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In terms of personality, BPD patients have four common characteristics:

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 1. Their emotions are very sensitive: that is, they may be the same thing, and other people will not experience emotions, but BPD patients will easily experience emotions. It’s fair to say that their emotional threshold is very low.

2. Their emotions are very strong: the same example, when two people are sad because of something, BPD patients are much sadder. In other words, once they experience emotion, the intensity of the emotion is very high.

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3. Their emotions last a long time: when two people experience strong emotions at the same time because of something, it may take an hour for people without BPD to calm down, but BPD patients may still experience strong emotions a few hours later or even the next day. 

4. They experience emotions that are prone to impulsive behaviour: emotions generally make us want to do certain behaviours, such as wanting to lose our temper when angry, wanting to cry when we’re sad, wanting to run away when they’re anxious, and the average person can stay sane and not act on emotions, but BPD patients will be very likely to make impulsive choices and behaviours according to emotions, and so on.

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In terms of personal experience and social environment, BPD patients generally have the following experiences:

1. A variety of obvious traumatic experiences: including years of abuse (including physical, sexual, emotional, and linguistic abuse), and kindness

Abuse, sudden traumatic events (including suicide, criminal cases, natural disasters, car accidents, etc.), school bullying, parents

2. Not significant, but long-standing traumatic experiences: including parents not expressing emotions, parents suppressing their children’s emotional expressions, parents having high expectations, parents’ very subjective lack of understanding of their children and imposing their will on their children, excessive parental denial of their children, prolonged abuse in school, long-term discrimination against mental health problems, even trauma suffered during psychological treatment, etc.

3. In general, BPD itself is already very emotional but put them in a family, school, and social environment where emotions are not valued, ignored, suppressed, and even biased against emotions, critical, school, social environment, BPD patients and the surrounding environment are out of place. It’s like BPD itself is a rose, you tend to think of it as a dandelion to raise the same, the result is not good, mainly because the external environment and personality traits do not match.

In terms of illness, the core of BPD’s patients is the loss of control:

1. Emotional loss of control: A small thing can trigger particularly strong emotions that can last for a long time and feel out of control when strong negative emotions appear. These emotions are strongly felt in cognition, speech, behaviour, and even the body’s senses. Many times, BPD’s emotions and realities do not match, or the intensity and reality of emotions do not match.

2. Behavioural dysregulation: Once strong emotions appear and we have no way to manage them, we tend to follow them and then engage in impulsive, irrational, responsive behaviours, including suicide, self-harm, drug use, alcoholism, aggressive behaviour, dieting, and so on.

3. Cognitive disaggregation: Once emotions get out of control, we can easily get into cognitive loss, which means that our cognition and reality can be very different, and even if others correct us, we can’t see what’s wrong with us. This includes delusional, non-black-and-white thinking, delusional conclusions, extreme distrust of others, and even the symptoms of dissociation experienced in extremely negative situations, such as feeling that the things around you no longer feel real, that they feel like they are living in a dream, and that they are “soul-like”.

4. Relationships out of control: Because emotions, awareness, behaviour out of control, these out of control will certainly affect our relationships, resulting in our relationship’s ups and downs. For a while thinking the other side is the best person, their own with others for a lifetime, a whole feels that the other side is the worst person, hate to leave others immediately. Or extreme fear that others will abandon themselves, either over-seeking comfort from the other side, begging others not to leave themselves, or directly severing ties to protect themselves.

5. Identity out of control: Because so much of the above out of control, when we are in the emotion, behaviour, cognition, interpersonal relationships every day out of control, when the ups and downs, we can not help but lose their self-identity, completely do not know what they want, what kind of people, want to become what kind of people, what kind of values. We may constantly change ourselves to cater to others, and as a result, we have no idea who we are. Many times, BPD patients will say that they experience a strong sense of emptiness from within the body, usually in the chest or abdomen, which can be unbearable and want to commit suicide and self-harm. In the face of so much out-of-control, BPD patients’ lives, schools, and jobs will be seriously affected, so that they live in crisis every day, and social function will be significantly reduced. Asked by a friend about the relationship between FRD and post-traumatic stress disorder PTSD, here’s a brief answer:

1. First, trauma under the definition of PTSD is a serious trauma and must be an event that can cause serious harm to an individual’s physical safety, such as violent attacks, sexual assault, ill-treatment, car accidents, witnessing a suicide, etc., and some OFD trauma experiences may not reach this level.

2. According to clinical studies, about 60% of BPD patients are diagnosed with PTSD at the same time, which I feel is quite true, at least I have seen a lot of BPD patients clinically have PTSD. 3. However, if we associate BPD with PTSD too much (I feel that there is such a bias in society, even professionals tend to think so), it can have a negative impact. Because it’s true that many BPD patients haven’t experienced severe trauma, and that parents may be emotionally negative for their children, but these parents may be very protective of their children (but unfortunately they don’t experience emotions, don’t express emotions, don’t manage emotions), so these BPD patients feel that they have no reason to experience BPD’s condition, they are too sensitive, too much. BPD is associated with severe trauma, but not causation.

4. BPD and PTSD are still very different from the medical condition, BPD is mainly out of control (dysregulation), PTSD is mainly reflected in three aspects: re-experience trauma experience (re-experience), physiological over-awakening (arousal), and avoidance behaviour (avoidance).

5. In terms of treatment, according to the model of dialectical behavioural therapy (DBT), BPD should be treated first, followed by PTSD. Personally, including in hospitals, I provide DBT treatment first and then Cognitive Processing Therapy cognitive processing for PTSD

1. Bidirectionality is intermittent, and of course, mania and depression may occur, but the vast majority of bipolar patients do not go both ways every day, and BPD’s symptoms are relatively stable, i.e. BPD symptoms occur basically every day, without a period of depression, and then a period of mania imagination. Or, BPD and two-way are big ups and downs, but BPD’s big ups and downs are within a day, or even within a few hours, but two-way ups and downs usually last for several days, and not every day to see big ups and downs, many two-way patients months or even years only once (manic symptoms).

2. Bidirectional symptoms (at the onset of the disease) and BPD symptoms are completely different, mania will be exuberant, do not need to rest sleep, feel particularly good about themselves, overconfidence, make various high-risk behaviours, speak too fast, temper abnormally grumpy, and even appear psychotic symptoms, these symptoms and BPD is very different, and once the doctor can feel the difference between the two, the former is a very physiological condition, the patient can not control the latter. Cognitive disorders, the patient has a sub-control. It can be said that the two-way big ups and downs are generally much bigger than the BPD’s big ups and downs.

3. At the therapeutic level, the two-way response to the drug is good, but BPD is gone. Many BPD patients also take mood stabilizers, but the effect is generally not particularly good, or need psychological treatment.

4. In general, bidirectionality occurs occasionally, and BPD is the norm. To sum up, BPD’s main performance is out of control, the core of which is the emotional loss of control. If in doubt, seek medical attention and professional help.

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