When I was practising law many years ago, I had a client who had been diagnosed with Borderline Personality Disorder (BPD). At the time, I wasn't exactly sure what that meant, but I knew that in her case it involved violent outbursts that resulted once in her breaking her 10-year-old son's arm. Her two boys, one of whom was 14 at the time, were apprehended by the local child protection authorities. She was a single mother on welfare who was having extreme difficulty coping.
While I was watching a dvd of Gilbert and Sullivan's 'Iolanthe' operetta the other night, a song towards the end of the production made me think of BPD as the fairies were singing to the members of the House of Lords what basically amounted to: "we really can't stand you, but we love you, so don't go"!
BPD is still considered a controversial diagnosis in some circles. Decades ago, it was used as a 'catch all' classification for conditions which psychiatrists couldn't quite figure out.
As understood today, BPD manifests as significant emotional instability in which a person has a severely distorted self-image that makes him or her feel worthless and fundamentally flawed. Anger, impulsiveness and frequent mood swings may push others away, even though lasting and loving relationships are desired. Fear of abandonment is usually a strong underlying issue, and ironically, the behaviour of someone suffering from BPD usually does result in pushing away those who they strongly desire to be in relationship with.
Signs and symptoms of borderline personality disorder may include:
- Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees, or illegal drug use
- Awareness of destructive behavior, including self-injury, but usually feeling unable to change it
- Wide mood swings
- Short but intense episodes of anxiety, or depression
- Inappropriate anger and antagonistic behavior, sometimes escalating into physical fights
- Difficulty controlling emotions or impulses
- Suicidal behavior
- Feeling misunderstood, neglected, alone, empty or hopeless
- Fear of being alone
- Feelings of self-hate and self-loathing
- An insecure, unsure sense of self (self-identity, self-image, sense of self rapidly changes)
- Feelings of not existing or of disappearing; of not being thought of or cared about
- Tumultuous relationships with shifts to fury and hate over perceived slights/minor misunderstandings
- Tendency to view things in either black or white (not seeing the grey areas of issues).
As with most mental disorders, personality disorders may be inherited, or strongly associated with other mental disorders among family members, environmental factors such as child abuse, neglect or lack of proper attachment to caregivers/loved ones, or brain abnormalities.
Certain medications can help, but ideally should be combined with an effective form of therapy and support. Certain psychotherapies can go a long way towards nullifying some of the symptoms and teaching better coping strategies.
Dialectical behavior therapy was designed specifically to treat BDP. This method of counselling (which I just recently began to study for use in my counselling practice) uses a skills-based approach combined with physical and meditation-like exercises which teach how to regulate emotions, tolerate distress/discomfort and improve relationships. Other effective treatments include: cognitive behavioural therapy, mentalization-based therapy, schema-focused therapy, and transference-focused therapy.
To be diagnosed with borderline personality disorder, you must exhibit at least five of the signs/symptoms spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- Intense fear of abandonment
- Pattern of unstable relationships
- Unstable self-image or sense of identity
- Impulsive and self-destructive behaviors
- Suicidal behavior or self-injury
- Wide mood swings
- Chronic feelings of emptiness
- Anger-related problems, such as frequently losing one's temper or having physical fights
- Periods of paranoia and loss of contact with reality (1)
A diagnosis of borderline personality disorder is usually made in adults, rather than in children or teenagers because acting out during the younger years is likely a phase that will pass. If it doesn't pass, then BPD may be implicated. Additionally, substance abuse can cause symptoms which look like BPD, and BPD can cause substance abuse.
D.
(1) www.mayoclinic.com/health/borderline-personality-disorder/DS00442
