AAPEL
borderline personality disorder, BPD and dissociation, depersonalization...
 Introduction:
In presence of a person suffering of a borderline disorder, it is possible to think that this person has several personalities by her "Dr jekyll and hyde", sometimes seeming like an "angel", sometimes like a "demon". The truth is, of course, much more complex beyond often misleading appearances.  Clinical studies, although very interesting not bring THE answer and you will find on the last part of this document our vision which we hope more comprehensive
and listening to their suffering
Meme page en Francais / Same page in french
Glossary
Dsm definition
Data, studies
When, how ?
Aapel view
Stories

Dissociation, depersonalization, psychotic, ... What is it ?

Delusion : When someone believes something that is not true
Depersonalization : The dissociative experience of loss of identity as a person
Derealization : A feeling of estrangement or detachment from one’s environment. My be accompanied by depersonalization
Dissociation: The capability or process of separating thoughts, emotions, affects, or experiences from one another either purposely or involuntarily. 
Fragmentation : Separation into different parts
Hallucination : When you see, hear, feel or smell something which does not exist, usually because you are ill or have taken a drug
Hypnagogia : The hypnagogic state is that state between being awake and falling sleep. For some people, this is a time of visual and auditory hallucination"
Psychotic: Hallucinations and delusions are generally considered psychotic symptoms. The individual experiencing them may be described as psychotic
Defense mechanism.
It's a way to protect ourselves in some way. There is a lot, lot of defense mechanim possible.
Example
- Acting out: Allows a person to avoid thinking about a painful situation or experiencing a painful emotion Leads to acts that are often irresponsible, reckless, and foolish
- Avoidance: A defense mechanism consisting of refusal to encounter situations, objects, or activities
- Deflection: Also detected when the individual is in group therapy and consists of redirecting attention to another group member. The distortion campaign is a deflection ("HE is the sick one, not me !")
- Denial:Failing to recognize obvious implications or consequences of a thought, act, or situation (I'm ok)
- Dissociation: See above
- Humor: The individual deals with emotional conflict or external stressors by emphasizing the amusing or ironic aspects of the conflict or stressors
- Projection: Allows a person to attribute his own feelings or thoughts to others Leads to prejudice, suspiciousness, and excessive worrying about external dangers
- Somatization: Conflicts are represented by physical symptoms involving parts of the body
- Splitting: A way to divide the world in "all good" "all bad". It is a black and white way to see the world without "grey"

DSM / Apa dissociation in borderline disorder
During periods of extreme stress (e.g., perceived or actual abandonment), these individuals may experience transient paranoid ideation or severe dissociative symptoms (e.g., depersonalization).

Bpd central
Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.


Data studies (statistics, prevalence, comorbidity, co-occurency)
"The percentage of patients with borderline personality disorder who also have dissociative identity disorder is unknown"
"It is estimated that one-third (33%) of patients with dissociative identity disorder also have borderline personality disorder(apa)

* Ross - Institute for Psychological Trauma, Richardson USA.
2007 J Trauma Dissociation
"On the Dissociative Disorders Interview Schedule, 59% of the borderline patients met criteria for a dissociative disorder compared with 22% of the non-borderline patients"

* van der Kolk BA, Hostetler A, Herron N, Fisler RE - Trauma Clinic, HRI Hospital, Brookline, Massachusetts
1994 Psychiatr Clin North Am - Trauma and the development of borderline personality disorder.
Dissociation have a high correlation both with the degree of borderline psychopathology and with the severity of childhood trauma
Dissociation is a way of coping with inescapably traumatic situations by allowing the person to detach from the reality of the situation. Often there is a loss of the memory and the relief of pain for the situation, the person can feel numb or spaced out. For some people this becomes a conditioned response to stress even if the situation is not inescapably stressful

* Jonas JM, Pope HG.
1984 Psychiatr Dev- Do patients with borderline personality disorder (BPD) display psychotic symptoms as part of their syndrome?
Broadly defined psychotic,symptoms, such as depersonalization, are much more often reported in BPD, but many of these symptoms have also been reported frequently in patients with non-psychotic disorders and in normals. Thus, the evidence for psychotic symptoms in BPD remains equivocal.

* Zanarini MC, Ruser T, Frankenburg FR,... - Lab Study of Adult Development, McLean Hospital, Belmont, MA
2000 Compr Psychiatry - The dissociative experiences of borderline patients.
290 borderline patients. Result : 42% with a moderate level of dissociation, and 26% of BPD patient have a high level similar to that reported by patients meeting criteria for dissociative disorders


When, how ?
"Cutting often occurs during periods of dissociation.
I have a personal belief that dissociation, when it occurs with BPD is actually a panic symptom" (mhsanctuary.com)

"Dissociation occurs in certain personality disorders (eg depersonalization during self-mutilation episodes in borderline personality disorders) as weel as in eating disorders (eg derealization during binging episodes) etc." (Alain brunet Ph D 2001)

"There's always hope. Sometimes the mind disconnects from the body. This is called dissociation. Those are times when the body being hurt does not look or feel to be your own. It is hard to stop. With treatment, dissociation can be relieved, especially with DBT" (Melissa Ford Thornton: Author of the book: Eclipses: Behind the Borderline Personality Disorder)

"Often when something does hurt, or frighten them they do not know why. Much of the borderline experience carries with it differing levels of dissociation. This means that borderlines often experience things in the present as if they were things in the past. A sudden loud noise outside, for example, which likely has no consequence in the borderline's life, in the present, will be perceived as a threat" (Ms aj mahari)

"In some of the more severe individuals with bpd there is a complete fragmentation.  It becomes really confusing since so many statements and behaviors appear to be contradictory" (Kathi Stringer)

"BPD - Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnagogic phenomena) during times of stress" (HealthyPlace)


Aapel view of dissociation and borderline personality disorder
Here is our feelings about dissociation and BPD
For us, the BPD diagnosis does not include Dissociative Disorder
In our thought, that's mean that "only BPD" people don't have multiple personalities (each personality ignoring the other(s) )
In a more clear way a BPD person is not "several persons in one body"
Bpd people doesn't know who he is, he seems to have several personalities, but in fact he's looking for its personnality.
When he is docteur Jekyll he knows this and remember that when he is mr hide  (and the opposite)
It is the mood swing which create the feeling that he has both personalities, but they aren't

Dissociative episodes
In our opinion bpd people can experiment dissociative / depersonalization episodes in these circonstances

- Child trauma (empty memory. Sometimes the trauma has been "erased" from memory)
- Self-harm , self mutilation, self injury (no pain during cuting, burning, scratching...)
- Suicide attempt
- Bulimia
- Dysphoria(out of his mind)

We are also asking ourself if BPD people could have transient dissociative episode during panic attack (rage attack)
The answer seems "yes"

Our conclusion is that "multiple personality" is not a necessary BPD symptom for diagnosis

Please read
Borderline and Post Traumatic Stress
Borderline and memory, vision impairment
Borderline and self-mutilation
Borderline and somatoform
Borderline and schizophrenia or delusional disorder


Story
Lucie:
"Concerning the manifestations of dissociation, medically speaking, I will answer you that, no, fortunately it never comes to me of living such episodes.
On the other hand, at the time of very strong anxiety or very large feeling of faintnesses I have this state "of blank" which is inside me.  Approximately it results like:  to be there, without being there.  See its body to function, move, but by innate memory.  Me, at this moment I don't control anything.  Not to distinguish the real sounds and the imaginary sounds, as well as the lights and the glares. To have eye trouble and lot of small phenomena like that.  I believe that it is as much destabilizing, because on the contrary of the psychotic who does not realize, me I am conscious.
In fact it is really that, for me, the borderline state.  It is as if I realized that I am about to become crazy, I have really a foot outside and a foot inside reality.  At the beginning, when it comes, I finished with the urgencies of the hospital, now, that always makes me cry, but I try to solve this alone, because I recognize a little this state.  I could not describe you the horror to be confronted with my colleagues and to be at work when that arrives.  That arrives to me approximately 1 time per month... or a little less, that depends !!"
Read BPD and lie
AAPEL - Back to BPD summary page
 

,
Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
 

last update April 24th 2007
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Author, Alain Tortosa, psychotherapist, founder president of the Aapel
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