borderline personality disorder --> high creativity

Postby Sarah_N » Fri Dec 29, 2006 10:19 am

Is it true that borderline personality disorder results in increased creativity?
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#1

Postby suddengreen » Fri Dec 29, 2006 10:29 am

Sorry, cannot help you much there....
I don't know of any definitive proof linking BPD to higher creativity.
If you want more info on BPD, try this link:
http://www.nimh.nih.gov/publicat/bpd.cfm
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#2

Postby Sluagh » Sat Dec 30, 2006 10:53 am

the last two days I have been trying to copy and paste this very interesting article on here but it just wont let me!!!
How frustrating!
Here is the link to read it (but you need to be registered, sorry)
http://counselling.forumup.org/viewtopi ... ounselling
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#3

Postby Sluagh » Sat Dec 30, 2006 10:54 am

BORDERLINE PERSONALITY DISORDER: THEIR

RELEVANCE TO GENESIS AND TREATMENT

Lee C. Park, MD, John B. Imboden, MD, Thomas J. Park, PhD,

Stewart H. Hulse, PhD, and H. Thomas Unger, MD

This clinical study of 23 borderline outpatients and 38

outpatients with other personality disorders provides evidence

that individuals who become borderline frequently have a

special talent or gift, namely a potential to be unusually

perceptive about the feelings of others. We postulate that this

talent is derived from an innate characteristic rather than

simply arising from early environmental influences. We also

present evidence that chronic, severe, pervasive psychological

abuse, or "mind abuse," is the most frequent and significant

form of caretaker abuse (vs. sexual or physical) in the

childhood histories of this disorder. Our data support the

hypothesis that the interaction of a child's gifted

characteristics with this abuse creates a tragic drama that is

etiological for BPD in a substantial number of cases. We

propose that the abuse markedly perverts not only use of the

perceptual talents (e.g., powerfully compelling projective

identification) but overall psychological development. We

discuss how these issues are relevant to the conduct of

effective therapy.

Almost all clinicians who have significant experience with borderline

patients are impressed at times with their exceptional ability to sense

psychological characteristics of significant others in their lives, including

therapists. This ability tends to be coupled with the manipulative induction

of feelings like those the patients themselves experience, that is, projective

identification (Kernberg, 1975; Ogden, 1982). Patients may also employ

this talent in engendering strong rescue and attachment responses, as well

as disagreements, quarrels, or "splits" among those who are involved in

their lives, for example, between members of the family or clinic staffs,

especially inpatient staffs (Adier. 1985; Gunderson, 1989; Gutheil, 1989).

It is our hypothesis that the significance of this talent goes far beyond

these particular symptomatic manifestations of the disorder. We assert that

there is an inborn talent and need to discern the feelings and motivations of

others, and, to emphasize its positive value as well as its innateness, we

choose to refer to this characteristic as a gift. Much as one would refer to the

mathematically gifted person or the musically gifted person, we believe

many borderline patients have a cognitive giftedness in the area of self- and

other-perceptiveness called "personal intelligence" (Gardner, 1983, 1985).

This talent has remained unrecognized both because it occurs in very

perturbed individuals for whom it is generally unavailable in a conscious

fashion, and because it is embedded in the service of self-protection, needlness,

control, and rage.

Under favorable circumstances an infant born with this gift would not, of

course, grow up to have borderline personality disorder (BPD). We assume

that such persons, given other healthy attributes and an appropriately

nurturing environment, would grow up to become particularly successful in

their relationships and careers. But what of the infant whose primary

caretaker has defective capacity to be empathically attuned to others, even

resents or is threatened by an unusually perceptive child and responds by

psychologically abusing the child?

We are proposing the etiological hypothesis that BPD frequently results

from the interaction of two factors (Gunderson & Zanarini, 1989), one of

them biogenetic, the giftedness; and the other a disturbed parental involvement

factor, severe, chronic verbal/psychological abuse by caretakers during

infancy and childhood. The psychological abuse may differ in many

ways from child to child, but it always includes chronic resistance to or

assault on the healthy development of a child's perceptions and sense of an

autonomous self. This abuse is so threatening and damaging that any

intuitive talents become almost totally directed to pathological patterns of

relating that are the basis for the characteristic, perhaps pathognomonic

(Zanarini, Gunderson, Frankenburg, & Chauncey, 1990) interpersonal

powers of these patients. Attachment theory (Bowlby, 1988) can explain the

clinical manifestations of BPD as resulting from the interaction of these two

factors, without assuming other biogenetic factors such as inborn abnormal

personality traits or defects (Soloff & Millward, 1983). However,

since there may be a number of combinations of innate and environmental

factors that facilitate development of BPD, studies of borderline

individuals in various populations are required to determine the validity

and clinical significance of any etiological hypothesis (Millon, 1987; Stone,

1990a).

There are numerous references in the BPD literature to a skill or talent to

perceive, involve, and influence people, although there has been minimal

formal investigation of this characteristic. It is considered to be a man

ifestation of pathology and/or a skill that is peculiar in some way, and/or

simply a learned response to childhood stress. Adier (1985) and Gunderson

(1989) discuss the tendency of borderline patients to evoke disturbing

emotional conflicts between hospital staff members, as well as intense

feelings of rage and helplessness in therapists. Gutheil (1989) and Averill et

al. (1989) emphasize their ability to be remarkably appealing and/or compelling,

and to frequently "seduce, provoke or invite" even experienced

therapists Into serious boundary violations, including patientótherapist

sex. Numerous authors have described an "uncanny capacity" (Krohn,

1974) of many borderline patients to recognize, and often to overreact to or

act manipulatively or even helpfully upon, unexpressed or private attitudes

and judgments, hidden feelings, and unconscious impulses of other people

(Carter & Rinsley, 1977; Gabbard, 1990; Kernberg, 1984; Kernberg, Salzer,

Koenigsberg, Carr, &Applebaum, 1989; Kreisman & Straus, 1989; Masterson,

1976; Shapiro, 1978; Stone, 1985). Krohn refers to this intuitive talent

as "borderline empathy." It is intriguing that there has been no consideration

of a DSM-III-R criterion for this striking characteristic since it might, if

proven valid, help distinguish BPD from other personality disorders such as

histrionic, antisocial, and narcissistic.
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#4

Postby Sluagh » Sat Dec 30, 2006 10:55 am

There are few studies exploring psychological abuse in the histories of

borderline patients. In a controlled study. Zanarini, Gunderson, Marino,

Schwartz, and Frankenburg (1989) found that chronic verbal psychological

abuse, defined as chronically devaluative and/or blaming statements, occurred

in the childhood histories of 72% of their borderline patients. This

was far more common than physical (46%) or sexual (26%) abuse and was

the only form of abuse that distinguished the borderline group from each of

2 control groups. Stone (1990b) found that 73% of 15 BPD patients reported

a history of intense verbal abuse, with physical and sexual abuse having

occurred in 47%. Psychological abuse generally has been explored as a

relatively unidimensional phenomenon. However, the psychological development

of human offspring is uniquely impacted by complex and subtle

verbal and nonverbal cues that deserve closer examination. In our patient

review, which follows, we examined a number of categories of psychological

abuse, including one that may be particularly damaging to the psychological

development of a gifted child: pervasive negative feedback to a child's

Intuitive perceptions.

In this study we evaluated information about 23 borderline patients and

38 patients with other personality disorders, all in long-term outpatient

therapy, with special reference to evidence for giftedness, for severe psychological

abuse in the childhood history, and particularly for a concurrence

of giftedness and psychological abuse. We also reviewed patient reports

about family constellations for evidence of caretaker personality characteristics

and marital patterns that were associated with psychological

abuse.

METHODS

Our clinical experience with BPD comes primarily from private practice with

patients of above average socioeconomic background. We reviewed the clinical records

of 107 private outpatients and identified 23 (18 women) who met the

DSM-III-R definition ofBPD, that is, 5-8 criteria (American Psychiatric Assn., 1987;

Frances, Clarkin, Gilmore, Hurt, & Brown, 1984). Treatment duration of at least 6

months was specified because brief contact may not reveal hidden intuitive talents

or history of abuse, particularly psychological abuse. Twenty of these patients also

had a history of Axis I, primarily affective, disorders (Fyer, Frances, Sullivan, Hurt, &

Clarkin, 1988; Schwartz, Blazer, George, & Winfield, 1990; Widiger & Frances,

1989). Because only 6 patients had been hospitalized and only 7 met more than 5

diagnostic criteria, our results could differ from those of more severe cases. Furthermore,

although several tended to manifest a few of the DSM criteria for antisocial

personality disorder, only 1 of them satisfied enough criteria for the diagnosis, with

2 others meeting 4 adult criteria. Therefore, we may be working with a particular

subset of BPD patients (Frances, Pincus, Widinger, Davis, & First, 1990; Stone,

1990a). As a control group we identified 38 (23 women) of the 107 patients as having

other personality disorders and 2 or fewer DSM-III-R diagnostic criteria for BPD,

with 22 controls also having a history of Axis I disorders. All but 2 of the 61 study

patients were in individual therapy, the great majority seen 50 minutes once every 1

or 2 weeks. Six borderline patients and 1 control received concomitant group therapy,

and 2 controls received only group therapy. Clinical judgments were made on a

consensus basis but were not blind.

Currently, there is no reliable instrument that directly assesses cognitive personality

features such as intuitive talents or giftedness (Costa & McCrae, 1990;

Stemberg & Smith, 1985; Taylor & Cadet, 1989). For this exploratory study, we

developed a rough rating scale derived from Gardner's work on the concept of

"personal intelligence" (1983, 1985). Gardner has provided detailed evidence that, in

humans, there are at least six relatively independent or modular (Gould, 1992)

categories of intelligence: linguistic, musical, logicalómathematical, spatial, bodilyó

kinesthetic, and personal. Personal intelligence consists of two intimately interrelated

information-processing capacities involving perception of self and others:

intrapersonal intelligence, or "access to one's own feeling life"; and interpersonal, or

"the ability to notice and make distinctions among other individuals and, in particular,

among their moods, temperaments, motivations, and intentions" (Gardner,

1983. p. 239). Accurate labeling of the latter includes empathy, the ability of a

person to "place oneself into the skin of specific other individuals" (1983, p. 250).

This sophisticated form of intelligence is unique to and has been central in the

evolution of primates, and its expression is markedly vulnerable to cultural and

caretaker influences (Byrne, 1991; Cheney and Seyfarth, 1990; Gardner, 1983;

Lieberman, 1991; Small, 1990). Gardner provides an argument that, as with other

forms of intelligence, personal intelligence has a range of individual variation,

including exceptional individuals.

Our scale is based on the proposal that borderline patients are such exceptional

individuals. Because of additional assumptions that borderlines are largely blocked

from access to this talent due to caretaker assault, but that they retain a strong

innate need for such access, we included preoccupation with, as well as access to,

feelings and perceptions. The preoccupation must reflect efforts to understand or

resolve feelings and perceptions about self and others, rather than simply reflect a

burden of symptomatic distress or strong affects.

We estimated the degree of personal intelligence or giftedness by rating patients

as clearly showing the following:
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#5

Postby Sluagh » Sat Dec 30, 2006 10:56 am

1. Intense preoccupation with and/or talented access to their feelings.

2. Intense preoccupation with and/or sense of the feelings of others.

3. At least 3 perceptive intuitions or insights about others expressed during

therapy.

4. (a) Capability of empathic concern for important others is clearly evident at

times; and (b) grandiosity, devaluation, and envy are not pervasive.

Item 4 is added based on the commonsense assumption that perceptual giftedness

generally would not be associated with absence of a capacity for genuine

concern or caring for others, or with pervasive grandiosity/devaluation. Further,

. Perry and Cooper (1986) found that omnipotence and devaluation are characteristically

narcissistic but not borderline defenses. Grandiosity, devaluation and envy

were judged to be pervasive if they were detected frequently and in many contexts,

and were highly resistant to change or insight.

A score of 1 to 4 was given to each patient according to how many of these criteria

were met, and we arbitrarily assigned patients with scores of 3 or 4 as gifted.

We examined histories for evidence of caretaker abuse, and for patterns of parental

behaviors and attitudes. This information was obtained from review of records

and from direct questioning of patients, who were informed this was for research as

well as for treatment purposes.

Caretaker abuse was categorized as chronic physical, sexual, and chronic, pervasive

verbal/psychological. We realize that physical and sexual abuse are also forms

of psychological abuse (Byers, 1987; Wolfe, 1991), but for the purposes of this study

they are classified separately. Again, there is no satisfactory standardized rating

scale for varieties of psychological abuse, and we devised a simple one for this study

based on our clinical experience and review of the literature (Bowlby, 1984, 1988;

Cicchetti & Carlson, 1989; Kohut, 1971; Miller, 1981; Shapiro, 1978; Soloff and

Millward, 1983). We subcategorized chronic verbal/psychological abusive behaviors

as: neglect; constant devaluation; intrusion/invasion; attack on autonomy; and

attack on, depreciation of, or total nonrecognition of the child's special access to

intuitive Insights. We required clear reports Involving incidents or behaviors that

occurred on a repetitive basis. Because psychological abuse cannot be measured

clearly, we did not make a rating unless we felt it should be obvious to anyone, and

did not classify a patient as psychologically abused unless 2 categories were checked.

In order to investigate in more detail our findings about psychological abuse, we

further categorized patients' perceptions of parental behaviors and attitudes as:

psychologically dominating, controlling, warm, empathic, and hostile.

RESULTS

Seventeen of the 23 BPD patients (74%) met the definition for giftedness,

meeting at least 3 personal intelligence criteria, with 11 (48%) meeting all 4

criteria. A significantly smaller proportion of the controls (34%: 13/38) met

at least 3 criteria, with 6(16%) meeting all 4 criteria (x2 = 7.52, df = 1, p <

.01). The second criterion, intense preoccupation with and/or sense of the

feelings of others, was the most discriminating (96% borderlines vs. 45%

controls), and the fourth, presumably an indicator of narcissistic tendencies,

was the least (65% vs. 66%). (Only 2 borderlines and 4 controls met 4

or more DSM-III-R criteria for NPD.)

We reviewed these scores for gender differences and found that male

borderlines received significantly higher scores than female borderlines

(3.80 vs. 3.06: t = 1.82, df = 21, p < .05). Because there were only 5 males,

this unexpected finding is suspect. However, it is in line with our clinical

experience that all the male borderlines could be exquisitely sensitive to

subtle cues from others, although this was not evident on casual acquaintance

because they all tended to respond with male stereotypical concealment

of personal feelings and/or with "antisocial" impulsive, threatening,

angry, destructive, or self-destructive behaviors. For the controls, the average

score was 2.00 for males and 2.13 for females (t = .33. df = 36, NS).

Examination of caretaker abuse histories for the borderline patients revealed

26% (6/23) chronic physical and 13% (3/23) sexual. Thirty percent

(7/23) had sexual abuse histories if noncaretakers were included. Fewer

control patients were physically or sexually abused but this was not statistically

significant.

Chronic, pervasive verbal/psychological abuse had occurred in 100% of

the BPD sample. Psychological abuse subcategory findings were : 30%

(7/23) chronic neglect; 70% (16/23) constant devaluation; 83% (19/23) intrusion/

invasion; 74% (17/23) chronic attack on autonomy; and 74% (17/

23) chronic attack on, depreciation of, or total nonrecognition of the child's

special access to feelings and intuitive insights. At least 2 forms of verbal/

psychological abuse had occurred chronically in the lives of all 23 BPD

patients, with 3 or more occurring in 17 cases. In comparison, 32% (12/38)

of the control patients met the criteria for psychological abuse, a significant

difference (x2 = 24.70, df = 1, p < .001).

Table 1 compares BPD and control patients. There are substantial numbers

of gifted and abused patients in both groups. However, 74% (17/23) of

the BPD patients were rated as both gifted and psychologically abused in

contrast to only 13% (5/38) of the controls (x2 = 20.38, df = 1, p < .001).

Review of the borderline patients' perceptions about parental dominance

and capacity for warmth revealed that in 91 % (21/23) of the cases there was

a dominant parent (see Table 1), who was also the primary psychological

abuser, and a parent who played only a secondary role in the abusive

pattern. The parent perceived as dominant was not always the one who

might look and sound in charge but was the one whose psychological power

over the patient was greatest (Byers, 1987). This sometimes became clear

only later in treatment. In 18 of the 23 BPD cases (78%), the mothers were

experienced by the patients (14 females, 4 males) as very dominating and

controlling, and either quite limited or lacking in expression of warmth. In

3 cases (13%) the fathers were seen as very dominant and controlling,

usurping the parenting role and overattached to their children (in all 3

cases, daughters) in ways that had sexual overtones. In 1 case the parents

as a rigid unit were very dominating to the patient; and in 1 case a judgment

about dominance could not be made.

Patients frequently described the 21 dominant parents in ways that fit

DSM-III-R criteria for narcissistic personality disorder (NPD). For instance,

they invariably were described, particularly later in treatment, as very

limited in empathy and as having a controlling sense of entitlement, the

latter often expressed as parental wisdom. At least seven (33%) were frequently

or chronically profoundly hostile to the child, and in all but one of

the other cases (62%:13/21). the patients felt they avoided rage and

abandonment only through skillful submission, sometimes with subtle or

disguised manipulation of vulnerabilities of the parent.

The nondominant parents (21/23), usually fathers (18/23), were generally

experienced as not intrusive and as somewhat warmer as a group, but in all

cases not able, unavailable, too dependent, and/or too symptomatic to influence

their abusing partners. In a number of cases (6/23) psychologically

dominant mothers facilitated the perception that the fathers were dominant

because of the male role and/or intimidating temper and/or physically

abusive behaviors, a perception that tended to conceal or blur the mother's

primary psychic power until after childhood. One of the dominant fathers

functioned analogously, blaming the mother's dramatic emotionality. The

finding of 30% neglect took into account only the dominant caretakers, but

if the partner's behavior is also considered, there was a pervasive atmosphere

of emotional neglect playing a background accompaniment to the

active abuse. The most frequent family pattern, occurring in 61 % (14/23) of

the cases, consisted of a dominant, unempathic mother, an emotionally

neglectful father, and a borderline daughter.
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#6

Postby Sluagh » Sat Dec 30, 2006 10:57 am

In summary, for our group of borderline patients, there was major

biparental psychological failure, by combined commission and omission,

throughout childhood and adolescence. In addition to the categories of

psychological abuse already described, there was in every case a chronic

family atmosphere of morbid, disturbing dramas between parents, and/or

between one or both parents and the child, usually involving strong negative

affects. One of the few softening notes was that the dominant parents

generally had grandiose ideas of competence, with malevolence demonstrated

in tactics of control rather than in long-term designs of deliberate

harm. The children frequently had strong feelings of love and concern (also

rage, hate, fear, and so forth) for one or the other, sometimes both, parents,

and at times were burdened by a painful wish to take care of and protect

these parents. In addition, in a number of cases the dominant parents were

appreciated for their intense attention to education and social development,

although this was experienced later as for the parent rather than for the

child.

Review of family constellations in the control group revealed that significantly

fewer patients (37%: 14/38) had dominant, controlling, unempathic

parents, all mothers, who were also reported to be quite lacking or limited in

expression of warmth (x2 = 15.22, d f= l , p < .001). Only 1 of these parents

was profoundly hostile to the child, with just 8 other control patients

reporting that they avoided rage and abandonment through skillful submis

sion. There was not a general background atmosphere of neglect, disturbing

family dramas, and negative affects, with only 6 spouses of dominant

parents experienced as markedly unavailable.

Links and Blum (1990) recently speculated that intrusive overlnvolvement

associated with criticism, abuse, and a highly malevolent parental

attitude may be particularly characteristic of the borderline's childhood

caretaker environment. With regard to this scenario, 78% (18/23) of the

borderline patients and 29% (11/38) of the controls experienced chronic

intrusion/invasion along with constant devaluation and/or chronic attack

on autonomy, (x2 = 13.65, d f = 1, p < .001). In line with this. Reiser (1986)

distinguishes intuitively gifted, depressed, but not borderline individuals

who apparently experienced intrusive overinvolvement without conspicuous

threat or hostility from caretakers (Miller, 1981), from borderline

individuals who were subjected to severe hostility.

There are a number of weaknesses in this study that are often present in

long-term clinical research, including small sample size, limited testing

instruments, and lack of blind evaluation (Frances, 1990). Data are derived

retrospectively from subjective reports and are potentially biased by both

observers and patients. On the other hand, some of the results are very

strong statistically. Also, self-reports of childhood trauma and abuse have

been quite similar throughout a number of studies (Briere & Zaidi, 1989;

Herman & Schatzow, 1987; Jacobson, 1989).

DISCUSSION

For clinicians who treat borderline patients, the most striking personality

feature is the "flavor" of their involvement in the treatment relationship.

particularly their ability both to access and then to strongly influence our

private emotions, engendering the classical "countertransference problems/

'special' treatment relationships" that Zanarini et al. (1990) found to be one

of seven "more specific or even pathognomonic features" (p. 166) ofBPD. We

have presented evidence compatible with the hypothesis that this unusual

ability to access private emotions reflects a healthy innate intuitive talent or

gift, and that the highly developed skill to influence detected emotional

vulnerabilities reflects a learned capability that could develop only though

years (Millon, 1987) of constant, often subtle (to an observer), interactions

with caretakers who relate to the child in a severely controlling, threatening

fashion, and in a biparental situation that isolates the child from significant

empathic support or validation (Gunderson & Zanarini, 1989; Kohut,

1971; Links & Blum, 1990).
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#7

Postby Sluagh » Sat Dec 30, 2006 10:58 am

We propose that this explanation for the interpersonal characteristics of

BPD can also provide an understanding of other clinical manifestations of

the syndrome. The interactive combination of giftedness and psychological

abuse in the genesis of borderline symptomatology is elucidated by attachment

theory, which proposes that when there are incompetent, abusive

caretakers, the child blames himself or herself and absolves the caretaker in

order to maintain a "secure base" (Bowlby, 1988; Crittenden & Ainsworth,

1989; van der Kolk, 1987), that is. in order to maintain the perception that

the caretaker is at least "good enough" (Winnicott, 1960) for basic psycho

logical survival. This scenario would be especially significant and complex if

the child were intuitively brilliant, and the interaction would be particularly

destructive if the parent rejected and assaulted the child for its very perceptions,

because the child must then experience himself or herself as

profoundly bad for having core mental processes that cannot be stifled.

After a childhood of such pervasive requirement to experience black as

white and vice versa (Gantt, 1944; Shengold, 1989), the only behavioral clue

to giftedness in the adult is a defensive pattern suggesting a very complex

yet provocative confusion about self and others. This formulation accounts

for the paradoxical combination in the borderline patient of cognitive and

affective disarray, enormous distress, and helplessness, coexisting with

surprisingly persuasive interpersonal powers (Gutheil, 1989). It also

accounts for the observation that intuitive borderlines paradoxically can

frequently be perceptively dense, since healthy perceptiveness can be overwhelmed

by biases and introjections resulting from parental intrusive intents

and behaviors.

The concept of a crucial interraction between social perceptivity and the

quality of child-rearing receives support from recent primate and pediatric

research. Suomi (1991) found that rhesus monkeys selectively bred to be

"high reactive" (i.e., very fearful and anxious in new or challenging situations)

and who are highly aware of their environment from birth (i.e.,

possibly gifted) (Suomi, personal communication, 1991) tend to maintain

this anxious pattern to reach a relatively marginal adult adjustment.

However, when raised by unusually nurtuing foster mothers, such monkeys

become the most socially skilled and dominant members of their peer

groups. Boyce, Chesney, Kaiser, Alkon-Leonard, and Tschann (1991) report

findings suggesting that there is a subset of children with a "heightened

sensitivity to the social world" (gifted?) whose developmental and emotional

outcomes, ranging from unusually successful to unusually poor, are critically

dependent upon the character of early child-rearing conditions (Boyce,

personal communication, 1991). It appears that an apparent biogenetic

vulnerability may actually reflect an advanced social potential that requires

special nurturing (i.e., an appropriate parental "fit") for the proper development

of this potential (Brazelton & Cramer, 1990; Thomas & Chess, 1984).

It can be extremely important to distinguish a talent requiring such special

care from a defect. For instance, we do not say the human infant is defective

because it requires very attentive and sensitive care for many more years

than any other creature. These issues may be relevant not only to BPD but

also to other psychiatric disorders, particularly those involving affects.

There are two published controlled studies that support our findings of

Intuitive capacities in borderline patients. In the first, Ladisich and Fell

(1988) evaluated empathy in 20 borderline, 20 neurotic, and 19 patients

with a history of schizophrenia, all in inpatient group therapy. Patients and

group therapists evaluated themselves and other group members using

personality trait and social attitude tests, with empathy assessed by

calculating how accurately a person could rate other persons' ratings of

themselves. The borderline patients scored significantly better than both

the neurotic and schizophrenic groups and, in fact, were as good as the

therapists, who presumably had more knowledge of the patients. The authors

suggested that high empathy (i.e., personal intelligence) in borderline

patients might reflect a vulnerability for psychosis.

In the second study. Frank and Hoffman (1986) compared two groups of

patients, borderline and neurotic, employing the Brief Exposure Profile of

Nonverbal Sensitivity. They demonstrated significantly higher nonverbal

sensitivity in the borderline group, which they felt provided empirical confirmation

of a "borderline" or symptomatic type of empathy in BPD that

developed as a way of contending with maternal emotional neglect. They

also found (Hoffman & Frank, 1987) correlations consistent with the hypothesis

that a constitutional vulnerability contributes to the nonverbal

sensitivity. However, the scientific literature supports the concept that the

capacity for empathy is a healthy inborn trait (Brothers, 1989; Neubauer &

Neubauer, 1990) rather than an inborn weakness or vulnerability, a susceptibility

for psychosis, or a manifestation of childhood stress per se

(Cicchetti & Carlson, 1989).

Because there has been no prior consideration of giftedness as having

major relevance for etiology and clinical manifestations of BPD, there are no

published estimates of its prevalence. The Zanarini et al. (1990) report that

63% of 120 borderline patients engendered countertransference problems

and special treatment relationships, and our finding of 74% gifted individuals,

suggest the possibility that as many as two thirds to three fourths

of borderline individuals have unusually high levels of personal intelligence.

In line with this. Bond (1990) reported a pilot study in which two thirds of a

small borderline group scored significantly higher for defense mechanisms

that included projective identification than a control group of other personality

disorders.

Our findings about patterns of parenting behaviors are in line with a

preliminary report from Zanarini and Gunderson (1987), who found evidence

for chronic verbal abuse by female caretakers, along with inconsistency

and physical neglect by male caretakers. Similarly, Soloff and

Millward (1983), in a controlled study of 45 BPD inpatients, found a significant

pattern of intrusive, controlling, overinvolved mothers, along

with underinvolved or absent fathers and a confllctual marital relationship.

It appears that different patterns of caretaker abuse tend to be etiological

for differing clinical syndromes, with terrorizing and dramatic abuse, particularly

sexual and physical, predominant in the history of multiple

personality disorder (Putnam, 1989), and severe psychological abuse that

pervasively and insidiously affects routine workings of the mind predominant

in the history of BPD. The finding of 100% psychological abuse suggests

that this is a necessary etiological factor for BPD, and that giftedness

is frequently present but not essential. Although an emotionally gifted child

would be uniquely vulnerable to, and characteristically responsive to, such

caretaker behaviors and attitudes, severely abusive and chaotic family environments

could be expected to elicit significant borderline characteristics

in almost anyone, with and without clinical manifestations of intuitive

talents. The literature also suggests that borderline characteristics can be

engendered by reasonably well-meaning, even generally empathic, parents

who have very strongly held but very faulty and severe child-raising concepts.

or who respond very negatively or Inappropriately to certain highly

stressful phenomena such as difficult temperaments, significantly defective

impulse, attention or affect regulation, severe learning disabilities, and

marked hyperactivity (Feldman & Guttman, 1984; Gunderson & Zanarini,

1989; Kernberg, 1975; Linehan, 1989; Miller, 1983). In all these scenarios,

the essential factor in the development of borderline symptomatology is

severely defective caretaker empathy for, and response to, the child's psychological

state, that is, broadly speaking, psychological abuse. Biogenetic

factors such as a child's physical appearance and behaviors would not be a

major antecedent for BPD per se, as the development of such psychopathology

would not be expected with appropriate parenting (Brazelton & Cramer,

1990; Miller, 1981; Werner, 1989).

NARCISSISTIC CHARACTERISTICS IN PARENTS

Of special interest to us was the high occurrence of a dominating, unempathic

parent who exhibited impressive narcissistic characteristics and

who appeared to have low or defective (Gardner, 1983; Gould, 1991;

Mountcastle, 1975) innate personal intelligence, an exceptionally poor fit

(Thomas & Chess, 1984) for an emotionally gifted child. The very nature of

pathological narcissism (Kernberg, 1975; Kohut, 1971) includes primitive

defenses that would be very disturbing such as splitting with alternating

mental states, exploitativeness and intimidating rage in response to envied

qualities and autonomous strivings of significant others. Possibly contributing

to the relative scarcity of speculation about parental narcissism in

the genesis of BPD is the skewing of criteria for NPD toward identifying

relatively overt exploitative behaviors seen in stereotypical male roles rather

than in subtle, disguised, or concealed behaviors (Gunderson, Ronningstam,

& Bodkin, 1990) common in parenting.
Sluagh
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#8

Postby Sluagh » Sat Dec 30, 2006 10:58 am

The domain of NPD as it relates to BPD requires a great deal of study,

considering that there may be very different forms and expressions of

narcissism, such as states versus traits, and including individuals with

varying potentials to experience empathy and caring. Widiger and Frances

(1988) point out that psychodiagnostic research has not demonstrated a

substantial overlap of these two disorders. We are investigating the possibility

that individuals who develop these conditions tend to be at extremes of

personal intelligence, with psychopathology often reflecting complex interactions

of caretakers at one extreme with offspring at the other.

THERAPEUTIC APPROACHES

Validation of the etiology we have proposed may lead to new therapeutic

strategies for BPD that will have significant consequence both for rate of

improvement and for decrease in the high suicide rate early in treatment

when hope is most often abandoned (Frances, 1990). We believe that the

current average of 15 or more years before recovery (Gunderson & Zanarini,

1989) may well reflect, in part, negative or devaluative formulations about

these individuals, their histories, and prognosis.

We are currently investigating the effect of validating, when appropriate,

six major characteristics of borderline patients that are either positive or

encouragingly explanatory: exceptional personal intelligence; history of severe

psychological abuse/neglect with concomitant enormous suffering;

compulsive self-blame and self-devaluation as attachment characteristics;

"staying power"; "real self versus introjected narcissistic characteristics of

abusers; and the absolute right to experience their innate capacity for freely

enjoying their feelings, their perceptions, and thoughts. We are also informing

patients of recent hard data that the natural, long-term course for most

borderline individuals is improvement to essentially normal functioning.

which means we are able to communicate optimism that is sincere, is

confidently based on knowledge, and carries no false bravado that an intuitive

patient might detect (Frances. 1990; Perry, Herman, van der Kolk. &

Hoke. 1990; Stone, 1990a).

By validating personal intelligence or giftedness as an innate characteristic,

we can provide a therapeutic "mirroring" or "holding environment"

(Kohut. 1971; Lear. 1990; Warnes, 1981) in which the borderline individual

experiences an unconditionally and inherently good quality. Krohn (1974)

grasped the importance of recognizing and validating occasional penetrating

perceptions by borderline patients, but he did not remark on the

possibility of an underlying talent. Similarly, Frank and Hoffman (1986)

recommended giving more credence to perceptions of borderline patients

and helping them learn to modulate an abnormal sensitivity to nonverbal

cues. Carter and Rinsley (1977) commented on the value of recognizing that

the borderline patient's intuitive perceptions can be accurate but did not

consider the therapeutic benefit of verbalizing this to the patient.

Validation of chronic physical, sexual, and psychological caretaker abuse

is essential for the gradual dissolution of profound shame, self-blame,

self-hate, and self-loathing (Miller, 1983; Perry et al., 1990). We find that it

is absolutely necessary for Intuitive patients to understand relevant

moment-to-moment behaviors, intents, and even dynamics of their parents

and others. "Staying power" refers to the relentless urgency and effort to

survive destructive childhoods and endless suffering, and to be complete

persons.

CONCLUSIONS

The etiology ofBPD remains one of the significant challenges for psychiatry.

more so now that it has been established as a clearly defined syndrome not

specifically related to schizophrenia or to depression. We have presented

evidence that an understanding of BPD may be found by investigating the

Interaction of a child's healthy intuitive talents and developmental requirements

with severe psychological abuse from caretakers. The concept of

giftedness in borderline individuals may have important implications for an

Improved psychotherapeutic environment, which in turn may significantly

alter the prognosis, suicide rate, and length of treatment for patients who

are generally viewed in a rather negative conceptual framework.
Sluagh
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Posts: 1119
Joined: Thu Oct 12, 2006 12:51 pm



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