All too often treatment for personality disorders, especially in Cluster B just train people how to better fake “normalcy” and to speak the language of therapy.

I'm not sure that's a meaningful distinction. That is to say, a "disorder" should be something that interferes with your ability to function and flourish in a normal environment. I'm not sure it's meaningful to draw a distinction between people who absolutely cannot function and people who merely effectively cannot function. Just because your ankle is sprained and not broken doesn't mean you don't need medical care or that you should be walking.

To be clear I am trying to illustrate the idea that a disorder seems inherently devilish to define.

She was very good at hiding her feelings during most casual interactions, and was clever and generous and fun to talk to when calm, but had almost a second personality which would come out when she became even slightly stressed which was bitter and entirely self-centered and extremely manipulative. She was at that stage of her life completely incapable of maintaining a close personal relationship, and she was frequently (on a daily basis) under extreme stress about perceived grievous slights from everyone around her that were to an outside observer inconsequential mistakes or misunderstandings, and she was harboring numerous long-term grudges.

It seemed like she knew she had a problem, and during times where she wasn’t stressed out would regret her outbursts and seemed to wish she generally had better emotional control. She seemed generally pretty miserable about it, but maybe I was projecting based on the way her problems made me feel.

I feel absolutely awful for people who date high-functioning borderlines and never learn about it. At least with the ones who are low-functioning, you absolutely know something is deeply wrong with them at all points in the relationship. With a high-functioning one, you second-guess yourself constantly.

I really do think there needs to be more general awareness about Cluster B personality disorders. The occurrence rate among the population is low, but the nature of the disorder means a high-functioning borderline establishes relationships with (and potentially harms) a large number of people. It's hard for victims to seek help when they don't even know the name or nature of what they're dealing with.

We only dated for a relatively short time, but it took me a move across the country and a year to sort out my feelings and start dating again.

YMMV.

[0] which what made me start reading about BPD [1] he'd either talk about this or berate me, wouldn't mention anything else, work or anything. We were always super chatty about literally everything so yea

But the typical response to a minor misunderstanding like that is to make the communication more explicit with a simple request that the boyfriend come to bed and share that you felt upset about it, trusting that your caring boyfriend will feel sorry, make a note and try to do better next time. Not to lead with accusations of ill intent and quickly escalate to a full range of emotional manipulation and threats of physical violence.

But people are increasingly aware of it. The "creepy abuser" (male) and the "crazy chick" (female) are stereotypes for a reason, and both of these seem to closely match Cluster B. More specifically, people are also becoming aware of Cluster B's associated dysfunctional thought patterns, and how to mitigate those, or at least how to effectively counter e.g. the gaslighting, unprovoked outbursts/tantrums, fanciful accusations, etc. that result from such thought patterns.

>More specifically, people are also becoming aware of Cluster B's associated dysfunctional thought patterns, and how to mitigate those, or at least how to effectively counter e.g. the gaslighting, unprovoked outbursts/tantrums, fanciful accusations, etc. that result from such thought patterns.

I also like to think that this is true, but I still don't think awareness is spreading as fast as it should be. We'll get there, though, right?

No, they don't, because built into the definition of disorder is the impact it has one someone's life.

It’s important to distinguish between diagnostic criteria, and the disorder itself, if they are actually disorders.

There is no frame of reference for psychology to use except society and general assessments of normality and expected behavior. That mean the only method to determine whether or not something is a disorder at all is a) determine the impact of the condition on the individual's ability to function, and b) determine whether or not the condition results in harm to the individual or others. These are both very subjective measures. The fact that we think we're more right today than we were yesterday is really pretty immaterial.

Really effective, non-superficial therapy is very hard. You may have to dig deep. Really deep. And when you do reach the roots there's still the issue of how to deal with what you find. It's not like surgery where you take out an infected appendix and say "you're cured".

>> If you consider it in those terms, then “treatment” amounts to having someone voluntarily attempt to change their personality at a fundamental level. Even if they wanted to, how likely is that to succeed?

That's exactly why it's hard. The fundamental drivers are often hidden and can be scattered (my term). You don't really change until you change the core. Most therapy seems to try to work from the outside in - probably because it's easier to do but less effective.

The distinction is most useful because many mental illnesses aren't necessarily qualitatively different than "normal" or "healthy" human behavior and cognition; they're just more extreme versions. For example, normal people regularly engage in compulsive rituals, and engaging in these rituals is sometimes beneficial to them--consider a baseball player's ritual at stepping up to the plate, or a basketball player's ritual when stepping up to the free throw line. But if you start engaging in rituals that are a little too compulsive and too disruptive to "living a normal life", that's when it crosses the line into obsessive-compulsive disorder.

However, even if you can life a "normal" and successful life, that doesn't mean you aren't harming the people around you, unless you harm them enough that the long-term social consequences end up hurting you. Most cluster B personality disorders end up with the disordered person alienating people and suffering the consequences of their antisocial behavior. But if you're a high-functioning narcissist or whatever and you get away with everything...?

Here's a rather snarky example of this standard being applied to a certain alleged narcissist (whose name I'll redact in my quote, below, since this person's identity is a bit of a distraction from the more general point): https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychi...

> Most amateur diagnosticians have mislabeled <<a prominent individual>> with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and <<this person>> doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder. <<this person>> causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.

tangentially, on a population level evolution happens on the margins and medicalization can only dampen that process (not that this is important on a personal level).

And the high functioning people with PDs would explain to you the all the very specific deficits they have to overcome in order to function.

And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs.

Interviewing people in Cluster B is often an exercise in being lied to. It also requires them to have insight which is generally lacking as a clinical feature. Their caretakers are in a tough position, since they’re often the target of many manipulations gauges to engender sympathy and continued care. All in all it reveals a weakness in diagnosis and formulation of disorders by anecdote.

And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs.

When they can accurately predict such outcomes from first principles even as well as they do for something like major depressive episode, schizophrenia, etc, I’ll take those claims seriously.

My BPD stems from childhood abandonment (absent father) and persistent emotional abuse from my likely NPD mother. I learned to doubt things I feel/thought and often reality sometimes. Real love and emotion connection were terrifying to me on a subconscious level. I never could trust anyone, not even myself (the only one to trust was my abuser). I developed so many coping mechanisms to protect myself from my mother that involve projection, distortion of reality and emotional manipulation. My brain learned all these horrible ways of protect myself from my abuser and I applied those behaviors to everyone around me.

It has taken years of unpacking my childhood trauma to get to like 90% remission of symptoms. Before that it was years of denial about my behaviors before I even started to entertain the fact I had BPD.

I'm sorry to hear BPD is effecting both you and your brother. There is hope but he has to be on board and it's a long road.

I'll always love my brother but, for this reason, I'd need to see proof that he's doing what you are. My brother has taught me that forgiveness does not imply a return to the previous status quo: we have our own, our spouses' and our childrens' mental health to protect.

I wish the best for you and patching up things with your family; I'm sure that they all still love you and want nothing more than a healthy relationship with you.

Last I checked, the only accepted treatment for any PD is DBT, and then only for borderline PD. I think real change is quite possible but it's LOT of internal mental work. Work you can only begin once you can see the problems. Half the stuff therapists do is really superficial and possibly harmful. The other half can be useful to varying degrees. And I'm gonna guess the line that divides these two varies a bit depending on both the person and the therapist.

Probably not a good idea, to self-diagnose online.

Sounds like a completely shit therapist, because the vast majority of people with BPD know full well they have a problem and are desperately seeking help for it.

> 96% of patients with BPD have a mood disorder during their life, and lifetime depression is reported at 71% to 83%. Anxiety disorders are also extremely common: 88% of patients have an anxiety disorder, 34% to 48% have panic disorder, and 47% to 56% have PTSD. Alcohol and substance abuse or dependence are reported by 50% to 65%; eating disorders affect 7% to 26% over a lifetime

http://www.psychiatrictimes.com/borderline-personality/comor...