anankastia

Anon: I read in the DSM that people with PPD can have comorbid BPD. What does that look like? Are there any recourses or comparisons of symptoms? No rush!

Let’s start with similarities/comparisons.

I’ve complained repeatedly on Twitter about how the DSM PD criteria and descriptions usually discuss effect, not cause, and in a shallow/surface-level manner which doesn’t cut to the core of the issue. The overlap stated here is that both BPD and PPD can cause angry reactions to minor stimuli. However, it says nothing about why.

The intense anger in BPD is linked to their overall emotional dysregulation. It is often also triggered by rejection, as a coping mechanism/attempted replacement for the pain of abandonment, perceived abandonment, or abandonment anxiety. The anxiety can be triggered by minor events, because of their emotional impermanence, because they need to overcompensate for their feelings of emptiness, and because childhood trauma has taught them to be hypervigilant about potential abandonment.

With PPD, individuals might feel angry at people they suspect to be harming them/planning to harm them for, well, wanting to harm them. Minor events can trigger them to believe that harm/intent of harm is occurring, thus the passage above.

A tendency towards a reasoning bias that jumps to conclusions has been a consistent and robustly replicated finding of empirical research in paranoia [87] [88]. This work must be interpreted in light of the severe thought disorder encountered in psychotic populations. Research in samples with non-psychotic, PPD individuals has confirmed that the same reasoning bias applies in PPD [89]. Similarly, in community samples on non-psychotic, non-patients, “jumping to conclusions” is predictive of paranoia [90].

A similar mechanism works in individuals with BPD—except with BPD, the result is an expectation of abandonment or paranoia about being abandoned, not paranoia about being plotted/conspired against/harmed.

Further similarities:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Replicating the association of PPD with childhood trauma, PPD is associated with higher levels of emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse relative to normal control subjects, as measured by the Childhood Trauma Questionnaire (CTQ) [123] (Table 4). There were no significant differences between PPD+BPD, PPD-only, and BPD groups for any of the CTQ subscale scores. The results confirm previous reports of strong relationships between PPD and childhood trauma. Interestingly, PPD, unlike BPD, was not correlated with the CTQ Lie scale, a measure of positive response bias. This would suggest that retrospective reports of childhood trauma by PPD individuals are not contaminated by response bias.

A subset of subjects completed a multi-dimensional questionnaire assessment of cognitive and emotional empathy, the Interpersonal Reactivity Index (IRI; [124]) (Table 6). So, for reasons of statistical power, two separate ANOVAs were computed to control PPD and BPD to normal controls. PPD and BPD shared a pattern of diminished cognitive empathy (decreased Perspective Taking), and some aspects of enhanced emotional empathy (increased Personal Distress). These data replicate previous work finding decreased cognitive empathy and intact or increased emotional empathy in BPD [125], and suggest that PPD shares a similar profile with respect to empathy. To our knowledge, this is the first characterization of social cognition in PPD.

Let’s look over the general criteria.

PPD:

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

4. Reads hidden demeaning or threatening meanings into benign remarks or events.

5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).

6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

These are all basically examples of effects of the core reasoning bias in PPD, which leads to an irrationally disproportionate high level of suspicion of others. These would make for an immensely distressing personal experience, as having no one you believe you can trust makes you feel unsafe and constantly on edge. Not fun.

Some articles about IRL people with PPD (note: they are from the POVs of outsiders, not sufferers themselves, so expect some bias and NTs-making-our-issues-about-themselves):

https://www.families.com/paranoid-personality-disorder-peters-story

https://www.brightquest.com/blog/living-with-paranoid-personality-disorder-how-our-family-survived/

https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2016.110103

https://sci-hub.se/10.1002/jclp.23201

I hunted around for posts by people with PPD about their experience. It was difficult sifting through all the ones about “dealing with a loved one with PPD,” but I eventually stumbled across these:

https://www.youtube.com/watch?v=mROYI1Mckz0

A video I made to help you understand the nightmare of living PPD and how unhappy it makes me.

https://themighty.com/2018/12/paranoid-personality-disorder/

We peeled back the first layer and exposed a deep rooted paranoia. I first noticed the symptoms, which truthfully were always there, when my wife said, “Why do you always assume the worst of me?” and, “Stop jumping to conclusions.” It suddenly hit me: I had heard her say that consistently since I really gained traction with my recovery. So, to Google I went, searching through various sites, focusing on the ones I knew were trustworthy. Through my digging, I stumbled upon paranoid personality disorder, or PPD.

There are also the Tumblr tags if you want to hear more of pwPPDs’ experiences.

BPD, on the other hand:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

https://bpdrotten.tumblr.com/post/158394113961/

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

https://www.verywellmind.com/borderline-personality-disorder-identity-issues-425488

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Relationships between PPD and impulsivity and aggression are depicted in Table 5. Overall, both BPD and PPD are characterized by higher levels of impulsivity and aggression than normal controls. However, BPD is more impulsive and more self-injurious than PPD, the latter finding mirroring the higher rate of suicide attempt in BPD. However, PPD is significantly more aggressive than BPD. Effects of comorbidity are also seen. PPD comorbidity with BPD increases aggression relative to BPD alone. BPD comorbidity with PPD increases impulsivity and self-aggression. These results highlight the importance of recognizing PPD when it is comorbid with other more widely acknowledged personality disorders.

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Although both PPD and BPD have a higher rate of suicide attempt and self-injurious behavior relative to normal controls, BPD has a significantly higher rate of suicide and self-injurious behavior than PPD. Interestingly, the comorbid PPD+BPD group has a higher rate of suicide attempt and self-injurious behavior than the PPD only group but the comorbid PPD+BPD group did not have a higher rate of suicide attempt and self-injurious behavior than the BPD group. This suggests that having comorbid PPD does not increase the risk of suicide or self-injury in individuals with BPD, while having comorbid BPD does increase the risk of suicide in individuals with PPD. This is the first data that we are aware of addressing the risk of suicide and self-injury in PPD.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

https://anezkadragon.tumblr.com/post/666229678322892800/

https://shitborderlinesdo.tumblr.com/post/130694849984/

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

https://shitborderlinesdo.tumblr.com/post/157393553684/is-paranoia-part-of-bpd

BPD can cause paranoia/paranoid ideation during times of stress (typically linked to a psychotic episode). If you are paranoid outside of times of stress, strongly and consistently, it it likely it is being caused by something else.

I’ll note that it depends on the type of paranoia, though. Paranoia that people will leave you, or are going behind your back, are all paranoid thoughts commonly caused by BPD.

dissociation masterpost

An individual with comorbid PPD and BPD would experience traits from both disorders: constant suspicion that people esp. those close to them are planning to harm them based on little to no logical evidence; constantly assuming that people have malicious or otherwise negative intent when interacting with them; holding grudges; struggles with trusting others; constantly fearing their loved ones will turn against them or abandon them; frequent behaviors to avert predicted harm or abandonment; as well as emotional dysregulation (especially anger), feelings of emptiness, suicidality, strong self-destructive impulses, splitting, and an unstable sense of self-identity.

https://paranoidpdsuggestion.tumblr.com/post/665989953592950784/

Other symptoms you might relate to:

- being a bit humorless and unable to take certain jokes and possibly becoming hostile/angry if you feel someone is insulting or belittling you in some way
- belief that others are out to get you in some way, such as by being harmed or deceived
- the perception of innocent remarks or nonthreatening situations as personal attacks
- having delusions and possibly experiencing psychotic episodes - extremely stubborn nature
- difficulty apologizing

BPD - it has paranoia as a symptom (stress related paranoia), intrusive thoughts, jealousy, and grudge holding (usually caused by splitting)

And, as with all PDs, there is also a possibility or having one or a few people around whom symptoms are uniquely more or less severe: with BPD, the term “favorite person” is used to indicate an individual around whom the abandonment anxiety is much more severe, much smaller indications of potential abandonment/rejection are exaggerated far more, there is an extreme need for constant positive interaction, and the splitting is much more black-and-white and frequent. Whereas with PPD there is often a “trusted person” around whom the paranoia is much reduced. I imagine there are possibly the opposites present for each disorder too (i.e. someone around whom a pwBPD would feel less abandonment anxiety around; someone whom a pwPPD would feel even more paranoid about, etc.) (So far I’ve only seen both sides discussed when it comes to NPD: FPs whose criticism is much harder to cope with vs. FPs whose criticism is much easier to cope with, etc. I wrote a long comment about it on Instagram, I’ll share it here later if you want.)

Experiences of people with comorbid PPD and BPD:

https://paranoidpdsuggestion.tumblr.com/search/bpd