What You Need to Know about Borderline Personality Disorder

Borderline personality disorder (BPD) is a long-standing psychological disorder in which a person lacks a clear sense of self-definition, has difficulty maintaining boundaries in relationships with others, and may engage in occasional acts of self-harm. It’s not easy to spot, and once you’ve had a relationship with a person who has this disorder, you may never feel the same way about yourself, or relationships, ever again. By the same token, if you have been diagnosed with this disorder, you know that relationships with others are one of your chief problem areas of life.

Unfortunately, there are media images of people with this disorder that reinforce its worst, and scariest, qualities. Alex, in the movie Fatal Attraction (the one who cooked her lover’s rabbit), is perhaps the most memorable. The young women in Girl, Interrupted (based on Susanna Kaysen’s remarkable book), also presented a view of people with this disorder that emphasized its most extreme qualities.

In case you’re wondering where the term came from, its origins can be traced to psychoanalysts who believed that people with certain chronic disturbances were at the “border” between neurosis and psychosis. In other words, they experienced such “neurotic” symptoms as anxiety and depression but also showed “psychotic” symptoms in which they seemed to lose touch with reality. The diagnosis of BPD was rather imprecise and based, in part, on the individual’s symptoms not fitting neatly into any particular category. As its use in psychiatry and psychology evolved, the diagnosis of BPD became more precise. However, therapists still continued to use BPD as a catch-all diagnosis, sometimes reserving it for their clients who were most resistant to treatment. In many ways, people with BPD were the clients that therapists loved to hate.

Part of the difficulty in dealing with clients who have BPD (however defined), is that these many of these individuals can be very sensitive to any signs of rejection by their therapist. They might storm out of a session if they believe that they’re not getting the right kind, or enough, attention. If their therapists announce that they’re going on vacation, the BPD clients might quit therapy in advance, so as not to be the ones who are left behind. Many theories about BPD were based on the notion that they suffered real, or imagined, abuse from their parents. Other clinical theories proposed that their mothers were too interfering in their lives to the point of suffocating their individuality.

As friends and lovers, people with BPD can present similar challenges. They may get very close, very fast. Once they sense that you’re retreating, they may become enraged at you, pursue you, or suddenly drop you entirely. The character Alex was an exaggeration, but in real life, a person with BPD may make your life quite difficult until the situation resolves itself.

There are ways to detect whether a potential partner has BPD, but because many people are below the threshold (a fact recognized in the upcoming DSM5), the signs may be tough to spot. Your best key may be one that has the technical term “counter-transference.” This sounds very psychoanalytic, and it certainly is where the term originated. However, in daily life, we experience counter-transference all the time. Here’s how it goes. Transference occurs when someone unconsciously “transfers” onto you the feelings they had about an important figure in their lives (often a parent). For example, they think you’re being critical of them when you’ve done nothing at all (transfering their insecurity onto you). In counter-transference, you react negatively to a person who, at a level below your conscious awareness, triggers problematic feelings within you. Without knowing why, you find yourself feeling uncomfortable.

Counter-transference can also lead you to act in uncharacteristic ways. The person with BPD may seem extremely enticing and desirable to you, and you feel like you’ve found your soul mate. You’re getting too close too fast, but you can’t stop yourself. By looking at your behavior and stopping yourself before you get in too deep, you might head off a relationship that will only create problems further down the road.

However, it’s important to recognize that people with BPD don’t want to make your life, or theirs, miserable. They don’t want the relationship to end badly, it just does. Research by Mount Sinai psychiatrist Antonia New and colleagues (2012) suggests that people with BPD have difficulties in understanding their own, and other people’s, emotions, in ways that land them in relationship trouble. 79 adults with BPD completed a questionnaire testing the fascinating term “alexithymia” meaning, simply, the inability to read emotions in others. Based on the premise that people with BPD have impaired social interactions, the research team decided to find out whether people with BPD could read the emotions of others compared to how they could read their own emotions. If people with BPD can feel, but not identify, emotions, this could provide clues to their problematic relationships with others.

The focus of the study was a task in which participants saw a series of pictures depicting people in various situations and rated what they believed the people in each picture were feeling. Then, looking at the pictures again, they were asked to imagine themselves in the situation and rate what they would feel.

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The findings showed that people with BPD (compared to healthy controls) were less able to identify feelings, but it was the feelings within themselves that gave them the most challenge. Their difficulty was in putting themselves into the situations, especially when the feelings depicted were negative. Unlike people with antisocial personality disorder, individuals with BPD can feel compassion toward others and even empathy. It’s their own inability to tolerate (and therefore think about) negative emotions that seems particularly disturbed.

These new results add to the scientific data on BPD which is bringing new light into understanding this complex and mysterious psychological condition. If you’re in a relationship with a person who has (or might have) BPD, the findings can help you understand the distancing that your partner may engage in when it comes to painful emotions. If you’re an individual who has this diagnosis, the findings point to a possible way that you can gain insight into your own experiences with negative feelings. By gradually acknowledging them, people with BPD may be able to accept not only these feelings but also gain greater self-awareness and acceptance.

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Copyright Susan Krauss Whitbourne, Ph.D. 2012

Reference:

New, A. S., Rot, M., Ripoll, L. H., Perez-Rodriguez, M., Lazarus, S., Zipursky, E., & ... Siever, L. . (2012). Empathy and alexithymia in borderline personality disorder: Clinical and laboratory measures. Journal Of Personality Disorders, 26(5), 660-675. doi:10.1521/pedi.2012.26.5.660