Mental health articles

borderline personality disor The diagnosis of borderline personality disorder refers to a severe disturbance
of personality function with a range of identifiable features, rather than a
description of a person with challenging behaviours. Borderline personality
disorder is characterised by disturbed attachment relationships, impulsivity,
poor anger control, mood instability and self-defeating behaviours that impair
social functioning and cause individual distress. People with borderline
personality disorder shift rapidly between trying to be too close in relationships
(idealising) and rejecting contact (devaluing). This behaviour is detrimental to
all interpersonal relationships and reflects a deficit in the person’s sense of self
and identity. The person may over-identify with others in an attempt to anchor
herself, but then become anxious and overwhelmed by this intimacy. This
unstable sense of identity is unpleasant and disturbing to the sufferer and may
result in substance abuse and self-harm as a way of attempting to manage
negative feelings (APA, 2001). The term ‘borderline personality disorder’ is
often used as a general term to refer to severe personality disorder.
As the following vignettes show, people with borderline personality disorder
can experience extreme frustration in trying to get appropriate help and to have
their problem recognised.
Each day is hard to determine what it will be like. Some can be great, depending
on what goes on (just like everyone else), but little things can set you off even if
you start out OK. Little things can turn it into a nightmare. I would find I might
be working and someone will say something to me that upsets me; a little criticism
perhaps, and I will think, ‘I hate them’, hate the job and think about leaving on the spot when really it was over nothing and could easily be resolved. I have had
a shocking childhood with feeling rejected and worthless. I have had difficult
relationships, one with abuse, one with an alcoholic, and just many failed ones due
to their being very wrong and I just was with them for fear of being alone. I’ve
lost boyfriends because I’ve pushed them away with my behaviour. I’ve had many
lost jobs, been fired and quit many times, and feel very unsure of my future in
terms of what I want to do. All in all it makes you feel very scared and confused.
At times I feel like I’m almost on the edge of insanity and even now think of
suicide regularly. I have attempted that a fair few times in my life. Sometimes for
attention but other times for just a way out and as a cry for help. (Jodie, 35.)
I’ve had a lot of people say it’s an excuse I use in life to not work and that things
that go wrong in my life are because of me, not it. I find not many people have
heard of it and those that have either have their own reasons for what they believe,
that is, a label for many people that are hard to diagnose. I’ve come across many
counsellors and GPs that haven’t heard of it. I even had a GP ask me to explain
to him what it meant—very confusing and humiliating, really, because I could tell
he found it hard to believe. My own parents, who I believe caused this, deny that
I have a problem but use this term in my face if I say something about anything
they don’t like me talking about. If I get upset my mother will say, ‘Oh Ben, that’s
just your illness talking’.
The DSM-IV criteria define borderline personality disorder as a severe disturbance of
personality functioning characterised by affective dysregulation, identity problems,
poor impulse control and persistent difficulties in interpersonal functioning (APA,
1994).There is probably a larger group who do not meet these criteria but who still
have significant interpersonal difficulties and problems in parenting and may be
described as having ‘borderline traits’. In community samples, up to 4 per cent meet
the criteria for borderline personality disorder and in clinical samples, up to 25 per
cent (APA, 2001). Significantly, in clinical samples, up to 90 per cent recall
traumatic early experiences and report sexual and emotional abuse that occurred in
the context of disturbed relationships with caretakers (Ogata et al., 1990).
As in many other disorders, a number of aetiological factors appear to
contribute to the development of borderline personality disorder including
genetic/neurobiological, family environment and personality/cognitive factors
(Trull, Stepp & Durrett, 2003). (An integrated model has been outlined by
Hoffman-Judd and McGlashan, 2003.) The majority of individuals with severe
personality disorder have experienced multiple adversity and failure of the
caretaking environment. Abuse and early trauma, particularly during the infant period, disrupt the crucial brain pathways needed for control of impulses and
emotions and for an understanding of social relationships (see Chapter 10).
Severe personality disorder involves disturbances of self and relationships
and the ability to maintain stable attachments. These individuals have
maladaptive coping styles and are often seen as ‘difficult’ or self-defeating. They
may experience current and ongoing distress related to early trauma similar to
Post-Traumatic Stress Disorder. All have features that affect parenting capacity.der symptoms dsm