Borderline Personality Disorder

A PERSONAL NOTE: Well, as it turns out, I don't suffer from BPD after all. However, while I don't fit all the criteria, I definitely have some of these traits, and I still think more information on this common and intriguing disorder is necessary in order for anyone to heal.

Personality disorders can be ugly things. Most ugly of all is living with one. A personality disorder can't be fixed by anything except behavioral changes. Recognizing your unhealthy behavior and then acting to change that behavior results in success, and eventually, the unhealthy behavior no longer occurs to you. I have practiced this for months and am doing quite well with it, although it is certainly not easy. So here's the scoop:

Borderline personality disorder, or BPD, is by far the most common of personality disorders. Yet despite its prevalence, it remains virtually unknown to the general public, partly because the diagnosis is so new. For years, "borderline" was used as a catchall category for patients who did not fit more established diagnoses. The disorder also appeared to coexist with, and border on, other mental illnesses: hysteria, bipolar disorder, schizophrenia, multiple personality disorder, [et al]. In 1980, the disorder first appeared in the Diagnostic and Statistical Manual's third edition (DSM-III.) There are 8 generally accepted criteria for BPD, 5 of which must be present for diagnosis. The eight symptoms are seen to be intricately connected, interacting with each other so that one symptom sparks the rise of another. The 8 criteria may be summarized as follows:

• Unstable and intense interpersonal relationships
• Impulsivity in potentially self-damaging behaviors
• Severe mood shifts
• Frequent and inappropriate displays of anger
• Recurrent suicidal thoughts or gestures, or self-mutilation
• Lack of clear sense of identity
• Chronic feelings of emptiness and boredom
• Frantic efforts to avoid real or imagined abandonment

EMOTIONAL HEMOPHILIA

For the borderline, much of life is a relentless emotional roller coaster with no apparent destination. Mood changes come swiftly, explosively, carrying the borderline from heights of joy to the depths of depression. A borderline suffers from a kind of emotional hemophilia; he lacks the clotting mechanism needed to moderate the spurts of feeling. Stimulate a passion, and the borderline bleeds to death.

Sustained periods of contentment are foreign to the borderline. Chronic emptiness eats at him until he is forced to do anything in order to escape. In the grip of these lows, the borderline is prone to a myriad of impulsive, self-destructive acts---drug and alcohol binges, eating disorder behavior, sexual promiscuity, shopping sprees, or self-mutilation.

WHY?

A borderline childhood is often a desolate battlefield, scarred with the debris of rejecting, indifferent, or absent parents; emotional deprivation, and/or chronic abuse. A history of prolonged separation and/or neglect by primary caregivers seems to be the most important factor in distinguishing borderline patients from those with other disorders. These unstable relationships then carry over into adolescence and adulthood, where romantic attachments are highly charged and usually short-lived. The borderline will frantically pursue a man (or woman) one day and send him packing the next. Longer romances are usually filled with turbulence and rage, wonder and excitement.

It is known that borderline children often have borderline mothers, who in turn have borderline mothers. Debate still continues on the genetic transmission of both schizophrenia and BPD. Since many of these bordering disorders have themselves been linked to genetic factors, it stands to reason that BPD may also have genetic roots.

SPLITTING

The borderline cannot tolerate human inconsistencies and ambiguities; he cannot reconcile another's good and bad qualities into a consistent, coherent understanding of that person. At any particular moment, one is either "good" or "evil"; there is no in between, no gray area. Nuances and shadows are grasped with great difficulty, if at all. Lovers and friends may be idolized one day, devalued the next. When the idealized person finally disappoints (as we all do, sooner or later), either the idol is banished to the dungeon, or the borderline banishes himself in order to preserve the "all-good" image of the other person. This type of behavior, called "splitting," is the borderline's primary defense mechanism, and is intended to shield the borderline from a barrage of contradictory feelings and images. However, the splitting mechanism often achieves the opposite effect, and the borderline's sense of his own identity and the identities of others shifts even more dramatically and frequently.

STORMY RELATIONSHIPS

A borderline desperately seeks out new relationships, for solitude is more intolerable than mistreatment. To escape the loneliness, the borderline will flee to the arms of somebody--anybody--to meet someone who might save her from the torment of her own feelings. And in the relentless search for a structured role in life, the borderline is typically atracted to---and attracts to her---others with complementary personality disorders. Yet, for a borderline, relationships often disintegrate quickly. Maintaining a closeness with a borderline requires an understanding of the syndrome and a willingness to endure a long walk on a perilous tightrope. Too much closeness threatens the borderline with engulfment. Keeping one's distance or leaving a borderline alone---even for brief periods---recalls the sense of abandonment he felt as a child. In either case, the borderline reacts intensely.

In a sense, the borderline carries only a sketchy map of interpersonal relationships; she finds it extremely difficult to gauge the optimal psychic distance from others, particularly significant others. To compensate, she caroms back and forth from clinging dependency to angry manipulation, from outpourings of gratitude to irrational hate. She winds up repelling those with whom she most wants to connect.

There are unstable and intense interpersonal relationships with marked shifts in attitude towards others, and prominent patterns of manipulation exist. Internal feelings in relationships are dramatically translated into intense, shifting, manipulative couplings. The borderline often makes unrealistic demands of others, appearing to observers as "spoiled." The borderline may use seduction as a manipulative strategy, even with someone known to be inappropriate and inaccessible. These unstable relationship patterns are directly related to the borderline's intolerance of separation and fear of intimacy.

IMPULSIVITY

The borderline's behaviors may be sudden and contradictory, since they typically result from strong, momentary feelings---perceptions that represent isolated, unconnected snapshots of experience. Because historical patterns, consistency and predictability are generally unavailable to the borderline, similar mistakes are repeated again and again. Often, impulsive actions such as drug or alcohol abuse serve as defenses against feelings of loneliness or abandonment.

MOOD SHIFTS

The borderline undergoes abrupt mood shifts,lasting for short periods---usually only hours. His base mood is not usually calm and controlled, but more often either hyperactive and irrepressible, or pessimistic and cynical.

RAGING BULL

The borderline's outbursts of rage are as unpredictable as they are frightening. Violent scenes are disproportionate to the frustrations that trigger them. The anger may be sparked by a particular offense, but underneath the spark lies an arsenal of fear from the threat of abandonment and disappointment. The rage, so intense and so near the surface, is often directed at the borderline's closest relationships, and it may represent a cry for help, a testing of devotion, or a fear of intimacy. Whatever the underlying factors, it pushes away those whom the borderline needs most.

WHO AM I?

Central to the borderline syndrome is the lack of a core sense of identity. The borderline does not accept her own intelligence, attractiveness, or sensitivity as constant traits she possesses, but rather as comparative qualities to be continually re-earned and re-judged against others. For example, the borderline may consider herself attractive until she spies a woman whom she feels is prettier; then she feels ugly again.

For the borderline, identity is graded on a curve. Who she is (and what she does) today determines her worth, with little regard to what has come before.

The borderline's struggle in establishing a consistent identity is related to a prevailing sense of inauthenticity---a constant sense of "faking it." Most of us experience this sensation at various times in our lives, but it is transient and soon overcome by our adaptation to new circumstances. The borderline, however, never reaches that point. He continues to feel like he is faking it and is terrified that he will, sooner or later, be "found out." This is particularly true when the borderline achieves some kind of success---it feels misplaced, undeserved.

ALWAYS HALF EMPTY

Lacking a core sense of identity, borderlines commonly experience a painful loneliness that motivates them for new ways to fill up the "holes." For the borderline, the search for a way to relieve the boredom usually results in impulsive ventures into destructive acts and/or disappointing relationships. In many ways, the borderline seeks out a new relationship or experience not for its positive aspects, but to escape the feelings of emptiness---thus experiencing a kind of existential angst. Suicide may appear to be the only rational response to a perpetual state of emptiness. The need to fill the void or relieve the boredom can lead to outbursts of anger, self-damaging impulsiveness, and mood swings designed to elicit sensations of feeling.

***From "I Hate You---Don't Leave Me", Understanding the Borderline Personality, by Jerold J. Kreisman, M.D. and Hal Straus, Avon Books, c. 1989