Last year I wrote a post on the similarities and differences of Borderline Personality Disorder (BPD) and Asperger’s syndrome, I realised that the lands of research in this area were relatively baron but I did not expect the overwhelming response the post has had; 8669 readers to this date! As the first link in google to come up when Borderline and Asperger’s are typed in together, I feel some responsibility to address some of the issues the post raised. Much of the comments and feedback were positive and constructive, however there were some nearing abusive posts thrown into the mix and some less than complimentary comments made (I have approved all of these and published them to the blog, except those with excessive bad language). Some were quite personal but of course each one had an underlying point, perhaps I had been too dismissive of the disorder I know least about (Borderline Personality Disorder), and seemed too biased towards my own condition (Asperger’s). The overall point I endeavored to make is that the two result in similar types of behavior but each with a completely different trigger. That is not to say that either individual is in anymore control of their difficulties and behaviour than the other, and for the record I would not prefer to have one more than the other, but you only know what it is like to have what you have, and the thought of change is a scary one! So back to the science…
The official criteria for Borderline Personality disorder is a ‘pervasive pattern of instability or interpersonal relationships, self image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of context’. This may be apparent by a deep fear of abandonment and frantic efforts to avoid this; intense and unstable relationships, obsessive about someone one minute then feeling nothing but hate for them the next; difficulty with self-image; impulsivity, such as spending, sex, substance abuse, reckless driving, and binge eating to name but a few; suicidal behaviours, including threats and self-harm; rapid cycling of mood states, anxious for hours then a sudden shift to intense irritability for example; chronic feelings of emptiness; problems with misplaced anger and control; and finally temporary states of stress induced paranoia and dissociation with oneself. Quite an exhaustive list of symptoms which could cover a number of other disorders, Asperger’s in particular. For instance we see a fear of abandonment in many of these individuals also, unstable relationships as a result of misunderstanding feelings and intentions, rapid mood cycling swinging from euphoric joy to meltdown madness, and quite commonly in those who are also mentally ill, dissociation and paranoid states. So on the surface there are elements of Borderline in all ‘Aspies’ and elements of autism in all ‘Borderliners’, however Asperger’s is seen as a learning disability, as opposed to a personality problem; it encompasses a whole neuronal network of functions and cognitions expanding beyond relationships and mood, these problems are rather the byproduct of the original classic impairments. Both can be considered genetic and could have a common cause of atypical brain chemistry and structure. Unlike Asperger’s though, Borderline does typically start in adolescence, whereas to have an autism spectrum disorder you must have been born with one. We also know that it is quite common for BPD sufferers to have been victim to family problems, neglect and/or childhood abuse. This by no means speaks for all individuals, but typically even if at a milder degree this issues are often present before the BPD.
Now put all this aside, because these facts and figures are completely irrelevant if you want to truly understand both conditions and how they affect real people’s lives. There is so much prejudice surrounding Borderline PD, the symptoms lead others to think the person is manipulative and attention seeking, and medication and therapy wise it is a tough nut to crack. People with Asperger’s have it no easier, often the victims of bullying and prejudice as their symptoms lead others to think they are ‘weirdos’, however there is an air now of superiority due to the increased awareness in the media, it has become quite a pop topic, no doubt fueled by the knowledge that it is considered ‘incurable’ and even a benefit to have. Working with both ‘Aspies’ and ‘Borderlines’ can be a frustrating mission and often seeming like an impossibility, many give up with this battle forgetting that the methods they use to treat the difficulties are the very difficulties they have to be treated; they are asking people to discuss their thoughts and feelings who have difficulty trusting and relating to others and understanding these feelings in the first place. Relentless and unconditional perseverance, reliability, and reassurance are the key.
I pity those professionals who try to give me self-help material for my Aspeger’s and mental health difficulties, my head is begging them to not go down that route, for their sake rather than my own. I am not uncooperative but I have received an Amazon rain forrest worth of self-help books, booklets and leaflets over the years. From social anxiety, to health anxiety, conquering depression, learning to live in solitude, to feeling the fear and doing it anyway. There is not much I have not tried to help myself about. The good ones manage to worm their way into my head for at least two weeks before fizzling into the abyss. So when my psychiatrist recently tentatively printed off and handed me a modulised work booklet on ‘Distress Intolerance’ I almost rolled it up and squatted him around the hand. Being the matyr that I am I instead took it home, adamant I could prove its uselessness, after reading the first page however, I realised I was on to a winner (don’t get excited yet, my relationship with the self-help booklet does not end well). Intolerance to distress was exactly what I was experiencing, it was the cause of most of, if not all, my mental health difficulties, and it is also a key component to Borderline PDs, in fact it was for this condition the booklet was written for. The symptoms of distress intolerance including feeling like being upset is unbearable; constantly focussing on feeling bad; feeling it is the worse thing possible; wanting to avoid feeling distressed at all costs; feeling ashamed for having the negative emotions; and having the need to immediately react to the emotions to stop them.
So being intolerant to negative emotions could be the link, but where does this come from? I moved onto the second module, it promised me there was good news ahead. I felt full of hope, until I tried the first activity. It focused on mindfulness, an ability which many will take for granted. Mindfulness, or mentalisation, is about being able to think about thinking, being able to examine your own thoughts and feelings and assess how useful and realistic they are; basically being able to step outside yourself and become an observer. Well this sounds like a challenge to a mind already overwhelmed with outside stimuli, and seems to be the very thing those with autism are impaired with (lack of Theory of Mind, supposedly). I sat for several minutes, completed all the relaxation exercises, tried to talk to my inner self and still nothing came. I drew a blank, and then suddenly something came to me, panic I could not feel anything and intolerant to the distress which was quickly mounting. Back to the start. It is no wonder that for individuals unable to mentalise that unstable relationships occur, sharp shifts in mood, and impulsive reactions and behaviours. It is also no wonder that abuse in early childhood could block a person from accessing their inner thoughts and picking up autistic like traits such as these, or why those with autism may be more vulnerable to such abuse, bullying and neglect and thus pick up borderline traits such as these.
So what to do? From an Aspie perspective all we can do is sit back, relax and watch it happen. That in itself will reach a certain level of mindfulness without us even knowing it. And the differences between Borderline and Asperger’s do not particularly matter either, the point is that both require similar support.