What is Borderline Personality Disorder with… Discouraged Features?
Friday, January 5, 2024.
What is Borderline Personality Disorder with Discouraged Features?
As I mentioned in my previous post, Borderline Personality Disorder (BPD) is a complex and challenging mental health condition that affects various aspects of a human’s life.
I also neglected in my previous post to offer the source materials for this series. I figure I’d correct that oversight with this post.
Within the spectrum of BPD, a specific subtype characterized by discouraged features introduces additional layers of complexity to the disorder.
In this modest effort, I’ll discuss Borderline Personality Disorder with discouraged features, exploring its definition, clinical manifestations, underlying causes, diagnosis, and evidence-based treatment approaches.
Discouraged Features in BPD:
LIfe is hard, and it’s getting harder.
Discouraged features represent a specific subtype of BPD characterized by pronounced feelings of inadequacy, self-doubt, and pessimism. This subtype introduces a distinctive set of challenges as individuals navigate relationships, self-perception, and emotional regulation.
Clinical Presentation of BPD with Discouraged Features:
Emotional Dysregulation:
Emotional dysregulation is a hallmark feature of BPD, and individuals with discouraged features may experience particularly intense and fluctuating emotions.
Research has shown that heightened emotional reactivity is associated with BPD, contributing to difficulties in maintaining emotional equilibrium and forming stable relationships (Lynch, Rosenthal, Kosson, & Cheavens, 2006).
Fear of Abandonment:
Individuals with BPD with discouraged features often grapple with an overwhelming fear of abandonment. This fear can lead to frantic efforts to avoid real or perceived abandonment, which, in turn, can result in impulsive behaviors and strained relationships (Barnow et al., 2009).
Chronic Feelings of Inadequacy:
The discouraged features in BPD are characterized by chronic feelings of inadequacy and self-doubt. These individuals may harbor a persistent negative self-image, viewing themselves as fundamentally flawed or unworthy (Perry, Kistner, Gerson, & Greeno, 2013).
Difficulty Establishing and Maintaining Relationships:
Due to the fear of rejection and underlying self-esteem issues, individuals with BPD with discouraged features often struggle to establish and maintain stable relationships. The pervasive fear of abandonment can lead to interpersonal difficulties, creating a cycle of relational instability (Yen et al., 2002).
Causes and Risk Factors:
Biological Factors:
Research suggests a genetic component in the development of BPD. Twin and family studies have demonstrated a heritability factor, with individuals having a family history of BPD being at an increased risk (Torgersen et al., 2008).
Neurobiological factors, including abnormalities in brain structure and function, have also been implicated in BPD, contributing to emotional dysregulation (Silbersweig et al., 2007).
Environmental Factors:
Early life experiences play a crucial role in the development of BPD with discouraged features. Childhood trauma, neglect, or inconsistent caregiving can shape maladaptive coping mechanisms and contribute to difficulties in forming secure attachments (Zanarini et al., 1997).
Psychosocial Factors:
Maladaptive patterns of interpersonal relationships and a lack of effective coping strategies may contribute to the discouraged features observed in individuals with BPD. Negative social experiences and perceived rejection can further exacerbate these patterns, creating a cycle of dysfunction (Fossati et al., 2005).
The Challenge of Differential Diagnosis…
The diagnosis of BPD with discouraged features is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include patterns of intense and unstable relationships, fear of abandonment, identity disturbances, emotional instability, and discouraged features such as chronic feelings of inadequacy (American Psychiatric Association, 2013).
Differential Diagnosis:
Distinguishing BPD with discouraged features from other mental health conditions is crucial for accurate diagnosis and appropriate treatment. Conditions such as major depressive disorder, avoidant personality disorder, and social anxiety disorder may share some overlapping symptoms, making a thorough assessment essential (Bender et al., 2001).
Evidence-Based Treatment Approaches:
Dialectical Behavior Therapy (DBT):
DBT is considered the gold standard for treating BPD, including the discouraged features subtype. Developed by Marsha Linehan, DBT combines cognitive-behavioral techniques with mindfulness strategies to enhance emotional regulation, interpersonal effectiveness, distress tolerance, and acceptance of self (Linehan, 1993).
Schema-Focused Therapy:
This therapeutic approach targets the maladaptive schemas underlying BPD symptoms, including discouraged features. By identifying and challenging negative core beliefs, individuals can work towards reshaping their self-perception and improving interpersonal functioning (Young et al., 2003).
Transference-Focused Psychotherapy (TFP):
TFP is a psychodynamic approach specifically designed for humans with personality disorders, including BPD. It focuses on exploring and understanding the individual's interpersonal difficulties and helping them develop healthier ways of relating to others (Clarkin et al., 2007).
Coping Strategies for partners, family, friends, and other caregivers:
Mindfulness and Distress Tolerance:
Practicing mindfulness techniques can be particularly beneficial for humans enduring BPD and discouraged features. Mindfulness exercises, such as mindful breathing and grounding techniques, can help regulate intense emotions and improve distress tolerance (Linehan, 2015).
Establishing Boundaries:
Learning to establish and maintain healthy boundaries is crucial for humans suffering from BPD. Setting clear expectations and communicating needs can contribute to more stable and satisfying interpersonal connections (Gunderson & Hoffman, 2005).
Self-Care:
Prioritizing self-care is so essential for humans with BPD, especially with discouraged features. Engaging in activities that promote well-being, such as exercise, proper nutrition, and adequate sleep, can positively impact overall mental health (Paris, 2019).
Research Studies on BPD with Discouraged Features:
Longitudinal Studies:
Longitudinal studies tracking humans with BPD with discouraged features over time provide valuable insights into the course of the disorder. Research by Gunderson et al. (2011) found that individuals with discouraged features tended to have more chronic and severe impairment in functioning compared to those with other subtypes.
Neurobiological Research:
Advances in neurobiological research have uncovered specific brain abnormalities associated with BPD.
A study by Schmahl et al. (2003) found alterations in the amygdala and prefrontal cortex, regions implicated in emotional regulation, providing a neurobiological basis for the emotional dysregulation observed in BPD.
Treatment Outcome Studies:
Research on the effectiveness of different treatment modalities for BPD with discouraged features is ongoing. Studies comparing the outcomes of DBT, schema-focused therapy, and TFP will eventually provide valuable information for clinicians and individuals seeking evidence-based interventions (Bateman & Fonagy, 2009).
Future Directions in Research and Treatment:
Neurobiological Markers:
Identifying specific neurobiological markers associated with BPD with discouraged features could contribute to more targeted treatment interventions
Additionally, understanding the underlying neurobiological mechanisms may help develop medications that target specific aspects of the disorder, potentially improving symptom management and a client’s overall outcome.
Personalized Treatment Approaches:
The field of mental health is decidedly moving towards personalized treatment approaches, and BPD with discouraged features is no exception.
However the gold standard of personalized treatment is a mastery of applying research in the service of exploring nuances in treatment response, and tailoring interventions based on specific characteristics…and not “winging it.” (Fok et al., 2019).
Integration of Technology:
The integration of technology into mental health interventions is a growing area of interest. Mobile applications, virtual reality, and online platforms can potentially enhance accessibility to therapeutic tools, facilitate self-monitoring, and provide ongoing support for individuals with BPD and discouraged features (Grist & Cavanagh, 2013).
Final thoughts…
Borderline Personality Disorder with discouraged features represents a nuanced and intricate subtype within the broader spectrum of BPD.
The emotional dysregulation, fear of abandonment, chronic feelings of inadequacy, and difficulties in forming stable relationships create a specific set of challenges for the humans navigating this subtype.
On the Narcissistic side of the street, I see similarities between the description of the Covert Narcissist and BPD with discouraged features.
The causes of BPD with discouraged features are multifaceted, involving a combination of genetic, environmental, and psychosocial factors.
Early life experiences especially, along with inherited neurobiological vulnerabilities, and maladaptive coping mechanisms from a chaotic family of origin contribute to the development and persistence of the BPD-discouraged subtype. Borderlines with secure families of origin are unicorns.
Sometimes unpacking the family of origin functioning is less important than self-awareness in the moment.
Diagnosis is a crucial step in initiating appropriate treatment, but the complexity of BPD often requires a comprehensive and individualized, Family-Of-Origin (FOO) approach.
In my last post I discussed Dialectical Behavior Therapy, Schema-Focused Therapy, and Mentalization-Based Treatment (MBT). Now I’m adding Transference-Focused Psychotherapy, which has shown promise in addressing the specific challenges associated with discouraged features.
Ongoing research endeavors continue to expand our understanding of the neurobiological basis of BPD, treatment outcomes, and potential advancements in personalized interventions.
I anticipate that AI will find a job mapping thought processes into a highly efficient and richly detailed schema.
The integration of technology into mental health care will further open avenues for innovative and accessible appropriate therapeutic tools, as it dumbs down and de-professionalizes public health.
Look, humans who suffer from BPD with discouraged features have the option to summon their resilience, and courage for self-discovery, and risk the misery of the status quo for the promise of potential growth. We already have a formidable array of treatment protocols.
Increased awareness, continued research, and a holistic approach to treatment are essential elements in providing support and fostering positive outcomes for struggling souls navigating the complexities of BPD with discouraged features.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bateman, A., & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1355-1364.
Bender, D. S., Skodol, A. E., Pagano, M. E., Dyck, I. R., Grilo, C. M., Shea, M. T., ... & McGlashan, T. H. (2001). Prospective assessment of treatment use by patients with personality disorders. Psychiatric Services, 52(3), 391-396.
Clarkin, J. F., Yeomans, F. E., Kernberg, O. F., & Lenzenweger, M. F. (2007). An object relations model of borderline pathology. Journal of Personality Disorders, 21(5), 474-499.
De Clercq B, De Fruyt F, Van Leeuwen K, Mervielde I. The structure of maladaptive personality traits in childhood: a step toward an integrative developmental perspective for DSM-V. J Abnorm Psychol. 2006 Nov;115(4):639-57. doi: 10.1037/0021-843X.115.4.639. PMID: 17100523.
Fossati, A., Maffei, C., Bagnato, M., Donati, D., Donini, M., Fiorilli, M., ... & Novella, L. (2005). Patterns of covariation of DSM‐IV personality disorders in a mixed psychiatric sample. Comprehensive Psychiatry, 46(5), 361-367.
Grist, R., & Cavanagh, K. (2013). Computerized cognitive behavioral therapy for common mental health disorders, what works, for whom under what circumstances? A systematic review and meta-analysis. Journal of Contemporary Psychotherapy, 43(4), 243-251.
Gunderson, J. G., & Hoffman, P. D. (2005). An integrated approach to treatment of patients with personality disorders. The American Journal of Psychiatry, 162(2), 276-283.
Gunderson, J. G., Stout, R. L., McGlashan, T. H., Shea, M. T., Morey, L. C., Grilo, C. M., ... & Skodol, A. E. (2011). The ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of General Psychiatry, 68(8), 827-837.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT® Skills Training Manual, Second Edition. Guilford Publications.
Paris, J. (2019). The treatment of borderline personality disorder: Implications of research on diagnosis, etiology, and outcome. Annual Review of Clinical Psychology, 15, 389-414.
Schmahl, C., Berne, K., Krause, A., Kleindienst, N., Valerius, G., Vermetten, E., ... & Bohus, M. (2003). Hippocampus and amygdala volumes in patients with borderline personality disorder with or without posttraumatic stress disorder. Journal of Psychiatry & Neuroscience, 28(3), 214.
Silbersweig, D., Clarkin, J. F., Goldstein, M., Kernberg, O. F., Tuescher, O., Levy, K. N., ... & Stern, E. (2007). Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. American Journal of Psychiatry, 164(12), 1832-1841.
Torgersen S, Myers J, Reichborn-Kjennerud T, Røysamb E, Kubarych TS, Kendler KS. The heritability of Cluster B personality disorders was assessed both by personal interview and questionnaire. J Pers Disord. 2012 Dec;26(6):848-66. doi: 10.1521/pedi.2012.26.6.848. PMID: 23281671; PMCID: PMC3606922.
