DSM 5 Impairment 10 – Significant impairments in personality functioning: Intimacy: marked by mistrust, neediness.

What We Know

I found only one study that dealt directly with distrust. Bhar and others (2008) examined 184 BPD patients on the Personality Beliefs Questionnaire and identified three factors: dependency, distrust, and the belief that one should act pre-emptively to avoid threat. All three were significantly associated with depression. Dependency and distrust correlated significantly with hopelessness; however, distrust was the only factor significantly correlated to suicidal behavior.

On the topic of neediness (which I find to be quite separate from distrust), Levi and others (2007) looked at 29 hospitalized BPD patients and 27 other patients with depression using the Symptom Checklist-90-Revised Depression Scale (SCL-90-R-DS) and the Depressive Experiences Questionnaire (DEQ). They discovered that BPD patients scored higher than the other depression patients on anaclitic neediness and that neediness was significantly associated with interpersonal distress, self-destructive behaviors, and impulsivity. In addition, I found an abundance of other articles and blogs lamenting the insatiable neediness of their BPD life-partners, one of which defined her partner as a vampire that was sucking her life energy out of her mind, heart, and soul.  

So what does this mean in real life terms? First of all, we recognize the fact that both distrust and neediness are defining impairments of people with BPD and these impairments are related to distress, hopelessness, depression, and suicidal behavior. In other words, these are life-threatening characteristics that have to be addressed.  

Secondly, we acknowledge that distrust makes it very difficult for those of us with BPD to seek help. We mistrust health care providers; we don’t own that “we” have a problem; the problem is outside of us; everyone else is to blame. We particularly don’t trust psychologists and psychiatrists and only seek their  help when ultimatums are given by parents or spouses.We make excuses to avoid appointments, and If we are put on medication, we do not acknowledge the effects and constantly refuse or neglect to take it. These feelings of mistrust  often lead to anger and repression which makes it almost impossible for anyone to live with us and care for us. We seem bent on driving everyone away.

The other side of the coin is neediness. Neediness is almost as hard to live with as distrust. We want so much to feel loved that any disagreement on anything  seems to affect our sense of self-esteem and self-worth. We become moody and withdraw or sulk and demand that others meet our needs.  We may be quick to apologize even though we feel the other is to blame. We can’t seem to let go of these memories and revisit these disagreements over and over again in our minds. Eventually, we come to the conclusion that the parent or spouse does not love us and we withdraw further into ourselves leading to hopelessness and depression.

In conclusion, both distrust and neediness are calls for help. Even though distrust and anger are hard to live with, they are better characteristics than neediness. These people with BPD are still fighting it. It is the ones with excessive neediness that I am most concerned about. They are just one step away from hopelessness which is one step away form suicidal behavior. 

Sounds hopeless doesn’t it? Yes that’s exactly how we feel. We need help, professional help.

 

 

 

Bhar, Sunil S.; Brown, Gregory K.; amd Beck, Aaron t.. Dysfunctional Beliefs and Psychopathology in Borderline Personality disorder.Journal of Personality Disorders. April 2008.

 

Levy, Kennith N.; Edell, William S.;  and McGlashan, Thomas H..  Depressive Experiences in Inpatients with Borderline Personality Disorder. Psychiatric Quarterly. June 2007. Read More: https://guilfordjournals.com/doi/abs/10.1521/pedi.2008.22.2.165