Borderline Personality Disorder and Fixed Delusions vs. Psychosis

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Reader’s Question

My mother has been formally diagnosed with Borderline Personality Disorder. One of her traits is that she rewrites history to fit her own view of things, even to the point of denying something she’s said only a few moments earlier. For example, she denies ever raging at my sister and me and hitting us with a belt (she would often explode into a violent rage-tantrum at us when we were kids/teens), she claims that our dad beat her (our dad was a non-violent, non-confrontational and even-tempered person), and she also claims that her own father was easily triggered into rage and would beat her, but my mother’s sisters do not corroborate this claim and my sister and I never saw our grandfather lose his temper or hit anybody.

She shifts blame and projects her own feelings, thoughts and motives onto me (and my Sister.) My whole life she has accused me of saying things that I didn’t say, or meaning something that I did not mean at all.

If I didn’t have my sister to corroborate my experiences and memories of emotional and physical abuse, I believe I would think that I was going insane, myself. I thank God that sister and I can be each other’s reality-check.

My mother has basically created a fantasy world to live in based on her selective memories, in which she is perfect and everyone else is crazy, mean, violent, and telling lies about her.

Isn’t this being psychotic? Engaging in projecting, paranoid thinking, black-and-white thinking and selective memory are not what I’d call being connected to reality at all. I guess I don’t understand the difference between having “fixed delusions” and having “psychosis”.

Can you explain the difference, if there is one?

Thanks,
Annie

Psychologist’s Reply

Annie, it’s terrible to see you suffering this way and I join you in being thankful to your sister for the reality check. You mother sounds to be both suffering borderline personality and delusional. I say delusional because her distortions of reality are non-bizarre for the most part. Does she have psychotic symptoms? Absolutely. When you hear ‘borderline personality’, have you wondered what it is borderline to? One’s personality borders on psychosis and can decompensate under certain conditions. One may appear normal for all intents and purposes, and then suddenly succumb to the idealizations, reversals, and violence that you’ve described.

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In the end, it really doesn’t matter if we call it delusional or psychotic, because the treatment is the same. The ‘newer’ antipsychotic medication is the first line of treatment. Medications such as Risperidone have been effective in containing the delusions and damping down the agitated behavior. The medications are available in slow-release injections as well (although they are expensive). Injections are often preferred if your mother will not take daily doses of a medication.

I’m concerned about the child abuse you’ve suffered. It is critically important that your mother does not have current access to children whom she may harm in one of her episodes. After all, if her delusion is contained and harms no one else, then that is sad for her but for no one else (any more). However, if she assaults someone, then that is another matter. Then, an individual’s civil rights must be compromised by the need for community safety; her freedom would need to be restricted. I encourage you to talk to your family and discuss the treatment options available (if you haven’t already). Then, decide together how to approach her to enlist her cooperation with a treatment plan (which will certainly include a psychiatrist heading the treatment team). If she is amenable to treatment, then you’re off to a very good start. If she is not AND if you feel she may be a danger to others, then the conversation needs to change. In the US, there is a legal process called Conservatorship, and similar processes exist in other countries. Through such a process, an adult is legally declared to be a dependent adult with the rights of a minor, an underaged person. Under such conditions, her guardian, usually a professional appointed by the Court, is responsible for her treatment and safety.

Although this legal process sounds scary and a throw back to the old ‘snake pit’ mentality, it is not. The status of an individual is reviewed annually. If the individual is no longer dangerous or disabled, then the conservatorship is rescinded. Even while conserved, the treatment is guided by the need to place her in the least-restrictive environment. If that means she can function normally, at home, under the condition that she take her meds and attend therapy, then all the better.

Take care of yourself, Annie. You are the one we should be talking about. I hope you and your sister can get the help to heal.

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