BORDERLINE PERSONALITY DISORDER

Perhaps no issue has had as profound an effect in my life as Borderline Personality Disorder (BPD). No I don't suffer from it myself, but I have known many people who either have the disorder, who I believe have the disorder, or who exhibit many of its traits. My interactions with them have had a profound effect on me, as they do on most who interact with a Borderline.

I believe that Borderline Personality Disorder - perhaps along with Narcissistic Personality Disorder - is the core disorder of our culture. We live in what Jerold J. Kreisman, M.D., author of I Hate You, Don't Leave Me: Understanding the Borderline Personality calls, "the borderline society". In the chapter of that name in his book (see a review I wrote about this book), he offers great insight into the factors that have led to this situation. Borderline is by far the most common personality disorder in our culture, and I believe it is so by an even greater degree than we realize due to the lack of understanding of it in the mental health community, leading to underdiagnosis. I believe often Borderlines are mistakenly diagnosed as Bipolar, for example.

So why do I feel Borderline represents the core disorder of our culture? For several reasons, many of which relate to the factors I consider essential for attaining health, and many of which are tenets of the philosophy of my personal coaching, consulting and training company, Emergent Associates, LLC:

• If health and healing is about finding win-win outcomes and reconciling false dichotomies, Borderline Personality is about lose-lose situations and generating double binds.
  
  
• If health and healing is about finding one's positive core, those assets, values and beliefs that are most true to one's self, Borderline Personality is about feeling a lack of any such consistent core and simply changing to adapt to any particular situation.
  
  
• If health and healing is about reconnecting (to the universe, to other people, to the lost parts of one's self) and interconnectedness, Borderline Personality is about a constant cycle of disconnecting and tearing apart close ties.
  
  
• If health is about healing the inner child, Borderline Personality is the epitome of an ongoing cycle of punishing and re-punishing the lost, lonely inner child.
  
  
• If health and healing is rooted in Erikson's first stage of developing trust in the universe, in others and in ourselves, Borderline Personality is the epitome of inability to trust and fear of abandonment.

DIAGNOSTIC CRITERIA FOR BORDERLINE PERSONALITY DISORDER (BPD)

While I am highly critical of the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition), the main book used by mental health professionals for identifying and diagnosing disorders, I believe that it is relatively accurate in its criteria for BPD. I do believe that the name of the disorder, which was so called because these individuals lie on the border between neurotic and psychotic states, is overdue to be changed to a more descriptive term such as Emotional Regulation Disorder or Dyslimbia.

Nonetheless, the DSM-IV defines Borderline Personality Disorder as "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."

The technical diagnosis of Borderline Personality Disorder requires that an individual display five or more of the following nine symptoms. Please note that not all nine symptoms must be present, which means that some BPD sufferers, for example, may not self-mutilate while others will and some may be violent and exhibit raging symptoms while others may in fact repress their anger. Requiring any five of these nine symtoms means that Borderline Personality Disorder comes in hundreds of different "flavors" consisting of different combinations of these traits.

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
   
   
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation .
   
   
3. Identity disturbance: markedly and persistently unstable self-image or 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). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
   
   
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
   
   
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).
   
   
7. Chronic feelings of emptiness.
   
   
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
   
   
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
   
   

TREATMENTS FOR BORDERLINE PERSONALITY DISORDER (BPD)

Borderline Personality Disorder has become known as a notoriously difficult condition to treat both due to the lack of effective therapeutic measures and the high level of resistance to treatment among clients with the disorder. There are mental health professionals who find the condition so frustrating that they simply refuse to work with such clients. I can understand this frustration, as the deep mistrust and misperceptions involved can indeed make attempts to relate with such individuals seem hopelessly unhealthy and doomed to failure.

However, both for the sake of the individuals themselves, as well as due to the profound impact that this condition has on our society and world on all levels, I believe it is imperative that we continue to seek new and more effective approaches to relating with such individuals, both in formal mental health settings, as well as in our personal relationships. In recent years, thankfully, there have been treatments that have shown relative promise in helping these clients improve in their emotional and interpersonal functioning. Some of those treatments that have interested me the most are:

• Schema Therapy
  
  
• Dialectical Behavioral Therapy

LEARN MORE ABOUT BORDERLINE PERSONALITY DISORDER (BPD)

Or Visit my Borderline Personality Disorder Bookstore for more selections.

RESOURCES FOR NONS

"Non" is a term referring to a person who is in a relationship of some kind with a person suffering from Borderline Personality Disorder. These are some resources where you can find support if you suspect someone you care about may have or exhibit traits of BPD.

• Stop Walking on Eggshells; Coping When Someone You Care about Has Borderline Personality Disorder by Paul T. Mason, Randi Kreger - One of the best books around on understanding and dealing with a person in your life who has BPD.
  
  
• The Stop Walking on Eggshells Workbook: Practical Strategies for Living With Someone Who Has Borderline Personality Disorder by Randi Kreger, James Paul Shirley - Companion to the Kreger and Mason classic.
  
  
• Understanding the Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship by Christine Ann Lawson - A book about the unique issues faced by those raised by a mother with BPD.
  
  
• Land of Oz - Relating to a Borderline can so twist your sense of reality and identity that it has been compared to entering another land - namely the Land of Oz. This site offers many resources and the Land of Oz Email List is for people who are coping with someone in their life who has borderline personality disorder (or traits of BPD or a similar disorder).
  
  
• BPD411.org - BPD411.org is an Internet -based information service and support group. Its purpose is to provide a safe environment for the education, healing and recovery of persons who are in a relationship with someone who exhibits traits of Borderline Personality Disorder (BPD). Its list of resources alone is enough to blow your mind if you've ever been close with a Borderline as it specifically names experiences you have probably had, but never been able to put a finger on.
  
  
• BPD Central - BPD Central is a list of resources for people who care about someone with borderline personality disorder (BPD). It is one of the oldest and largest sites about BPD on the web.
  
  
• BPDFamily.com - BPDFamily.com is a site devoted to providing education and emotional support to "family, friends, and relationship partners of individuals with borderline personality disorder, emotional regulation disorder, or emotional intensity disorder." I strongly suggest reading through the messages on its Message Board, where you'll read about the experiences of many people that will help you feel less alone.

BORDERLINE AND GIFTEDNESS

Borderline may have some correlations with "giftedness" as evidenced by the work of Lee Crandall Park, M.D., including:

• "The Gifted Borderline: An Heuristic Hypothesis for New Directions in Research", Department of Psychology, University of Texas, Austin, Texas, March 9, 1990.
• "Giftedness and Psychological Abuse in BPD", 145th Annual Mtng., Am. Psychiatric Assn., Wash. D.C., May, 1992.

OTHER RESOURCES RELATED TO BORDERLINE PERSONALITY DISORDER

• Essays on Borderline Personality Disorder - Intro page to a series of articles I've written on various aspects of Borderline Personality Disorder.
  
  
• All of my Blog Posts Tagged Borderline Personality Disorder
  
  
• National Education Alliance For Borderline Personality - NEA-BPD's mission is to "raise public awareness, provide education, promote research on borderline personality disorder, and enhance the quality of life of those affected." They offer many educational resources on and through their website, sponsor meetings and conferences and conduct and promote research.
  
  

Dr. Howard Ditkoff is a personal coach, group/organizational/business consultant and trainer through his company, Emergent Associates, LLC, which shares its unique knowledge, understanding and tools to support health in human systems of all types. Howard helps people discover and develop their deepest talents and potentials, bringing greater satisfaction to all areas of their lives, ranging from health to career to relationships, while helping groups, organizations and businesses of all kinds achieve greater success. For more information, or to contact Howard about setting up a Free Introductory Consultation, visit Emergent Associates, LLC's Website or email him.

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