Complex Borderline Personality Disorder by Daniel J. Fox is aimed at people who have borderline personality disorder along with a co-occurring mental disorder. It describes how these combinations can present and how to manage them.
The co-occurring conditions that it addresses are bipolar disorder, depression, psychosis, ADHD, and PTSD/complex PTSD. The author refers to BPD in combination with any of these other disorders as complex BPD, or CBPD. For each combination, there’s a chapter that focuses on symptoms followed by a chapter that focuses on management of the conditions. There’s an emphasis on gaining awareness of and insight into your symptoms, and the book guides readers through teasing apart what symptoms related to what. There are exercises throughout the book, and the author encourages readers to start a journal to make notes and do the exercises in.
The author describes personality disorders this way: “Personality disorders are best defined as the inability to adjust your thoughts and behaviors based upon the environment you’re in.” He explains that CBPD is very common among people with BPD, but without a systematic approach to assessment, the chances of missing a co-occurring disorder are over 50%.
The book differentiates between surface structure content and core content. Core content “makes up the internal part of yourself that represents how you think and feel about yourself, others, and your world,” while “Surface structure content are the behaviors or symptoms that rise to the surface as a result of the core content.” The author explains that medications can help to manage surface content but not core content.
The author used wording I hadn’t heard before when describing diagnostic criteria, “socioeconomic dysfunction,” to refer to the criteria in the DSM-5 related to impairments in social and occupational functioning. Maybe it’s just that I haven’t come across that usage, but in my head, socioeconomic means something different.
The section on depression talked about differentiating major depressive episodes from what the author referred to as BPD depressive episodes, which are short and intense, with an identifiable trigger. The interplay between these was described in terms of the relationship between core content and surface content.
The section about psychosis wasn’t diagnosis-specific, and it included quasi-psychotic symptoms (which sounds like what I’ve heard referred to as micropsychosis in the context of BPD), dissociation, and dissociative identity disorder (DID). The case study that was given involved an individual who developed a brief psychotic disorder in response to significant stress rather than someone with a chronic psychotic disorder. To me, this section was the weakest, as I found it vague and a bit too much of a hodgepodge.
The chapter explaining PTSD and complex PTSD (C-PTSD), on the other hand, I thought was quite well done. It involved case studies of a war vet with PTSD, someone who had C-PTSD related to childhood abuse, and someone with combined C-PTSD and BPD. I thought the author did a good job of distinguishing the different features and identifying what overlapped and what didn’t.
Overall, I found this book quite interesting. I liked the emphasis on building insight and teasing apart symptoms. Probably most readers aren’t going to have all of the CBPD combinations that the book covers, but I think most readers with BPD will find at least some bits that are more broadly relevant throughout the whole book. This is the first book I’ve come across that deals with BPD and co-occurring conditions, and it’s an important subject area to address.
The author also brings his own conceptualizations to this book; the term complex BPD is his own, and from what I can gather from Google, he’s also come up with the distinction of core content and surface structure content. This offers readers a perspective that’s different from what they’ve read in other books, and I think that’s a good thing. I also think readers will find the book quite validating, and they’ll come away from it with a greater understanding of their condition.
Complex Borderline Personality Disorder is available on Amazon (affiliate link).
I received a reviewer copy from the publisher through Netgalley.