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Mental Health Best Medications for Borderline Personality Disorder?

ChemicallyEnhanced said:
So does the fact that it was very much several trauma's mean I have CPTSD?
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Pretty much, yes. I have CPTSD too <3


NB: an extremely reputable psychiatrist explained to me that BPD and active addiction mimic each other almost precisely. So if someone is an active addict to anything, it's almost impossible to diagnose them with BPD. (That's not applicable to you @ChemicallyEnhanced as I know you already have a diagnosis). I just thought it was an interesting thing to note in this discussion.
 
Yeah, I mean I'm pretty sure I'm borderline. I took a test for it and out of everything I scored higher for that. This was back when I was like 21.

Like others have said, medications really only help mask and manage the symptoms, but therapy is in order.

I've never gotten far into CBT, and I've never done DBT. I'm diagnosed with a slew of other stuff, but the things that have worked for me best are probably Adderall or Vyvanse, and Seroquel. Abilify as well, but it's kind of the no fun pill since it limits your ability to trip and such. Seroquel is just more functionally useful for me, as I can just take one whenever I feel out of line, or to sleep really. I take it probably most nights. Gabapentin/Lyrica have been really helpful for anxiety too.

But like I said I'm also diagnosed with ADHD, depression, anxiety, schizoaffective, bipolar 2.

In all honesty, I don't really trust any of my diagnoses, but I know what works for me.
 
ChemicallyEnhanced said:
So does the fact that it was very much several trauma's mean I have CPTSD?
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Not necessarily. Cptsd is PTSD with additional symptoms in interpersonal relationship skills and affect regulation. Namely:

  • feelings of shame or guilt
  • difficulty controlling your emotions
  • periods of losing attention and concentration (dissociation)
  • physical symptoms, such as headaches, dizziness, chest pains and stomach aches
  • cutting yourself off from friends and family
  • relationship difficulties
  • destructive or risky behaviour, such as self-harm, alcohol misuse or drug abuse
  • suicidal thoughts
Complex PTSD is often caused by unique types of trauma. Someone can experience multiple traumas and never end up with complex PTSD. Rather it is the 'unescapable' nature of the trauma which defines resultant complex PTSD. Think long term child sexual abuse or physical abuse by a parent or caregiver, being a child soldier, being in a concentration camp, being a POW and experiencing torture.

It's not simply stacked trauma, it's the actual nature of the traumatic events that cause this particular kind of issue for people. For me it was decades of emotional, physical, financial, and sexual abuse from a parent as well as then falling into forced sex work which recreated my initial traumas almost exactly, and a series of issues with people grooming me in a way that was similar to my parent.

I've experienced being in a war zone, being raped as an adult multiple times, car accidents. None of those things have resulted in any trauma symptoms because they don't register to me as being traumatic on the scale of what I experienced. That isn't to say they're not traumatic for another person, rather that for me personally, I moved on incredibly quickly and suffered no ongoing issues from any of those experiences.

BPD is a very stigmatised diagnosis and we know that trauma plays a role in it, so the misdiagnosis rate is high. Even I was misdiagnosed with it at one stage before I disclosed more of my history to the psychiatrist who immediately rectified it to complex PTSD when she understood the nature of the trauma I've experienced.

I would say that the defining difference between BPD and CPTSD though is the issue at the centre of both diagnoses. A person with BPD does tend to fear abandonment and their behaviour is driven around trying to prevent this from occuring. A person with CPTSD fears trusting people and allowing people to get close to them so their behaviour is driven by that. It can look very similar, as both people tend to be very push-pull with their relationships (and I know I definitely am) but I'll give you an example.

A couple of months ago I fell out with someone who was incredibly important to me. Probably as close to that 'favourite person' thing as I can define, in my life at least. When it became readily apparent that he was basically done being my friend due to his own actions (and I very much mean that, it was a clusterfuck) I straight away went into 'cut off' mode and fucking went off at him to burn the bridge, because I had not felt as betrayed by anyone in my life since my original traumas. There was no begging him to be my friend again, no saying I was going to hurt myself if he didn't come back. I didn't even tell him I relapsed because as far as I was concerned, he didn't have a right to know anymore. I wasn't upset because he stopped being my friend - it was how he did it that was the issue. It was just massively fucked up and manipulative and disrespectful at the bare minimum, and malicious at worst, all because I had asked him to do something he'd offered to do.

If I had BPD I probably would have kept contacting him waaaaaay after we stopped being friends. I sent a couple of messages to highlight how he'd actually been a pretty shitty friend for a decent period of time leading up to that and called him out on something he'd done months ago that fucked me over, but aside from that I didn't contact him at all, nor do I want to. The CPTSD means that once someone shows me they can't be trusted, they're out. There is no back and forth 'oh I miss them maybe we will be friends again' it's done. I simply cannot allow this person back into my life. I was not thrilled with them for the entire year leading up to that event and it was just the icing on the cake which proved my suspicions true so I had to cut him lose.

So while behaviour may look similar, the reasoning behind it is critical.

To also take a look at my self harm and drug use - it isn't impulsive, it's deliberate and serves as a maladaptive coping mechanism. It's not done to get responses out of people - I actually hide it from everyone for the most part. I'll admit when I've done it and not lie about it, but I've never self harmed or used drugs to have someone respond to me in a particular way. That's just been the outcome of the situation when I admit what I've done, but the driving force behind these actions is self punishment due to self blame and because I want to avoid triggers.

If you think you'd be better off with W cptsd diagnosis I encourage you to think about it. There's no issue with keeping the one you have, it's equally as valid (except for its overdiagnosis in women as a modern hysteria diagnosis) but it's something to think about in terms of treatment you'll receive.
 
Eligiu said:
Not necessarily. Cptsd is PTSD with additional symptoms in interpersonal relationship skills and affect regulation. Namely:

  • feelings of shame or guilt
  • difficulty controlling your emotions
  • periods of losing attention and concentration (dissociation)
  • physical symptoms, such as headaches, dizziness, chest pains and stomach aches
  • cutting yourself off from friends and family
  • relationship difficulties
  • destructive or risky behaviour, such as self-harm, alcohol misuse or drug abuse
  • suicidal thoughts
Complex PTSD is often caused by unique types of trauma. Someone can experience multiple traumas and never end up with complex PTSD. Rather it is the 'unescapable' nature of the trauma which defines resultant complex PTSD. Think long term child sexual abuse or physical abuse by a parent or caregiver, being a child soldier, being in a concentration camp, being a POW and experiencing torture.

It's not simply stacked trauma, it's the actual nature of the traumatic events that cause this particular kind of issue for people. For me it was decades of emotional, physical, financial, and sexual abuse from a parent as well as then falling into forced sex work which recreated my initial traumas almost exactly, and a series of issues with people grooming me in a way that was similar to my parent.

I've experienced being in a war zone, being raped as an adult multiple times, car accidents. None of those things have resulted in any trauma symptoms because they don't register to me as being traumatic on the scale of what I experienced. That isn't to say they're not traumatic for another person, rather that for me personally, I moved on incredibly quickly and suffered no ongoing issues from any of those experiences.

BPD is a very stigmatised diagnosis and we know that trauma plays a role in it, so the misdiagnosis rate is high. Even I was misdiagnosed with it at one stage before I disclosed more of my history to the psychiatrist who immediately rectified it to complex PTSD when she understood the nature of the trauma I've experienced.

I would say that the defining difference between BPD and CPTSD though is the issue at the centre of both diagnoses. A person with BPD does tend to fear abandonment and their behaviour is driven around trying to prevent this from occuring. A person with CPTSD fears trusting people and allowing people to get close to them so their behaviour is driven by that. It can look very similar, as both people tend to be very push-pull with their relationships (and I know I definitely am) but I'll give you an example.

A couple of months ago I fell out with someone who was incredibly important to me. Probably as close to that 'favourite person' thing as I can define, in my life at least. When it became readily apparent that he was basically done being my friend due to his own actions (and I very much mean that, it was a clusterfuck) I straight away went into 'cut off' mode and fucking went off at him to burn the bridge, because I had not felt as betrayed by anyone in my life since my original traumas. There was no begging him to be my friend again, no saying I was going to hurt myself if he didn't come back. I didn't even tell him I relapsed because as far as I was concerned, he didn't have a right to know anymore. I wasn't upset because he stopped being my friend - it was how he did it that was the issue. It was just massively fucked up and manipulative and disrespectful at the bare minimum, and malicious at worst, all because I had asked him to do something he'd offered to do.

If I had BPD I probably would have kept contacting him waaaaaay after we stopped being friends. I sent a couple of messages to highlight how he'd actually been a pretty shitty friend for a decent period of time leading up to that and called him out on something he'd done months ago that fucked me over, but aside from that I didn't contact him at all, nor do I want to. The CPTSD means that once someone shows me they can't be trusted, they're out. There is no back and forth 'oh I miss them maybe we will be friends again' it's done. I simply cannot allow this person back into my life. I was not thrilled with them for the entire year leading up to that event and it was just the icing on the cake which proved my suspicions true so I had to cut him lose.

So while behaviour may look similar, the reasoning behind it is critical.

To also take a look at my self harm and drug use - it isn't impulsive, it's deliberate and serves as a maladaptive coping mechanism. It's not done to get responses out of people - I actually hide it from everyone for the most part. I'll admit when I've done it and not lie about it, but I've never self harmed or used drugs to have someone respond to me in a particular way. That's just been the outcome of the situation when I admit what I've done, but the driving force behind these actions is self punishment due to self blame and because I want to avoid triggers.

If you think you'd be better off with W cptsd diagnosis I encourage you to think about it. There's no issue with keeping the one you have, it's equally as valid (except for its overdiagnosis in women as a modern hysteria diagnosis) but it's something to think about in terms of treatment you'll receive.
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Very good post, thank you.
 
n3ophy7e said:
Very good post, thank you.
Click to expand...
You're welcome. CPTSD is not as known about as it should be given the high rates of adverse childhood experiences and the misdiagnosis of BPD where CPTSD is more accurate is a sore spot for me, not only because I experienced it for a short time but because the treatment approach is vastly different in many respects.

With BPD, DBT tends to work very well for most people who readily engage with it. Getting people to enagage is the hard part.

With CPTSD? Well, DBT can be and is used, but I've done probably every kind of therapy that exists for trauma - TFCBT (Trauma Focussed CBT), Cognitive Processing Therapy, exposure therapy, psychodynamic psychotherapy, DBT, EMDR. All of them have been useful in their own respects but a far more tailored approach is necessary for CPTSD and it really does need to be done with the same trusted therapist throughout the duration of treatment. I owe much of my success to having had the same clinical psychologist for 8 years, same Psychiatrist for 6 years, and a regular social worker for 2 who did a lot of work around shame and guilt.

Having a complex trauma diagnosis also makes my frequent hospital stays far more bearable. They're not particularly kind to people with a BPD diagnosis in my experience and from what I've heard and I'm sure they've considered that label for me with self harm, but once I disclose my history to them and explain I was diagnosed by my Psychiatrist of 6 years well, they can't really relabel me at that stage and it would be detrimental for them to do so. They might want to, but their hands are really kind of tied and I often get sympathy instead of harsh treatment. It makes a world of difference.

The two disorders look remarkably similar on close glance and when a person hasn't had the chance to tell much of their story, but anyone who has spent significant time around people with BPD and CPTSD can tell there are subtle differences in behaviour which warrant the diagnoses being kept seperate as two distinct mental illnesses.

However bearing in mind it is entirely possible, and in fact not infrequent for someone to have both issues and that is a whole other problems for mental wellness. I count myself extraordinarily lucky that I only ended up with complex trauma and don't have any BPD traits, moreso than anyone else with mental health issues. I just don't fear abandonment - I expect it, and resign myself to it really because I've learnt from experience that people are not dependable. It doesn't upset me when people leave my life because sometimes people aren't meant to stay. What upsets me is if I've trusted them with information about myself that then I worry about them spreading if we ended on bad terms or they don't respect the confidence I told it to them in. So again it comes down to a fear of trust being broken, rather than abandonment.

I think BPD is thrown around too lightly these days. I think it's a very real diagnosis, but I do think if you're going to label someone with something that stigmatised you need to be absolutely certain about it and also point them in the correct direction for therapy, otherwise you're resigning them to the fuck it bucket of mental health treatment.
 
Eligiu said:
You're welcome. CPTSD is not as known about as it should be given the high rates of adverse childhood experiences and the misdiagnosis of BPD where CPTSD is more accurate is a sore spot for me, not only because I experienced it for a short time but because the treatment approach is vastly different in many respects.

With BPD, DBT tends to work very well for most people who readily engage with it. Getting people to enagage is the hard part.

With CPTSD? Well, DBT can be and is used, but I've done probably every kind of therapy that exists for trauma - TFCBT (Trauma Focussed CBT), Cognitive Processing Therapy, exposure therapy, psychodynamic psychotherapy, DBT, EMDR. All of them have been useful in their own respects but a far more tailored approach is necessary for CPTSD and it really does need to be done with the same trusted therapist throughout the duration of treatment. I owe much of my success to having had the same clinical psychologist for 8 years, same Psychiatrist for 6 years, and a regular social worker for 2 who did a lot of work around shame and guilt.

Having a complex trauma diagnosis also makes my frequent hospital stays far more bearable. They're not particularly kind to people with a BPD diagnosis in my experience and from what I've heard and I'm sure they've considered that label for me with self harm, but once I disclose my history to them and explain I was diagnosed by my Psychiatrist of 6 years well, they can't really relabel me at that stage and it would be detrimental for them to do so. They might want to, but their hands are really kind of tied and I often get sympathy instead of harsh treatment. It makes a world of difference.

The two disorders look remarkably similar on close glance and when a person hasn't had the chance to tell much of their story, but anyone who has spent significant time around people with BPD and CPTSD can tell there are subtle differences in behaviour which warrant the diagnoses being kept seperate as two distinct mental illnesses.

However bearing in mind it is entirely possible, and in fact not infrequent for someone to have both issues and that is a whole other problems for mental wellness. I count myself extraordinarily lucky that I only ended up with complex trauma and don't have any BPD traits, moreso than anyone else with mental health issues. I just don't fear abandonment - I expect it, and resign myself to it really because I've learnt from experience that people are not dependable. It doesn't upset me when people leave my life because sometimes people aren't meant to stay. What upsets me is if I've trusted them with information about myself that then I worry about them spreading if we ended on bad terms or they don't respect the confidence I told it to them in. So again it comes down to a fear of trust being broken, rather than abandonment.

I think BPD is thrown around too lightly these days. I think it's a very real diagnosis, but I do think if you're going to label someone with something that stigmatised you need to be absolutely certain about it and also point them in the correct direction for therapy, otherwise you're resigning them to the fuck it bucket of mental health treatment.
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Thank you so much for sharing your experience.
 
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