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October 24 - November 27, 2021
The lifetime prevalence rate of BPD in the population is twice that of both schizophrenia and bipolar disorder combined, and yet the National Institute of Mental Health (NIMH) devotes less than 2 percent of the monies apportioned to the studies of those illnesses to research on BPD.
disrespect and dehumanization of referring to people by their medical conditions
Recent studies estimate that 18 million or more Americans (almost 6 percent of the population) exhibit primary symptoms of BPD, and many studies suggest this figure is an underestimation. 1 Approximately 10 percent of psychiatric outpatients and 20 percent of inpatients, and between 15 and 25 percent of all patients seeking psychiatric care, are diagnosed with the disorder. It is one of the most common of all of the personality disorders.
inconsistency is the hallmark of BPD. Unable to tolerate paradox, borderlines are walking paradoxes, human catch-22s.
50 percent of all patients admitted to a facility for an eating disorder.9 Other studies have found that over 50 percent of substance abusers also fulfill criteria for BPD.
Self-destructive tendencies or suicidal gestures are very common among borderlines—indeed, they are one of the syndrome’s defining criteria. As many as 70 percent of BPD patients attempt suicide. The incidence of documented death by suicide is about 8 to 10 percent and even higher for borderline adolescents.
DSM-IV-TR lists nine categorical criteria for BPD, five of which must be present for diagnosis.15
If nothing else, BPD serves to remind us that the line between “normal” and “pathological” may sometimes be a very thin one. Do we all display, to one degree or another, some symptoms of borderline personality? The answer is probably yes.
One widely accepted model suggests that individual personality is actually a combination of temperament (inherited personal characteristics, such as impatience, vulnerability to addiction, etc.) and character (developmental values emerging from environment and life experiences)—in other words a “nature-nurture” mix.
Some prospective studies have noted that children diagnosed with ADHD frequently develop a personality disorder, especially BPD, as they get older.
Almost 75 percent of individuals with BPD experience some dissociative phenomena.
Since both BPD and PTSD have frequently been associated with a history of extreme abuse in childhood and reflect similar symptoms—such as extreme emotional reactions and impulsivity—some have posited that they are the same illness.
As many as 70 percent of BPD patients attempt suicide, and the rate of completed suicide approaches 10 percent, almost a thousand times the rate seen in the general population.
Though very sensitive to others, the borderline lacks true empathy.
Because of the borderline’s inability to see the big picture, to learn from previous mistakes, and to observe patterns in his own behavior, he often repeats destructive relationships.
The borderline never reaches that point of confidence. He continues to feel like he is faking it and is terrified that he will, sooner or later, be “found out.”
Borderlines frequently report the calming effects of self-mutilation; rather than feeling pain, they experience soothing relief or distraction from internal psychological pain.
As the latest research strongly suggests that BPD may be at least partly inherited, parent and child may both experience dysfunction in cognitive and/or emotional connection. A poor communication fit may perpetuate the insecurities and impulse and affective defects that result in BPD.
During the entire separation-individuation period, the developing child begins to sketch out boundaries between self and others, a task complicated by two central conflicts—the desire for autonomy versus closeness and dependency needs, and fear of engulfment versus fear of abandonment.
Ritualized, superstitious acts, when done in extremes, may represent borderline utilization of transitional objects.
In such cases, treatment of the borderline may require treatment of the entire family (see chapter 7).
Though no evidence supports a specific BPD gene, humans may inherit chromosomal vulnerabilities that are later expressed as a particular illness, depending on a variety of contributing factors—childhood
First, if borderline pathology originates early in life—and much of the evidence points in this direction—an increase in the pathology is likely tied to the changing social patterns of family structure and parent-child interaction.
Second, social changes of a more general nature have an exacerbative effect on people already suffering from the borderline syndrome.
Third, the growing recognition of personality disorders in general, and borderline personality more specifically, may be seen as a natural and inevitable response to—or an expression of—our contemporary culture.
The borderline syndrome represents a pathological response to these stresses. Without outside sources of stability and validation of worthiness, borderline symptoms of black-and-white thinking, self-destructiveness, extreme mood changes, impulsivity, poor relationships, impaired sense of identity, and anger become understandable reactions to our culture’s tensions.
The looming possibility of a catastrophic event—the threat of nuclear annihilation, another massive terrorist attack like 9/11, environmental destruction due to global warming, and so on—contributes to our lack of faith in the past and our dread of the future.
Sixty percent of marriages for couples between the ages of twenty and twenty-five end in divorce; the number is 50 percent for those over twenty-five.
often marry at a young age to escape the chaos of family life. They cling to dominating husbands with whom they recreate the miasma of home life.
some researchers estimate a significantly increased rate of sexual perversions among borderlines.
From what we understand of the roots of BPD (see chapter 3), abuse, neglect, or prolonged separations early in childhood can greatly disrupt the developing infant’s establishment of trust.
For example, a 2007 study by Microsoft (which should know something about this topic) found that “ego” is the largest driver of participation: people contribute to “increase their social, intellectual, and cultural capital.”32
can be frustrating for everyone in regular contact with the borderline personality because, as we have seen, their explosions of anger, rapid mood swings, suspiciousness, impulsive actions, unpredictable outbursts, self-destructive actions, and inconsistent communications are understandably upsetting to all around them.
characterized by three major feeling states: terrifying aloneness, feeling misunderstood, and overwhelming helplessness.
“SET”—Support, Empathy, Truth—is a three-part system of communication
UP stands for Understanding and Perseverance—the goals that all parties try to achieve.
The S stage of this system, Support, invokes a personal, “I” statement of concern.
With the Empathy segment, one attempts to acknowledge the borderline’s chaotic feelings with a “You” statement:
The T statement, representing Truth or reality, emphasizes that the borderline is ultimately accountable for his life and that others’ attempts to help cannot preempt this primary responsibility.
The Truth part of the SET system is the most important and the most difficult for the borderline to accept since so much of his world excludes or rejects realistic consequences.
search for something to fill the emptiness that continually haunts him.
Compared to teenagers with other psychiatric disorders, borderline adolescents experience some of the most severe pathology and dysfunction.
Broken bones heal and infections clear up, but scars on the psyche may require longer treatment.
Transference in exploratory therapy is more intense and prominent than in supportive therapy. Dependency on the therapist, together with idealization and devaluation, are experienced more passionately, as in classical psychoanalysis.
tends to be less dependent on the therapist and to form a less intense transference. Though some clinicians argue that this form of therapy is less likely to institute lasting change in borderline patients, others have induced significant behavioral modifications in borderline patients with this kind of treatment.
Borderline patients constitute as much as 20 percent of all hospitalized psychiatric patients, and BPD is far and away the most common personality disorder encountered in the hospital setting.
hospitalization include resolving the precipitating crises and terminating destructive behaviors.
Borderline Personality Disorder is the only major psychiatric illness for which there are more evidence-based studies demonstrating efficacy from psychosocial therapies than for pharmacological (drug) treatments.
A system of treatment developed by Aaron Beck, CBT focuses on identifying disruptive thoughts and behaviors and replacing them with more desirable beliefs and reactions.
Developed by Marsha M. Linehan, PhD, at the University of Washington, DBT is the derivation of standard cognitive-behavioral therapy that has furnished the most controlled studies demonstrating its efficacy. The dialectic of the treatment refers to the goal of resolving the inherent “opposites” faced by BPD patients; that is, the need to negotiate the borderline’s contradictory feeling states, such as loving, then hating the same person or situation. A
