Borderline Personality Disorder

An essay I wrote for PSYC 1 a few years ago:

Borderline Personality Disorder

The Borderline Personality Disorder is one which has much controversy and uncertainty

since it’s inception. While fragmented, the genealogy of the disorder has lead to many opinions about it and therefore treatment options. Ultimately theories surrounding Borderline Personality Disorder are varied, but each offer intriguing and promising glimpses into the mind, for those with and without the disorder alike.

Borderline Personality Disorder has been looked at from many different angles since at least the 1950’s. The original terminology described it as on the borderline between neurotic and schizophrenic psychotic. While modern conceptions of the disorder has shifted in many elements and there isn’t a clear consensus, the general model still looks at it in a similar manner. The disorder is primarily characterized by extremely polarized thinking, unstable interpersonal relationships, negative but unstable affect, low but unstable sense of self, impulsivity, manipulative suicide attempts/threats, and low achievement. Typically the individual is able to function, but the disorder comes out in extremely polarized thinking. This leads them to have unstable and critical self image, rocky and turbulent interpersonal relationships, and often depression associated with these two issues.

Most doctors agree in the biopsychosocial view of the development of the Borderline Personality Disorder. Also most agree that a key trigger or stressor in the onset is an overwhelming feeling (and fear) of abandonment stemming from unstable and unreliable familial interactions, and often abuse (sexual, physical, or verbal). The qualities correlate highly with the disorder, and it is theorized that such experiences is what pushes the individual into a more regressed and polarized worldview.

Individuals with the disorder tend to have a pressing fear of abandonment. It is largely this fear, and their polarized expectations and interpretations of others’ actions which leads them to have unstable, intense, and short-lived friendships and relationships. They tend to have negative but not flat affect. And they express anger, bitterness, damandingness, sarcasm, and sometimes rage. They tend to be very self-critical with their opinion of themselves dependent on other people. As such, they have extreme abandonment anxiety and have crashes in their self-image upon the dissolving of an interpersonal relationship. Another indicator of a Borderline person is extreme impulsivity. This is most often seen through patterns of serious periodic alcohol or other substance abuse, and often in sexual promiscuity and impulsivity. Furthermore while the borderline patient tends to be able to function, they have low achievement often despite apparent talent and potential. This seems to be a manifestation of the “black and white” thinking and a fear of and sensitivity to failure.

The guidelines to diagnose a patient with Borderline Personality Disorder according DSM-IV-TR (1) criteria:

“A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by fiver (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger, or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or sever dissociative symptoms

Note: (1) and (4) exclude suicidal or self-mutilating behavior (covered in criterion 5).”

If diagnosed with Borderline Personality Disorder, treatment options that have been shown in randomized controlled trials to be effective are psychoanalytic/psychodynamic therapy and dialectic behavior therapy. These have weekly meetings with an individual therapist, one or more weekly group sessions, and meetings of therapists for consultation/supervision. Additionally, treatment can include pharmacotherapy to help deal with symptoms. Such an option would start with SSRI or related antidepressants, and then can be augmented with more antidepressants, low-dose neuroleptic, and Clonazepam, and if that doesn’t work then the treatment can be changed to MAOI, ultimately adding or switching to Lithium, Carbamazepine, or Valproate.

While controversial, Borderline Personality Disorder has proved to be an important part of Psychology. It is often difficult to diagnose or see because the individual can maintain seemingly normal functioning, but unfortunately if left untreated the disorder can become destructive.

Incorrectly formatted bibliography:

• American Psychiatric Association – Practice Guideline for the Treatment of Patients with Borderline Personality Disorder
• Fine Ph.D., Reuben – Current and Historical Perspectives on the Borderline Patient
• Gunderson M.D., John – Borderline Personality Disorder and Borderline Personality Disorder: A Clinical Guide
• Judd Ph.D., Patricia and McGlashan M.D., Thomas - A Developmental Model of Borderline Personality Disorder
• Links M.D. M.Sc. F.R.C.P.(C), Paul – Family Environment and Borderline Personality Disorder
• Paris – Borderline Personality Disorder