Saturday, August 2, 2008

You Keep On Pushing Me Over the Borderline: Personality Disorder, That Is

You Keep On Pushing Me Over the Borderline:
Personality Disorder, That Is

Borderline Personality Disorder, a controversial mental disorder, is one of the major personality disorders. The first significant psychoanalytic work to use the term "borderline" occurred in 1938. The term Borderline was first used to describe a person who seemed on the “borderline” of neurosis and psychosis, or nearing a schizophrenic state. Personality refers to an ongoing, continuous pattern of thoughts, feelings, and behaviors that form who we are. When elements of someone’s thought patterns, feelings, or behaviors are pervasively negative, causing significant interpersonal issues in life, the possibility of a disorder exists. Because personalities form and are developing throughout one’s early life, the condition is not usually diagnosed until later on.
Borderline Personality Disorder: those three words can strike terror into the heart of anyone, therapists and psychiatrists notwithstanding. There is a copious amount of stigma associated with BPD. The controversy surrounds the idea that given this diagnosis, the whole person is pathologically flawed and problematic, rather than just a part of said person. Other synonymous names for BPD include Emotional Regulation Disorder which is very commonly used along with Emotional Intensity Disorder. It is seen in 10% of psychiatric outpatients, and 20% of psychiatric inpatients.

Borderline Personality Disorder is generally characterized by impulsive actions, rapidly shifting moods, and stormy relationships. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. “Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone”, states the National Institute of Mental Health.

Specifically, symptoms include self harm, such as cutting oneself, or repeated attempts or hints about committing suicide. Frantic attempts to avoid real or imagined abandonment occur, as in threatening to harm yourself if someone leaves, or threatening to hurt them if they leave you. Alternating between idealizing a person and demonizing them is also common. Borderlines tend to have a very shaky sense of self. They tend to fluctuate in confusion over sexual identity. Compulsive behaviors are common, such as gambling, overspending, abusing drugs and alcohol, driving recklessly, and risky sex, and binge eating. Another element of the disorder is known as splitting: friends, family, loved ones are viewed as "all good" or "all bad." There is no middle ground, no in-between.
The affected might form an immediate and intense attachment to a person, at first idealizing them, only to jump to extremes of anger and resentment if any perceived or actual separation happens. For example, a patient whose therapist goes on vacation may freak out and feel hatred at the therapist for “abandoning” them. The DVSM says of the issue of anger, “The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil.” They try to deal with feelings of emptiness and rage by acting out toward those around them-blaming, criticizing, abusing verbally or physically, accusing them of things that are often outrageous. Attempting to set boundaries with a person with BPD can be excruciating as they are capable of great maliciousness. Often, loved ones feel they must “walk on eggshells” in order to avoid the outcome of crossing said affected person.
A person diagnosed with is extremely sensitive to rejection and has trouble with what is known as “object constancy”. He or She feels difficulty with emotional connection to important people when they are physically absent. The psychic infrastructure, the emotional skeletal system as it were- within the disordered person is dysfunctional, thus they are unable to seek comfort in an internalized image of another person. For example, through the repeated consistent comings and goings of mother , AND through the toddler’s genetic ability to adapt (ego endowment), a new image of mother begins to shape internally. The toddler’s capacity to internalize his mother through traces of memory serves as a source of comfort and security when she is not available in a physical sense. The nurturing and soothing mother is internalized as a constant object. This is known as object constancy.
One woman diagnoses with BPD said, "One day I would think my doctor was the best and I loved her, but if she challenged me in any way I hated her. There was no middle ground as in like. In my world, people were either the best or the worst. I couldn't understand the concept of middle ground." People who love and care for a person with BPD usually feel like they are walking on egg shells, and try to avoid horrible rows by hiding their thoughts and feelings. You may feel blamed for everything that goes wrong, even when it is not logical. You may not know who you are living with, the loving person you fell in love with seems to be replaced with a tyrannical rageaholic. People with BPD are in pain, as are the people who love them. When one has BPD, one has difficulty with emotional control. They are often in a state of upheaval, seemingly forever involved in drama and chaos — perhaps as a result of harmful childhood experiences or brain dysfunction.
With borderline personality disorder one’s image of oneself is extremely distorted. The resulting feeling about oneself is that of worthlessness and intrinsic badness. Sometimes, one with BPD feels as if they don't exist at all.
This drama, anger, impulsivity and frequent mood swings push others away, though paradoxically there is yearning for loving relationships.

Neurobiology is a factor in BPD. Studies show that people predisposed to impulsive aggression have impaired emotional regulation, the neural circuits that modulate emotion are not working properly. A small almond-shaped structure deep inside the brain, the amygdala, is an important component of the circuitry regulating negative emotion. It marshals fear and arousal, and if dysfunctional, may explain why BPD sufferers are so hyper sensitive. A plausible explanation is sexual abuse in childhood. Forty to 71 percent of BPD patients report having been sexually abused.
The primary treatment for BPD is psychotherapy. This can be tricky however, as some with BPD are extremely resistant to getting treatment. They tend to see therapist’s as threatening, and harbor deep hostility of which they may or may not be aware.
Symptom-targeted pharmacotherapy is another useful treatment option.
If you or someone you love are in need of help, do not hesitate to seek it. Keep yourself safe, have compassion but do not be a doormat. Set boundaries and fortify yourself against the inevitable “borderline bait” as I call it, where the affected possibly responds malignantly and spitefully.
According to the Mayo Clinic, “If you notice these things in a family member or friend, talk to him or her about seeing a doctor or mental health provider. But keep in mind that you can't force someone to seek help. If the relationship has you unduly distressed, you may find it helpful to see a therapist yourself.”

1 comment:

Anonymous said...

Thanks for the great information.