Subtypes of BPD, Part III

“A crucial element of the real self is its unconditional acceptance of itself.”
― Michael Adzema
Introduction
        The first post provided a brief overview of BPD by way of metaphor and part II reviewed the first two types of BPD and provided some initial treatment possibilities. This final post will review the last form of BPD, initial treatments, and suggest ways existentialism can continue to provide treatment for people with BPD. Lastly, this post will propose new research to help anticipate and reduce recidivism in people with BPD.
Subtypes of BPD
     
Type III
         The metaphor of the Window Painter applies to all three types of BPD. However, in the third type of BPD, the person with BPD has grown up in a reassuring and secure environment with few double-bind messages or abandonments. They have experienced adequate safety and security with little social, familial, or psychological instability. While this person may struggle with some minor forms of mood lability and a flair for the dramatic, overall functioning is healthy and they are able to maintain long lasting relationships. BPD would, rightfully so, not be diagnosed, although borderline traits may be noticeable. However, they would not meet the essential criteria for BPD.
          According to the DSM 5, the essential feature of BPD “is a pervasive pattern of unstable interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” (2013, p. 663). In this sense, BPD could be sitting dormant. While the diagnostic criteria does not allow for a diagnosis without at least 5 specific symptoms. Most experienced clinicians will assess for personality traits and provide treatment focusing on attachment, boundaries, and relationship maintenance.
     Gestational diabetes (GD) is a discrete episode of diabetes which occurs during pregnancy. It is monitored and treated until several hours after delivery. There are several factors that can Most of the time, blood sugar levels return to normal within a few hours after birth. However, having GD can increase the risk of permanently developing type II diabetes. 

Treat personality shifts like internal fugue state. Situational dependency. Catastrophic events removing available

Initial Treatment
Conclusion
Sources
      Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. New York, NY: Brunner-Routledge. 

God Can’t: A Review

“I am convinced that God is love, this thought has for me a primitive lyrical validity. When it is present to me, I am unspeakably blissful, when it is absent, I long for it more vehemently than does the lover for his object.”

― Soren Kierkegaard, Fear and Trembling

     There’s a good chance Dr. Oord’s new book, God Can’t, may threaten the very foundations many believers hold dear. I do not want to imply this book is divisive, far from it. In fact, understood correctly, this book has the potential to join very disparate groups of people in the commonality of their human experience. Unfortunately, many people may not be ready for the challenges this book brings. However, for those who are ready to be challenged, this book offers a path of healing. On the other side of that path is a deeper, truer, and more authentic faith. If you are ready for the difficult call of authenticity offered here, then I would highly encourage you to pick up God Can’t. In this post, I’m going to give you a brief overview of the book from an existential perspective, explain why I believe the ideas are important, and discuss how some of these concepts may be applied in therapy, the Church, and in theology.

Overview:

     The problem of evil goes like this: God is all powerful and all loving. An all loving being would want to prevent evil things from happening to those they love. And all powerful being would be able to prevent evil things from happening to those same people. Evil happens to us, the beings God claims to love. This means God is either not all powerful (unable to prevent evil from occurring), or not all loving (doesn’t care if evil happens). Therefore, God does not exist. This is a legitimate issue many people have struggled over. In addition, there’s the issue of freewill and foreknowledge: If God knows the future, and God is never wrong, how can we have freewill?
    Dr. Oord has answered these questions through multiple publications on love (The most recent of which are: The Uncontrolling Love of God, Uncontrolling Love, and God Can’t). For Oord, freewill is a necessary condition of God’s love for us; an “Essential Kenosis” (EK). What this book adds to the already published works is a teleological application of the theological concepts. It’s one thing to talk about a general “trauma” and to offer platitudes like, “God works in mysterious ways”. That may be, but that doesn’t mean God is illogical, chaotic, capricious, and flippant. If we take seriously the idea that God is love, we must also take seriously the pain and suffering in the world.
   God Can’t explores the idea of EK, the existence of trauma (evil), and how we can respond. If you read this book, you take a big risk. You may have to accept genuine responsibility. And that’s not something everyone is willing, or ready, to do.

Responsibility:

     Many therapeutic conversations work to distinguish the difference between fault and responsibility. Fault is about blame; who did what to whom, and when. Responsibility is about response: our ability to respond to a situation. We are not always completely at fault. We are always 100% responsible for how we respond. I have written about this in the past, but Yalom defined responsibility like this:

“To be aware of responsibility is to be aware of creating one’s own self, destiny, life predicament, feelings and, if such be the case, one’s own suffering. For the patient who will not accept such responsibility, who persists in blaming others — either other individuals or other forces — for his or her dysphoria, no real therapy is possible”.

What does this mean for those who have experienced trauma? It means so many things, but I am going to break it down into 3 sections: Be, Do, Have. The BDH model has been around so long, I can’t find out where it came from, but there’s a great explanation here: Be Do Have. Briefly explained, BDH is the idea that we must first know who we are (Be), and allow that to inform our behaviors/decisions (Do), and commit to altering and changing our actions until we get what we are working for (Have). The problem happens when we start with what we think we want (Have), then work and stress (Do) to try and get it so that we feel validated/ “ok” (Be). This process makes the security of our personhood dependent on outcomes and what we own. That externalization of self turns small threats into massive, existential, threats about our very being!

Be

 

Not Necessarily Truth.

“I remember driving to therapy and thinking, ‘Well, this is it. I’m all out of stories’. I didn’t know what I was going to say. And that was when therapy really began.”

-Dr. Ron Wright on attending therapy while in his graduate program
     Many parents and couples “warn” me when they believe a member of their family participating in therapy struggles to tell the truth or are manipulative. I appreciate the heads up and it almost always reminds me of an experience from grad school.
     A client told me a horrendous story regarding the loss of his wife and children on halloween night as they came to visit him. He cited this tragic loss as the reason for slipping into depression, alcoholism, and ultimately losing his job and becoming homeless. I worked with the client for several weeks before court documents from his very un-dead-yet-not-a-zombie-wife appear requesting garnishment of his wages. His wife did not die, nor did he lose his children. They simply left him when his alcoholism began overrunning their life. 
     With this realization fresh in mind, I burst into my supervisors office ranting about the gall of a client to waste my time, his time, the worlds time, on complete lies. My supervisor, calm and patient as always, asked one question, “so what?” It made no sense to me at the time. Not until several years later did it finally sink in: there was truth in the lie. The factuality of the content was null and void. The meaning beneath the content contained truth. The story he told was false. The abandonment he felt was real. I was so hung up on factuality I missed the truth. 
     For those, like myself, who can sometimes get so hung up on truth we miss it, think about this: If a bear appeared behind you right now, how would you feel? Happy? Hungry? Excited? Probably none of these. Assuming you are coherent and aware of said bear, you would be scared. You probably, hopefully, don’t have a bear behind you right now. This does not change the truth that you would have been scared. Fear would have been your primary emotion. 
     Does it matter if the bear was there or not? Does it matter if the man’s family died or not? However, the emotions underlying those experiences are universal and translate to multiple contexts. The situations may vary. The underlying emotions will remain. This “truth” allows for common ground and removes the necessity for “rightness”. 

Different Discussions

Along with the loss of the sense of self has gone a loss of our language for communicating deeply personal meanings to each other. This is one important side of the loneliness now experienced by people in the Western world.

Rollo May, Man’s Search for Himself.

     One of the most frequent requests in couples therapy is help with communication. Over the years, I’ve noticed that most conversations in relationships fall into three general categories: Debates, Dialogues, or Dialectics. I don’t think either of these types are inherently bad or good. However, some are more beneficial than others in different situations, so it’s important to know what type of communication you’re having! Without that, who knows if your conversation is moving you in the direction you want?

Debates

    When someone tells me they want to be heard, I usually ask, “How will you know when the other person really hears you?” More often than not, the answer I get back is, “They’ll agree with me!”
     Look, we all have a little bit of narcissism in us. It’s good to have some