I Hate You--Don't Leave Me - Jerold J. Kreisman [16]
BPD and Pain
Borderlines have been demonstrated to reflect paradoxical reactions to pain. Many studies have shown a significantly decreased sensitivity to acute pain, particularly when self-inflicted (see “Self-Destruction” on page 45). However, borderlines exhibit greater sensitivity to chronic pain. This “pain paradox” appears unique to borderlines and has not been satisfactorily explained. Some posit that acute pain, especially when self-inflicted, satisfies certain psychological needs for the patient and is associated with changes in electrical brain activity and perhaps quick release of endogenous opioids, the body’s own narcotics. However, ongoing pain, experienced outside the borderline’s control, may result in less internal analgesic protection and cause more anxiety.9,10
BPD and Somatization Disorder
The borderline may focus on his physical ills, complaining loudly and dramatically to medical personnel and acquaintances, in order to maintain dependency relationships with them. He may be considered merely a hypochondriac, while the underlying understanding of his problems is completely ignored. Somatization disorder is a condition defined by the patient’s multiple physical complaints (including pain, gastric, neurological, and sexual symptoms), unexplained by any known medical condition. In hypochondriasis the patient is convinced he has a terrible disease despite a negative medical evaluation.
BPD and Dissociative Disorders
Dissociative disorders include such phenomena as amnesia, feelings of unreality about oneself (depersonalization) or about the environment (derealization). The most extreme form of dissociation is dissociative identity disorder (DID), previously referred to as “multiple personality.” Almost 75 percent of individuals with BPD experience some dissociative phenomena.11 The prevalence of BPD in those suffering from the most severe form of dissociation, DID, as a primary diagnosis is even greater.12 Both disorders share common symptoms—impulsivity, anger outbursts, disturbed relationships, severe mood changes, and a propensity for self-mutilation. There is frequently a childhood history of mistreatment, abuse, or neglect.
BPD and Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a complex of symptoms that follows an extraordinarily severe traumatic event, such as a natural disaster or combat. It is characterized by intense fear, emotional re-experiencing of the event, nightmares, irritability, exaggerated startle response, avoidance of associated places or activities, and a sense of helplessness. Since both BPD and PTSD have frequently been associated with a history of extreme abuse in childhood and reflect similar symptoms—such as extreme emotional reactions and impulsivity—some have posited that they are the same illness. Although some studies indicate that they may occur together as much as 50 percent or more of the time, they are distinctly different disorders with different defining criteria.13
BPD and Associated Personality Disorders
Many characteristics of BPD overlap with those of other personality disorders. For example, the dependent personality shares with the borderline the features of dependency, avoidance of being alone, and strained relationships. But the dependent personality lacks the self-destructiveness, anger, and mood swings of a borderline. Similarly, the schizotypal personality exhibits poor relations with others and difficulty in trusting, but is more eccentric and less self-destructive. Often a patient exhibits enough characteristics of two or more personality disorders to warrant diagnoses for each. For example, a patient may demonstrate characteristics that lead to diagnoses of both borderline personality disorder and obsessive-compulsive personality disorder.
In DSM-IV-TR,