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ADHD, Borderline Personality Disorder and Relationships

People toss around the term “borderline” a lot, without knowing exactly what it means, so I am going to quote from the DSM-V the definition of Borderline Personality Disorder.

        A pervasive pattern of of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following:

        1. Frantic efforts to avoid real or imagined abandonment

        2. A pattern of unstable and intense relationships characterized by alternating extremes of idealization and devaluation

        3. Identity disturbance: markedly and persistently unstable self-image

        4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

        5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

        6. Affective instability due to a marked reactivity of mood

        7. Chronic feelings of emptiness

        8. Inappropriate, intense anger or difficulty controlling anger

        9. Transient, stress-related paranoid ideation or severe dissociative symptoms

         Since the term “Borderline” is used so loosely, and is common in discussions of people who have ADHD, particularly females, I thought it would be a good idea to present a clear definition.  While there is some cross-over between people who have ADHD and borderline personality disorder, it is rare in my experience.  People who have ADHD are commonly intense, but rarely borderline.

          Sometimes psychiatric diagnosis is used as a camouflaged way of insulting a person.  This is the case with borderline, often.  When a mental health professional does not like a female patient he will often call her borderline.  When he does not like a male patient, he will often call him a sociopath or an addict or both.

            Of course, in our profession we should aim to understand, not judge.  Used properly, the diagnosis of Borderline Personality Disorder can be a powerful tool in understanding a person and advancing treatment. 

Question:  If you are paired with someone with BPD, what are your best avenues to figuring out what to do to calm the relationship?  Are there particularly good resources?  See a therapist?

Answer:  There’s a good book called: Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder.  And yes, the BPD person REALLY needs to see a therapist for sure.  The best treatment is dialectical behavioral therapy.  And a couple therapist for sure.  It’s workable, and can make for a very intense, exciting relationship, but can also prove disastrous without the right help.

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