Borderline Personality Disorder (BPD): An Overview
Written by Lane Gormley, EdS, LPC, NCC
Symptoms of BPD
Clients diagnosed with Borderline Personality Disorder are emotionally unstable, or emotionally dysregulated. They often have a distorted self-image and feel as though something is “wrong” with them. They may fear abandonment. The resulting anger, impulse-driven behaviors (including self-injury), and moodiness may threaten their relationships.
Persons with Borderline features often view the world in black and white terms – in other words, someone is either “good” or “bad”. A person with Borderline characteristics may adore and admire someone one moment and treat the same person with rage and contempt the next.
Suicide threats and suicide attempts during moments of despair often occur among Borderline Personalities, and sometimes they are successful. Borderline Clients often doubt that they are loved; it often seems as if they are trying to prove to themselves that no one loves them “enough”. They are volatile because their symptoms are so uncomfortable. Sometimes they do not respond to traditional short-term treatment.
Some researchers believe that people with Borderline features share developmental issues – in other words, they may have missed out on developmental stages or “tasks” essential to the maturation process. There are several “models” for (or ways of conceptualizing) human development. Many clinicians like Erik Erikson’s approach as explained in his book, Identity and the Life Cycle. Clients with features of Borderline Personality Disorder may have had problems with the early developmental stages that Erikson describes. Erikson, by the way, coined the term “identity crisis” for what takes place when an individual is trying to pass from a difficult stage to the next. Borderline Clients may not have weathered one or more of their identity crises.
It is my personal belief that most of my Clients who have Borderline features had problems with Erikson’s First Psychosocial Stage, Basic Trust vs. Mistrust. This stage takes place from birth to two years old. If babies and toddlers do not learn to trust at this time – if they do not solve that identity crisis – it will be very difficult for them to trust anyone later. This will make other, subsequent developmental tasks difficult for them if they cannot trust their teachers, spouses, colleagues, and therapists.
A Case Study
Cara S. (* my Clients are never identified by their real names) was raised by very young parents who were both addicted to a variety of substances, legal and illegal. No one comforted Baby Cara when she cried. She often went hungry with diapers unchanged. She recalls tiptoeing around the house at night, terrified, stepping over the inert bodies of parents and their friends who had passed out from drug and alcohol abuse. No one made her feel safe. No one helped her learn and grow. Cara spent a great deal of her time trying to win her parent’s love but was never sure she had it. She grew up to continue that pattern, focusing constantly on attaining the love and attention of others… but never sure that she has it. When she is loved, it does not satisfy her because she does not believe in it and feels unworthy of it. When she does think, for a moment, that someone loves her, contempt for them will follow. Anyone who loves me, Cara feels, must not be worth much. Today, Cara is 32. She is my Client. It has taken a long time for her to say that she trusts me. What does she understand trust to mean? I do not know.
A difficult first developmental stage may, in fact, be a clue to the Borderline’s tendency to split people into categories of “totally good” and “totally bad”. Since they find trust unachievable or at least very difficult to sustain, they may actually change their opinions of others based on spur of the moment criteria. If I do something that pleases Cara, she “loves” me; I am a wonderful therapist. If I suggest something that threatens her, she withdraws love and becomes angry. The family members, loved ones, and close associates of Borderline personalities sometimes have a bumpy ride.
Indeed, I had a Client who told me in the second session that, if only I had been her mother, she would be a happy and well-adjusted woman. The following week, in group, she called me a f***ing b**** [Sorry… our Clinic Director does not allow the kind of language for which I am justifiably famous]. I had apparently said something that caused my Client to lose faith. This was a “typical” (if there is such a thing) borderline episode in that it shows the quick idealization and the equally sudden devaluation of the therapist. As it happens, I, like most people, am neither a Perfect Mother nor a f***ing b****. I am simply a human woman with both positive and negative attributes. I believe that I am also, by and large, quite trustworthy.
Treatment for BPD
Borderline Personality Disorder can be treated in several ways. A doctor at a hospital where I once worked told me that, in individual therapy, the treatment could be lengthy because the helping professional may have to, literally, re-raise the Client or, at the very least, help them to review and succeed at any developmental tasks that were missed.
In addition to regular therapy (understanding the past in order to release the hold it has on the present, becoming conscious of thoughts and emotions, stress management, the acquisition of coping skills), Borderline Clients may profit from Dialectical Behavior Therapy (DBT). DBT is the product of psychologist Marsha Linehan; and it is a phased approach to teaching skills that a person with unstable moods can learn in order to calm and center themselves.
DBT is often taught in a group setting where Clients learn skills that they can begin, in group, to practice. The four basic skills of DBT are Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness; they are subdivided into a series of lessons that teach Clients how to control their attention, how to be in a healthy relationship, how to govern emotions and behaviors, how to be assertive, and how to stop harming themselves. The entire DBT training might last 10 or 12 weeks.
DBT is not just for those diagnosed with Borderline Personality Disorder. I think that DBT can be an effective treatment for any disorder having symptoms that include emotional instability. Many Clients can profit from learning these skills. Naturally, what I like most about DBT is that it focuses on solutions and not on problems.
If you would like to know more about DBT, please call Ray of Hope. We have DBT Groups for adults and adolescents. There are also books, workbooks, and websites where you can learn more. A book that helped me understand both the symptoms of emotional instability, how very uncomfortable they are, and how DBT can help them is The Buddha and the Borderline by Kiera Van Gelder. It is a young woman’s autobiographical account of growing up and being diagnosed with Borderline Personality Disorder and of her experience with Dialectical Behavior Therapy.