Book Review: Complex Borderline Personality Disorder

Book cover: Complex Borderline Personality Disorder by Daniel J. Fox

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.

You can find my other reviews on the MH@H book review index or on Goodreads.

You can visit the post What Is… Borderline Personality Disorder for all things BPD on MH@H.

29 thoughts on “Book Review: Complex Borderline Personality Disorder”

  1. I’ve never heard the term “socio-economic dysfunction” when it comes to diagnoses, but I like it. I great review: I’m very interested in personality disorders. I’m connected to several people who struggle. 💖

  2. I found your comment really interesting. Someone in my life believes they have a personality disorder. They have been diagnosed with ADHD, anxiety and previously depression. They almost have many ASD traits. A medical professional has told the someone in my life that there’s an overlap of symptoms there. It’s interesting to hear that from someone else.

    1. To me, the doing anything about it piece is key. If a diagnosis can give a lightbulb over the head moment of understanding or point the way towards effective treatment, then that’s great. Otherwise, it’s just another label.

  3. “…inability to adjust your thoughts and behaviors based upon the environment you’re in” – good way to sum up the crux of it, and goes well with his newly devised concepts. I kinda like core content vs surface structure content, because there can be a discord between the two for various reasons.

    Sounds like an interesting read. Fab review as always, Ashley.xx

  4. Such an interesting subject. I have a friend who received a diagnosis for BDP but did not agree/accept it. I think so much of that was the frightening and negative information she read about BDP.

  5. Wow! Interesting… I may have to get this…
    Thank you Ashley…

    Sorry, you’ll never guess what I did….again… the other day…I removed my like 5 followers I think I had, and then put my blog to private 🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️

  6. I will have to get this book since both my daughters have been diagnosed and I’m pretty certain my mother-in-law had BPD as well.

    My daughter Arabella has every single symptom of BPD and there is no questioning she has BPD. But she also has other symptoms not related to BPD. She has seen many therapists, psychiatrists, nurses and has been hospitalized inpatient, outpatient, and residential. What I find the most frustrating is that every psychiatrist/nurse/therapist gives her a different diagnosis (besides BPD). She has been diagnosed with major depression, bipolar 2, schizoaffective, schizoid PD, PTSD, ADHD, GAD, substance abuse. Her childhood was relatively normal. Honestly, I don’t even know where to begin or what to believe anymore.

    How can she get the help she needs if no one can agree what the problem is? Maybe this book could shed some light on this issue and give me (and perhaps her) greater insight.

  7. This sounds both interesting and helpful. Understanding what is occurring is one of the major components in healing. I also appreciate the differentiation between core feelings and and surface manifestation of symptoms. Reaching the core issue, as it is understood, truly aids in lasting change. Another book I will add to my list. Thank you Ashely.

    I hope you are having a good start to your Sunday morning.

  8. Great review. It is all very confusing. I’m diagnosed as having a Personality Disorders including emotionally unstable personality disorder which I believe is the same as Borderline Personality Disorder and Adjustment Disorder. I recently realised I am probably suffering from Imposter Syndrome too as I hide different aspects of myself although this is undiagnosed. My blog is my mental health therapy, so is my fictional work. I literally started laying out my life online so I can get a grip on it. Thank you for your insightful review of this book, which I may try.

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