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What causes Borderline Personality Disorder and its definitions?
Linehan theorizes that borderlines are born with an innate
biological tendency to react more intensely to lower levels of stress
than others and to take longer to recover. They peak "higher"
emotionally on less provocation and take longer coming down. In addition,
they were raised in environments in which their beliefs about themselves
and their environment were continually devalued and invalidated. These
factors combine to create adults who are uncertain of the truth of their
own feelings and who are confronted by three basic dialectics they have
failed to master (and thus rush frantically from pole to pole of):
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vulnerability vs invalidation
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active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)
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unremitting crises vs inhibited grief.
Kernberg's Borderline Personality Organization
- Diagnoses of BPO are based on three categories of criteria. The first,
and most important, category, comprises two signs:
- the absence of psychosis (i.e., the ability to perceive reality accurately)
- impaired ego integration - a diffuse and internally contradictory concept of self. Kernberg is quoted as saying, "Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like."
The second category is termed "nonspecific signs"
and includes such things as low anxiety tolerance, poor impulse control,
and an undeveloped or poor ability to enjoy work or hobbies in a meaningful
way.
Kernberg believes that borderlines are distinguished from neurotics
by the presence of "primitive defenses." Chief among these
is splitting, in which a person or thing is seen as all good or all
bad. Note that something which is all good one day can be all bad the
next, which is related to another symptom: borderlines have problems
with object constancy in people -- they read each action of people in
their lives as if there were no prior context; they don't have a sense
of continuity and consistency about people and things in their lives.
They have a hard time experiencing an absent loved one as a loving presence
in their minds. They also have difficulty seeing all of the actions
taken by a person over a period of time as part of an integrated whole,
and tend instead to analyze individual actions in an attempt to divine
their individual meanings. People are defined by how they lasted interacted
with the borderline.
Other primitive defenses cited include magical thinking (beliefs that
thoughts can cause events), omnipotence, projection of unpleasant characteristics
in the self onto others and projective identification, a process where
the borderline tries to elicit in others the feelings s/he is having.
Kernberg also includes as signs of BPO chaotic, extreme relationships
with others; an inability to retain the soothing memory of a loved one;
transient psychotic episodes; denial; and emotional amnesia. About the
last, Linehan says, "Borderline individuals are so completely in
each mood, they have great difficulty conceptualizing, remembering what
it's like to be in another mood."
Gunderson's conception of BPD
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Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
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Repetitive self-destructive behavior, often designed to prompt rescue.
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Chronic fear of abandonment and panic when forced to be alone.
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Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
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Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman's statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).
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Impulsive behaviors that often embarrass the borderline later.
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Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.
The Diagnostic Interview for Borderlines, Revised.
Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:
1. Affect
- chronic/major depression
- helplessness
- hopelessness
- worthlessness
- guilt
- anger (including frequent expressions of anger)
- anxiety
- loneliness
- boredom
- emptiness
2. Cognition
- odd thinking
- unusual perceptions
- nondelusional paranoia
- quasipsychosis
3. Impulse action patterns
- substance abuse/dependence
- sexual deviance
- manipulative suicide gestures
- other impulsive behaviors
4. Interpersonal relationships
- intolerance of aloneness
- abandonment, engulfment, annihilation fears
- counterdependency
- stormy relationships
- manipulativeness
- dependency
- devaluation
- masochism/sadism
- demandingness
- entitlement
The DIB-R is the most influential and best-known "test" for diagnosing BPD. Use of it has led researchers to identify four behavior patterns they consider peculiar to BPD: abandonment, engulfment, annihilation fears; demandingness and entitlement; treatment regressions; and ability to arouse inappropriately close or hostile treatment relationships.
Miscellaneous attributes of people with BPD:
- People with BPD are often bright, witty, funny, life of the party.
- They may have problems with object constancy. When a person leaves
(even temporarily), they may have a problem recreating or remembering
feelings of love that were present between themselves and the other.
Often, BPD patients want to keep something belonging to the loved one
around during separations.
- They frequently have difficulty tolerating aloneness, even for short
periods of time.
- Their lives may be a chaotic landscape of job losses, interrupted
educational pursuits, broken engagements, hospitalizations.
- Many have a background of childhood physical, sexual, or emotional abuse or physical/emotional neglect.
Resources
Books:
- Marion Woodman
- Addicted to Perfection
- Owl was a Baker's Daughter
- Tsar Maiden with Robert Bly
- Any Marie Van-Franz
- Joseph Campbell
- The Hero with a Thousand Faces
- Myths to Live By
- Power of Myth
- Richard and Iona Miller
- The Modern Alchemist
- The Collected works of Carl Jung
- Christine Anne Lawson
- Understanding the Borderline Mother
Movies:
- YahYah Sisterhood
- Satr Wars
- Excalibur
- The Cell
- Postcards from the Edge
- Stephenwolf
- Finding Nemo
Web Pages:
- The Guide To Life
- In Depth Borderline Study allot was paraphrased from this site.
- Community style support page filled with stories and newsletter and sources
Yes, Borderline children have existed for all of time. Haven't you ever associated yourself with Cinderella,Snow White, against the witch or evil Step Mother. How about Pinnochio?