Read I Hate You—Don't Leave Me for Free Online Page B

syndrome often masquerades as a different illness and is often associated with other illnesses, clinicians often fail to recognize that BPD may be an important component in evaluating a patient. As a result, the borderline often becomes, like Carrie, a well-traveled patient, evaluated by multiple hospitals and doctors and accompanied throughout life by an assortment of diagnostic labels.
    BPD can interact with other disorders in several ways (see Figure 2-1). First, BPD can coexist with state (Axis I) disorders in such a way that borderline pathology is camouflaged. For example, BPD may be submerged in the wake of a more prominent and severe depression. After resolution of the depression with antidepressant medications, borderline characteristics may surface and only then be recognized as the underlying character structure requiring further treatment.
    Second, BPD may be closely linked and perhaps even contribute to the development of another disorder. For example, the impulsivity, self-destructiveness, interpersonal difficulties, deflated self-image, and moodiness often exhibited by patients with substance abuse or eating disorders may be more reflective of BPD than the primary Axis I disorder. Although it could be argued that chronic abuse of alcohol could eventually alter personality characteristics in such a way that a borderline pattern could evolve secondarily, it seems more likely that underlying character pathology would develop first and lead to alcoholism.

    FIGURE 2-1. Schematic of position of BPD in relation to other mental disorders.
    The question of which is the chicken and which is the egg may be difficult to resolve, but the development of illnesses associated with BPD may represent a kind of psychological vulnerability to stress. Just as certain individuals have genetic and biological dispositions to physical diseases—heart attacks, cancers, gastrointestinal disorders, etc.—many also have biologically determined propensities to psychiatric illnesses, particularly when stress is added to an underlying vulnerability to BPD. Thus, under stress, one borderline turns to drugs, another develops an eating disorder, still another becomes severely depressed.
    Third, BPD may so completely mimic another disorder that the patient may be erroneously diagnosed with schizophrenia, anxiety, bipolar disease, attention deficit/hyperactivity disorder (ADHD), or other illnesses.
Comparison to Schizophrenia
    Schizophrenic patients are usually much more severely impaired than borderlines and less capable of manipulating and relating to others. Both kinds of patients may experience agitated, psychotic episodes, but these are usually less consistent and less pervasive over time for borderlines. Schizophrenics are much more likely to grow accustomed to their hallucinations and delusions and are often less disturbed by them. Additionally, both may be destructive and self-mutilating, but whereas the borderline usually can function appropriately, the schizophrenic is much more severely impaired socially.
Comparison to Affective Disorders (Bipolar and Depressive Disorders)
    â€œMood swings” and “racing thoughts” are common patient complaints, to which the knee-jerk diagnostic response from the clinician is to diagnose depression or bipolar disorder (manic depression). However, such symptoms are consistent with BPD, and even ADHD, both of which are significantly more prevalent than bipolar disorder. The differences between these syndromes are dramatic. For those afflicted with bipolar disorder or depression, episodes of depression or mania represent radical departures in functioning. Mood changes last from days to weeks. Between mood swings, these individuals maintain relatively normal lives and can usually be treated effectively with medications. Borderlines, in contrast, typically have difficulties in functioning (at least internally) even when not displaying prominent mood swings. When self-destructive,