*Borderline Personality Disorder (BDP): 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.
They try to avoid abandonment, separation, or rejection. Changes to the environment, especially involving perceived or real separation or rejection alters their self-image, cognitions, and emotions.
Unstable or intense interpersonal relationships (idealization and devaluation). “You are brilliant and the most caring person I have ever met.” “You suck! You walk around here like you know everything, all high and mighty.”
Unstable self-image or sense of self “I don’t know how to function without . . .”
Impulsivity (spending, sex, binging, substance use)
Suicidal gestures or threats, self-mutilation “If you break up with me I will kill myself.”
Reactive mood (irritability, anxiety, or dysphoric).
Chronic feeling of emptiness “I’m never good enough,” “I just can’t get it right.”
Inappropriate intense anger.
Transient, stressed-related paranoia. Dissociative symptoms. “Are you seeing someone else? Am I not good enough? You just use me for entertainment when you have no one else to spend time with.”
Persons can appear delusional. What you are seeing is the person misinterpreting their interactions and responding with fear. Back in the day when Freud spoke and everyone listened, he and other psychoanalysts said Borderline behaviors are the result of poor child-caregiver interactions. Specifically, the caregiver’s responses vacillated between indifference and harshness and hyperattention and controlling. Overtime, this unpredictability turns into the child’s to fear abandonment and a fight against being consumed. And voila, you have an adult that wants to be close to people, but can’t trust their friends or loved ones to meet their needs. SO they cleave and push.
Our self-image comes from our early interactions. If no provides a child with consistent feedback that s/he is capable and good, s/he lacks that self-knowledge. SO s/he seeks out people who will tell them who they are. The problem is people cannot constantly reassure someone, fill up their emptiness. See how relationships can become an exhausting tango?
My first clue that the client I am seeing might be suffering from BPD is when I feel a push and pull-typically early in the session--during our conversation. At the end of the session therapist often say they feel like they have been raked over the coals or placed unjustly on a pedestal. The placement on the pedestal is short lived. Typically saying the “wrong” thing or challenging a belief the person holds will get a therapist, a friend, a spouse kicked off the pedestal. The book I Hate You, Don’t Leave Me by Jerold Kriesman, discusses BPD.
In general, treatment success is poor. However, if the client can tolerate the most common treatment for BPD, Dialectical Behavior Therapy (DBT), success is more likely. DBT teaches mindfulness, emotions, emotion regulation, and thought stopping and thought restructuring. Also, the treating professional MUST have firm boundaries, patience, and compassion.
Most of the time * Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revisions (DSM-IV-TR); American Psychiatric Association (2000).
* Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revisions (DSM-IV-TR); American Psychiatric Association (2000).