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Borderline Personality Disorder (BPD) Print E-mail

Dr. Kennedy Borderline personality disorder is characterized by pervasive instability in self-image, moods, interpersonal relationships, and behavior. This instability disrupts family and work life, long-term planning, and the individual's sense of self-identity. While originally considered at the "borderline" of psychosis, people with borderline personality disorder (BPD) suffer from disorder of emotional regulation. While less well known than bipolar disorder (manic-depressive illness) or schizophrenia, BPD is more common, afflicting 2% of adults who are usually young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide and suicide attempts and sometimes completed suicide in severe cases. Patients often need extensive mental health services and account for about 20% of the psychiatric hospitalizations. Those who remain outside the mental health care system seek romantic relationships in which they are idolized in an attempt to assuage an extreme fear of abandonment. Fear of abandonment lies at the core of this illness and makes these individuals highly suspicious of those who love them therefore incapable of successful long-term relationships.

People with borderline personality disorder have a constitutional tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak emotionally higher on less stimulus and take longer in the recovery phase. They are raised in environments which invalidate their perceptions of themselves and their environment on a continuous basis. These conditions combine to create uncertainty of the truth of their own being.

The following characteristics are common in borderlines, but these are also common human characteristics. Only a predominance and a dominance of these characteristics should lead the clinician to suspecting BPD. Likewise, not having some of these characteristics does not exclude the diagnosis.

  • At times total vulnerability with the appearance of helplessness and then a sudden change to strong criticism of those closest to them.
  • Apparent competence (appearing to be capable when internally they are falling apart)
  • Passivity when confronted with a problem and actively seeking a rescuer (commonly casting a therapist or priest in that role)
  • Impaired ego integration - a diffuse and internally contradictory concept of self
  • Low anxiety tolerance
  • Poor impulse control
  • Splitting, in which a person or thing is seen as all bad or all good. These extreme views can shift back and forth regarding the same object.
  • Absence of object constancy. They experience each action by people in their lives as if there had been no prior experience of those people. They do not have a sense of continuity and consistency about people and things in their lives. They have difficulty experiencing an absent loved one as a loving presence. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they last interacted with the borderline. It is a "What have you done for me lately" approach to life. They have an inability to retain the soothing memory of a loved. Therefore, they cannot experience love from the written word and this makes letter writing and emailing about personal relationship unadvisable.
  • Magical thinking - the belief that thoughts can cause events
  • Feel sometimes omnipotent
  • Projection of unpleasant characteristics in themselves onto others
  • Use of projective identification, a process where the borderline tries to elicit in others the feelings they are having. This takes the appearance of seeking revenge, however this is actually not what is going on.
  • Chaotic, extreme relationships with others
  • Denial of what seems obvious truths to others
  • Emotional amnesia; so completely in each mood, great difficulty remembering what it's like to be in another mood
  • Intense unstable relationships; always ends up getting hurt
  • Repetitive self-destructive behavior, seemingly designed to prompt rescue
  • Chronic fear of abandonment and panic when forced to be alone
  • Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others
  • Unusual sensitivity to nonverbal communication
  • Impulsive behaviors that often embarrasses later
  • Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.
  • Entitlement and Demandingness: feeling that one is special, better than others and deserving of special treatment
  • Righteousness: the belief that one is always right, never wrong. In an argument they never say the words "I see your point."
  • Emotional dependence: inability to be happy and satisfied without the emotional support of others
  • Alternate clinging and distancing behaviors. "I Hate You - Don't Leave Me!"
  • Difficulty controlling emotions. It has been said that lacking emotional skin, they feel agony at the slightest touch.
  • Shifts in mood lasting only a few hours
  • Anger that is inappropriate, intense or uncontrollable
  • May feel they do not know who they are, or what they think, or what their opinions are, or what religion they should be. Instead, they may try to be what they think other people want them to be.
  • Chronic feelings of emptiness or boredom, need for entertainment
  • Feeling of "needing" someone else to survive; heavy need for affection and reassurance; some people with BPD may have an unusually high degree of interpersonal sensitivity, insight and empathy
  • Transient, stress-related paranoid ideation
  • Severe dissociative symptoms: feeling "out of it," or not being able to remember what one said or did. This mostly happens in times of severe stress
  • (People with BPD are often bright, witty, funny, life of the party.)

    Treatment, for those able to accept it, is termed Dilectical Behavioral Therapy.

The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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