Perhaps no disturbance of personality is regarded with as much apprehension as borderline personality. And perhaps no personality disorder diagnosis is as feared — by lay persons and professionals alike — as Borderline Personality Disorder.
Borderline personalities have a fractured and unstable sense of self and can exhibit a wide variety of high risk behaviors, including extreme emotional volatility, self-injurious acts and gestures, and sometimes even breaks with reality. So helping folks with borderline personality disturbances achieve a more integrated, stable sense of self is a real challenge. Fortunately, with recent advances in both therapy techniques and medical interventions, the prognosis for helping borderline personalities lead healthier, happier lives has improved considerably.
Understanding the Syndrome
The term borderline is often misunderstood. Originally, the term was applied to individuals whose psychological functioning was thought to lie on the border between neurosis — a raging unconscious conflict between a person’s primal urges, or id, and superego, or conscience, producing anxiety and resulting in various maladaptive symptoms — and psychosis — a state of impaired reality testing resulting from a breakdown of neurotic defenses. However, while some individuals with borderline syndrome can indeed experience transient psychotic episodes, most professionals these days don’t conceptualize borderline personalities that way. Rather, most see the syndrome as the result of a failure of the person to successfully solidify a sense of self. Borderline personalities haven’t been able to integrate various aspects of themselves well and therefore lack a solid sense of identity.
Some of the Hypothesized Causes
Several things appear to contribute to borderline personality formation. Principal among these is trauma. While not all borderline personalities have significant abuse, neglect, or other trauma in their histories, many do. Among its other effects, trauma stunts growth. The great psychologist Erik Erickson suggested that we all go through distinct phases in our psychosocial development. We learn whether we can trust our environment to be supportive and nurturing or whether we need to be wary of things. We can gradually learn to be comfortable functioning on our own, or we can let shame and doubt about ourselves hold us back. There are other stages too, and to move successfully to the next stage it’s necessary to have resolved at least fairly well the issues involved in the stage before. But emotional, physical, or sexual abuse, or the experience of any other trauma or chaos can really impair a person’s ability to do that. So, by the time you’re supposed to be forming a solid sense of who you are (one of key stages Erickson talks about, usually mastered in adolescence), you can’t successfully do it because you’ve yet to master the stages preceding.
Many borderlines also seem to have innate difficulty modulating and moderating their emotions. For some, emotions can turn on a dime. Elation can change to dread within minutes. Or there can be a burst of anger that appears to come out of nowhere.
Borderline personalities also have a penchant for what some call dialectical thinking. That is, they’re particularly prone to seeing both sides of things and thinking in terms of polar opposites, which often makes it difficult for them to decide which way to go when it comes to resolving internal emotional conflicts. That kind of thinking, however, can also contribute to immense creativity. In times past, many would say they were prone to over-utilizing the defense mechanism of splitting. But most these days acknowledge this penchant for dialectical thinking, and some therapists have actually found ways to use this predisposition to their advantage, fashioning a specialized form of cognitive-behavioral therapy (CBT) called Dialectical Behavior Therapy (DBT).
Hope for Healing
For a long time, folks with borderline personality disturbances were regarded as virtually untreatable. Yes, you could manage some of the symptoms, but truly ameliorating the personality disturbance itself was thought highly unlikely. But like many other clinicians, I’ve found something surprising happening when I’ve dared to do what for too long many were hesitant to do: namely, focus like a laser beam on the core issue, the person’s fractured sense of self.
Not too long ago a young man with all of the troubling features of borderline personality disorder sought my help. He had experienced trauma not only in his childhood but also recently. As a result, he was truly fractured, displaying almost all of the highest risk behaviors, including volatile, intense, and easily shifting moods. I was apprehensive about being able to afford him the level of care I though he needed, but we agreed from the outset that all we would focus on in our work was his self-definition. In the process, every single issue that led to his difficulty doing that in the past surfaced, and we dealt with them, one by one. As is often the case with personality disturbances, it will be a long time before he is done with his work, but now he has a much more stable sense of who he is, and most of his troubling symptoms have decreased dramatically. He no longer has self-destructive thoughts. He doesn’t go into unpredictable and uncontrolled angry rages, so he didn’t even require the medications frequently needed to lessen mood swings. And he’s able to embrace all the mixed feelings and polar opposite thoughts he entertains. What he’s been doing in the process is slowly solidifying an identity — and one that both he and others can live with, at that. That is where the hope for healing often lies for borderline personalities: claiming a more integrated, healthy, and stable sense of self.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Dr Greg Mulhauser, Managing Editor on .on and was last reviewed or updated by