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I can think of arguments for both cases. Also, is it a personality disorder or developmental disorder?
Is BPD egodystonic or egosyntonic?
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Why does it have to be one or the other?
I think of BPD as a dissociative disorder, or at least a trauma-related disorder. The Complex PTSD concept really accounts for it better than personality disorder. There seem to be developmental factors, such as high sensitivity and maybe also decreased ability to display nonverbal cues for emotional distress. There is also a lot of interaction with the environment - emotional neglect and invalidation, and skills for emotion regulation, distress tolerance, and interpersonal interaction that are not adequately learned (whether because these were not taught or due to innate factors or some combination). Yes, I am a big fan of Marsha Linehan and DBT.
If I can ask another question, I realize that CPTSD is not yet a DSM diagnostic category, but have heard it most likely will be in the DSM V. How do you see the distinctions if any between BPD and CPTSD? They seem to be essentially the same thing to me, only I prefer the CPTSD perspective.
I think of BPD as a dissociative disorder, or at least a trauma-related disorder. The Complex PTSD concept really accounts for it better than personality disorder. There seem to be developmental factors, such as high sensitivity and maybe also decreased ability to display nonverbal cues for emotional distress. There is also a lot of interaction with the environment - emotional neglect and invalidation, and skills for emotion regulation, distress tolerance, and interpersonal interaction that are not adequately learned (whether because these were not taught or due to innate factors or some combination). Yes, I am a big fan of Marsha Linehan and DBT.
If I can ask another question, I realize that CPTSD is not yet a DSM diagnostic category, but have heard it most likely will be in the DSM V. How do you see the distinctions if any between BPD and CPTSD? They seem to be essentially the same thing to me, only I prefer the CPTSD perspective.
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Well, assuming that all BPD cases can be traced back to early-life trauma, they are very similar. Except that CPTSD is inherently more optimistic of a diagnosis than BPD, as it is not supposedly a lifelong disorder and "impossible" to treat. This makes it more likely that psychiatrists can perscribe meds and psychotherapy, not to mention more likelihood of insurance coverage.
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I've heard the argument that borderline PD really is just PTSD, but it's PTSD done at an earlier developmental level vs. the usual PTSD we see in adults. I think there is merit to that argument, though it is a bit more complex than that. E.g. SSRIs don't offer as much benefit for borderline vs. PTSD, several issues are going on in borderline other than anxiety, etc.
But it's certainly someting to consider, and the two are often comorbid. I think it's kinda like the bipolar-psychosis spectrum. They are two distinct entities, but there's a lot of overlap.
Is it ego-syn or dystonic? I don't think it's possible to say this for all cases, or even a significant majority. There's a lot of black and white thinking with BPD. It can go either way.
Someone close to me was severely molested as a child. She has PTSD, but does not have borderline PD. Her parents were very supportive, gave her a loving environment, and helped her with the trauma she suffered.
The two disorders go hand-in-hand, but I still see them as separate.
But it's certainly someting to consider, and the two are often comorbid. I think it's kinda like the bipolar-psychosis spectrum. They are two distinct entities, but there's a lot of overlap.
Is it ego-syn or dystonic? I don't think it's possible to say this for all cases, or even a significant majority. There's a lot of black and white thinking with BPD. It can go either way.
Someone close to me was severely molested as a child. She has PTSD, but does not have borderline PD. Her parents were very supportive, gave her a loving environment, and helped her with the trauma she suffered.
The two disorders go hand-in-hand, but I still see them as separate.
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Don't you have to have more of an ego for something to be syn- or dystonic with it?
*This statement only needs to be true enough for the sake of sarcasm, not for the sake of dynamic correctness...
*This statement only needs to be true enough for the sake of sarcasm, not for the sake of dynamic correctness...
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great reply.
Then again, all of our egos are fragile enough, onces you unwrap all the layers.
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from my experience with it in med school and from reading about it I would wager to say that it is both, with milder and more treatable manifestations ego dystonic and more intense and less responsive forms more ego syntonic mainly because I think successful management requires a degree of metacognitive ability on the patient's part to be able to recognize disordered behavior. In general it's a little more tough to recognize the behavior when the patient sees it as normal to begin with. I've seen it both ways, but I'll readily admit the "n" of my sample is pretty small. Just my 2 cents.
