Borderline Personality Disorder: A Primer

To raise awareness of this perplexing personality disorder, this article summarizes the essential aspects of Borderline Personality, including its aetiology, characteristics and possible treatments.

For a variety of reasons — some valid, some not so valid — it seems like Borderline Personality Disorder (BPD) is getting a lot of attention these days. But even with the plethora of information available from popular books, internet articles, and other sources, there are still many misconceptions about just what BPD is, how people come to have it, and what hope there might be for treating it. So, rather than possibly confuse folks even more about a topic already difficult enough to understand, I thought I’d present as concise as possible a summary of the nature of this unique type of personality dysfunction.

Personality disorders are a special kind of psychological abnormality. Personality is often defined as the distinctive and relatively enduring “style” a person develops of perceiving and relating to the world at large. And, as I mention in my book Character Disturbance, most researchers and clinicians these days adopt a multi-dimensional perspective of personality, recognizing that biological/constitutional factors, environmental/ learning factors, and a dynamic interaction between the two aforementioned factors all contribute to the development of each person’s “style” of relating. And while everyone has a distinctive personality of their own, there are several relatively common personality types that have long been recognized by the professional community, and with which most of us are familiar.

While our various distinctive styles or personalities are in part what makes each of us unique and interesting, sometimes the very way we tend to perceive things and relate to others causes problems. And when the nature of our personality creates distress at work, at home, in our relationships, etc., or perhaps even leads to other forms of psychological dysfunction, then it’s quite possible we have a personality “disorder.”

Borderline Personality Disorder is a most unique, perplexing, and often troublesome disorder. Some have called the condition a “disorder of the self.” That’s because individuals with the condition generally have a hard time developing and maintaining a comfortable and stable sense of personal identity. There are many stages of personality development a person has to successfully master to come to a sound and secure sense of self. But largely as the result of two factors: trauma (borderline personalities often have histories marked by significant childhood trauma) and impaired ability to regulate emotions (borderline personalities often have a history of unpredictable, erratic, and excessive emotional reactions) persons with BPD don’t pass certain key milestones successfully, making it hard for them to develop a healthy and enduring sense of self.

Unsure of who they are at the core, borderline personalities can present significant challenges to those with whom they are in relationship. They can, for instance, be inordinately emotionally dependent and “clingy.” And, as I mention in In Sheep’s Clothing, in their attempts to hang onto sources of support they inwardly fear they might lose, they can be quite manipulative. At the outset of a relationship, they might engage in rampant over-valuation of their partners, only to become hostile and vindictive when they perceive their partners fail to live up to the over-idealized picture they have painted. Dramatic, attention-getting, erratic, and self-destructive behaviors (e.g., substance abuse, self-mutilation, suicidal behavior) are very common. As a result, most relationship partners quickly feel the urge to run. But, sensing the potential for the one thing they dread the most: abandonment, the borderline personality is only likely to ‘up the ante,’ so to speak, with respect to manipulative behaviors. Given all this, relationships with borderline personalities are likely not only to be challenging, but also to be characterized by high degrees of intensity and instability. Perhaps this is what led Kreisman and Strauss to title their book on the subject I Hate You, Don’t Leave Me . A relationship with a person with BPD is destined to be an emotional roller coaster ride. And, generally speaking, unless the other party in the relationship is also psychologically unhealthy in some way, for all its intensity, a relationship entered into with a borderline personality is quite likely to be brief.

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While the main characteristics of BPD are fairly well-known, many mental health professionals, including myself, recognize that not all borderline personalities are alike. In fact, because they have such a poorly developed sense of personal identity, borderline personalities can often display features of a variety of different personality disorders. And, as I mention in Character Disturbance, depending upon which traits tend to be more dominant in their personality structure, the degree to which their character is impaired varies also. A borderline personality with prominent dependent personality traits is, for example, a very different type of individual to deal with than one with prominent antisocial or narcissistic characteristics.

Securing effective treatment for BPD is a considerable challenge. Because of the typical trauma-influenced developmental stage delays common in the histories of borderline personalities, psychoanalytic and/or other psychodynamic therapies have demonstrated renewed utility. And possibly because of their great penchant for dialectical thinking and perception, a unique kind of cognitive-behavioral therapy called Dialectical Behavior Therapy (DBT) has also shown promise in treating borderline personalities. Still, the very nature of the disorder makes effective therapeutic intervention difficult. So generally, multi-pronged approaches are employed, using medications to help stabilize mood, firm behavior contracting to mitigate the risk of self-destructive behavior, and providing various psychotherapies to assist in the development and shoring-up of a healthier and more stable sense of self.

During my years of active practice as a therapist, I encountered many individuals struggling to forge a healthy sense of self. Fortunately, in some cases, intervention came early enough, lasted long enough, and provided sufficient support to help these individuals work through the trauma that had been impairing their growth, learn sufficient self-regulatory skills, discover and embrace who they really were, and claim a healthier life for themselves. But for others, the story did not have such a happy ending. And it will likely be considerable time yet before we have sufficient understanding of, as well as adequate intervention for, Borderline Personality Disorder to provide full healing and health for those afflicted with the condition.

Suffice it to say that there’s a whole lot more that could be said about Borderline Personality Disorder. But hopefully, I’ve provided enough of the essential aspects of this condition in a digestible enough way to raise awareness about a condition that so significantly impacts the lives of those who encounter it. Still, you might look for a few additional articles on this general topic in the coming months.

• character disturbance
• personality disorders