It is very difficult to find treatment for a male borderline. So many folks want to just classify them as bipolar and be done with it. This is a mixed blessing – while it DOES give these guys an Axis 1 dx, and makes it possible to get mental health parity for insurance purposes, it does not get them the treatment that they so desperately need. My son is also bipolar, but these symptoms are pretty much under control with lithium.
What's left requires work and behavior modification and you can't get that from a pill! There is a camp of researchers who believe that borderline is a sub-type of bipolar disorder and another camp who believe that bipolar II (especially the "rapid-cyclers") are really misdiagnosed borderlines. Personally, I don't care where they draw the line. They can fight amongst themselves till hell freezes over, as long as my son has access to what will has helped him - lithium for cyclic, untriggered mood swings, and DBT for the emotional dysregulation of
Borderline Personality Disorder.
One mother on the list wrote: “Males are typically found in the criminal system where their traits are rarely diagnosed since these findings are quite new. Kill someone and you will be punished. Insanity is no defense. These guys know what they are doing and simply don't care about others. Some fall into the category of sadists. The ethic is "I will do anything I want, as long as I don't get caught." Some are very clever about getting away with it too. We have several major cases on trial now in which the man killed his wife and sometimes his children with no remorse.”
ChrisK responded: I have a son who is bpd. It is very difficult to get him treatment - but not because he is a sociopath. It is true that male bpd's tend to act outwardly (and hence, combined with their seemingly random explosivity, the confusion with bipolar disorder), but they are not sociopaths. A sociopath, has no conscience and no regrets or remorse. They do know what they are doing, and don't care about the welfare of their victims.
However, if you have ever seen a male bpd (and if you haven't, please come to visit my home for just a few hours!), you will know right away that one of their deepest pains is the remorse they feel over what they have done to cause pain to the victims of their rages. Note that I did not say "their victims", but "the victims of their rage". I have heard bpd rage defined as "a loud self-distraction from other feelings that are even more frightening" and I firmly agree with that. When my son was raging, he was trying to cause a distraction so that he had something to focus on - no matter how horrible - other than what was inside of him. He was attempting to manipulate his environment so that he had something concrete to feel bad about - something that wasn't as scary as all those memories or ghosts or whatever it was that was haunting him. This is not sociopathy.
It is true that males are in the minority in the BPD population, and perhaps this is why they are often misdiagnosed. Their symptoms look very much like other illnesses - bipolar disorder and sociopathy to name two. However, the pre-rage and post-rage environment, if the clinician goes deeply enough into it, (and unfortunately, most are too willing to slap a diagnosis on them at first glance), will point to their real illness. Bipolar disordered dysphoria, which looks exactly like bpd rage, has no event trigger. It comes out of nowhere. As we know with borderlines there is always some event, some cognitive perception or misperception, that triggers their rage. And after the rage, the male borderline is filled with remorse. My son's remorse and regret at hurting me and his brother was so significant at times that he sank into an abysmal depression and couldn't get out of bed for days (again, many confused this event-chain of his bpd with the cyclic mood changes of bipolar disorder.)
Male borderlines today have both a hard time getting diagnosed (it's extremely lucky that my son happened upon John Gunderson when he was at McLean Hospital and that Gunderson recognized my son's illness as BPD!) and they have a hard time finding treatment. The vast majority of DBT groups are female-only and when there is a multi-sex group, it often feels so uncomfortable to the women to have a man there (because so many of the issues are sexual or related to sexual abuse) and so lonely to the lone male, that the arrangement doesn't work out.
Please do not confuse male bpd with sociopathy.
Are Parents To Blame for Their Child’s BPD?
I see no value in going back into history, as parents, and debasing our actions which may or may not have made some contribution to the BPD that our children have. My situation is so critical and crisis ridden on a daily basis and the diagnosis so new, I am intent upon dealing with the present and looking towards the future. I cannot fix the past and blaming myself or being concerned about others blaming me or any other parent feels so counterproductive.
When it comes to our past actions as parents, blame and shame get us nowhere but down. However, the point in ACKNOWLEDGING our past behaviors is so that we can learn from them and change our future responses to the same or similar stimuli. We can't fix that which we don't see as broken.
On DBT Skills and the treatment of her Borderline Son, ChrisK writes:
I haven't read her entire text cover to cover, but I have read the
Skills Training Manual, and nowhere in this does she say that parents are
to BLAME for bpd - she says that it is a combination of biology and an invalidating ENVIRONMENT - parents, friends, and teachers - only carrying out the invalidation
that is encouraged by OUR SOCIETY at large - and that an invalidating
environment does no harm to most children, and in some cases, children
are actually helped by it.
I really and truly do not see this as a judgment that I am responsible
for my son's illness. However, the book goes on to say that if you
a) eliminate some of the invalidation and b) prepare the child to better deal with what remains, then the child has a fair chance of living a better life.
As far as I'm concerned, DBT saved my son's life - and it saved our family life. In 3 years, he went from long-term commitment in residential treatment to living at home, not even meeting the BPD criteria! It is never too late for DBT - I think everyone could stand to learn these skills. Since my son has improved so drastically, I started learning the skills and adding them to my life. Now all of my relationships are better - and I'm not even BPD. Our family life went from always chaotic to always calm.
DBT is the only recognized treatment for BPD. It is a cross between standard cognitive-behavioral therapy and Zen. It deals with dialectics, or seeming contradictions (the glass being half-empty and half-full at the same time). There are dialectics in everyone's life, but more so in the minds of the BPD patients, since they live in such a black-and-white world. (like a teen not understanding that she is still loved by the person telling her that she cannot go out late at night)
DBT can help to show you that it doesn't have to be like this - just 2 camps - on my side or on the other side. It can teach you how to draw and keep limits - AND that there are things to love even in people who don't choose to show you respect the way you think it should be shown, even in people who don't keep commitments. It can teach you to radically accept and validate and even love your daughter, while still maintaining your boundaries.
With DBT, patients learn new skills like Distress Tolerance, and a new way of processing sensory inputs, such as observing and describing before acting. On the Zen side, it deals with such concepts as Radical Acceptance (I accept myself just the way I am) and Mindfulness (finding Wise Mind instead of Emotional Mind, which is where a BPD sufferer lives most of the time). Usually it consists of a dedicated DBT therapist and group therapy, where they learn and practice skills. For many of our kids (my 21-year-old son included), it has meant the difference between life and death, and it has allowed my son to reach the point where he is a pretty functional member of the family and society. He is still behind his peers in terms of emotional development, but he is catching up.
My advice is to get your family involved in DBT as fast as you can! As a parent, the skills of Radical Acceptance and Distress Tolerance have really made a difference in the way that I perceive my son, and that has made a vast improvement in our relationship. I really think that the whole family needs to be committed to it in order for the BPD patient to improve.
We have to stop thinking about BPD as being their problem and acknowledge that there are changes that we need to make ourselves. If your family will not seek treatment, then you will find that just learning the skills yourself and practicing them will make a difference for you. There are those on this site who will disagree with me, but my son's recovery speaks for itself.
My son used to say that I was the sick one, that I need therapy, that I was the reason he couldn't cope. I used to roll my eyes, until he started hitting home. The more DBT he did, the more functional he became, and he started pinpointing some traits that I couldn't deny, and I started to take him seriously.
When I first started wondering if I had bpd, I was horrified. It was the most awful thought I could have, and so I denied the illness with full force. The thought that I could have some of the same traits that my son manifests was sickening to me. I rejected that idea - just threw it down and stomped on it. I am so not him. I'm high-functioning and intelligent. But it kept nagging at me. Little by little, I entertained the safe things. Yes, I do sometimes get 'emotionally dysregulated'. Ok. Well, that's not bpd all by itself. And I do sometimes do some pretty serious splitting - I sometimes see things as pretty much black and white. Still doesn't qualify me as bpd. What about bad interpersonal relationships and abandonment issues? Yep, they're there sometimes, too.
In the end, I decided that I don't suffer from full-fledged BPD, but like many parents of BPD kids, I have some of the traits. Does my son have bpd because I passed the traits on to him - or did I pick them up from him (either from PTSD from all of his abusive ways, or maybe just because it 'rubbed off' on me?) It's the old chicken-and-egg question. But the answer doesn't matter.
A lot of us parents have these same traits. It doesn't matter where they came from, what name they're given, whether they pin that label on us or not, what our official diagnosis is. What matters is that we acknowledge our flaws, love ourselves in spite of them, and figure out how we can improve (you say you've studied DBT - well, this is the old 'acceptance and change synthesis') - improve to make our lives better, but also to set good examples for our children.
Male Borderline’s Rage and Parental Concerns About Them Driving
Another parent on the Borderline Tempest List wrote to express her concern about her BPD son just having got his driving permit. She expressed that she is terrified by the idea of him behind the wheel of a car and flying into a rage.
ChrisK responded:You ARE living my old life! This worried me sick. It's sad to admit this, but I think that I got to the point where I cared less about what he would do to himself than I did about what he might do to some innocent 3rd party. It was much easier for me, because J was in residential treatment by the time he was 16. I refused to sign parental permission for his learner's permit until he was violence-free for 6 months. This means no punching walls or throwing anything or even doing violence to himself (his wrists are scarred from stitches from his multiple slashings). When he would do something even remotely violent, I would "reset the clock". After a number of resets, he finally realized that I was not going to make any exceptions, and he got serious about it too.
Then, when he finally did get his learner's permit at 18, I told him he had to be violence-free for another 6 months before I would pay for his driver's ed classes (in MA, if you are under 25 and don't have a
driver's education certificate, your insurance is absolutely unaffordable.) It took him until he was almost 19 years old to get his license, but he did it!
That same parent responded: with a thank you for input about her dilemma regarding her son driving. She mentioned that it was up to her to
pay for and grant her son permission to take driver’s education or not. So she decided
that it might be best to try to use her son’s strong desire to drive to try and get him to
be more med compliant.
ChrisK responded: About linking the driving to taking meds: I would be very careful about negotiating deals with him. The consequence MUST be directly tied to the behavior you want to cease. Are you withholding the driving lessons because he is not taking his meds or because you are afraid he will get violent behind the wheel?
I've found that my son always finds loopholes, and he is much better at wheeling-and-dealing than I am. I ALWAYS get burned by too much lack of direction. You absolutely cannot enforce his taking the meds, unless you push them down his throat
and gag him and hold his nose until he passes out..
There are all kinds of ways that they can fake you out and make you THINK that they've taken their meds when they haven't. Trust me, I've been there. And trust me
on this one, too - you don't want to become his drug enforcement officer. The motivation to take the meds MUST come from him. He has to want to do it. You might want to try getting him started with a small bribe, but then it's got to stop. You've got to be open about it and tell him that this is a 1-time "reward".
If you tie the driving lessons to the meds, and he takes them but the violence continues, what are you going to do? You've got to be consistent. Now, what you MIGHT do if you hold him to a period of non-violence in order to get the license is
to SUGGEST that one thing that might help his violent mood swings is the
meds. Tell him that you've noticed that the rages are less frequent
when he is taking his meds and offer to help him get a system going so
that he takes them regularly. But you really can't do more than that
without being his crutch. (I DID do more than that and I was sorry later.)
as of December 9, 2003
