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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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Borderline Personality Disorder

Q: Dear Frank, We received an email asking what is Borderline Personality Disorder. Can you give us a short synopsis of this condition?

A: Dear Joyce, Diagnoses, particularly personality disorder diagnoses, tend to pigeon-hole people and diminish their complexity and humanity. Borderline Personality Disorder (BPD) certainly has been used by some mental health professionals to label rather than to explain. Let me do my best to explain what is intended and what can be learned about this complicated condition. First, borderline was intended, almost half a century ago, to be the boundary between psychosis and neurosis. Some people were observed to have difficulty managing anxiety (neurosis), but they also lost touch with reality (psychosis) when extremely distressed. Unlike persons suffering from schizophrenia or bipolar disorder, they were usually free of prolonged episodes of disordered thinking or of mood fluctuations. But they often had relatives who were diagnosed with these disorders (schizophrenia; bipolar). So some psychiatric researchers, particularly those who focused on biological issues, believed "borderline" was linked genetically to the spectrum of major disorders of thought and mood. Some "borderlines" are also "bipolar," less frequently, "schizophrenic."

Second, borderline, or BPD, appears to be driven by problems of attachment to the mother, beginning in late infancy or early childhood. The very first criterion for giving the diagnosis is "frantic efforts to avoid real or imagined abandonment." Therapists who follow Freudian and similar theories look for significant events in the early stages of life, formative events, and they place great weight on such life-shaping experiences.

In the case of BPD, these therapists believe that the little child, one and one half years to three years old, was separated, physically or emotionally from the mother, and there were no other sources of reliable comfort available. The child felt abandoned. The emotion was one of extreme fear and it turned into rejection of the mother. With child-reason, full of fantasy, the youngster began a fruitless search for ideal protectors (guardian angels) and became vulnerable to the second criterion of BPD: "a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation." I have been on the receiving end of this pattern, admired beyond reason then reviled with rage. Most therapists understand and tolerate borderline emotion, realizing it is based on child-like reason. Most unfortunately, this condition includes feeling dead inside. Some people with BPD will cut themselves, not because they are suicidal, but because they want to feel something real. Physical pain is, on occasion, preferable to feeling dead. Persons with BPD are confused about who they are and what their life really means.

Because BPD includes such intense emotion, interpersonal relationships are roller-coaster affairs and are very confusing, sometimes infuriating, to the partner. Violent abuse or insensitive rejection follows. Persons with BPD are often victims of trauma.

From the perspective of the therapist, this is a real challenge. Warmth and collegiality are misinterpreted as deep, personal friendship or as sexual signals. It is a mistake for a therapist to encourage anything but a professional relationship when treating a person with BPD. You have to keep boundaries clear with a borderline person.

It just helps to know that our biology and our earliest experiences may make us exquisitely sensitive to rejection from a parent-like person, setting us on a very difficult path of being drawn to such persons, seeking love in all the wrong places, then causing us to turn on the person we were once attracted to --attracted to for reasons that have more to do with our infancy than with current reality.

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Page created on 9 Febrruary 2010
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