BPD and AsPD comorbidity

I've seen the issue of BPD/AsPD comorbidity discussed in the board before, and it is a topic that has interested me greatly, because I was diagnosed with BPD/AsPD myself, twice. It interests me because I don't fit the traditional model of a borderline nor an antisocial, in the sense that I am not a "pure" borderline or antisocial, but rather a mix of symptoms. I do meet the minimum requirements for full diagnosis of both, and I will discuss that, and I don't mind talking about it.

I realized that in a way I was in denial of my AsPD diagnosis for a long time, I think in large part due to the social stigma as one member pointed out, but the night before last it finally became clear to me, and I have accepted it.

It interests me also because at face value, they appear to be polar opposites of each other, and don't seem compatible to me at all. Even though one of the psychiatrists that diagnosed me assured me that they are highly comorbid, and that antisocials can suffer from anxiety, fear and depression. But it wasn't until I looked at my big picture, do I see that it does fit, and fits me quite well.

So if anyone is interested in how they can be comorbid, I will show you how BPD and Aspd present in my case. First I will start with the DSM IV criteria.

I fully meet 6 of the 9 criteria for BPD (5 are required). Namely,

- fear of abandonment, and frantic efforts to avoid it.
- idealization and devaluation. history of unstable relationships.
- identity disturbance. huge problems with lack of identity and sense of self.
- chronic feelings of emptiness.
- intense anger, anger problems.
- stress related paranoia and severe dissociation.

I fully meet 5 of the 7 criteria for Aspd (3 are required), which includes conduct disorder as a child.

- long criminal history. disregard for social norms, especially with regards to the law.
- decietfullness. I'm also highly manipulative and exploitative.
- impulsivity and failure to plan ahead.
- consistent irresponsibility (work, financial or other obligations).
- lack of remorse. Also note I have a lack of empathy. I completely lack empathy and remorse.

So on one hand, I fear abandonment, I have extreme black and white thinking and split, major problems with identity and looking to others for my sense of self, have chronic feelings of emptiness, anger problems, and paranoia and dissociation. I am an attention seeker.

But on the other hand, I have a complete lack of empathy and remorse, I'm impulsive, decietful, have a long criminal history and have no trouble breaking the law or using/hurting others. I have a history of being abusive, and a history of being violent. I abused animals off and on for 30 years, have been abusive and violent toward people. Have a history of manipulating for pleasure, stealing, etc. I enjoy cruelty, abuse and manipulation especially. I have no feelings for others at all, except for disdain and hatred.

Yet, I am extremely sensitive to criticism, ridicule and rejection. I am vulnerable to feelings of shame and humiliation, anxiety and fear. I believe it is due to the trauma I suffered in middle school. I was severely bullied all throughout middle school, and have PTSD as a result.
It was at a time in my life that I was also being abused and neglected at home. I desperately needed validation and attention, and I turned that need toward others, and instead was bullied severely.

As a result, I'm very sensitive to criticism and resulting feelings of humiliation, and they usually send me into rages. Full rages. Incredibly intense, uncontrollable anger.

I believe that looking to others for my sense of self also made me vulnerable to it. After middle school I became a chameleon. Because I needed to find my sense of self in others, and needed validation, I have been a big attention seeker my whole life.

At 5 years old I started abusing animals. I was abusive to my mother as well. I tried to kill a neighbor kid when I was 8 or 9. I vandalized a lot as a kid, and I have done a lot of sh*t throughout my life. I have only felt true guilt twice in my life, both times when I was a kid. I have never felt remorse or empathy.

Emotionally, I am not labile. I am extremely flat and have a very flat affect. The only emotions I feel are ego-centric emotions (self-directed, about me), otherwise I feel nothing. Even then, besides anger and depression, my emotions are short-lived and shallow.

When I get depressed, I feel worthless, and in the past I had a history of self-harming and suicidal thoughts when I got depressed. It was very recently that I discovered that I get depressed because I feel invisible and unnoticed, because I don't get attention, and it makes me feel worthless. Because I've needed to find my sense of self in others. Without it, I feel like I have no existence.

So in all, it is a mixture of symptoms, but I finally realized that it does fit when you take in the big picture together. My big picture is complex, and there are many different things at play, but that is how borderline and antisocial present in my case.

Maybe someone may find this interesting, but it is possible to have BPD and Aspd. There is a lot of overlap with the Cluster B's.

I have the same diagnosis and then some which will remain unmentioned as this is not the place for them.
This paragraph you wrote I can definitely relate to as it describes me to a tee. I also have the inability to love and few people as objects here for the sole reason to fulfill my needs . I meet every list of symptoms of the Hare psychopathy test. I can not form relationships with others and I talk to very few people because they fill a need for me. I too have hurt others and enjoed it with no remorse or guilt about any of my life's actions.

"But on the other hand, I have a complete lack of empathy and remorse, I'm impulsive, decietful, have a long criminal history and have no trouble breaking the law or using/hurting others. I have a history of being abusive, and a history of being violent. I abused animals off and on for 30 years, have been abusive and violent toward people. Have a history of manipulating for pleasure, stealing, etc. I enjoy cruelty, abuse and manipulation especially. I have no feelings for others at all, except for disdain and hatred."

As far as my BPD I use to cut frequently deeply every time and do all other types of self-mutilation. I have spent 9yrs of my adult life locked up in the looney bin for BPD and the ramifications that go with it. Had three suicide attempts where I died all three time all in 2010. However during all this BPD behavior I was using drugs as I did for 31yrs. The drugs and alcohol clouded my mind and make me view myself differently than I normally would have. I realize that now as I am clean and my mind is crystal. I know longer have any thoughts at all of self-harm including suicide. I like myself today and feel comfortable in my own skin. Drugs & hospitals are a thing of the past for me.

I see 2 soon to be 3 therapists every week for tools I need to better my life. Gain control over my mind as I was always controlled by something my entire life. I still have trouble with boundaries & manipulation of others to get what I want. I am done with drama and attention seeking behavior cultivated by my drug use. As fear as fear of abandonment goes I do not have any fears, in fact there is nothing that alarms me or causes concern whatsoever. I have never shown fear of anything since I was a child. I will say this that once I feel comfortable with a person (say a therapist) They become like a habit I get used to them and I like them. If they do something to piss me off that directly stops them from fulfilling my needs I will cut them off without a second thought.

I have written a novel here and I'm not even sure I helped you better understand how the two are related but I did share my experience with them and that I can relate to what you posted.
If you wish to talk further about this I'll see what I can dig up that is not on the table. You know how to contact me.

blank identity and Wuernos,

This is an interesting topic. May I ask, do you have some desire to change the way that you are and to relate better to other people, or do you only discuss ASPD (and BPD) out of theoretical interest? Therapists often talk about how antisocial people are not motivated to change. That's not meant critically - rather, hopefully you can change if you want to. Btw, it does seem doubtful that antisocials are never motivated to change.

Also, can you watch sad movies and feel sadness when there are tragic scenes in them? This was always something that helped me relate and feel human.

My view on these diagnoses is a bit controversial so I'll say up front that it's not meant to offend anyone. But, I don't believe they can be strictly separated using the criteria in the DSM. Rather, to me all the symptoms are valid/real, but the division into medical categories/strict diagnostic areas is not. It is meaningful to say someone is "borderline" or "antisocial" because these descriptions have a lot of consensual meaning based on groups of symptoms. As human beings we often tend to categorize things and to see order and clear divisions where none exist. But the world is much more complex, random, strange, and unpredictable than we often want to consider.

The British Psychoanalytical Society now has the position that these conditions (BPD and ASPD) are actually not distinct diagnoses, but rather are "spectrums" of gradually increasing pathological behavior which relate to different types of historical trauma. In their model, there is no moment or dividing line based on observable symptoms beyond which one suddenly becomes "BPD" or "ASPD." Rather, one simply becomes more borderline or antisocial or more healthy/non-pathological. They accept that it does have some utility to label someone in everyday language as borderline and/or antisocial if they have a lot of the traits. But, they use those words subjectively, as terms describing a generalized range of (pathological) functioning, not as medical diagnoses.

In any case, it would certainly make sense, under these models, for someone to have a mix of "borderline" and "antisocial" traits, without even bringing the notion of a formal diagnosis into the picture.

There was one writer on ASPD who you might be interested in - Donald Rinsley. In his old books from the 1980s, he wrote about how he had tried to treat criminals. His basic viewpoint was that they had very strong acting out defenses, and constant use of denial/splitting/projection to remain unaware of their feelings. He wrote, "To the degree that an antisocial individual also exhibits borderline traits, a positive response to therapeutic intervention can be expected." I thought this was quite insightful. In his object-relations terms, he meant that the positive/libidinal object relations units of the borderline coexisted alongside the antisocial structures (meaning areas of the mind where there were little to no receptors for positive relationships), and that in as much as these regions existed, they could be reached and mobilized by the therapist. So he thought that borderline/antisocial combinations could actually be successfully treated. But he thought they usually had to be confined to a hospital or prison (bad place anyway) in order to control their acting out, so this made treatment difficult. But all of this doesn't mean that if you have some motivation to change, that you can't do it.

I just wanted to let you know I enjoyed reading your take on BPD AsP. I use diagnosis to describe my issues out of merely habit having spent so much time locked up in hospitals. I agree they are restrictive and can be misleading.

You must be British are you? You don't have to answer if you don't want to. I just noticed you were familiar with their documentation on the subject matter.

I think anyone has the capacity to change if motivated. I presently am for certain reasons taking my therapy seriously as never before. I see 2 therapists weekly one via Skype. I have an assessment lined up to get a 3rd because I need all the tools I can gather from them to change the things I want.

Again thanks for posting!!

@Wuernos, I am the same way. I care nothing for others and don't have the ability to love as well. The only thing I care about is having my needs met.

@bpdtransformation, I have accepted myself and I have no desire to change. I am quite happy with myself as I am. I have no problems with it.
I do not believe that PD's can be cured, only managed. I am close to 40, my personality is set, and my inner core cannot be changed, nor do I desire for it to be. I am fully self-aware now, and that is all that matters to me.

Wuernos,
I am a dual British and American citizen. But that is not why I like British writers - that is kind of coincidental; it is only because a lot of development of psychoanalytic theory went on in England in the 20th century. British psychoanalytic writers like R.D.W. Fairbairn and D.W. Winnicott put together a lot of the basic psychodynamic theories on which ideas of personality disorders were based, writing in the mid 20th century (40s/50s/60s). Then nativized American psychodynamic theorists like Otto Kernberg and Gerald Adler continued their work on personality disorders here in the US, in the later 20th century. There must be a lot of work on these diagnostic/theory issues done in other languages as well, but I'm obviously not familiar with those.

Blank Identity,
I must absolutely disagree with your view that personality disorders can only be managed but not cured. I am living proof that that is wrong, and so are many other former borderlines who write blogs about recovering fully from the disorder. However, none of us can stop you from believing that if you choose to. It may be more comforting for you to believe that, and if you are happy with the way you are, then that is good.

I'm not just a borderline, but you're right, I am happy with the way I am, and that's all that matters.