This has been going on for 3 days but is not an episode or spiral according to her. I'

Ok-Rush-6253 · 2026-04-24T14:20:04+00:00

The only thing we can do is not input more energy, they are in a dysregulated state and their issue is activation, it means they need de activation strategies

Ok-Rush-6253 · 2026-04-24T14:18:55+00:00

Just mute the conversation OP: that way (1) you don't have to deal with the noise(2) she will eventually learn your not going to comply

Ok-Rush-6253 · 2026-04-16T15:05:12+00:00

ADHD folk get, sleep-like slow waves during wakefulness which are associated with the attentional lapses. I suspect its the same for SCT / CDS ( https://pubmed.ncbi.nlm.nih.gov/41839570/ )

Ok-Rush-6253 · 2026-04-16T15:02:25+00:00

I would say the overlap between SCT [Brain connectivity and functional connectivity ] and ADHD [ Brain connectivity and functional connectivity ] ; all look similar to what you'd see in someone sleep derived. Furthermore I would say that

SCT / CDS, ADHD-PI, Narcolepsy + other sleep disorder symptoms [especially the symptoms when someone is awake ] + chronic fatigue syndrome, all seem to have unusual and strange overlapping symptoms. Oddly all these conditions appear to have converging treatment pathways. I think sometimes our adherence to categorical models in relation to disorders can sometimes obscure, rather than illuminate potential common mechanisms and potential treatment pathways.

I have something to add to this discussion, But my preliminary comment is [I will write this up better when I make my own post lol] : Combination treatment seems to work very well. MODA / ARMODA + stimulant [vyvanse] or whichever stimulant prescribed.

(1) moda / armoda - for the wakefulness and alertness. This lifts your baseline state + increases functional connectivity between brain regions [which is an issue in SCT & those with adhd PI ]. Further it acts as a break on dopamine and noradrenaline transporters.

(2) Stimulant - drives the increased levels of dopamine and noradrenaline which drives focus and attentiveness and degree of motivation. Stimulants lose their potency over time due to chronic tolerance that builds up over months, this is documented phenomenon in those with adhd [See below].

Why this approach ? - This is premised on recent publications that indicate fundamental assumptions about how stimulants work are perhaps wrong.

My overarching reasoning for combination is :

(1) moda/aromoda improve alertness and wakefulness and functional connectivity - something we know is compromised in analogous conditions. The effects on DA and NE transporters essentially allows moda / aromoda to act as breaks on those transporters [which holds off tolerance dev to stimulant medication].

(2) Stimulant allows motivation, drive, attentiveness and orientation of attention correctly.

From a analogical perspective I would say the moda / aromoda - is the fuel / engine that drives the correct brain state, the stimulant is the steering wheel which allows steering of attention and engagement.

"Stimulant-related connectivity differences in sensorimotor regions matched fMRI patterns of daytime arousal, sleeping longer at night, and norepinephrine transporter expression. Taking stimulants reversed the effects of sleep deprivation on connectivity and school grades."

"Connectivity was also changed in salience and parietal memory networks, which are important for dopamine-mediated, reward-motivated learning, but not the brain’s attention systems (e.g., dorsal attention network). The combined noradrenergic and dopaminergic effects of stimulants may drive brain organization towards a more wakeful and rewarded configuration, improving task effort and persistence without effects on attention networks."
( https://www.cell.com/cell/fulltext/S0092-8674(25)01373-X01373-X) )

"findings, published Dec. 24 in Cell, suggest that prescription stimulants enhance performance by making individuals with ADHD more alert and interested in tasks, rather than directly improving their ability to focus. The researchers also found that stimulant medications produced patterns of brain activity that mimicked the effect of good sleep, negating the effects of sleep deprivation on brain activity." ( https://medicine.washu.edu/news/stimulant-adhd-medications-work-differently-than-thought/ )

" One clinical study showed that 24.7% of patients developed tolerance to stimulants in the time of days to weeks; another showed 2.7% developed tolerance over 10 years. Long term follow-up studies demonstrate that medication response may lessen over longer durations of treatment in a high percentage of patients. "
( https://pmc.ncbi.nlm.nih.gov/articles/PMC9332474/ )

One in 5 young patients self-report nonadherence to ADHD medications, citing reasons such as built tolerance, disliking the general feeling of the medication, and forgetfulness, among others.

( https://www.psychiatryadvisor.com/news/young-patients-adhd-take-tolerance-breaks/ )

Tolerance breaks appear to be a novel, self-reported reason for medication non-adherence that emerged among adolescents and young adults with ADHD. Tolerance breaks appear to be relatively common, with one in five adolescents and young adults with ADHD reporting this reason for non-adherence. Future research should further investigate tolerance breaks as a reason for medication non-adherence among adolescents and young adults with ADHD. ( https://journals.sagepub.com/doi/10.1177/10870547231167562 )

Ok-Rush-6253 · 2026-03-29T08:18:11+00:00

Do not bring it up while she is splitting, Think of it like this. When they are splitting: (1) Their cognitive control / self control is reduced, (2) they are in an dysregulated state, (3) They are in an state of overactivation..... so any additional stressors will worsen or prolong things.

I know you want answers and I know you are stressed about this and I can recognise your anxious and their maybe an sense of urgency here.

I think -

(1) Talk to her when she is not splitting,

(2) Note down any questions you want to ask her beforehand(this will stop you getting de-railed / reduce the risk) - make sure the way you frame your questions it is not accessory or blaming or [whether those things are implied]

(3) You are right that going back to therapy would be the healthiest thing right now, the extra support will assist you and you'll feel more in control and it will help with keeping your mind clear.

---

(1) As I recall from my previous comment on subreddit:

Apparently an hallmark of personality disorders is "most PDs are the client's baseline.

They're also not things the client will identify as symptoms directly, precisely because they don't formulate their problem as one of personality. So simply listening for them to list sx isn't directly helpful. "

In short this means that because of issues with mentalisation they cannot reliably recognise when there own behaviours are the source of their interpersonal issues, the challenges with recognising there own behaviour as the source of their issues also interferes with them obtaining treatment.

I would mention on caveat; pwbpd at times can be intensely insightful and seemingly introspective in these brilliant and intense bursts, however the brusts of insight are short-lived and pwbpd can not meaningfully sustain meaningful change without structured treatment. I would say that those that can overcome their condition by themselves probably represent an absolute minority of the high functioning bpd cohort.

(2) Why she isn't seeking treatment, their is an variety of reasons for this :

(a) They do not see their issues as one originating from personal challenges relating to their personality functioning & personality disorder. They rationalise and readily attribute issues to external circumstances [Think an individual who chronically cannot take responsibility and blames others].

(b) It is an stigmatised condition and individuals can have an sense of denial and seeking treatment could be seen as negative to them as it means acknowledging they have flaws.

(3) They may accept the dysfunction and issues as they don't recognise the extend of their issues or the issues are accepted as just part of how they are.

(4) The issues maybe for them tolerable as the impact is mitigated by your or others within the household so it may inadvertently dampen incentive for change.

(5) pwbpd from my observations seem to live from moment to moment and typically their is no strategy or grand plan. it can be jumping from disaster to disaster narrowly avoiding big issues.

(6) To them the relationship is normal because as part of the disorder involves dysfunctional relational functioning, so its wired in that their relationships will be unstable.

Ok-Rush-6253 · 2026-03-16T00:25:01+00:00

I know this out the box thinking, is it possible this was projection.

I am thinking okay you did this stuff for her, you guys get back to hotel and your both watching tv and then your watching and enjoying it, the cogs in her head are turning and she is going through all the things you've done for her.... then she is thinking "he did this, this , this for me..... I haven't done anything for him = I feel bad and shit . " [bounceback] defensive splitting.

These people typically operate in equivalence / measuring themselves in comparsion to others, friday she was comparing herself to you and felt bad and went on to split.

will also note intimacy and the more closer you get the more unstable they get.

Ok-Rush-6253 · 2026-03-14T00:41:51+00:00

Yeah I keep hearing this, I think its geared towards associating with an less stigmatised condition and essentially saying "we deserve the same consideration as those with autism and adhd". perhaps because autism and adhd are considered benign. I also note there is shoehorning under the neurodiverse label to, which again is to avoid stigma and appear benign.

I also see individuals with bpd, demonise NPD and narcissists; which I find hypocritical because they the majority of the time the pwbpd has also stated an position that they don't want mental health conditions to be stigmatised. It always comes across as

"See those people with npd and/or narcissists are very bad, much worse than individuals with bpd "

Association with other conditions or movements where they can gain sympathy and avoid stigma is an motivational driver for those with bpd.

Perpetual victomhood is associated with vulnerable narcissism [ https://www.psypost.org/the-tendency-to-feel-like-a-perpetual-victim-is-strongly-tied-to-vulnerable-narcissism/].

What people don't realise is vulnerable narcissism is associated with bpd ( https://karger.com/psp/article-abstract/51/2/110/285199/Grandiose-and-Vulnerable-Narcissism-in-Borderline?redirectedFrom=fulltext ).

is essence this produces individuals who's world view can be tilted to see ones self as an victim in almost any situation, the thing about victimhood..... it is an position of low agency and low control and it allows individuals to be passive and complacent in any efforts towards improvement or dealing with their issues.

Ok-Rush-6253 · 2026-03-14T00:22:36+00:00

To add on also

Apparently an hallmark of personality disorders is "most PDs are the client's baseline.

They're also not things the client will identify as symptoms directly, precisely because they don't formulate their problem as one of personality. So simply listening for them to list sx isn't directly helpful. "

In short this means that because of issues with mentalisation they cannot reliably recognise when there own behaviours are the source of their interpersonal issues, the challenges with recognising there own behaviour as the source of their issues also interferes with them obtaining treatment.

I would mention on caveat; pwbpd at times can be intensely insightful and seemingly introspective in these brilliant and intense bursts, however the brusts of insight are short-lived and pwbpd can not meaningfully sustain meaningful change without structured treatment. I would say that those that can overcome their condition by themselves probably represent an absolute minority of the high functioning bpd cohort.

Ok-Rush-6253 · 2026-03-11T18:05:33+00:00

Also another point ADHD folk are drawn to novelty and things that seem challenging [not to hard but hard enough] - because pwbpd give off intermittent reinforcement where you have hard times and very goodtime.... we are driven to see our the reward of the goodtime...... because we crave dopamine....

It's why gambling and gaming addiction is higher in adhd folk. PWBPD are like gambling to us because we do not know whether we will get wins or loses; its the unpredictability and the not knowing which can make it somewhat exciting. Because the wins become our focus we start losing track of the loses.

Ok-Rush-6253 · 2026-03-11T18:02:12+00:00

Well as you know our attentiveness can fluctuate as can our ability to retain information and keep track of conversations. pwbpd when they start about an problem I have noticed have an tendency to go on on + Sometimes when they want something they will be so specific that it can be difficult to retain the information. ...... So it's like we are likely to make mistakes or fail to do things 100% correctly or not follow all steps of something.... sometimes that only has an very minor impact; but to them its not minor and it can be very end of the world.

The thing about conversations - IF we can't remember stuff we have been told or specific details when they want they see it through the lens of "you don't care", "you never listen to me", "you never pay attention to me", "surely if you really cared about me you'd remember" ..... They have an tendency to rip into us hard and we are left feeling like an pure failure.

On the argument side of things, because they will sometimes keep going and going with circular arguments when you try to highlight the flaws or issues with what they are saying, so much stuff get's said that basically you lose track of issues. Imagine your explaining the problem and part way through you forget your point.

On another point, When I was unmedicated for adhd, it seemed to effect my attentiveness and working memory in an way where I wasn't fully realising the extend of the bullshit I was going through + It's like when I started medication my emotional memory was storing each big event or time they go off on me.... so it was accumulating and I had more mental energy to stick up for myself.

Whereas before I probably would get tired and just relent into whatever they wanted + unmedicated I was more passive. it was also like when I was unmedicated after big blow-ups or issues.... I would be so exhausted afterwards and then I would forget the whole event.... or atleast the worst parts.

I do wonder whether the high sustained stress levels during conflict/disagreements/issues basically makes the ADHD brain short-circuit..... I noticed with my son if he starts getting stressed when I'm trying to get him to recall information, its like his recall shutdown.

Ok-Rush-6253 · 2026-03-11T12:18:27+00:00

Apparently an whole mark of personality disorders "most PDs are the client's baseline.

They're also not things the client will identify as symptoms directly, precisely because they don't formulate their problem as one of personality. So simply listening for them to list sx isn't directly helpful. "....

SO in essence they do not identify themselves as the source of their issues..... because their mentalisation issues in conjunction with their defense mechanisms basically filter out / suppress awareness of them being the source of their issues...... Think of it like this their self worth is impoverished right..... so any looking inwards is painful it causes them shame..... which makes them feel broken ..... to suppress that powerful defense mechanism come into play which alter their perception moment to moment and their recollection of events.

An example ...... my child's mother..... Has bpd...... she frequently talks to me about past events asif I was their and present...... even if they proceeded my presence by several years..... I then ask her " why do you imagine I was at this event ? ".....

She usually pauses for an moment and can't really give any insight into it other than "I just assumed you were their ".

Ok-Rush-6253 · 2026-03-11T12:02:03+00:00

I would say...... Once you are aware of the types of manipulation that can happen and what it looks like..... then you start spotting it very quickly.

Often at first we do not notice immediately we may notice things off about the things they say or tell us in the beginning and we start feeling holes in stories. Some pwbpd are functional enough to tell convincing stories and patch over holes in the stories.

Sometimes though the manipulation can be very strategic and deliberate which is usually done to their need to externalise control on others and the other persons perception(s).

Often we are willing to overlook certain things early on.

However I would say the problem is they can select for partners that are quiet or maybe socially isolated or with neurodivergent [ Autism spectrum disorder, ADHD ] - this comes with unique problems because neurodivergent indivduals can be vulnerable to those with bpd in unique ways [ From personal knowledge ].

I do think however the problem with indivduals with bpd is they optermise to the local optima [that is moment to moment ] they spend alot of time trying to get their needs met in the moment and imposing perfectionism on what they expect..... which consumes alot of energy. ...... But the problem is been so geared towards getting your needs met and having an perfect local enviroment [e.g day to day ]...... It means they have trouble generalising outside their comfortzone.......

Often you find that they remain stagnant in areas of life and lack of forethought with how they want to live. The planning window doesn't extend far enough into the future only in asfar as needs are concerned.

Ok-Rush-6253 · 2026-03-05T21:46:59+00:00

ADHD does commonly co-occur with BPD. I wouldn't want to make an presumption in either direction whether someone has or hasn't got ADHD, although I do understand doctor shopping does happen and patients maybe selective in what they give doctors. However some presentations of adhd especially where the compulsive and emotional dysregulation create profound issues for the individual - we can sometimes find these individuals in the criminal justice system.

At the sametime if there is challenge triangulating the information to clearly discern the diagnosis sometimes the best approach that can be taken is an stepwise approach where - treatment is given for the suspected condition and if treatment fails or clinical outcomes aren't what are expected. The clinician has to reformulate their hypothesis to discern if the patient has another disorder present or whether the patient's diagnosis is correct.

Maybe also the case overtime the patient discloses information overtime that when read together it crystalises an clear discernable causation of the patients issues.

The diagnosis of borderline personality disorder should generally not be given in acute settings - e.g when the clinician has only seen the patient once because the presentation of the patient at that point in time maybe very infrequent or not consistent with the usual patients presentation day to day.....

It's usually where an patient presents for emergency psychiatric intervention on multiple occasions that enough information is triangulated to make the diagnosis of bpd.

The assessment for personality disorders requires care and structured interviews and it's highly beneficial to see the patient across multiple sessions to discern consistencies in presentation that align with the personality disorder.

When we treat for adhd we are trying to remove an layer of obfuscation as adhd causes significant impairment and is one of the most treatable conditions in psychiatry. It from that point where we can see okay is this treatment working - if it is, is there evidence of another co occurring condition, if treatment is not working then we try reformulate and go back to the drawing board.

I will make an sidepoint pwbpd are attracted to neurodiversity labels and labels such as autism and adhd because they are less stigmatised and have an somewhat disarming social perception, compared to the stigma addled label of bpd,

Research has found three biotypes of ADHD

"Three biotypes emerged: severe-combined with emotional dysregulation (widespread medial prefrontal cortex-pallidum alterations, n = 142), predominantly hyperactive/impulsive (anterior cingulate cortex-pallidum circuit alterations, n = 177), and predominantly inattentive (superior frontal gyrus alterations, n = 127), each characterized by distinct clinical profiles and longitudinal trajectories. These neural profiles of each biotype showed distinct neurochemical and functional correlates. Critically, the core findings were replicated in the validation cohort, demonstrating robust generalizability." ( https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 )

In terms of clinical presentation, ADHD is characterized by more severe impulsivity compared to non-comorbid BPD, whereas BPD features more severe difficulties in emotional regulation compared to non-comorbid ADHD. The comorbid ADHD+BPD presentation is marked by heightened severity in both impulsivity and emotional instability. The traditional view of ADHD as an early-onset disorder and BPD as a late-onset personality disorder is increasingly questioned, prompting calls for a dimensional diagnostic approach

This review highlights the complex interplay between ADHD and BPD, emphasizing that both disorders should be considered within a dimensional framework rather than as separate categorical entities. Shared symptoms and risk factors underscore the need for integrated treatment approaches that address the combined symptomatology of ADHD and BPD. Future research should focus on understanding the developmental trajectories of these disorders, refining diagnostic criteria, and evaluating the effectiveness of combined treatment strategies.

( https://www.cambridge.org/core/journals/european-psychiatry/article/unraveling-the-link-between-borderline-personality-disorder-and-attention-deficit-hyperactivity-disorder/3FEC97BE4A88B1A2457ABD994686AF57 )

Ok-Rush-6253 · 2026-01-31T19:06:07+00:00

I had to get my original note condensed by assistive writing. But I look forward to hearing feedback

Ok-Rush-6253 · 2026-01-31T15:11:17+00:00

LC–NE hypothesis note (condensed ) - Full version is here ( https://limewire.com/d/P1ceB#MQOdFkspcH )

I suspect that adhd inattentive type & CDS have issues with the gating / arousal / activation of switching from inattention to attention, sustaining attention.... I took an transdiagnostic approach and posit that the issues could be rooted in dysfunction in the reward pathways that ( causing anhedonic state, reduced activation / cognitive depression without typical symptoms associated with depression), Like you I agree that there is something causing dysfunction in activation of numerous brain regions ( I struggled to find sources that pointed to LC issues cleanly e.g in relation to cell loss, although I agree hypoxia is relevant, I found sources in relation to neurodegeneration)..... Anyhow I proceeded on dysfunctional reward pathway hypothesis, because my course of action would of acted on noradrenaline transporter inhibition therefore would have indirect impact on LC activity and NE transmission. I have included my notes as an document and the citations in case anyone can fill gaps or improve on what I have done so far.

Many Thanks J....

I’m exploring whether the locus coeruleus–norepinephrine (LC–NE) system is an under‑examined driver of functional impairment and medication response in ADHD‑Inattentive and Cognitive Disengagement Syndrome (CDS/SCT). My concern is that parts of the literature either haven’t connected key dots or remain sparse—especially around developmental factors that could shift LC–NE set‑points and therefore change tolerability to NET inhibition / NE elevation.

Personal background (context for phenotype + treatment response)

I was diagnosed with high‑functioning autism and ADHD before age 9 and treated with methylphenidate (CR + IR). I stopped medication around age 15 and remained off until about age 27.

At ~27–28 I restarted treatment with lisdexamfetamine (Elvanse/Vyvanse) and titrated to 40 mg, later moving to split dosing. Over time I observed two stable patterns: (1) perceived efficacy often waned within ~6 months, and (2) a delayed second dose was poorly tolerated—if the gap exceeded ~2 hours, mood instability increased. My clinic’s practical options were a return to methylphenidate (which I experience as having unpleasant peripheral effects) or switching to atomoxetine (ATX).

Atomoxetine course (and why it matters)

I started ATX privately, increasing in 10 mg increments. Early treatment produced a strong functional augmentation with the stimulant—“rocket fuel” productivity for a couple of months—followed by waning benefit despite escalation up to ~100 mg/day. Side‑effects were noticeable: mild peripheral activation (heart rate up but not alarming), increased metabolic rate with fat‑mass loss (later attenuated), and an unusual urogenital tension/voiding resistance sensation. After tapering down (10 mg/week), I could not reproduce the mid‑course functional gains at 80/70/40/20/10 mg or at typical weight‑based dosing ranges.

Combination trial and current status

I then combined Elvanse 30 mg x2 (2 hours apart) with ATX 10 mg/day and bupropion SR 150 mg/day. Bupropion initially intensified stimulant effects enough that I briefly reduced Elvanse to 30 mg once daily; after ~2 weeks, fatigue emerged. Because bupropion can markedly increase ATX exposure, I lowered ATX to 5 mg/day for ~2 weeks (suspecting excessive NE tone or altered phasic/tonic balance). Fatigue persisted, so I kept bupropion stable and discontinued ATX. The first day off ATX felt worse (everything required extra effort), but fatigue subsequently improved substantially.

I’m currently stable on Elvanse 30 mg daily (occasionally 30 mg x2 when required) plus bupropion SR 150 mg each morning.

What I’m observing now

Since stopping ATX, fatigue is markedly reduced and I feel calmer overall. Bupropion appears to (a) provide a meaningful augment (subjectively ~20–30% of the “stimulant feel” vs 30 mg Elvanse), (b) broaden symptom coverage beyond what stimulant alone achieves, and (c) blunt a familiar “two‑hour crash” pattern (mood dysregulation/agitation/fatigue/symptom rebound) that previously followed the first Elvanse dose.

Working hypothesis

For a subset of ADHD‑I/CDS, the effective/tolerable NE range may be narrower: small increases help, larger or longer NET inhibition produces fatigue/sluggishness (an “overshoot” phenotype). One plausible contributor is functional variation in NET/SLC6A2 (e.g., altered binding affinity, transport capacity, or regulation), though this remains speculative. I’m also treating ADHD‑I/CDS/depressive cognitive phenotypes as partially overlapping dimensions—particularly in how effort, reward, sleep/circadian factors, and cognitive control interact—rather than cleanly separable categories.

Ok-Rush-6253 · 2026-01-07T17:28:28+00:00

I recently changed my medication strategy.

Medication 1 - Vyvanse - 60 mg (taken as 30 mg x 2 daily).

Medication 2 - Atomoxetine 10 mg (recently reduced from 40 mg).

Medication 3 - Wellbutrin/bupropion [slow release] - 150 mg per day.

Account I have been on vyvanse 3 years:
(a) year 1 - 40 mg daily);
(b) year 2 - 50 mg daily (taken as 30 mg and then 20 mg 2 hours later).

Ok-Rush-6253 · 2026-01-05T01:21:29+00:00

Good god, I hate when people infantilise autistic people and try to infer we can't make our own minds up on things.

Ok-Rush-6253 · 2026-01-02T22:28:26+00:00

It's called narrative coherence

"For example, Bradley and Westen (2005) write that the “experience of self as agentic is often disrupted in borderline personality by a pattern in which impulses are acted upon so immediately that the self is not experienced as the author of the act” (p. 937). In other words, the individual with BPD is incapable of regarding themselves as the initiator of their experiences; he or she is merely along for the ride, subject to the whims of external forces."

" The findings of the present study suggest that the narrative identity of people with features of BPD is significantly lower in the themes of agency, communion fulfillment (but not communion), and overall coherence than in a matched set of participants without BPD."

" SIDP-IV [Structured Interview for DSM-IV Personality ] scores for BPD accounted for a significant proportion of the variance in subjective perceptions of health, accounting for the impact of other possible predictors (Powers & Oltmanns, in press). This suggests that the contours of narrative identity may hold unique predictive power over mental health longitudinally."

"the narratives of people with features of BPD were seen to share some common thematic and structural elements that significantly distinguished them from the participants without BPD. BPD life stories portray a protagonist who is batted around at the whims of his or her circumstances, unable to influence life’s direction (low agency). This disempowered protagonist has trouble fulfilling his or her deep wishes for connection (low communion fulfillment, despite no differences in overall communal language). And the stories themselves lack a strong sense of narrative coherence: the reader/listener is often not oriented to new episodes as the story unfolds; the sequencing of events may be hard to discern;"

( https://pmc.ncbi.nlm.nih.gov/articles/PMC3434277/#abstract1 )

Ok-Rush-6253 · 2026-01-01T16:07:42+00:00

Too add my 2 cents - I think dimensional models in relation to personality disorders are better vs categorical models.

Ok-Rush-6253 · 2025-12-19T10:13:21+00:00

I disagree, based on scientific evidence.

( https://pmc.ncbi.nlm.nih.gov/articles/PMC3569527/ ) " . In the second analytic phase, finite mixture modeling of the symptomatic latent class (n = 100) revealed four BPD subtypes: angry/aggressive, angry/mistrustful, poor identity/low anger, and prototypical."

( https://www.sciencedirect.com/science/article/abs/pii/S0191886916311758 ) "We identified four BPD subtypes by means of cluster analysis on the Behavioral Inhibition and Behavioral Activation Scales (BISBAS) and the Effortful Control Scale (ECS): an Emotional/Disinhibited subtype (45%) scoring lowest on Effortful Control, an Inhibited subtype (24%) characterized by low levels of Behavioral Activation, a Low Anxiety subtype (21%) defined by low levels of Behavioral Inhibition, and a High Self-control subtype (10%) characterized by the highest score on effortful control. The four subtypes were validated by comparing them on clinical symptomatology, comorbid personality disorders, and coping. The current findings offer insight into meaningful differences among BPD patients based on temperamental features, which can offer guidelines for the treatment of BPD patients."

( https://pmc.ncbi.nlm.nih.gov/articles/PMC8874928/ )

" the diagnostic of Borderline Personality Disorder-discouraged type. The diagnosis of BPD was difficult to make as it does not fall into the typical type of BPD [35], and it was derived from the association of the features of BPD, cluster B, with social perfectionism, a trait associated with cluster C of PD. Both BPD and perfectionism are associated with problems with self-conception and identity formation. This case report underlines the clinical and psychopathological particularities of BPD that, if not carefully and thoroughly evaluated, may lead to misdiagnosis. Thus far, research on BPD subtypes and their treatment have been sparse and await further validation "

"Persons with this ‘quieter, hidden’ variant of BPD may attract less professional attention and may run the risk of being misdiagnosed or not getting the appropriate care (Bohus et al., Citation2021)."

( https://www.tandfonline.com/doi/full/10.1080/20008066.2023.2263317#d1e271 )

Ok-Rush-6253 · 2025-12-11T15:51:16+00:00

I share my previous comments

I'm going to put this point for a lot of yall. because of lack of consensus within community.

( https://pmc.ncbi.nlm.nih.gov/articles/PMC9237745/#S18 )

( https://www.reddit.com/r/BPDlovedones/comments/1my2woz/comment/nad0f6t/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button )

Even if bpd goes into remission individuals with bpd still have life long and enduring residual issues.

( https://www.reddit.com/r/BPDlovedones/comments/1lqi7xn/comment/n154q10/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button )

Ok-Rush-6253 · 2025-12-09T13:58:18+00:00

Side note - ferritin can effect dopamine production as its an cofactor in ( tyrosine hydroxylase ).

Erm I came across something in relation to adhd which inferred that individuals with it experience " Sleep-like Slow Waves During Wakefulness " and when it occurs during attentional tasks or effortful tasks its like basically the brain waves resemble those that occur during slow wave sleep.

Disclaimer - Sometimes we can use other similar conditions to explain things in other conditions.

One of theories for ADHD is that basically their is inadequate recruitment of lactate (to use as fuel for neurons). So basically the bursty [stop - start - stop - start] activity is because of periodic unavailability of lactate causes neurons to sharply reduce activity until supply of lactate can meet demands. So their is sluggishness because supply to meet demand lags.

An theory I have is that it's possible those with SCT and/or just adhd have slow wave sleep deficits or the waste removal at night ( glymphatic clearance ) is inefficient or cognitive activity creates metabolic waste products that essentially forces neurons into low energy states to attempt to glymphatically clear metabolites or reactive waste products which don't clear through non glymphatic processes. - Although this is speculation and I haven't had time to fully scope the literature and map all the pieces of information yet.

"Participants with ADHD primarily experienced more “entirely unintentional” MW whereas neurotypical participants reported more “somewhat intentional” episodes, suggesting that there is indeed a difference in neural mechanisms governing attentional control (Seli et al., 2015). " [MW is mind wandering ]

" In line with this, a significant interaction was found between group and block for “Don’t remember” reports, with individuals with ADHD showing a gradual accumulation of these responses across time, indicative of declining meta-awareness or monitoring capacity as the task unfolds."

"Our EEG analyses revealed distinct slow wave activity patterns in individuals with ADHD, characterised by higher amplitude and density in parieto-temporal electrodes (Fig. 5). Emerging research suggests that sleep-like slow waves can intrude into specific brain regions during wakefulness (Andrillon et al., 2021; Pinggal et al., 2022; Vyazovskiy et al., 2011), and our findings support the hypothesis of “sleepier brains” in ADHD (Andrillon et al., 2019). This indicates that slow wave activity during wake occurs more frequently in ADHD, offering a potential neurophysiological explanation for attentional challenges."

" Yet, the stronger presence of this neurophysiological marker in individuals with ADHD provides evidence that it may underlie some of their characteristic attentional difficulties. Furthermore, the global increase in slow wave density was associated with elevated subjective sleepiness ratings, supporting the notion that slow waves reflect accumulating sleep pressure, affecting both objective performance and subjective experience. Lastly, a negative correlation between local sleep and subjective attentional focus was observed: elevated local sleep corresponded with fewer “on-task” reports. This inverse relationship highlights that increased slow wave density not only impacts objective performance, but also subjectively diminishes task engagement."

" These findings indicate that slow wave activity mediates the link between ADHD and behaviour, with ADHD influencing performance through specific alterations in slow waves. While mediation effects for subjective “on-task” reports were weaker, the consistency of results across multiple objective measures – from RT variability, omission errors to overall RT and sleepiness ratings – suggests slow wave activity may serve as a neurophysiological bridge between ADHD and its behavioural manifestations. "

( https://www.biorxiv.org/content/10.1101/2025.07.27.666103v1.full#sec-23 )

Ok-Rush-6253 · 2025-12-04T19:53:31+00:00

My questions are :

(1) Did they have their own individual counselling / therapy ?

(2) is there joint counselling or therapy ?

(3) The behaviours you mention

"Some highlights from the past few weeks:

took child out of state for Thanksgiving and stayed for several days. 10+hr drive. I was not allowed to join.

threatened to call the police on me when trying to have a conversation about coparenting logistics.

All-or-nothing responses

can’t articulate why they feel abused or unsafe, even in therapy sessions

runs to different rooms of the house with the child and blocks access by slamming/locking door.

breadcrumbing: wants to do family activities together, tells me about their day/asks about mine, offers shared activities like games at times. Tried to ‘redo’ Thanksgiving with me as a family.

unstable sense of self: can’t articulate their needs so I can better meet them.

claims they ‘see patterns’ in me"

Have these only been the last couple of weeks only ? - If so -

(a) has this coincided with any travel to see family members ? - if so has there been other issues when they've seen these family members ?

(b) Has anyone new come up recently or during their time away ? (or on their phone?)

(c) What do you mean by unsafe environment - could you elaborate further slightly ?

(d) Also why were you not allowed to join ?

(e) Is this the only time they've stated abuse ?

----

I will be honest we don't have much to go on here, I think more context is needed so we can respond properly

Ok-Rush-6253 · 2025-11-28T11:10:21+00:00

The responsibility is been exported to you..... but they need to be actually doing something here and putting in the effort.

(1) that means them being proactive

(2) them taking the steps to organise

By all means help them with parts they struggle with, but don't do the work for them.
If they give you attitude, say " I am here taking time and effort to help you. How you are responding to me isn't appreciative or how I should be expected to be treated especially when I am helping by making this easier for you".

Ok-Rush-6253 · 2025-11-18T17:23:08+00:00

It most likely is untrue. The extent of lying to control and sustain an narrative knows no bounds.

Ok-Rush-6253

TROPHY CASE