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Afterthought: I wonder if there is also Borderline BPD? The lacking a consistent and integrated sense of identity thing is not something I have experienced, and the 'splitting' only at a low level. I suppose it makes sense that anything with diagnostic criteria will have some people at the margins.

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If only these terms were as clear in everyone's head as they are in this article. And then replaced altogether.

I will look up Elinor Greenberg's writing.

From what you say, borderline psychopaths would be fascinating to hear more from, with that complex and individually varied interplay between the emotional and the psycopathic traits. People who straddle two worlds- cultural, psychological, neurotypes, gender, all areas really- can have a great insights and a lot to say.

I would add two comments to the BPD treatment list. Medication can be of help not just for the comorbid conditions. There's the familiar story of people quickly going off their antidepressants because they hate that their feelings are dampened just too much. Well, some of those old fashioned heavy meds will do that. And while you might not want to take them for a lifetime, the partial numbness can for quite a while be a blessed relief for someone with BPD. Brain and body healing can occur, the patient can get a hopeful glimpse of an undreamt of possible existence with less pain, and then in time, all the practical steps can be taken to improve things. Also, it is a boon if a patient is lucky enough to have or find an important relationship with a safe person who will not compound the patients emotional deregulation with their actions and responses, but is prepared to work with them.

I had not considered the sexism angle for BPD diagnosis. I made me think of an opposite example, the atypical borderline who acts inwards more than outwards, where meltdowns do occur but much of the time the patient seems composed. (And half the time the meltdowns occur because of the cumulative strain of maintaining this composure while in turmoil!) For many women, who have been trained since childhood to be nice, accommodating, a good sport, and to behave a certain way to men/perform femininity, I believe that could result in a misdiagnosis of simple depression. The therapist may misjudged the severity of the problem if they haven't enough wild material to go on.

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