Borderline Personality Disorder

People with this disorder display great instability,
including major shifts in mood, an unstable self-image, and impulsivity

• Interpersonal relationships are also unstable

• People with borderline personality disorder are prone to bouts of anger, which sometimes result in physical aggression and violence
  • Just as often, however, they direct their impulsive anger inward and harm themselves

Many of the patients who come to mental health emergency rooms are individuals with the disorder who have intentionally hurt themselves

• Their impulsive, self-destructive behavior can include:
• Alcohol and substance abuse
• Reckless behavior, including driving and unsafe sex
• Self-injurious or self-mutilation behavior
• Suicidal threats and actions

People with the disorder frequently form intense conflict-ridden relationships while struggling with recurrent fears of impending abandonment

Between 1% and 2.5% of the general population are thought to suffer from this disorder

• Close to 75% of those diagnosed are women

The course of the disorder varies

• In the most common pattern, the instability and risk of suicide reach a peak during young adulthood and then gradually wane with advancing age

How Do Theorists Explain Borderline Personality Disorder?

Because a fear of abandonment tortures so many people with the disorder, psychodynamic theorists look to early parental relationships to explain the disorder

• Object-relations theorists propose a lack of early acceptance or abuse/neglect by parents
• Research has found some support for this view, including a link to early sexual abuse

Some features of the disorder have also been linked to biological abnormalities, such as an overly reactive amygdala and an underactive prefrontal cortex

• In addition, sufferers who are particularly impulsive apparently have lower brain serotonin activity
• Close relatives of those with borderline personality disorder are 5 times more likely than the general population to have the disorder

A number of theorists currently use a biosocial theory, stating that the disorder results from a combination of internal and external forces

Some sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly

Treatments for Borderline Personality Disorder

It appears that psychotherapy can eventually lead to some degree of improvement for people with this disorder

• It is extraordinarily difficult, though, for a therapist to strike a balance between empathizing with a patient’s dependency and anger and challenging his or her way of thinking

Contemporary psychodynamic therapy has been somewhat more effective than traditional psychodynamic approaches when it focuses on the patient’s central relationship disturbance, poor sense of self, and pervasive loneliness and emptiness.

Over the past two decades, an integrative treatment approach, called “dialectical behavior therapy,” has received more research support than any other treatment for this disorder

• This approach grows largely from the cognitive-behavioral treatment model and borrows heavily from humanistic and psychodynamic approaches
• DBT is often supplemented by the clients’ participation in social skill-building groups

Antidepressant, antibipolar, antianxiety, and antipsychotic drugs have helped some individuals to calm their emotional and aggressive storms

• Given the numerous suicide attempts by these patients, their use of drugs on an outpatient basis is controversial
• Many clients seem to have benefited from a combination of psychotherapy and drug therapy

 

References:
Bernstein, D.A. & Nash, P.W. (2008). Essentials of psychology (4th ed.) Boston: Houghton Mifflin Company.
Comer, R.J. (2013). Abnormal Psychology (8th ed).  Worth Publishers
Diagnostic and Statistical Manual of Mental Disorders, (DSM-5) American Psychiatric Publishing, 2013
Feldman, R. (2013). Essentials of understanding psychology (11th ed.). New York, NY: McGraw-Hill.
Friedman, H.S. & Schustack, M.W. (2012), Personality: classic theories and modern research (5th ed). Boston: Pearson Allyn & Bacon.
McGraw-Hill.McGraw Hill Higher Education (2013), The McGraw Hill Companies, Inc.
Ryckman, R. M. (2013). Theories of personality (10th ed.). Mason, OH: Cengage Learning.
Sue,Sue, and Sue (2014).  Understanding Abnormal Behavior (10th Ed), Cengage Learning