I Hate You--Don't Leave Me - Jerold J. Kreisman [15]
FIGURE 2-1. Schematic of position of BPD in relation to other mental disorders.
The question of which is the chicken and which is the egg may be difficult to resolve, but the development of illnesses associated with BPD may represent a kind of psychological vulnerability to stress. Just as certain individuals have genetic and biological dispositions to physical diseases—heart attacks, cancers, gastrointestinal disorders, etc.—many also have biologically determined propensities to psychiatric illnesses, particularly when stress is added to an underlying vulnerability to BPD. Thus, under stress, one borderline turns to drugs, another develops an eating disorder, still another becomes severely depressed.
Third, BPD may so completely mimic another disorder that the patient may be erroneously diagnosed with schizophrenia, anxiety, bipolar disease, attention deficit/hyperactivity disorder (ADHD), or other illnesses.
Comparison to Schizophrenia
Schizophrenic patients are usually much more severely impaired than borderlines and less capable of manipulating and relating to others. Both kinds of patients may experience agitated, psychotic episodes, but these are usually less consistent and less pervasive over time for borderlines. Schizophrenics are much more likely to grow accustomed to their hallucinations and delusions and are often less disturbed by them. Additionally, both may be destructive and self-mutilating, but whereas the borderline usually can function appropriately, the schizophrenic is much more severely impaired socially.
Comparison to Affective Disorders (Bipolar and Depressive Disorders)
“Mood swings” and “racing thoughts” are common patient complaints, to which the knee-jerk diagnostic response from the clinician is to diagnose depression or bipolar disorder (manic depression). However, such symptoms are consistent with BPD, and even ADHD, both of which are significantly more prevalent than bipolar disorder. The differences between these syndromes are dramatic. For those afflicted with bipolar disorder or depression, episodes of depression or mania represent radical departures in functioning. Mood changes last from days to weeks. Between mood swings, these individuals maintain relatively normal lives and can usually be treated effectively with medications. Borderlines, in contrast, typically have difficulties in functioning (at least internally) even when not displaying prominent mood swings. When self-destructive, threatening suicide, hyperactive, or experiencing wide and rapid mood swings, the borderline may appear bipolar, but the borderline’s mood variations are more transient (lasting hours, rather than days or weeks), and more often reactive to environmental stimuli.3
BPD and ADHD
Individuals with ADHD are subjected to a constant scramble of flashing cognitions. Like borderlines, they often experience wild mood changes, racing thoughts, impulsivity, anger outbursts, impatience, and low frustration tolerance; have a history of drug or alcohol abuse (self-medicating) and torturous relationships; and are bored easily. Indeed, many borderline personality characteristics correspond to the “typical ADHD temperament,” such as frequent novelty-seeking (searching for excitement) coupled with low reward dependence (lack of concern for immediate consequences).4 Not surprisingly, several studies have noted correlations between these diagnoses. Some prospective studies have noted that children diagnosed with ADHD frequently develop a personality disorder, especially BPD, as they get older. Retrospective researchers have determined that adults with the diagnosis of BPD often fit a childhood diagnosis of ADHD.5,6,7 Whether one illness causes the other, whether they frequently travel together, or,