Borderline Personality Disorder
Personality disorder is a matter of false judgments of value. Listed below are the false value judgments that are at the root of Borderline Personality Disorder.
|for an intimate relationship
||frantic efforts to avoid real or imagined abandonment
|to alternately idealize and devalue the other in relationship; so, the other in the relationship
||the other in the relationship
||a pattern of unstable and intense interpersonal relationships characterized by alternating between extreme idealization and devaluation
|to alternately idealize or devalue the self
||identity disturbances; markedly and persistently unstable self-image or sense of self
|to shop and spend money; for sex; for mind and mood altering substances; for fast driving and other exciting activities; for food
||impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
|to cause themselves pain or to harm themselves, or to make gestures or to threaten to harm themselves
||recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
|to react to events in an unregulated expression of passion
||affective instability due to a marked reactivity of mood (e.g., episodic dysphoria, irritability, or anxiety
|the love, protection, and companionship of a nurturing, thoroughly good person (pg. 313)
||feelings of emptiness
||chronic feelings of emptiness||
|to frequently express anger
||inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)||
|to distance or distract themselves from reality
||transient, stress-related paranoid ideation or severe dissociative symptoms||
The Disease Perspective
Proposed Revision | APA DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pg. 654) describes Borderline Personality Disorder as 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 five (or more) of the following:
- frantic efforts to avoid real or imagined abandonment;
- a pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation;
- identity disturbance: markedly and persistently unstable self-image or sense of self;
- impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating);
- recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior;
- 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
- chronic feelings of emptiness;
- inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights);
- transient, stress-related paranoid ideation or severe dissociative symptoms.
The Dimensional Perspective
Here is a hypothetical profile, in terms of the five-factor model of personality, for Borderline Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):
- High Neuroticism
- Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.
- High Extraversion
- Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.
- Low Openness
- Difficulty adapting to social or personal change; low tolerance or understanding of different points of view or lifestyles; emotional blandness and inability to understand and verbalize own feelings; alexythymia; constricted range of interests; insensitivity to art and beauty; excessive conformity to authority.
- High Agreeableness
- Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.
- Low Conscientiousness
- Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.
Affective instability, dysphoric mood, periods of anger, panic, or despair rarely relieved by feelings of well-being and satisfaction, chronic feelings of emptiness, inappropriate, intense anger, intense abandonment fears, sudden despair, panic, fury, feelings of non-existence, depersonalization, reactivity of mood, intense episodic dysphoria, irritability, anxiety, shame and guilt, feelings of being evil (American Psychiatric Association, pp. 706-708).
Anxiety, panic, anger, depression (Beck & Freeman, pg. 179).
Character Weaknesses and Vices*
- mood lability*
- self-damaging acts*
- stormy relationships*
- identity disturbance*
- frantic fear of abandonment*
* Derived from Michael Stone's (pg. 22) list of the "personality traits" of DSM-III-R Borderline Personality Disorder. Descriptors marked with an asterisk, he says, are not true personality traits.
The Behavior Perspective
Want to be free to pursue their desires while still getting dependency needs satisfied.
Behaviors which destabilize personal relationships, idealizing and devaluation of potential care givers and lovers, angry disruptions of close relationships, frantic efforts to avoid abandonment.
Expression of inappropriate, intense anger or difficulty controlling anger; display of extreme sarcasm, enduring bitterness, or verbal outbursts; constantly seeking something to do.
Shifting goals, values, and vocational aspirations; sudden changes in opinions and plans about career, sexual identity, values, and types of friends; poor performance in unstructured work or school situations; undermining oneself at the moment a goal is about to be realized; recurrent job losses, interrupted education, broken marriages.
Impulsive, self-damaging behavior, gambling, spending money irresponsibly, binge eating, substance abuse, engaging in unsafe sex, driving recklessly; suicidal behavior, gestures, and threats; self-mutilating behavior. (American Psychiatric Association, pp. 706-710).
Impulsivity, self-destructiveness, expressions of aggression (Gunderson, pg. 2754).
Mood Disorders, Substance Related Disorders, Eating Disorders (notably Bulimia), Posttraumatic Stress Disorder, Attention-deficit/Hyperactivity Disorder (American Psychiatric Association, pg. 708).
Generalized Anxiety Disorder, Panic Disorder, Somatoform Disorders, Obsessive-Compulsive Disorder, Dissociative Fugue, Major Depressive Disorder, Bipolar Disorder, Schizoaffective Disorder, Brief Psychotic Disorder, Cyclothymic Disorder (Beck & Freeman, pp. 179, 183).
The Life Story Perspective
"Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder" (American Psychiatric Association, pg. 708).
"Borderline offspring of [overinvolved] families are often struggling with dependency issues by denial or by anger at their parents. Whether denied or reviled, these needs for dependency are often being gratified by the family" (Gunderson, pg. 2753).
Basic Belief: Other people must satisfy my needs. Strategy: Relationship change.
Representing themselves as relatively helpless in a hostile world but without a source of security, they are forced to vacillate between autonomy and dependence without being able to rely on either (Beck & Freeman, pg. 187).
The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32).
In Cognitive Therapy of Personality Disorders, Aaron T. Beck, Arthur Freeman, and associates (1990) have listed the typical beliefs associated with each of the other personality disorders. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." Here are some of the "possible expressions of early maladaptive schemas" (pg. 185), adapted from J. Young, that they have listed for Borderline Personality Disorder:
- No one would love me or want to be close to me if they really got to know me.
- I can't cope on my own. I need someone to rely on.
- I must subjugate my wants to the desires of others or they'll abandon me or attack me.
- People will hurt me, attack me, take advantage of me. I must protect myself.
- It isn't possible for me to control myself or discipline myself.
- I must control my emotions or something terrible will happen.
- No one is ever there to meet my needs, to be strong for me, to care for me.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed., text revision. Washington: Author.
Beck, Aaron T. and Freeman, Arthur M. and Associates (1990). Cognitive Therapy of Personality Disorders. New York : Guilford Press.
Beck, Aaron T. and Freeman, Arthur M. and Associates (2003). Cognitive Therapy of Personality Disorders, 2nd ed. New York : Guilford Press.
Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.
Gunderson, John G. (1989). Personality Disorders: Borderline Personality Disorder. Treatments of Psychiatric Disorders, Vol. 3.
American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.
McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.
Stone, Michael H. (1993). Abnormalities of personality: within and beyond the realm of treatment. New York: W.W. Norton.
Tamney, Joseph B. (2002). The Resilience of Conservative Religion. New York: Cambridge UP.
- Borderline Personality Disorder - Internet Mental Health.
- Health Center: Personality Disorders - Borderline
- Suite101.com Health: Mental Health: Borderline Personality - A. J. Mahari.
My experience with this topic is one of life experience. I
have lived with this all of my life. I have learned to cope
with it, to change and to grow through it, from it and because
- Borderline Personality: Functional and Structural Domain Descriptions - Theodore Millon.
- Dual Diagnosis and the Borderline Personality Disorder
- Psych Central: Borderline Personality Disorder Symptoms
- Mental Health Net - Borderline Personality Disorder Symptoms
- Borderline Personality Disorder Sanctuary
- Borderline Personality Disorder Articles - BPD Sanctuary.
- BPD Central
- Coping with BPD loved ones
- Linehan Training Group, Inc.
- Multidimensional Dichotomous Thinking Characterizes Borderline Personality Disorder
- An Overview of Dialectical Behaviour Therapy in the Treatment of
Borderline Personality Disorder
- McLean Hospital Psychiatric Update I:3 - A Promising Treatment for Borderline Personality Disorder
Dialectical Behavior Therapy, often referred to as DBT, is an empirically researched psychotherapeutic treatment developed by Dr. Marsha Linehan, Professor of Psychology,
University of Washington, for patients struggling with chronic suicidality, intentional self-harm and borderline personality disorder (BPD). This therapy, employing cognitive and
behavioral principles, is rapidly becoming a standard for treating borderline patients in both this country and abroad.
- Psychiatry Module 7: Transference/Counter-transference - Royal College of Physicians and Surgeons of Canada.
- To appreciate the ethical issues involved in the negative counter-transference to the borderline patient.
- To appreciate the psychiatrist's responsibilities in refusing to either hastily discontinue or arrange alternative therapy for a borderline patient.
- PubMed: borderline personality disorder/therapy AND (behavior therapy OR behavioral therapy)
- Borderline Personality Disorder - Concerned Counseling - Borderline Personality Disorder Conference.
- Borderline Personality Disorder - Diagnostic Issues - "Planning for borderline disorders must begin with diagnostic clarification. Misdiagnosis is common".
- Borderline Personality Disorder - slide presentation.
- Looksmart's Borderline Personality Disorder Links
- Open Directory - Health: Mental Health: Disorders: Borderline Personality Disorder
- Borderline Webring - members list.
- Borderline Personality Disorder Page - BPD Email Support List.
- Borderline Personality Disorder - one of the diagnoses associated with self-injury.
- Borderline Personality Disorder (BPD) - Dr. Ivan's Links.
- Novel approach offers hope for treating severe disorders - APA Monitor.
- Fact Sheet: Borderline Personality Disorder - Ask NOAH About: Mental Health.
- Google Search: borderline personality disorder
- Google Search: borderline.personality ~control