low high functioning bpd

Introduction:

Borderline personality and functioning. We can't speak about "the" borderline disorder but about borderline disorders. Each person is different

* Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, Grilo CM, Shea MT, Zanarini MC, Morey LC, Sanislow CA, Oldham JM. - Collaborative Longitudinal Personality Disorders Study
2OO2 Am J Psychiatry. - Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder.
Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder.
METHOD: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation--Baseline Version and the Social Adjustment Scale.
Results: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant personality disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology.
Conclusions: Personality disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive disorder alone.

* Hueston WJ, Mainous AG 3rd, Schilling R. - Dept of Family Medicine University of Wisconsin-Madison
1996 J Fam Pract. - Patients with personality disorders: functional status, health care utilization, and satisfaction with care.
BACKGROUND. Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk.
RESULTS. Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate...
Conclusion. Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.

* "What is the difference between "high functioning" and "low functioning" BPs? For instance, someone said cutting indicated low functioning.  What about job instability, raging, or promiscuity, for examples?

While those with BPD come in all 'shades', there are two extremes of the continuum, which are often designated 'low functioning' or 'high functioning'. Disclaimer:The management states: Please know that the following information is to be taken as general information only and not an indictment of any of the professions listed. ;-)

Indicators of low functioning BPD: cutting and other self mutilation, excessive risk taking, which may include numerous and near fatal traffic accidents, extreme addictions, and sex addiction, heavy duty involvement with psychiatric institutions and frequent hospitalization, successive non completed suicide attempts, inability to maintain employment, extreme instability in personal relationships, assaultive behaviour beginning pre-puberty or early adolescence and often early and prolonged involvement with criminal justice system and prisons. Most of the children seen in group homes and psychiatric institution with a history of the above, including cutting and self mutilation are female more often than male and may have a diagnosis of one of the personality disorders.
Raging appears to be a behaviour of all those with BPD, all across the continuum. The intensity may vary some, but it is a constant. It may be more problematic with low functioning, as they have less inhibition control and are more prone to rage in public and in front of many witnesses.

High functioning are the ones who "fool everyone" into thinking that they are 'Mr. or Ms. Wonderful', and reserve the extreme BPD behaviors for their partners or children. On the surface they appear to  function well in the majority of areas their lives. They are frequently psychiatrists, social workers, clinical therapists, or otherwise involved in the caring industry.  A second sub-set do very well in the military/prison system or customs where they are in control of those around them, in positions like: military officers, police officers, prison guards or customs officers.

These careers can and often do offer lots of rewards and reinforcement for black and white thinking, splitting, and an excessive need for power and control over others. The criminal or the speeder is the 'bad guy' and they (BPD) are therefore 'the good guy'. What they do is 'right', therefore they are 'good people'. These professions offer lots of positive reinforcement for BPD behaviors and patterns as well as places for excessive control over others to be tacitly or actively rewarded.

High functioning may rage only in front of their significant other. In fact many keep it so well hidden that Non's are not believed when they tell friends and family what is happening. Job instability may or may not be present in high functioning, but is usually found in low functioning. Those who are high functioning may choose professions where their behaviour will be rewarded or seen as 'normal' in the context of that profession. They mask their problems better, and are very good a moving from place to place in a 'logical' or 'justified' manner.

If the BP in your life fools everyone but you and maybe one or two others, they are usually high functioning. Those who are truly low functioning are obviously very disturbed and families get a lot more support from their communities than those who are high functioning..." (Deedee http://www.bpd411.com)

* "Types of BPD: High Functioning, Low Functioning
People with BPD vary a great deal in their functionality: that is, in their ability to live a normal lifestyle, work inside or outside the home, cope with everyday problems, interact with others, and so on.
Some people with BPD are so incapacitated by their illness that they are unable to work. They may spend a great deal of time in the hospital because of self-mutilation, severe eating disorders, substance abuse, or suicide attempts...
High-functioning borderlines act perfectly normal most of the time.  Successful, outgoing, and well-liked, they may show their other side only to people they know very well. Although these borderlines may feel the same way inside as their less-functional counterparts, they have covered it up very well-so well, in fact, that they may be strangers unto themselves...
Of course, there's a lot of room in between high-functioning (sometimes referred to as the "borderline" borderline) and low- functioning BPs." (www.bpdcentral.com)
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AAPEL - Back to BPD summary page
 

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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does

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