction for another person which is why he is pondering divorce more and now he's looking for validation by describing how awful his wife is. If his wife is so awful, then move on. Everyone deserves to be happy. From what he has described from her nature, he is more than justified to file for divorce. But I just don't think we are getting the full picture here.

 

Actually he and I are a lot alike. My wife displays some of these same behaviors and I have absorbed her dysfunction for 25 years. Just because his wife is not here to "defend" herself, don't assume he is lying.

 

Now I am no saint, but I gave been a good husband to my wife and a good provider to my kids, and I am getting prepared to leave my wife in June or July of this year after our youngest leaves home. And frankly, my wife deserves to be left.

 

My story is a bit different in that my wife also cheated on me about ten years ago. And I am not after another woman. In fact I do not care if I ever get together with another woman again for as long as I live.

[Downtown]

Is it possible to display very few traits mostly (for many years) & then go through 'stages' (even a year or so) of pretty much 100% traits or is that considered something else? Mental breakdown etc?

Shattered, please keep in mind that BPD is not something -- like chickenpox -- that a person "has " or "doesn't have." Instead, it is a set of basic human behaviors (ego defenses, actually) that we all have to some degree. This is why BPD is said to be a "spectrum disorder," which means we all are somewhere on that spectrum.

 

When psychologists call these basic human behaviors a "personality disorder," they do so only when these behavioral symptoms are so severe and persistent that the person has a lifetime problem with exhibiting very strong BPD traits. Yet, most displays of strong BPD traits -- even those full-blown BPD traits at the 100% level -- are NOT a result of the "disorder" itself. Rather, they mostly arise temporarily due to a hormone change, e.g., puberty, PMS, pregnancy, postpartum, or perimenopause. And, because some of these strong hormone changes can last a year or two, such a "flareup" of BPD traits can last that long.

 

In contrast, a lifetime BPD problem is believed to originate in early childhood -- typically before age five -- and to start showing strongly by the early teens. Absent years of intensive therapy, those strong BPD traits will remain strong throughout life even though they likely will drop a little below the 100% level starting in the late forties.

 

The result is that all of us exhibit BPD traits to varying degrees and each of us moves to different positions on the BPD spectrum in response to strong hormone changes, drug abuse, or (very rarely) brain damage. We all behave like full-blown BPDers 24/7 during our early childhoods. And many of us start behaving that way again for several years when our hormones are raging during puberty.

 

Hence, when a person displays only mild BPD traits for many years and then suddenly displays severe traits at the 100% level for a year or two, a psychologist likely would not regard that as evidence of a "BPD disorder." Rather, it would be regarded as simply a temporary flareup of the BPD traits that person always has. This, at least, is my understanding, Shattered.

[basil67]

I'm curious as to how your 12/13hr days (plus travel time??) impact your marriage. Do you think anything would change if you were present?

[salparadise]

Shattered, please keep in mind that BPD is not something -- like chickenpox -- that a person "has " or "doesn't have." Instead, it is a set of basic human behaviors (ego defenses, actually) that we all have to some degree. This is why BPD is said to be a "spectrum disorder," which means we all are somewhere on that spectrum.

 

The result is that all of us exhibit BPD traits to varying degrees and each of us moves to different positions on the BPD spectrum in response to...

 

Hence, when a person displays only mild BPD traits for many years and then suddenly displays severe traits at the 100% level for a year or two, a psychologist likely would not regard that as evidence of a "BPD disorder." Rather, it would be regarded as simply a temporary flareup of the BPD traits that person always has. This, at least, is my understanding, Shattered.

 

Downtown and I rarely disagree. He has a thorough, in depth understanding of BPD both from experience, and having obviously done his homework. However, the spectrum concept and normalcy of BPD behaviors is an aspect of his description that I believe he overemphasizes.

 

He is not wrong in one respect, but this characterization may give people who are trying to understand BPD the impression a borderline is just slightly different when in fact BPD is infamous in the psychological community as the most severe and dreaded disturbance that patients present with for outpatient therapy.

 

It is persistent, difficult to treat and impossible to cure. Patients are typically adversarial and will attempt to undermine, sabotage and/or seduce the therapist. They often [usually] quit before reaching the point of effectiveness due to their inability to tolerate the feelings of emptiness and self loathing associated with bringing their issues out from behind layers of defenses and into consciousness. They turn against the therapist, blame and direct hatred at them just like they do their intimate partners.

 

There are nine diagnostic criteria in the DSM, however, these are the tip of the iceberg in terms of full range of maladaptive behaviors exhibited by BPDers. They are selected as diagnostic criteria because they are the observable, objective departures from the way normal, healthy people interact in the world.

 

The fact is that normal, healthy people do NOT exhibit most of these behaviors to any discernible degree. BPD diagnosis requires five or more with a degree of severity that would obviate normal functioning in life (the diagnostic threshold). I think the spectrum concept is valid as a measure of severity within the group of people who do exhibit these behaviors.

 

Let's look at the diagnostic criteria one at a time with an eye to the likelihood that a healthy person would ever exhibit this behavior to any discernible degree...

 

1. Frantic efforts to avoid real or imagined abandonment

 

No. Healthy people do not live in constant fear of abandonment, much less exhibit observable, frantic efforts to avoid it. Normal, healthy people do not fear the loss of a relationship as if their very existence depended on it. Yes, healthy people do have feelings of vulnerability, which are usually well tolerated. There is a huge difference.

 

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

 

Healthy people are able to conceptualize their intimate partner as possessing both positive and negative characteristics at once, whereas to a BPD it's either good or bad depending on how he/she feels internally. Healthy people are able to have relationships that are mostly calm, stable and satisfying. That's not to say they always are, just that they have that ability, whereas BPDers do not.

 

3. Identity disturbance: markedly and persistently unstable self-image or sense of self

 

This is the essential issue with BPD. Normal people feel mostly whole and complete most of the time. They know who they are. BPD people have a huge deficit in this area. They typically use their partner's stable, complete sense of identity to fill that gap. This speaks to the fear of abandonment––they intuitively realize (subconsciously) that without the partner's stable sense of self they would go back to feeling lost and not knowing themselves.

 

Healthy people simply do not have this problem. Do healthy people sometimes question their existential destiny? Of course, but that's not the same thing at all. Healthy people have a mostly complete sense of self and identity (varying degrees); BPDers are strongly deficit in this area, and the difference is not subtle.

 

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)

 

Otherwise healthy people (non-BPDers) can be impulsive and engage in self-damaging behaviors such as binge eating and substance abuse, but most do not. This criteria is less definitive than lacking a good sense of self. But the fact is that there are many people who do not engage in any self-destructive behaviors. It is not something everyone does to some degree.

 

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

 

These are characteristics of more severe cases of BPD. High functioning BPDers may not have a history of suicide attempts or threats or self-mutilation. Healthy people do not usually do any of this stuff!

 

Suicidal behavior is often associated with some type of mental illness, but not necessarily, and not BPD specifically. Self-mutilation on the other hand is definitely a strong BPD indicator. I don't have statistics, but I'd guess that something like 98 percent of cutters would be diagnosable.

 

Are these behaviors that normal healthy people engage in to some degree? Hell no!

 

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

 

Otherwise known as splitting. My guess is that only those of us who have been intimate partners with a BPDer, or have a family member with the disorder, have any tactile feeling for what a splitting episode looks like. It's absolutely amazing how it can occur so suddenly, without apparent external stimuli, be so intense, and then subside almost as quickly as is happened.

 

Do normal healthy people get upset? Yes, of course. Do they have splitting episodes. Nope, never.

 

7. Chronic feelings of emptiness

 

The key here is chronic. Do healthy people ever have a feeling of emptiness? Yes, probably. Chronic feelings of emptiness? No.

 

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

 

Does a healthy person ever get angry? Yes, of course. Does a healthy person have inappropriate anger and difficulty controlling it. No.

 

9. Transient, stress-related paranoid ideation or severe dissociative symptoms

 

Healthy people are seldom to never paranoid. Paranoid and fearful are not synonymous. Dissociative symptoms? Probably not, at least not to the degree that it would be identifiable.

 

What are dissociative symptoms... disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation, a defense mechanism, pathologically and involuntarily.

 

What is a spectrum disorder? A spectrum disorder is a mental disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism.

 

I do not believe this should be interpreted to mean that everyone is on the spectrum.

Edited April 20, 2016 by salparadise

[Downtown]

Downtown and I rarely disagree.

True, Sal. Indeed, I'm glad we finally found some aspect of BPD to disagree over. I was starting to suspect that you and I must be the very same person, LOL.

 

What is a spectrum disorder? A spectrum disorder is a mental disorder that includes a range of linked conditions.... I do not believe this should be interpreted to mean that everyone is on the spectrum.

Skip Johnson (Exec. Director of BPDfamily.com) explains, "Personality disorders are spectrum disorders, meaning that there is a broad range or spectrum of severity." See BPDfamily. That range extends from normal to severe. This means that, like selfishness and resentment, BPD traits are merely behavioral symptoms that everybody has to some degree. Dr. C. E. Zupanick explains why the psychiatric community is now moving to a diagnostic manual showing that PDs apply to everyone because we all exhibit these traits to some degree. He writes:

Most psychiatric disorders are evidenced by a complete and total deviation from normal and healthy functioning. Clearly, Major Depression, Schizophrenia, and PTSD are not found in the vast majority of people. Either you have these disorders, or you do not. You can't have a wee bit of Schizophrenia. You might liken this to an ordinary light switch: either it's on, or it's off. However, unlike schizophrenia, everyone has a personality and you can indeed have a wee bit of nearly any personality trait. In this respect, personality represents a continuum, ranging from healthy to disordered. See

Zupanick, Psy.D.

It therefore was ridiculous for the psychiatric community to adopt a dichotomous approach -- wherein a client is deemed "to have" or "not have" BPD. Of course, a substantial segment of the psychiatric community knew in 1980 that this dichotomous approach to diagnosis makes no sense for behavioral symptoms that vary in intensity from person to person. They knew it is senseless to say a person meeting only 95% of the diagnostic criteria "has no disorder" and a person meeting 100% "has the disorder."

 

Doing so is as silly as diagnosing everyone under 6'4" as "short" and everyone under 250 pounds as "skinny." The psychiatric community adopted this silly approach only because the insurance companies (and the courts) -- who were long accustomed to "yes or no" diagnoses from the medical community -- were pressing for a single, bright line being drawn between those clients they would cover (or institutionalize) and those they would not cover.

 

There are nine diagnostic criteria in the DSM.... The fact is that normal, healthy people do NOT exhibit most of these behaviors to any discernible degree.

Actually, healthy people DO exhibit all of the nine BPD behaviors, as I noted above. This is not apparent in the APA's diagnostic manual (Sections I and II) because it was written incorrectly to portray PDs as extreme and bizarre behaviors. Hence, instead of listing the first BPD trait as "fear of abandonment" -- a fear that every normal person has experienced -- the manual (DSM-5) describes that trait as "Extreme reactions to abandonment." The presentation of these behavioral symptoms in such an extreme form was done to support the mistaken notion that BPD is something a small share of the population "has" and that most people "don't have."

 

The psychiatric community knows that this dichotomous approach is wrong. And they know that every adult on the planet exhibits BPD traits to some degree. This is why the blue-ribbon panel of experts (DSM-5 Work Group) recommended in 2012 that this dichotomous approach be gutted and completely replaced with a graduated (i.e., dimensional) approach that makes it clear that people have BPD (and other PD) traits to various degrees (i.e., "little to no impairment," "some," "moderate," "severe," and "extreme"). Because the APA membership wanted more empirical testing done before implementing the new approach, it appears in Section III of the current diagnostic manual to encourage research. And it likely will be adopted and fully implemented in the next revision of the manual.

 

[Downtown's] characterization may give people who are trying to understand BPD the impression a borderline is just slightly different....

Sal, if you can identify some specific part of my comments which has mislead people, please do so. I try to learn from my past mistakes. At this point, however, I don't see how my telling folks that everyone exhibits BPD traits varying in intensity -- from normal to severe and extreme -- can mislead them into concluding that BPDers are "just slightly different." To me, there is a world of difference between "normal traits" and "very strong traits."

 

Moreover, your view that "Healthy people do NOT exhibit most of these behaviors to any discernible degree" not only is incorrect -- as I noted above -- but also has created much harm in the past. One reason is that, by portraying BPD traits in such an extreme fashion, the public has been lead to believe that BPDers behave in such bizarre ways that their actions are totally unfathomable because they are like creatures from outer space. Hence, the notion that they exhibit behaviors that are alien to the rest of humanity continues to feed the false stigma that so many lay people have for BPDers.

 

Another reason this view is harmful is that it misleads lay people into believing that they cannot protect themselves by spotting strong BPD traits when they occur. Yet, because healthy adults are perfectly capable of spotting these behaviors, hundreds of mental health centers are trying to educate the public by posting those nine BPD symptoms on the Internet sites. The truth is that we all behave like BPDers 24/7 in early childhood due to our inability to regulate emotion and our weak self identities. And many of us (if not most) start behaving that way again when our hormones surge during puberty. On top of that, it is common for many adults to exhibit strong flareups of their BPD traits when subject to other strong hormone changes (e.g., pregnancy, postpartum, PMS, or perimenopause) or when abusing drugs.

 

BPD is infamous in the psychological community as the most severe and dreaded disturbance that patients present with for outpatient therapy.

Like I said, BPD traits range from normal to severe and extreme. I see no harm in adding "dreaded" to allow for a sixth graduated category in the PD spectrum.

 

Are these behaviors that normal healthy people engage in to some degree? Hell no!

Hell yes! You are hanging on to an outdated approach to defining personality disorders (i.e., the dichotomous approach) that was wrong when it was adopted 36 years ago. The new graduated (aka, "dimensional") approach is already in Section III of the current diagnostic manual and is widely expected to be fully implemented in the next revision.

[ShatteredLady]

Very interesting guys!

[veryhappy]

What's wrong with looking on the internet for information? It can be very helpful. I'd drop a specialist with a degree if he showed contempt for internet searches. There's no reasons for specialists to act so precious.

 

 

I have no personal experience with bpd, but from my incidental reading about it, I seem to remember it's one of the cases where staying on meds makes all the difference in the world.

 

 

OP, I suggest you try to get your wife to a psychiatrist (as much as I hate meds and prefer talk therapy). He can diagnose and prescribe meds. If she has bpd, find out if talk therapy to address childhood trauma would help her. It's obvious she's trying to recreate the flying scissors family and is freaking out when you stay calm, because she can't do peace.

 

 

Secondly, would you get your daughter most of the time if you divorced? Would you trust your wife with your daughter? Is an abandoned bpd person at risk to harm the child? Things you will need to consider. At the same time, divorce will be better if it's the only way to offer your daughter a peaceful home. Your daughter feels the same madness you feel, but she lacks the ability to make sense of it like you can and is much more vulnerable to it.

 

 

Don't act on the other person, or your wife might fly scissors your way.

[mellywell]

I have no personal experience with bpd, but from my incidental reading about it, I seem to remember it's one of the cases where staying on meds makes all the difference in the world.

 

Nope. You are thinking of Bipolar Disorder. This is why relying on the internet alone is NOT always helpful.

[hestheone66]

Whilst the attention of another woman may be the reason you are entertaining divorce at the moment when before you were terrified of it, it suggests that having been with an emotionally unstable person for so long your self esteem hit rock bottom. I daresay the reason for staying with her while red flags were flying prior to marriage also speaks of a manipulation that you weren't strong enough to see for what it was, and some co-dependancy on your part.

I was in this situation which was very toxic. Emotions from "I would die for you" to "you're a maggot and you make me want to vomit" had become the norm. You accept the cycle of abuse and focus on the positives which become so loaded with expectation that 'things have changed'. Any normal kindness becomes an event of such significance that you hold onto it in hope it signals change.

 

One day you have the last fight and something inside clicks and you decide 'I'm out' and mean it. You say nothing if this inner resolve but go about planning the separation.

The turning point for me that to allow my children to grow up in that relationship was tantamount to child abuse and that gave me such strength.

I wasn't running to someone, just away from the toxicity. I thank myself every day that I got myself back from brink of utter dispair.

Find your strength, change patterns, get counselling for yourself (any attempts at marriage counseling from his part were lipservice at best and he was very defensive about exposing the reality to an outsider)

 

Wish you luck and PM me if you want

[veryhappy]

Nope. You are thinking of Bipolar Disorder. This is why relying on the internet alone is NOT always helpful.

 

 

My main advice for OP was for his wife to see a psychiatrist. So yeah, "relying on the internet alone is NOT always helpful.".

 

 

OP, I'd also suggest you see a therapist. You were attracted to the craziness for your own reasons and upbringing, and it would benefit you to look into that. It can also help you to deal with what your wife throws at you. To complete the series of professionals, you could see a lawyer to face the realities of a potential divorce, especially regarding your daughter.

Edited April 22, 2016 by cutedragon

[salparadise]

Downtown, Thanks for the links and explanation. I can now see more clearly where you're coming from. You're a proponent of The Alternative DSM-5 Model for Personality Disorders, and are quoting R. Skip Johnson when you proclaim BPD to be a spectrum disorder. He is the only "authoritative" source I could find calling it that, however, I searched for his credentials and couldn't find anything (on bpdfamily or elsewhere). Dr. C. E. Zupanick is a Psy.D (clinical vs. research doc) but he doesn't call it a spectrum disorder. Nowhere did I find any support for the assertion that "everyone exhibits BPD traits." Well, except forum posts at bpdfamily and a few non-authoritative sources.

 

Where I suspect these two assertions are coming from is, the Alternative DSM-5 Model is based on the Big Five or Five Factor Model (FFM) personality assessment tool which ranks personality features on a five axis continuum. Now if you're saying that everyone has personality traits I could be in agreement, but that's quite different from BPD traits or behaviors. Only when an individual is functioning at such a low level as to be pathological does it enter the realm of personality disorders. I don't know where the alternative method places the threshold for the axes, or how many have to be concurrently low, or in what combination, for a diagnosis, but no matter how you slice it I cannot agree that even people who are functioning well on all axes are still somewhat borderline.

 

There is a marked distinction between healthy people (fully functional or nearly so) and personality disordered people, and using a continuous personality assessment tool doesn't negate that fundamental fact. BPD is a disorder. Using the alternative method of assessment it's fair to say that people are a little bit disordered when functioning drops to the impaired level, but a person functioning well in all areas can no more be said to be a little bit borderline than they could be deemed a little bit pathological. There is still a diagnostic threshold even if that threshold is graduated, and the graduation doesn't start at zero––it starts where functioning is considered to be impaired. In the case of BPD, identity deficit is not going away as the essential factor, and the entire population is not having a crises of identity.

 

What I can agree on is, it's rather obvious that having a thin-line threshold where a person either is or is not diagnosable, implying they are either normal and healthy or personality disordered (the light switch analogy), is not a realistic conceptualization.

 

What I disagree with is, "you are hanging on to an outdated approach to defining personality disorders (i.e., the dichotomous approach) that was wrong when it was adopted 36 years ago." Actually, this is still the current method in the DSM 5, and the Alternative DSM-5 Model for Personality Disorders has been recognized as having some merit/potential and is therefore included in Section III (Emerging Measures and Models). I am not against the alternative method, I am against extrapolating from the more granular, graduated conceptualization to support questionable populist notions like "everyone exhibits BPD traits," and "BPD is a spectrum disorder." The dichotomous method is not WRONG, it's just different––a different way of conceptualizing a thing that itself has not changed. Yes, it's less granular and it does have the light-switch problem, but the dimensional method isn't perfect either; it's plagued by complexity, lack of clarity and empirical testing, and perhaps the tendency [for its proponents] to blur or remove distinctions between healthy and disordered.

 

A lot of this is APA political infighting. Some proponents of the new alternative method have become so invested in their beliefs that it's almost like a arguing religion. Seriously, how far are we from hearing that Mother Teresa exhibited antisocial traits?

 

What's the point? Why is it so important to preface all discussion (using such a definitive, factual tone) with the two extrapolations (spectrum disorder, everyone has it) when these notions are not even close to being universally accepted, nor is it included in the language of the alternative method (as far as I can determine)? Is all of this coming from the bphfamily website? Are any authoritative figures other than R. Skip Johnson (credentials unknown) promoting these ideas as being key, or at all? I am not very familiar with bpdfamily, but from where I'm sitting it looks like an in-group/out-group situation where they encourage everyone to drink the koolaid.

 

This has gotten long already, so I won't delve into brain scan research showing marked physical and activity distinctions, and how this may soon be affecting how we measure and conceptualize BPD and PDs, and perhaps even move it toward a distinct medical diagnosis.

 

Sal, if you can identify some specific part of my comments which has mislead people, please do so. I try to learn from my past mistakes.

 

I am only questioning the "spectrum" and "everyone has it" aspects of your descriptions, and wondering if you can show me any broad, authoritative support for either. I would also like to know what "Skips" credentials are if you believe him to be an authoritative source. I am already aware of its use in a genetic study by Lohoff and Berrettini, but that's a different context. I do not think you've misled anyone per se, I am just perplexed as to why the frequent preface, the authoritative tone, and now a strong denouncement of the dichotomous perspective, when from everything I can tell these are not facts already in evidence.

[loveboid]

She isn't crazy; she's an A-hole.

 

It's not her abusive background, her mom, etc. She's making bad choices and she should face the consequences--the buck stops at personal responsibility.

 

She's decided to abuse you and others to get what she wants: catering, special treatment, attention, a roof over her head, etc. She causes trouble at big life changes because that is when you are most vulnerable and where she can get the most catering out of you.

 

She has a bad attitude, bad values and beliefs. These aren't likely to change.

 

I recommend the book "Why Does He Do That?" and substitute in your mind for yourself "Why Does She Do That?"

[Downtown]

You proclaim BPD to be a spectrum disorder.... Nowhere did I find any support for the assertion that "everyone exhibits BPD traits."

Sal, perhaps the following authorities will help you get started. They reference the work of numerous other professionals. Psychologists Trull and Widiger write (2013) that,

In a survey of members of the

International Society for the Study of Personality Disorders

and the

Association for Research on Personality Disorders

, 80% of respondents indicated that

“personality disorders are better understood as variants of normal personality than as categorical disease entities.”

See

Trull-Widiger 2013

at 1. The 2007 survey of 400 members of the two international psychiatric associations is accessible at

J Personality Disord. 2007

.

Dr. Marc-Antoine Crocq is a psychiatrist at the Institute for Research in Neuroscience and Neuropsychiatry in Rouffach, France. Commenting on the DSM-5's proposed graduated approach, he states:

Dimensional systems are better at depicting the variegated nuances of normal personality;

they emphasize the continuum between normal and abnormal personalities

.... See

Dialogues Clin Neurosci. 2013

at 1.

 

Emil Kraepelin (1856-1926) introduced personality types into modern psychiatric classification.... Kraepelin stressed the existence of a broad overlap between overt pathological conditions and personal features that are encountered in normal people. He noted that

the limit between pathological and normal is gradual and arbitrary.

See

Dialogues Clin Neurosci. 2013

at 1.

Dr. Friedel is teaches Psychiatry at Virginia Commonwealth Univ. and is author of the book, Borderline Personality Disorder Demystified. On his website promoting that book, he writes:

The

number and severity of symptoms of borderline disorder vary considerably from one individual to another.

You may have the minimum of five of the nine criteria required for the diagnosis of the disorder, and these symptoms may be of mild severity. See

Friedel Website

.

There is still a diagnostic threshold even if that threshold is graduated, and the graduation doesn't start at zero––it starts where functioning is considered to be impaired.

Actually, the gradation does start at zero. As I noted above (post 36), the proposed graduated approach (Section III of DSM-5) has five gradations, starting with "little to no impairment." That's the "zero" you're talking about. The other four gradations are "some," "moderate," "severe," and "extreme."

 

Under this proposal, a client would be considered to "be disordered" when satisfying the symptoms at the "severe" and "extreme" levels. Yet, as Trull and Widiger observe, an advantage of this dimensional approach is that the diagnostic thresholds can be set at more than one level. This is an advantage, they say, because "distinctions along the continua must be made for various social and clinical decisions, such as whether to hospitalize, medicate, provide disability benefits, and/or provide insurance coverage, to name just a few.... any single diagnostic threshold is unlikely to be optimal for all of these different clinical decisions." See link above.

 

I don't know where the alternative method places the threshold for the axes, or how many have to be concurrently low, or in what combination, for a diagnosis, but no matter how you slice it I cannot agree that even people who are functioning well on all axes are still somewhat borderline.

I am not saying that everyone is somewhat disordered. Rather, I'm only saying that everyone exhibits BPD traits to some degree and, at low levels, exhibiting these traits is not only normal but also essential to our survival. It is only when these behaviors become excessive that they become dysfunctional. And, because the strength of these behaviors is on a spectrum (i.e., continuum), it is quite arbitrary where the APA sets the threshold for "having the disorder."

 

Now if you're saying that everyone has personality traits I could be in agreement, but that's quite different from BPD traits or behaviors.

What I'm saying -- and what the professionals cited above are saying -- is that normal personality traits and BPD traits lie on the same continuum (or spectrum). They differ only by degree. This is an important point because it means that BPDers are not from outer space. Rather, they exhibit the same basic human behaviors we all exhibit but they do so far more frequently and intensely than the rest of us.

 

Angry behavior, for example, is occasionally exhibited by normal people when trying to protect themselves. In dire circumstances, a normal person may exhibit anger at moderate to strong levels. When taken to extremes, however, that anger becomes frequent temper tantrums and intense verbal abuse -- a behavior that usually is not seen in normal adults. Yet, this does not imply that normal folks don't exhibit that trait at a lower intensity. They do. Of course, it is not called "a little bit of temper tantrums." Rather, it is simply called anger.

 

There is a marked distinction between healthy people (fully functional or nearly so) and personality disordered people, and using a continuous personality assessment tool doesn't negate that fundamental fact. BPD is a disorder.

Yes, psychologists call it that. Strictly speaking, however, the BPD you see described in the DSM is simply a set of behavioral symptoms. Psychologists assume there is an underlying cause -- i.e., a disorder -- but nobody has yet proven what it is. There is a world of difference between spotting symptoms (which nearly any layman can learn to do) and making a real diagnosis, i.e., determining the underlying cause of those symptoms.

 

This is why Dr. Thomas Insel -- the psychiatrist who was Director of National Institute of Mental Health from 2002 until 2015 -- publicly stated that "While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each." Hence, instead of describing or identifying the borderline disorder itself, the DSM simply identifies and defines the symptoms caused by that unknown disorder. I discuss this in more detail at my 4-3-16 post.

 

As Dr. Insel observes, medical doctors had largely abandoned this symptom-based approach to "diagnosing" fifty years ago. Similarly, Dr. Michael Stone (Professor of Clinical Psychiatry) observes that "Those DSM definitions were to be considered atheoretic, since there was not enough information in the field to speak authoritatively about underlying causes." See Behav Neurosci 2014 at 26.

 

What I disagree with is, "you are hanging on to an outdated approach to defining personality disorders (i.e., the dichotomous approach) that was wrong when it was adopted 36 years ago." Actually, this is still the current method in the DSM 5. The dichotomous method is not WRONG, it's just different....

No, it is wrong -- from a scientific perspective. Any scientist knows it is silly to use a yes/no (dichotomous) approach to categorizing a factor that varies on a continuum. This is why we measure body height with a ruler instead of declaring everyone to be "short" or "tall." Moreover, nearly any high school student can tell you that basic human behaviors (e.g., showing jealousy, selfishness, impulsiveness, and displays of anger) vary by intensity from person to person.

 

Granted, this yes/no approach was successful in the sense that it achieved a political compromise appeasing the courts, insurance companies, and the APA members demanding a simple solution having a bright line. It therefore was able to get rid of a far worse diagnostic approach that had proven to be a disaster in the 1970s.

 

Yet, in a discipline that wants to be accepted as a social science, the diagnostic model should reflect actual reality -- not just political reality. Even the Chairman of the DSM-IV Working Group acknowledged in 1993 -- a year before he and his group released the fourth DSM -- that the dichotomous approach would have to be gutted and replaced eventually:

[A.J.] Frances had suggested that the switch to a dimensional model was not a matter of “whether, but when and which” (p 110). Frances was at that time the Chair of the forthcoming

DSM-IV.

It has now been almost 20 years since

DSM-IV,

and the primary coordinators of the forthcoming fifth edition of the diagnostic manual are embracing a shift of the entire manual toward a dimensional classification. See

Trull-Widiger 2013

at 1.

 

[standtall]

Then you are looking at relationships and marriages completely the wrong way. There is a young child involved, the OP has to do what's best for the child.

 

I couldn't disagree with you more..that mentality is a great contributor to the divorce rate...YOUR SPOUSE COMES BEFORE CHILDREN.

 

I'm not talking about feeding..basic crap. I'm talking about neglecting your marriage while your too busy with soccer practice and reading bedtime stories...making that child a bigger hobby than your marriage...putting more energy into the child/children than your relationship with your spouse...because all children grow up and leave the house, and if you have neglected your marriage and your spouses needs, then there is nothing left of your marriage when their gone. Alot of wedding vows ..at least mine did..state to put your spouse before ALL others, that's there for a reason.

[BettyDraper]

Tell your wife that unless she sees a psychiatrist for a full evaluation and starts weekly therapy after that appointment, you will be leaving her because her behavior is intolerable and you will no longer be subjected to it. She may also need medication; Depakote works wonders for those with mood disorders and BPD.

 

My husband is very patient with the issues I have which stem from my abusive childhood. I know this is partly because I have always taken steps to heal such as seeing a therapist for over two years. I have also embraced a healthier lifestyle and stopped smoking marijuana; I didn't want to live in a cloud of smoke to hide from my past. I'm sure my husband would have left me if I didn't seek counseling and make healthier changes.