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Discussion Starter · #1 ·
This is in response to another thread where folks were asking "what does borderline mean?"

The word Borderline is very over-used in psychiatry - and different theories (or schools of thought) will each use it differently. There is no such "THING" as "borderline." You need to ask in what context the word is being used.

The term you probably hear the most these days is BPD (Borderline Personality Disorder). All the personality disorders are basically "clusters' of traits and symptoms that seem to describe a type of person. They're not "things" you have but a type of thinking/personality/behavior that a person has developed from early childhood. Psychosis is really not going to figure into this kind of diagnosis - except that sometimes BPD type folks do have wild mood swings and may have delusions, obsessions, etc. that seem barely in touch with reality.

There is a more common use of the word borderline that many psychiatrists and psychoanalysts use - although the general public doesn't use it or hear it as much. But this use of the word was around LONG before the Borderline Personality Disorder term was created. Here the word refers to a "level" or "structure" of functioning. Those levels are usually: Neurotic, Borderline or Psychotic. Doctors may try to assess what Level the person's symptoms/disorder is organized around - it tells them if the person might benefit from anti-psychotic meds, if the person is likely to ever need hospitalization, if the person will likely be able to handle increased stress/anxiety during an intensive treatment, etc.

Regardless of what disorder a patient has or what symptoms they have) docs would label the patient's Level or Structure of Self as follows:
If self seems to be organized around a Neurotic Level of Functioning the person will be able to keep their reality testing totally intact (they basically seem perfectly normal, but have symptoms like anxiety, etc. that cause them problems). They might WORRY that they are losing reality, but they never rant or rave in delusional thought. Symptoms can be very bad, but the Cognitive ability is not in jeopardy.

Psychotic Level of Functioning means the person breaks out of reality under the slightest stress - they "decompensate" and entertain delusions, become non-functional, literally fall apart. Definitely will be in and out of the hospital and their overall ability to function will get worse as they age. Each break does damage. (whereas the higher levels, the person bounces back intact after/if symptoms can be cleared up)

Then the Borderline Level of Functioning is somewhere in the middle of those two. If someone's Self is organized around a Borderline structure, it means they do not have the Ego Strength of the rest of us, they CAN have breaks with reality, they MIGHT enter psychosis under extreme trauma, etc. This is probably what Ninnu's doctor meant by using the word "borderline" - as Ninnu had a trauma-induced psychosis, and seems to be capable of drifting INTO that psychotic state, but not as often or as severely as someone on a lower level.

A person with an anxiety disorder will either have a personality organized at one of those three levels. In other words, an anxiety disorder can be on the neurotic level, the borderline level or the psychotic level of functioning - based on the person's core psychological STRUCTURE. If a person is structured in a borderline phase, any and all symptoms they have will cluster in a borderline level. Likewise, a psychotic. A person with a psychotic level of function will experience anxiety differently from the rest of us - that person's anxiety is experienced on a lower structural level within the self.

The vast majority of us here are structured on a neurotic level. So any symptoms we get, anxiety, dp, dr, obsessiveness, depression, etc..will all reside in that level - which is why the doctor is much less concerned with "what I have NOW" in terms of some new symptom. The important thing is HOW I'm put together and where (on which level) all my mental experiences will cluster.

Then there are OTHER uses of the word "borderline" (as in "borderline schizophrenic" or "borderline behavior" and many others). Point being, you need to know HOW the professional is using the word rather than jumping to conclusions that the word itself MEANS somethign omminous.

Peace,
Janine
 
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Discussion Starter · #2 ·
So you are saying that different personality levels don't ever mix?

That means someone on a neurotic level always (whatever his experiences may be) develops symptoms that are neurotic (reality based)?

I just would like to make sure that I got that right.
 
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Discussion Starter · #3 ·
Yep. That's it.
And good question.

(I'm just so glad somebody READ my post, lol......)

it's not "personality" levels exactly, but the Level of ego function a person has. In short, it's "the way that person's mind WORKS" (i.e., is set up to work, how it is structured since very early development).

It's the "bad" news for people who developed a severely psychotic ego core during early childhood. It's now their "self structure' - the entire mind/self is a constellation based on psychotic defenses, so there is just not hardly anything that can be DONE in adulthood to change it. Meds can help, therapy can help keep the person out of major anxiety/stress, but the reality of that person's CORE is that when under duress, they will psychotically decompensate.

For the neurotic level of functioning, no matter HOW horrific the symptom base, no matter how utttery crippling the person's fears/emotions, there is still a cognitive awareness of reality. The only real way such a person could ever enter a temporary psychotic state would be chemically (the old "amphetamine psychosis" that anyone can acquire briefly using "angel dust" or massive amounts of cocaine). But this persons' brain cannot "enter" a psychotic form of functioning on its own (regardless of how utterly petrified their anxiety states may be).

Peace,
Janine
 

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So does that mean that none of us neurotic bunch will go on to develop psychosis when under stress?

I hope thats what it means!!
 
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Discussion Starter · #5 ·
THAT is my POINT! LOL.....by george, Genie has got it!

That is precisely why doctors just smile and completey discount our terrors of becoming psychotic.

It's not possible. It's not the way we are "constructed." It's not a question of having BAD enough anxiety DEEP enough dp, etc...

no matter HOW horrible (and I lived some horrific experiences) the brain, mind, SELF in my case had not developed in a psychotic defensive structure. Once you are developed, your psychological structure is set in stone. If you are older than four, you are SET in stone by now. Nothing you do or say or think or worry about can change your level of ego function. It is who you ARE.

"All" I could do, even if I had remained ill my entire life (God forbid!) would be to continue to find new lovely ways to terrify myself and make my dp dip and ebb and flow and torment myself to the end of my days.

I could no more "make" myself psychotic than the psychotic could wake up one day and become ME.

Peace,
Janine
 
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Discussion Starter · #7 ·
Ooooo...you be so smart. Seriously, I have a kindred spirit here!! Yep, you've really grasped it.

Kernberg, yes, was the one who came up with concept regarding ego structure levels of function and by all evidence, he seems to be right.

And you're correct - "thrown against the wall" though is a very subjective idea. See, I agree that if someone was severly traumatized (the amphetamine psychosis idea), sure...any level could be transgressed. But that level of trauma must be utterly extreme (given massive amounts of LSD and then sent into a war situation for example...I mean, EXTREME)

I do realize that someone with borderline level ego structure CAN have intermittent psychotic dips under "thrown to the wall" type stress. But that usually occurs ONLY when very young, teenage years, for example and then, the reality breaks are very temporary (called, or used to be called "micro-psychotic episodes" - I used to wonder, does that mean the person just imagines seeing 'little tiny people in their hallucinations?" LOL)

Those episodes are not like "regular psychotic breaks' because the person returns 100 per cent to the high coginitive level of thought that they once had. Other psychotic states (in the psychotic level) are decompensating...each time there is a break, the person is slighly more impaired and never completely returns to the original cognitive level.

But yes, at a borderline level, there are very odd symtpoms that can occur under stress. I'm fairly sure even I have a "high level borderline" ego level. I had some delusions as a teenager, young 20's - very disturbed times (only lasted a few days, and that's what they mean by "micro-psychotic" - VERY brief).

I think though, with all you've been though, Wendy, you have already seen your worst mental reactions. At this point, you're left with much anxiety around "going deeper" within yourself, but I am positive you're in no danger.

Also, Borderline ego levels seem to be the most vulnerable when the person is young. *younger than you, grin...not that you're old, but I mean YOUNG. And a huge part of what good psychotherapy does is that it can strengthen the ego, so that you rarely if ever regress to your lowest level again. That's the whole idea behind psychoanalytic treatment. It helps the person take their strongest aspects of self and make them even stronger. That's what keeps the person from having symptoms anymore. As said, I'm STILL a person who can dissociate. I just don't anymore because the rest of my ego function is stronger.

And the person in your group who is still BPD but functions on a neurotic level is a good example of that. That person probably has a range that incorporates the entire spectrum of borderline functioning - at her BEST, she is right at the cusp of neurotic level. They usually call it "a high functioning borderline" (referring to the BPD) and once someone is past say 20 or 25, they rarely if ever dip to their lower range if they've had successful psychotherapy. Their Ego strength is good enough and solid enough to keep them stable.
Peace,
Janine

(a Friend of Kernberg)
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I heard that same thing somewhere, but not put together so eloquently.
My doc told me that people who have psychotic/schizophrenic tendencies usually had psychological damage done much more early on than those on the neurotic level. In other words, we all have 'damage' caused by loved ones who usually knew no better, but the severity of our responses to anxiety depends on where in the continuum of development the damage started. So the more early on the damage occurred, the worse off you are. The later it happened, the better off you are. I think this is what I heard. Does that make sense Janine?? Is this what you were saying?? Help.
 
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Discussion Starter · #9 ·
Yep, that's right.

The person who has a psychotic structure probably had severe attachment problems VERY early in infancy. Or they had intense impingement somewhere around the first couple of years.

Preverbal is the key. Remember "Primary Process" thought - the type of thinking all infants use before they use language. If the trauma/damage is done to a child/infant at the point before they have mastered language, the 'damage' exists without words as symbols.

The structure IS one of primary process, and that makes it nearly impossible to change. Literally, there are not words to ever express it because there were not words when it developed. So the level of regression they are capable of is MUCH 'younger' - under massive anxiety, they re-enter a preverbal state of experience.

THe rest of us probably had our development problems around 5 at the earliest (*the Oepidal years). Our little brains were certainly immature, but we had mastered language and the level of thought it coincides with

Peace,
J
 
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Discussion Starter · #10 ·
Janine, where did you get all your knowledge from?
Are you just reading a lot of stuff or was it the psychoanalyst you worked with who made you aware of all the things?
Just curious.
 
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Discussion Starter · #11 ·
I'm OBSESSIVE, LOLOLOL

I was interested in the entire field all my life. During the analytic therapy, I learned more, honed in on the set of theories I found most helpful and well....I'm obsessive, lol. I didn't really LEARN it from my actual therapy, but as time went on we discussed theory, etc. and I got from him who all the best writers are, etc.....got pointed in the right direction for self-education.

I go to psychoanalytic conferences here in NY, attend workshops, etc....and read. Read. Read. It's my unofficial vocation.

Peace,
J
 

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but,but,but...Janine, when you wrote you have probably experienced the worst of your mental states ( i would quote you on it but i don't know how to do the quote thingy ) with regards to Wendy, how can one know when they have reached the worst? I thought I had experienced the worst until 2 years ago when I was driving after hearing some horrific news and started seeing the trees and houses pop up like in a pop up book and the road became like a "ribbon of hightway". Scarey as that was, I still think there are worse things the mind can do. ( May I please never experience them.) So how do you know when you have reached your own personal worst ?

just wondering...again. :?
terri
 

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Hi terri, I am not Janine but guess I also can say I've experienced the worst I can. Indeed I'm aware I may be capable of experiencing even worse things, but I feel my PTSD psychosis four years ago was the worst. I think like this because I'm pretty sure I will never experience psychosis again, as I havent had psychotic symptoms but once after that, and even that was induced by sudden withdrawal of antipsychotics. At the moment I could say that I feel a lot more well-balanced than for ages, I don't suffer from depression, anxiety nor psychosis. I can study well at school and have my creative hobbies and that's why I'm sure I needn't go through a PTSD break anymore. Of course one never knows for sure, but anyway - time really has a healing capacity. At least I think I will never break down in the same way I did in my past, as I have learned about it. Nowadays I do not want to mess with abusive people, and that's why I hardly need to develop any new PTSD psychosis to get on with my life...lol :lol:
 
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Discussion Starter · #14 ·
I don't know how to do the quote thing either, and I'm a moderator, lol...

Terri, the reason I said that re Wendy is because I know her and know her story. Based on that, and on how she has already responded dissociatively, and the type of treatment she is currently doing, she is having all kinds of trepidation about "going deeper" into herself. When I said she's seen the worst, I meant that a) based on what I know of her, and (b) the treatment she's in, and c) the insights she already has into her own situation, she is not in danger of regression.

Mostly the prediction (and of course, that's all ANYone can do is just predict) about whether someone has experienced the worst of their symptom states is based on when the symptoms started, how much if any trauma was involved at the onset, the type of treatment they've done and are currently doing, and the degree of psychological awareness they have regarding the origin of their symtpoms.

Peace,
Janine
 

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Ninnu...time does have a way of healing and that is a hopeful thought for everyone. I am so glad you have seen and made it thru your worst.

Hi Janine,
It hit me that you were speaking from a personal level about Wendy ( hi Wendy! ) after I made my post.

I thought maybe there was some kind of "crystal ball" ( of course not really, but certain precursors) one could look into and see you had reached your worst.

Hey, that would be a good question...If you had the power to know the worst part of your dp/dr, would you want to know? hmmmm....

Thanks for taking time to reply.
Peace back to you.
terri
 

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After lots and lots of thinking about this issue, and after lots of trial and error, I have finally hit on the definitive solution, one that absolutely solves this problem and one that works, at least so far, every time.

Hold down the left button on the mouse, drag the "cursor"(a kind of flashing little line) until the entire text one wants to quote is "highlighted" (color of text is inversed against a darker background.) Then move the same cursor upwards, untill it becomes some kind of arrow, and point this arrow at the little box above that contains the word "Quote." Then simply press the left button on the mouse again. Viola! For example:

I don't know how to do the quote thing either, and I'm a moderator, lol...
OH, and about that other stuff. What, I'm supposed to solve all your problems?
 
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Discussion Starter · #17 ·
After lots and lots of thinking about this issue, and after lots of trial and error, I have finally hit on the definitive solution
Whoa! You're GOOD. Don't apologize for not solving more. This may be the first definitive solution we've ever had on the board, grin

Peace,
Quote Chick
 

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JanineBaker said:
After lots and lots of thinking about this issue, and after lots of trial and error, I have finally hit on the definitive solution
Whoa! You're GOOD. Don't apologize for not solving more. This may be the first definitive solution we've ever had on the board, grin

Peace,
Quote Chick
hey there...just working on Dalai's theory. i don't quite have the hang of it as I did not mean to quote all of that. Thanks for offering the help, Dalai.
Why can't you do everything? :wink:
 

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JanineBaker said:
After lots and lots of thinking about this issue, and after lots of trial and error, I have finally hit on the definitive solution
Whoa! You're GOOD. Don't apologize for not solving more. This may be the first definitive solution we've ever had on the board, grin

Peace,
Quote Chick
hey there...just working on Dalai's theory. i don't quite have the hang of it as I did not mean to quote all of that. Thanks for offering the help, Dalai.
Why can't you do everything? :wink:
 

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Human potential is the same for all. Your feeling, 'I am of no value,' is wrong. Absolutely wrong! You are decieving your self. We all have the power of thought, so what are you lacking? With will power you can do anything.
-- HH the 14th Dalai Lama.

Evidently I can :)

I really love that guy. What a day it would be if he finally set foot again in Tibet :!:

(And the borderline discussion is very important and I'm sorry for the digression. Trying to be clever is about all I got :oops: :) )
 
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