What is Borderline Personality Disorder? What a dumb name and why should I care?
The term borderline was developed when psychoanalysis failed for a group of patients who did not have psychotic or neurotic symptoms. Put simply, borderline means on the border of psychotic and neurotic. This name does not speak to the real problem which really is a disorder that develops when an infant, toddler, child is neglected emotionally and or sexually physically abused. Such neglect leads a child’s inability to regulate feelings, self soothe, and tolerate any distress. While research has shown that predisposition to sensitivity, as well as brain abnormality could be behind some of the problems with emotional regulation, the studies are weak and are over ridden by evidence that supports emotional neglect and invalidating child hood environments as being key to developing borderline traits.
The expert and pioneer psychologist Marsha Linehan was the first person who came up with a treatment called dialectic behaviour therapy. While she did not take on the ridiculous name of the ” disorder,” she did very powerfully create strategies, and skills that address the major maladaptive behaviours within the borderline personality. Her treatment DBT (diabetic behaviour therapy) has shown to be so successful that many therapists now use dialectic skills training for all clients with complex trauma in their history.
The bottom line is borderline personality is a disorder that is the result of neglect during infancy particularly between the time of 0 – 24 mons. Beyond this time, neglect often leads to a child being vulnerable to any abuse whether this be sexual, physical or emotional. In the still face experiment, we observe that if a baby is neglected long enough, they will begin to dissociate which leads to a reinforced adaptation to distress, hence, this infant becomes an adult that struggles with dissociation when under stress. Combine this with zero skills on how to regulate emotions (because the parents were unavailable to mirror or validate emotions), and you have a child who grows up to become emotionally illiterate. Often for this person there are dramatic shifts between hyper arousal and hypo arousal within the nervous system, sometimes within hours. This can then lead to maladaptive ways of regulating the nervous system, like abusing substances, cutting behaviors, binge eating, and any behavior that will ease distress.
The following criteria identifies borderline personality
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. (Complex Trauma- which is repeated abuse over time or childhood trauma creates this i.e, my parents were not there for me in an emotionally meaningful way so why will you be different).
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Child hood neglect (which often leads to invalidating environments) creates a child who does not learn skills that are important to have meaningful relationships) Black and white thinking is an adaptive way of thinking in an abusive childhood. There was no grey. It was good or bad. My brain told me what I needed to know to survive my crazy environment! I see things in binary ways. Either you are good or bad.
(3) identity disturbance: markedly and persistently unstable self-image or sense of self ( I don’t know who I am because my parents did not reflect who I was back to me hence, I also do not understand my feelings or have a sense of self.
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating). (Regulating Behaviours or dissociative behaviours that helped me adapt to the insane environment I was brought up in.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior ( Regulating behaviours).
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) (Hyper or hypo arousal within the nervous system).
(7) chronic feelings of emptiness ( Neglect and invalidating environment creates loss of identity).
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) ( Hyper Arousal)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms ( dissociation as a way to self soothe) .
Crystal Arber CC 2015