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I'll point out that I have not been formally DX'd with BPD, but I exhibit some of the main symptoms. Bouts of of emotional intensity, hypersensitivity, dysphoria, loneliness, feeling lost and empty (excluding the impulsivity/anger). I've already done a year DBT group (and individual DBT) but wondering if any of you here have a med that has been most helpful for you with the least side effects? Any PRN recommedations? For example, have mood stabilizers been most effective, A/Ps, anti-anxiety or antidepressants - or only a combo of a BUNCH of these?

Note, I've tried like 30 different meds, many combos and often just end up feeling overmedicated/lethargic, dead, or physically bad, being on several meds can also make me dissociate or have paranoia, which is also a problem for BPD people. You can't shut down ALL of your emotions, there is a reason why emotions exist...

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34 minutes ago, Blahblah said:

I'll point out that I have not been formally DX'd with BPD, but I exhibit some of the main symptoms. Bouts of of emotional intensity, hypersensitivity, dysphoria, loneliness, feeling lost and empty (excluding the impulsivity/anger). I've already done a year DBT group (and individual DBT) but wondering if any of you here have a med that has been most helpful for you with the least side effects? Any PRN recommedations? For example, have mood stabilizers been most effective, A/Ps, anti-anxiety or antidepressants - or only a combo of a BUNCH of these?

Note, I've tried like 30 different meds, many combos and often just end up feeling overmedicated/lethargic, dead, or physically bad, being on several meds can also make me dissociate or have paranoia, which is also a problem for BPD people. You can't shut down ALL of your emotions, there is a reason why emotions exist...

I’ve never been dx’d with it either, but definitely struggle with the emotional intensity and emptiness at times...and Seroquel (specifically xr because it’s less likely to cause weight gain) has been superb in emotion regulation and helps with anxiety and sleep, and depression. Really a great med, though I did have to stop because I’m developing tardive diskonesia (sp). 

My newest antidepressant has worked better than anything else I’ve taken in a good few years. The GI issues can be pretty bad, however, the new medication viberzi, has completely solved that. And the slight inconvenience of having to take another medication for those issues is worth it by a long shot. 

I’m also taking the smallest dose of Cymbalta with it, mainly because I’m scared to completely stop it since titration from that to Viibryd and don’t want to rock the boat whatsoever! 

I hope you get some relief soon...you’ve been struggling far too long. 

 

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Have you ever heard of Reactive Attachment Disorder, RAD?  I was diagnosed with with emotionally unstable personality disorder in my 20's but never felt like it quite fitted as I'm not impulsive and I'm more withdrawn then anything. There is a large overlap with RAD and some personality disorders especially BPD. Both are linked to neglect in early childhood and the way it causes the brain to form. 

Thank you abusive alcoholic mother and semi absent father. I appreciate the lifetime of mental health problems you've given me.

Oh and I was on 2 different SSRI and diazepam. Meds didn't help but I do appreciate a good benzo. I was told that Schema therapy would be the best help, I don't actually know much about it really and its not available on the NHS so wasn't something I tried or could get access to. 

 

 

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@Raspberry no I've never heard of that. Interesting. I avoid benzos (unless for a night PRN absolute emergency) because they tend to make me more depressed.

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BlahBlah, I believe I have read you state that you have complex trauma, am I right? If that is the case, this and a lot of other things you describe around CB are indicative of present complex PTSD symptoms, which look similar to BPD from a distance, but require different treatment. In fact, for some people, treatment that is for BPD makes complex PTSD symptoms worse and more ingrained than they were to start off with, which is unfortunately what happened to me, because I had what Raspberry describes and if it isn't effectively treated, often it is believed to become a personality disorder, which may be true for some people, but it is actually more common to develop into complex PTSD, not a personality disorder. 

The difference is that complex PTSD is a set of learned survival mechanisms, a personality disorder is a set of dysfunctional traits that cause harm to the person, and or other people as a means of coping with triggers in the environment. This is an important distinction to make, one that can change the treatment necessary quite a lot. 

Is the emotional intensity really that, or is it a flashback? A flashback usually doesn't last and tends to come from a specific trigger, however it isn't always noticeable without learning how to notice. Flashbacks also typically have a sense of familiarity about them that indicates the emotion/s are tied to the trigger and some trauma in the past that happened during a time you were unable to express emotions freely for some reason or another. 

The only way to manage a flashback is by recognising it as one and learning to accept it and ground yourself back into the present time. Over time, doing that will reduce their intensity and frequency if you are also free to express yourself and emotions elsewhere in your life. You can think of these flashbacks as a drip down effect of a lack of emotional expression, as you indicated, it is not possible to go about life in such a way that you have no emotions without consequence. The flashbacks are one of the consequences. 

 

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40 minutes ago, Hopelessly Broken said:

BlahBlah, I believe I have read you state that you have complex trauma, am I right? If that is the case, this and a lot of other things you describe around CB are indicative of present complex PTSD symptoms, which look similar to BPD from a distance, but require different treatment. In fact, for some people, treatment that is for BPD makes complex PTSD symptoms worse and more ingrained than they were to start off with, which is unfortunately what happened to me, because I had what Raspberry describes and if it isn't effectively treated, often it is believed to become a personality disorder, which may be true for some people, but it is actually more common to develop into complex PTSD, not a personality disorder. 

The difference is that complex PTSD is a set of learned survival mechanisms, a personality disorder is a set of dysfunctional traits that cause harm to the person, and or other people as a means of coping with triggers in the environment. This is an important distinction to make, one that can change the treatment necessary quite a lot. 

Is the emotional intensity really that, or is it a flashback? A flashback usually doesn't last and tends to come from a specific trigger, however it isn't always noticeable without learning how to notice. Flashbacks also typically have a sense of familiarity about them that indicates the emotion/s are tied to the trigger and some trauma in the past that happened during a time you were unable to express emotions freely for some reason or another. 

The only way to manage a flashback is by recognising it as one and learning to accept it and ground yourself back into the present time. Over time, doing that will reduce their intensity and frequency if you are also free to express yourself and emotions elsewhere in your life. You can think of these flashbacks as a drip down effect of a lack of emotional expression, as you indicated, it is not possible to go about life in such a way that you have no emotions without consequence. The flashbacks are one of the consequences. 

 

Super glad you wrote this post. 

I hace been dx’d with cptsd as well, and never really put the puzzle together regarding what happens why and when. 

I have gained a lot of insight into my responses to things, and grew up in an extremely abusive, neglectful home, and I’m just really grateful for the way you explained everything. 

You too @Raspberry!

thank you both. 

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No problem, by no means am I a master at it, it takes time and a lot of skill that you unfortunately miss out on developing in the case of child abuse/childhood trauma. I have just educated myself rather vastly as a result of the lack of knowledge about complex PTSD, and expertise in treating it. 

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10 hours ago, Hopelessly Broken said:

The difference is that complex PTSD is a set of learned survival mechanisms, a personality disorder is a set of dysfunctional traits that cause harm to the person, and or other people as a means of coping with triggers in the environment. This is an important distinction to make, one that can change the treatment necessary quite a lot. 

Is the emotional intensity really that, or is it a flashback? A flashback usually doesn't last and tends to come from a specific trigger, however it isn't always noticeable without learning how to notice. Flashbacks also typically have a sense of familiarity about them that indicates the emotion/s are tied to the trigger and some trauma in the past that happened during a time you were unable to express emotions freely for some reason or another. 

The only way to manage a flashback is by recognising it as one and learning to accept it and ground yourself back into the present time. Over time, doing that will reduce their intensity and frequency if you are also free to express yourself and emotions elsewhere in your life. You can think of these flashbacks as a drip down effect of a lack of emotional expression, as you indicated, it is not possible to go about life in such a way that you have no emotions without consequence. The flashbacks are one of the consequences.

@Hopelessly Broken This is very helpful, thank you...You seem very knowledgeable with this.  I have been trying to understand what is going on for a long time :-(  This cluster of symptoms can relate to different diagnosis (C-PTSD, BPD, PMDD) I've been trying to just treat the symptoms, because no one has been able to adequately diagnose what it is..tough to work through trauma events in therapy that i can't really remember (wasn't abused, happy childhood, etc)

These intense episodes are very short (sometimes just 2 hours), yes, akin to an emotional flashback (I don't think of a particular event, i just feel overwhelmed and distressed - and have trouble calming myself,  and yes its always the same familiar feeling). The emotional intensity can be brought on by really any trigger that makes me stressed out...and it keeps happening on a regular basis. Like BPD, my emotional reactions look exaggerated and intense to the situation. It does feel like trauma, but then when I look rationally at the "trigger" it does not make sense that certain things should trigger my reaction, and then I feel ashamed.

Oh, and sometimes if I'm out in public and I feel a twinge reactive - I hold back tears and dissociate (and sometimes end up walking in the wrong direction or missing my bus stop) The emotions are really affecting my cognition.

Can you recommend any good books about dealing with unresolved "trauma flashbacks" and grounding techniques? I agree, sometimes a person can have trauma from childhood and have no idea what happened, it's just this...intense feeling....do you get it? I usually cannot express all my emotions freely (unless at a therapy appointment) No one understands this sensitivity....so I try to use behavioral techniques (DBT) and meds to mute these painful emotions. obviously, it is not working.

Edited by Blahblah
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Sounds more like an emotional flashback than pervasive emotional intensity. You can visit Pete Walker's website for information on managing them, and his book Complex PTSD: From Surviving To Thriving is a must have if you are interested in a decent education from both a professional and lived experience perspective, as he both lives with it and treats it in a private practice. 

The website Out Of The Storm is a support site for complex trauma survivors, if interested. I'm afraid I can't help with grounding skills, my specific survival mechanisms are dissociative and very strong, and I am not yet at a place in my journey where I am stable enough to be comfortable without dissociative symptoms for various reasons. Pete Walker's site and book discusses it well, however. 

Sometimes they don't make sense, and they don't have to in order to be valid. I understand the shame, though, very well. Mine is fading away with acceptance towards the fact I didn't cause or ask for this to happen, but yes, emotional flashbacks can be rather embarrassing. For me, I struggle a lot with the sense of immaturity they cause. 

For me, it also helps to know why the trigger is one at all, and why it keeps showing up, it just adds some degree of basis to support the validity of it all. It also teaches me to care more about it. 

I can't express mine, either, but I have my own story to say why that is at this point in time. I prefer not to see it as sensitivity but as an available means to let go at this point in time, I spent my whole childhood not being able to, so it makes sense that it is out of control to a point now. Although I don't see it that way, I see it as being acceptable given all I have faced in life.

Shutting it off does nothing but make it worse. You have to accept it and let it pass, because it will, and believe me, I very rarely say that, and I wouldn't unless I truly meant it. This is part of what made DBT rather contraindicated for me, it made the numbness a lot worse and reinforced that emotions are something I should ignore because they aren't rational and cause bad things to happen. It also made me more dissociative and worsened the shame by not being able to respond to the self-regulation skills like seemingly everyone else. I found it to be an invalidating module of therapy overall that undermined me and how ingrained my issues are. 

Edited by Hopelessly Broken
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2 hours ago, Hopelessly Broken said:

Sometimes they don't make sense, and they don't have to in order to be valid. I understand the shame, though, very well. Mine is fading away with acceptance towards the fact I didn't cause or ask for this to happen, but yes, emotional flashbacks can be rather embarrassing. For me, I struggle a lot with the sense of immaturity they cause. 

For me, it also helps to know why the trigger is one at all, and why it keeps showing up, it just adds some degree of basis to support the validity of it all. It also teaches me to care more about it. 

I prefer not to see it as sensitivity but as an available means to let go at this point in time, I spent my whole childhood not being able to, so it makes sense that it is out of control to a point now. Although I don't see it that way, I see it as being acceptable given all I have faced in life.

Shutting it off does nothing but make it worse. You have to accept it and let it pass, because it will, and believe me, I very rarely say that, and I wouldn't unless I truly meant it. This is part of what made DBT rather contraindicated for me, it made the numbness a lot worse and reinforced that emotions are something I should ignore because they aren't rational and cause bad things to happen. It also made me more dissociative and worsened the shame by not being able to respond to the self-regulation skills like seemingly everyone else. I found it to be an invalidating module of therapy overall that undermined me and how ingrained my issues are. 

Thank you again for the resources. I will check them out, I honestly haven't researched C-PTSD much. After the DBT indoctrination, I began to think I had a personality defect (yet I really never met full criteria for Borderline, nor Bipolar either) I hide if possible when the triggering happens, because I feel so much shame and embarrassment... The emotions engulf me, I can't control them. Even in therapy, I try to avoid crying and I frequently "zone out" to avoid it. Talk therapy (especially CBT) often makes me feel worse or agitated.

It's interesting that you say DBT reinforced that emotions are irrational and should be ignored. I have actually had several therapists tell me this - that I need to control the negative emotions (replace with rational thoughts), because they are emotions are lies, useless and negative emotions sabotage us. They are not the "truth" This reflection makes me realize that DBT might NOT be the best therapy for me, perhaps it is making my protection/coping mechanisms more ingrained.

Edited by Blahblah
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It's interesting, because if you read Marsha Linehan's books, properly done DBT would actually say the opposite.  The foundation of DBT is that emotions are useful, valid, and have a purpose, AND that we may at times want to try to change them anyway, if they are not serving us.  It's both.  Stage 1 PTSD treatment, for some people (not all, because not everything works for every brain) can look very similar to BPD treatment - I did DBT and benefited from it greatly.  I never liked CBT initially, but I'm doing some now specifically for PTSD and thus far tolerating it better than I anticipated that I would.

To be honest I think BPD vs cPTSD is a bit of a false dichotomy.  There are a lot of symptoms in common and even BPD in the absence of PTSD is frequently linked to trauma.

As to meds for BPD, there is mixed evidence for almost everything, and no high quality evidence that any particular medication is useful in treating BPD itself.  I've found antipsychotics (particularly quetiapine) very useful for meltdown emergencies.  Far more so than benzodiazepines.  Lamotrigine has been okay I think, but I've been on it for a long time, and doing lots of therapy concurrently, so it's really hard to say for sure.

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Interesting indeed. Thanks for letting me know that both my effort and the illness I suffer from is viewed as a false dichotomy. I really appreciate it.

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I wasn't talking about your experience specifically, or your effort, or your diagnosis.

I have complex PTSD too, and had a BPD diagnosis for a long time, so I've come at things from both angles.  The BPD diagnosis was useful for me in the early days, especially the piece around attachment.  I learned a lot about myself through that lens.  And then over the years it became less useful to me, and I probably also no longer meet criteria, so cPTSD makes more sense.  But when I look back on my own story, I see a lot of the overlaps, and I see how BPD treatment helped me a lot, and I think the diagnoses are in many cases not all that far apart.  I still mod the personality disorders section and I feel comfortable with that both because of my past diagnosis but also just because of the similarities in some of the core issues.  Maybe for you the two diagnoses are very far apart, all I'm saying is that that isn't always the case, and it's by no means an accepted fact that the treatments are entirely different (though of course DBT isn't the right therapy for everyone with cPTSD).

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If you are willing to go back down the self help route again as well as meds there are a few DBT workbooks that you can download for free. 

https://docs.google.com/file/d/1cyanUui4ZlpL0suxvBoGhgsBQwM5aAsHXKl4U2vdQ7eRPMqcwe-jPuTxqgl2/edit?pli=1#

I couldn't find a page here with links to free workbooks and worksheets, but I probably wasn't doing the best job of looking. I like workbooks, I get to use my crayons. 

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16 hours ago, tryp said:

 There are a lot of symptoms in common and even BPD in the absence of PTSD is frequently linked to trauma.

The symptoms (regarding emotional disregulation, anxiety, distress, relational/attachment issues) of both diagnosis are very similar (to me). I think this may be why I am confused as to the origin & defining features of each disorder. Someone can have "borderline traits" but without the impusivity, the "splitting" issue, or frequent unstable relationships, they will likely not meet the criteria (for BPD). Are these the distinguishing features between the two? BOTH disorders arise from past trauma.. Can you have both BPD and PTSD? And can one often lead to the other? (Sorry if these questions seem dumb, I'm searching for some clarification)

Edited by Blahblah

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So, this is how I have come to understand it based on both my own experience, as well as a lot of reading and study.

The historical perspective is probably helpful.  The DSM is phenomenological for the most part - and while there is now gathering evidence on causes and underlying biology etc., the early DSM editions were basically just psychiatrists describing what they saw and clumping people into groups based on that.

The original PTSD diagnosis came out of "shellshock" and soldiers returning from war.  At that time, there wasn't much thought about other kinds of trauma and that PTSD could result from those.  So the criteria emphasized (and still do) hyperarousal symptoms like anger and startling as well as traumatic intrusions.  The original BPD diagnosis started to be talked about in the 1930s based on a group of patients (mostly women) who appeared psychotic at times (they thought it was related to schizophrenia), especially under stress, and it was added to the DSM in the 1980s.  So the diagnoses came from very different roots and two different demographic populations (soldiers versus young women). 

Over the years, our understanding of both diagnoses has grown and evolved.  People have become more interested in PTSD resulting from other types of trauma including childhood and sexual trauma, and revisions to the criteria have been made to incorporate that (e.g. adding the negative alterations in mood and cognition, and the dissociative subtype).  Judith Herman coined the complex PTSD label, I believe, which is not in the DSM at all, in order to capture the specific developmental effects of childhood trauma.  Because children are doing tasks like learning emotion regulation, secure attachment, and identity consolidation, trauma in the developmental period affects this, and therefore these types of symptoms are part of the complex PTSD constellation.

At the same time, Marsha Linehan was working on the etiology and treatment of BPD and noticed that there are psychosocial factors that seem to lead to it - the biosocial theory constructs BPD as a combination of genetics and an invalidating environment where the child is told that their emotions are wrong/not okay.  Many (but not all) people with BPD have been abused.  If you look at her description of the invalidating environment - most likely all abusive environments are invalidating in some way, but not all invalidating environments are frankly abusive, if that makes sense.  So traumatic environments by definition have the makings of BPD (along with genetics) but it is possible to get BPD without frank trauma.  And both disorders involve some kind of childhood adversity.

So historically that is how the two sets of nomenclature have grown together.  My guess would be that when early psychiatrists were looking at young women and calling them hysterical or borderline, a lot of that was trauma, but because of how PTSD came to be, and because of societal stigma and denying of trauma, there was no understanding of the role of trauma, and BPD came up as an atheoretical diagnosis (there was no theory on what caused it) until Marsha.  So most likely in many cases what was then called BPD would be called complex PTSD just as easily.

I see it as sort of an overlapping Venn diagram, personally.  Many people could be diagnosed with either, some people clearly have one or the other.

In terms of differences, this is a really interesting paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723/

It basically compares a bunch of women with histories of abuse to see if they have BPD, PTSD, cPTSD, or some combination, and what makes the difference.  Cloitre (the author) concludes that frantic efforts to avoid abandonment (versus just fear of abandonment), unstable sense of self (versus stable negative self image), unstable and intense interpersonal relationships, and impulsiveness are the four BPD symptoms that distinguish it from complex PTSD.  Emotion dysregulation, interpersonal problems in general, and negative self concept were common between both groups.  Insecure attachment (frequently disorganized attachment style) is also a common factor, as is dissociation.

I think as time goes on, we are slowly parsing out what is cPTSD and what is BPD.  However, looking solely at the phenomenology and the symptoms that are listed in the DSM (especially since cPTSD is not as yet in the DSM) there is still a fair bit of overlap in my opinion and many people with BPD also meet criteria for PTSD.  In terms of treatment, many people with cPTSD benefit from specific work around  traumatic memories, where as BPD without PTSD, this would be less so.  But in terms of stabilization, the main issues causing instability (difficulties with people, difficulties with emotions) have enough commonality that some of the same treatments can be helpful.

So, you can definitely have both, especially if you are being diagnosed strictly based on the DSM, where cPTSD still does not exist and therefore PTSD + BPD may be the best way to capture the symptoms within a limited diagnostic system.  I wouldn't say that one can lead to the other - more so that the traits and symptoms co-exist and can feed each other.  When PTSD symptoms are very bad, people can look very Borderline just from being so unstable, but it can settle with PTSD treatment.

I'm not undervaluing the importance of diagnosis - I think it's very important - but to some degree psychiatric diagnosis will always be messy.  Where does unipolar depression stop and bipolar disorder begin?  What is the difference between someone who is schizoaffective and someone who has bipolar 1 with psychosis?  Can one person really have five different psychiatric disorders, or do they have one underlying problem that we haven't got a good name for, so we pin labels on it like the five blind men and the elephant?  To some degree the categories are artificial, because the line has to be drawn somewhere, and there will always be people who don't fit neatly.

Edited by tryp
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There was a time when I was convinced I had BPD and would spend all hours of the night researching the best treatments. Now, that said, I am obviously no expert. But I have read that antipsychotics have shown to be of benefit for those suffering from BPD. For PTSD, I am not so sure. I have heard that Seroquel helps particularly, but again, I am no expert. I have also heard that Lamictal is useful for BPD. Personally, when I took it I felt like I was floating on clouds -- slightly hypomanic. Not the typical response from someone with BPD, probably, but I've Lamictal is known as a great anti-depressant mood stabilizer. 

I've read that antidepressants like Prozac aren't of particular use for BPD, but that statement would be a whole lot more useful if I had the statistics behind them. <_< I'll try to dig them up. 

Edited by saoirse

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On 9/18/2018 at 3:17 PM, tryp said:

I see it as sort of an overlapping Venn diagram, personally.  Many people could be diagnosed with either, some people clearly have one or the other.

In terms of differences, this is a really interesting paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723/

It basically compares a bunch of women with histories of abuse to see if they have BPD, PTSD, cPTSD, or some combination, and what makes the difference.  Cloitre (the author) concludes that frantic efforts to avoid abandonment (versus just fear of abandonment), unstable sense of self (versus stable negative self image), unstable and intense interpersonal relationships, and impulsiveness are the four BPD symptoms that distinguish it from complex PTSD.  Emotion dysregulation, interpersonal problems in general, and negative self concept were common between both groups.  Insecure attachment (frequently disorganized attachment style) is also a common factor, as is dissociation.

I'll have a look at this paper. Thank you for the thoughtful post, diagnosis is indeed messy, but you have brought forth some clarification (particularly the above bit) that is helpful and has enlightened me a bit.

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