"The defining criteria of Borderline
Personality Disorder (BPD) is a pervasive pattern of instability of interpersonal
relationships, self-image, and affects, and marked impulsivity that begins by early
adulthood and is present in a variety of contexts, "as indicated by
five (or more) of the following:
 frantic efforts to avoid real or
imagined abandonment
a pattern
of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization
and devaluation
identity disturbance: markedly and
persistently unstable self-image or sense of
self; or sense of long-term goals; or career
choices, types of friends desired or
values preferred
impulsivity in at least two areas
that are potentially self-damaging: for example;
spending, sex, substance abuse,and binge
eating.
recurrent suicidal behavior,
gestures, or threats, or self-mutilating behavior
affective instability: marked
shifts from baseline mood to depression, irritability,
or anxiety, usually lasting a few hours
and only rarely more than a few days
chronic feelings of emptiness
inappropriate, intense anger or
difficulty controlling anger; frequent
displays of temper
transient, stress-related paranoid
ideation or severe dissociative symptoms.
It should be noted that many of the traits associated as being BPD traits are commonly
found in the general population as well.
The line is drawn between the average and the Borderline Personality Disorder person by
the number of characteristics listed above that effect them along with the severity or
intensity of that affect.
In Borderline Personality Disorder, like DID (MPD), there is a likelihood of a trauma
history: "Physical and sexual abuse, neglect, hostile conflict, and early parental
loss or separation are more common in the childhood histories of those with Borderline
Personality Disorder."'
How
Does Borderline Personality Disorder Manifest?
Borderline personality disorder (BPD) individual's almost always appear to be in a state
of crisis. Mood swings are common. These individuals can be argumentative at one moment
and depressed at the next and then complain of having no feeling at all, at another time.
There may be short-lived psychotic episodes rather than full-blown episodes or psychotic
breaks, and the psychotic symptoms of BPD are almost always circumscribed, fleeting, or in
doubt. The behavior of a BPD individuals is highly unpredictable which makes it difficult
for these individual's to achieve up to their potential in life. The repeated
self-destructive acts which are "acted out" by Borderlines reflects the very
painful nature of their lives. This self-destructive behavior often takes the form of
self-mutilation to either elicit help from others, to express anger, or to numb themselves
to overwhelming affect.(emotions)
Borderlines often feel both dependent and hostile which in most cases makes for tumultuous
interpersonal relationships. They can be very dependent on those to whom they are close
and they can express enormous anger at those close, around them in times of frustration.
Borderlines have a very low frustration tolerance level as well.
Most Borderlines have a very difficult time being alone. Most frantically will do almost
anything to avoid being alone.
Borderlines do not have a stable sense of identity and often inspite of many overwhelming
affects mention most often, depression.
Functionally, Borderlines are known to put people in either"all good, or all
bad" categories. This is known as splitting. The good person is idealized and the bad
person is devalued, there is no in between. It is the black and the white, there is no
gray area in the world of the unrecovered Borderline.
The depth to which most Borderlines feel their pain is for the most part not
understandable to non-borderline individuals. This deep intrapsychic pain is often the
pain of a traumatic childhood. Borderlines live in constant fear, terror of having to deal
with real or often imagined abandonment. Attachments and bonds are very difficult for
borderlines to develop because there are many control and trust issues with which they do
not cope well. They have a strong need to protect themselves from anymore pain which sees
most borderlines basically being incapable of dealing with their own vulnerabilities or
the vulnerabilities and emotions of others. Borderline individuals may not seem it to the
outside world around them but they are very sensitive people
in a great deal of pain. The very unfortunate reality of this personality disorder is that
when they need and what they need to the most Borderlines often are compelled by impulse
to push away, to sabotage in order to protect themselves from the agony increasing that is
ever present inside.
Borderlines, not unlike anyone often project, to a greater degree, grant it than the
average. It is this projection out onto others of all that is essentially reality inside
of the borderline themselves that leads them to often be so abusive to those around them.
Borderlines struggle very much with image of self and identity and in so doing often have
no clear definable understanding of where they end and the next person begins. This is a
boundary issue that has its roots most often in the way in which these individuals were
raised. The blurring of boundaries between self and other causes the borderline to act out
what is often their own self-hatred and disdain for self onto others. At times it seems as
though there is an "average collective reality" in the world and then there is
the reality of the Borderline Disordered individual. Disorder is the basis of this
lifestyle. It is a life that for any Borderline living it, is often entrenched in chaos
and marred by virtually inescapable feelings of helplessness and victimization.
Etiology
It is a common disorder with estimates running as high as 10-14% of the general
population. The frequency in
women is two to three times greater than men.
This may be related to genetic or hormonal
influences. An association between this disorder and severe cases of premenstrual tension
has been postulated.Women commonly suffer from depression more often than men. The
increased frequency of borderline disorders among women may also be a consequence of the
greater incidence of incestuous experiences during their childhood. This is believed to
occur ten times more often in women than in men, with estimates running to up to
one-fourth of all women.
This chronic or periodic victimization and sometimes
brutalization can later result in impaired relationships and mistrust of men and excessive
preoccupation with sexuality, sexual promiscuity, inhibitions, deep-seated depression and
a seriously damaged self-image. There may be an innate predisposition to this disorder in
some people. Because of this there may ensue subsequent failures in development in the
relationship between mother and infant particularly during the separation and
identity-forming phases of childhood.
Treatment
Treatment includes psychotherapy which allows the patient to talk about both present
difficulties and past experiences in the presence of an empathetic, accepting and
non-judgmental therapist. The therapy needs to be structured, consistent and regular, with
the patient encouraged to talk about his or her feelings rather than to
discharge them in his or her usual self-defeating ways. Sometimes medications such as
antidepressants, lithium carbonate, or antipsychotic medication are useful for certain
patients or during certain times in the treatment of individual patients. Treatment of any
alcohol or drug abuse problems is often mandatory if the therapy is to be able to
continue. Brief hospitalization may sometimes be necessary during acutely stressful
episodes or if suicide or other self-destructive behavior threatens to erupt.
Hospitalization may provide a a temporary removal from external stress.
Outpatient treatment is usually difficult and
long-term - sometimes over a number of years. The goals of treatment could include
increased self-awareness with greater impulse control and increased stability of
relationships. A positive result would be in one's increased tolerance of anxiety. Therapy
should help to alleviate psychotic or mood-disturbance symptoms and generally integrate
the whole personality. With this increased awareness and capacity for self-observation and
introspection, it is hoped the patient will be able to change the rigid patterns
tragically set earlier in life and prevent the pattern from repeating itself in the next
generational cycle.
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