This sentence is very telling: "It emerged over 60 years ago to describe patients on the border between neurosis and psychosis who might be amenable to treatment with psychoanalysis."<p>What I love about this article is it makes us question the thing we all think we can't question: the validity of the diagnosis itself.<p>What if the whole thing is wrong? What if it is this "easy" thing clinicians invented because they just got frustrated with how insanely certain patients acted when their underlying neuroses became so severe that they progressed into something closer to psychosis? What if focusing on a BPD diagnosis masks underlying conditions that are much easier to recognize and treat? What if it is just underlying disorders advanced to the Nth degree, that all somehow converge on a similar behavior set (much like psychosis), despite a differing underlying cause, and that focusing on that similar behavior set rather than on those underlying disorders is what causes BPD to be so untreatable?<p>A BPD diagnosis is often hopeless. There are no good drugs for it, and talk therapy works poorly. Almost all the comments here on HN from people who have someone with BPD in their life reflect this reality, and how terrible BPD is.<p>This article actually gives me hope for my sister. It gives me a new perspective on how we have been trying to help her, and why it might not be working.
My mom is BPD, she is a text book case. And I have been in therapy for almost a decade because of her emotional abuse. As many others have said, this paper is definitely beyond absurd.
I have close experience with not one but two people with BPD, over a long time, and before and after treatment (no medication involved). You wouldn't know they have (or "had"?) BPD.<p>One thing I noticed is that the popular stereotypes about people with BPD (which is unpleasant stuff) appears to not be true. Or rather, I bet it is true quite often, but <i>not</i> a direct result of BPD.<p>Rather, it seems to be what happens when people with BPD don't know how to deal with it. The underlying condition seems to be "emotions are really strong" and especially "internal emotional feedback loops", and if you don't know what's happening, I totally get how someone might confusingly react accordingly to what they are feeling in a bad way: Lashing out, paranoia, accusations, oscillating between thinking someone is a saint versus someone is terrible...<p>The two people I know both have been in talk therapy (not anymore), and they are generally very introspective. Knowing what they know, they seem to be perfectly able to separate their internal tumult from reality, and appear generally pleasant at least to me. A big part seems to be to recognize the feedback loops early and breaking out of them. That was different in the now distant past, but again, I totally get how their confusion back then led to that past behavior...
My pet theory is that all personality disorders are essentially ingrained responses to conditioning which could adequately be described as CPTSD, roughly categorized into the different types based on the types of trauma complexes experienced and the learned responses to them.
Yeh this paper is something else - I've never seen one written using a tone like this before.<p>My ex-GF was textbook BPD. Finding the survivor resources was so helpful - people who have never experienced someone who has BPD simply find it hard to believe what you say happened actually happened and those resources are almost as though someone has been dating your ex-GF as the experiences are so similar.<p>Either BPD doesn't exist and there's a grouping of consistent traits that many people have seen first hand or it does exist and either way the outcome is the same for those observing it.
Married to someone with BPD. I guess one can debate what to call her symptom group - but insinuating her challenges don't exist is beyond absurd.<p>After 25 years I could pretty well climb into her headspace. If I lived there, I don't think I could ever find my way out.
I can't find it but Scott Alexander had an essay where he laid out the hypothesis that some of the personality disorders (narcissism and BPD in particular) came about through evolutionary selection. It's notable that the prevalence varies among the sexes.
This is a BS article that's basically a clinician's pet peeves and grievances.<p>I know three close people with a BPD diagnosis. They had both a similar constellation of personality traits and all three were first medicated with antidepressants to no avail (a common trait in BPD is that it is easy to confuse for major depression). They took BPD-specific drugs and after a few trials and errors their quality of life increased _tremendously_, and there is evidence that BPD and associated personality traits are highly inheritable.<p>It is completely possible that a combination of adequate diet, exercise and sleep and lifestyle changes may take away these symptoms as they may possibly manifest the weird ways in which our minds and bodies react to the difficulties of modern life. But for most people that's just an option.<p>People may debate the minutiae of the biological underpinnings and the quantification of certain classes of symptoms. But that doesn't change that I've seen people who had a monthly episode of behaving like complete trash who totally changed their lives after taking lithium or other medication.