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ForwardIt’s Not “Just Borderline”: Does Unstable Affect Signal Dissociative Disorder?
Abstract
Volatile affect, alternating idealizing and devaluing states, non-suicidal self-injury – does branding this symptom cluster “borderline” help clarify the underlying dynamics - or just feed decades of stigma? Such disturbing symptoms are often caused by chronic relational trauma and insecure or disorganized attachment. These, in turn, may lead to a dissociative spectrum disorder, presenting with frequent shifts between preoccupied and dismissive attachment strategies. Being faced with intense, fluctuating affect may arouse clinicians’ own emotions in response. Bombardment with clients’ emotional swings and misinterpretation of their significance may fuel a vicious cycle. To defend against their own out-of-control feelings, therapists may fall back on outdated conceptions of borderline personality disorder (BPD) as “manipulative” or “untreatable,”.
A recent review documents widespread stigma associated with the diagnosis of BPD, ranging from questions about the legitimacy of the diagnosis to assumptions of untreatability, with sufferers not being believed, branded as manipulative, or even denied treatment. Much of the stigma seems to result from clinicians not understanding the origins of BPD in chronic trauma and insecure attachment, and lacking adequate training in treating this disorder.
The DSM 5 definition of BPD, itself, contributes to the confusion. A variety of combinations of five of nine very complex criteria, describing relational disturbances, affect dysregulation, impulse control, substance abuse, and self-harm symptoms may define very different individuals. In contrast, the criteria for the dissociative disorders (DD), simply specify dissociative symptoms, despite the high prevalence of affect, impulse and self-harm symptoms associated with DDs. While the trauma and stressor-related disorders have been updated since DSM III, the BPD criteria remain virtually unchanged, adding only a vague mention of “transient, stress-related paranoid ideation or severe dissociative symptoms.”.
Potential to Distress: No
Target Audience
Beginning/Introductory
Learning Objectives
Upon Completion of this webinar, participants will be able to:
- Compare and contrast characteristic diagnostic criteria for BPD, OSDD and DID
- Describe the non-specific and ambiguous characteristics of the DSM 5 definition of BPD
- List the range of dissociative symptoms prevalent in BPD
- Explain how dissociated self-states may develop from opposing attachment styles
- Identify how to recognize the defensive purposes of self-state shifts in BPD and DID
Presenter: Ruth A. Blizard, PhD
Presenter Bio: Ruth A. Blizard, PhD, is a psychologist practicing in the Binghamton, NY, area with over 40 years of experience in treating persons with severe trauma, dissociation, and personality disorders. She received her BA in psychology from the University of Colorado, Boulder, and her PhD in clinical psychology from Alliant University, Fresno, CA. She has presented internationally and published articles and chapters including, “Therapeutic alliance with abuser alters in DID: The paradox of attachment to the abuser,” “The role of double-binds, reality testing and chronic relational trauma in the genesis and treatment of borderline personality disorder,” “Masochistic and sadistic ego states: Dissociative solutions to the dilemma of attachment to an abusive caretaker,” “Disorganized attachment, development of dissociated self-states, and a relational approach to treatment,” “Double binds, dissociation and attachment to the perpetrator in families and oppressive groups,” “Lost-in-the-Mall: False Memory or False Defense?” (with Morgan Shaw) and “Chronic relational trauma disorder: A new diagnostic scheme for borderline personality and the spectrum of dissociative disorders,” (with Elizabeth Howell). She has taught the official ISSTD course, “Diagnosis and Treatment of Dissociative Disorders.” She is on the editorial board of the Journal of Trauma and Dissociation, and is past editor of the ISSTD News and Division 56 of the APA, Trauma Psychology News. She is currently on the ISSTD Scientific Committee, and has served on the Executive Board, Program and Membership Committees. She enjoys folk music, hiking, social activism and most of all, being a grandmother.
Available Credit
- 1.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Price
"Your Price" above reflects your final price based on your membership status and career level.
- ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation.
- ISSTD defines an emerging professional as mental health professionals who have completed an advanced degree and are in the first three years of their career (or first three years after graduation for researchers).
- If you do not fall into one of the above categories please register as Professional/Retired.
These prices are for Tier I countries. For a list of countries by Tier click here. If you are located in a country that falls into Tier II-VI please contact ISSTD at [email protected] to receive the appropriate discount code.