Let me begin by saying that if you have this disorder, stop reading right now. It is much more important that you follow the directions of your mental health professional than read a blog which might be confusing. We are going to talk in generalities about this disorder. It may or may not match your symptoms or your experience. You are the expert of your life, so don’t let anything you read here upset or confuse you.
Borderline Personality Disorder is a much misunderstood disorder. It is confusing and hard to diagnose. No one really knows what causes it, although some specialists feel that it might arise in a confluence of circumstances which include some or all of the following:
- Abandonment in childhood or adolescence
- Disrupted family life
- Poor communication in the family
- Sexual abuse
There is a higher prevalence in women and among hospitalized psychiatric patients. See http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/
There are only two diagnostic criteria in the DSM-V: significant impairments in personality functioning and pathological personality traits. These have multiple sub-heading and limiters, so be sure to check out this site for complete information:
But of course, nothing in psychiatry is simple.
People with this disorder may be uncertain about their identity. Imagine not being sure who you are and what you stand for. Your interests may change quickly. And this is combined with an ‘all or nothing’ view of the world. A friend is a saint one day and a bum the next. A husband is a kind loving partner tonight and an abusive SOB tomorrow. Of course, this makes it very difficult for them to maintain relationships.
Ironically, in the midst of these rapid and wide changes of opinion and behavior, the person with Borderline Personality Disorder has frequent displays of overwhelming anger. While getting mad at the world and everyone in it, they are equally terrified of being abandoned – they behave in a way that causes their greatest fear to be made real. And they have a real, intense, and almost overwhelming fear of being alone.
If you consider that what you value today can be the opposite of what you value tomorrow, it is easy to see a cascading waterfall of problems. Sexual behavior will not be consistent; use of money will swing from frugality to licentiousness. Extreme dieting to binge eating. Rigid honesty to brazen theft.
And overlaying all those behavior problems is a pattern of self-abuse and self-harm including cutting and overdosing.
As with any disorder, the degree of impairment and the prognosis for successful treatment vary by individual. But treatment is critical since extremes in behavior are their norm, making relationships with others and themselves very difficult. For some, the disorder is life threatening.
One example: An individual came to me because he was upset with his wife but was confused. They had a large family of small children and his wife had been feeling overwhelmed and needy of adult companionship. They agreed she should go out one night a week and chose Wednesday. After a couple of weeks, she didn’t come home. When she arrived in the morning, they discussed it and she had a good reason for her behavior. The overnighters continued, even though he didn’t like it, but she always arrived on time for him to get to work. A few weeks pass and they’re settling into this new ‘normal’ routine when she comes home on Thursday morning in hysterical grief.
Once he got her calmed down, she disclosed that she’s upset because her boyfriend died. Needless to say, he’s devastated and starts yelling at her that she can’t have a boyfriend because she’s married to him.
She replies: “Isn’t that just like you. Everything has to be about you and your rules.” And without another word, she walked out, never to return to see him or the children again.
He was confused about his role in their altercation and what to do about the future.
This is an extreme example of the behavior of a woman with BPD. But it shows the changing values, the changing sexual standards, the inability to be alone and the fear of rejection.
And yes, his behavior was normal, considering the circumstances.
The next post will look at treatment modalities and outcomes. While this disorder seems overwhelming, there are some excellent results being obtained from a combination of therapies.
What do you think? Know anyone with this confusing illness? Please share your experience but remember no diagnosing yourself or others.