A good friend who has been fighting the good fight recommended Joseph Nowinski’s book on MBPD: Hard to Love: Understanding and Overcoming Male Borderline Personality Disorder. It was published by Central Recovery Press in 2014. The book is written for two audiences: friends and family seeking to understand what it is to suffer MBPD and those with MBPD seeking to overcome it. Here’s the cover illustration:

Cover Illustration, Hard to Love by Nowinski

Hmmm, is that a picture of some brain process? I guess when you have a captive audience, cover illustration is not that important: people will read the book no matter what’s on the cover.

And the back blurb:

Renowned clinical psychologist Joseph Nowinski defines Male Borderline Personality Disorder, describes symptoms, and offers solutions that work. Borderline Personality Disorder (BPD) occurs commonly in both men and women, but is frequently misdiagnosed in men, resulting in either no treatment (or worse, jail time) or the wrong treatment. Dr. Nowinski lays out the origins of BPD in men and helps a man determine if BPD describes the problems in living he’s experienced, and if so, how to fix them. This book provides easy-to-implement solutions for BPD men and those who love them.

The following indicators are tell-tale signs of BPD: difficulty making relationships work, tendency to see things in black and white terms, starved for attention, emotionally instability, and drug/alcohol abuse. For some reason, the tell-tale signs of BPD reminded me of rock stars. According to Nowinski, BPD is the result of abandonment as a child. The way to overcome it is through building up psychological resilience: thinking thoughts along the lines of ‘my marriage is secure and my wife loves me’ instead of ‘I am not lovable or good enough for my wife’.

One of the reasons Nowinski wrote the book is to establish MBPD as a distinct disorder. Nowinski feels too often MBPD is misdiagnosed as depression or anxiety in men. This leads to the wrong treatment and the wrong medicines being prescribed. This was the hard part for me to understand: if the symptoms of BPD are difficulties staying in a relationship, a tendency to see things in black and white, being starved for attention, emotional instability, and drug/alcohol abuse, then how is it functionally different than depression? Here’s an easier example. Let’s say there are suitcases and backpacks. I say that suitcases are black, rectangular, have handles, and transport things. Then I say that backpacks are black, rectangular, have handles, and transport things. But then I say it’s critical not to confuse suitcases with backpacks. Would that be confusing?

Obviously backpacks aren’t suitcases. But to differentiate the two, distinctions must be made between the two: you can say, for example, that suitcases are hard and backpacks soft. I don’t feel that Nowinksi does this. He says MBPD is not depression but it’s not clear to me why they’re different. What the book needs is a chapter on the biological basis of MBPD. If not a chapter, at least a few paragraphs.

I understand the book is an introduction to MBPD. But even the short online blurb the National Institute of Mental Health reveals that there is a biological basis to MBPD:

Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness. Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative. People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder.

Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.

These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.

Nowinski argues that MBPD goes back to childhood abandonment. But then the National Institute of Mental Health suggests that the disorder is genetic and inherited:

Studies on twins with borderline personality disorder suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

So which is it–does it have a biological basis or is it from abandonment? If it has a biological basis, are drugs effective? If Nowinski argues that MBPD has environmental roots (this is my impression), he should at least mention the other viewpoints. After all, I think it must be safe for me to assume that Hard to Love and the National Institute of Mental Health are talking about the same disorder?

What Nowinski is good at is telling stories of the difficulties people with MBPD go through in their day to day lives. People with MBPD find it difficult in relationships to give the other person the benefit of the doubt: they automatically assume the worse about themselves and others. The book opened my eyes to how it would be difficult to live like this. So, to my friend and all the others out there suffering from MBPD, keep fighting the good fight!

Until next time, I’m Edwin Wong, and I’m Doing Melpomene’s Work.