― Shannon L. Alder
Similar to Type I Diabetes, Type I BPD manifests early in life, will impact multiple systems, and requires medical treatment in addition to lifestyle changes. Type I BPD would be present in the 80-60 percent of cases where CSA, trauma, or neglect are reported. These instances will most likely have multiple diagnoses of PTSD, RAD, or DSED along with BPD (Binks, 2006). The proclivity of comorbidity of Type I BPD can muddy treatment goals and overwhelm resources, providers, and family/social supports.
It is estimated that 90 percent of people with BPD attempt suicide at a 10 percent completion rate (Aguirre, 2007, p. 201). The rate of death due to diabetes is also 10 percent (National Diabetes Statistics Report, 2014). An additional commonality between Type I BPD and Diabetes is neuropathy. With diabetes, weakness, numbness, and pain from nerve damage, usually in extremities occurs. The resulting numbness can prevent people from noticing when they have a wound or injury. These injuries can then fester, become infected, and result in amputations. An emotional and relational equivalent also occurs in people with Type I BPD. They have experienced an emotional numbness that, when not addressed, can exacerbate relational wounds or injuries which fester to the extent the relationship requires amputation. This does not mean relationship repair is impossible. However, there are times when damage sustained from someone with BPD is so severe, the other person in the relationship is unwilling or unable to risk additional harm.
To summarize, Type I BPD is evident in people who have a history of trauma, complex/compound trauma, unhealthy attachments, self-harm, likely multiple acute psychiatric hospitalizations, and symptoms have been pervasive since adolescents. Type I BPD will require long term treatment due to inherent distrust, emotional lability, and difficulty with attachment/joining. Emotional neuropathy may require multiple specialists to address specific symptoms while an overarching therapy is maintained. This could include EMDR, DBT, CBT, or IOP.
This information is important to help understand and delineate types of BPD in order to specifically target forms of treatment in order to increase positive prognosis. As with any other diagnosis, knowing severity is important to assist in setting expectations and arranging necessary supports. If providers view every BPD case the same way, they may provide too many, or too few, resources. More research needs to be done to help clinically identify forms of BPD. Gestational BPD, a suggestion on how new research can be done, and how it may impact treatment will be covered in part III.
(C) 2016, Nathan D. Croy
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