Concepts Behind Borderline Personality Disorder

Borderline Personality Disorder is one of the most controversial diagnoses in psychiatry today. Since first being in the Diagnostic and Statistical Manual (DSM), psychiatrists have been trying to give the somewhat vague concepts behind Borderline Personality Disorder in a concrete form.
In this article, we will set forth the concepts of Borderline Personality Disorder as discussed by Herman, Linehan, Kernberg, and Gunderson.

Some researchers, such as Judith Herman, believe that Borderline Personality Disorder is a name given to a particular manifestation of Post-Traumatic Stress Disorder: in Trauma and Recovery. She theorizes that when PTSD takes a form that heavily emphasizes its elements of identity and relationship disturbance, it then gets called Borderline Personality Disorder.

Marsha Linehan has developed a form of therapy called Dialectical Behavior Therapy specifically for use with Borderline Personality Disorder. She theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than non-borderlines and to take longer to recover. They peak higher emotionally on less provocation, and take longer coming down. In addition, she believes, they were raised in environments in which their beliefs about themselves and their environment were continually devalued (invalidated).

These factors, according to Linehan, combine to create adults who are uncertain of the truth of their own feelings and are confronted by three basic “dialectics” that they have failed to master (and thus rush frantically from pole to pole of): vulnerability vs. invalidation; active passivity vs. apparent competence; and unremitting crises vs. inhibited grief. Dialectical Behavior Therapy tries to teach clients to balance these things by giving them training in skills of mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.

Kernberg's Borderline Personality Organization (BPO) diagnoses are based on three categories of criteria. The first, and most important, category comprises two signs: the absence of psychosis, and impaired ego integration. The second category is termed "nonspecific signs" and includes such things as poor impulse control, low anxiety tolerance, and an undeveloped or poor ability to enjoy work or hobbies in a meaningful way.

Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Most important among these is “splitting,” whereby a person is seen as “all good” or “all bad.” Also, that borderlines have problems with object constancy in people; in that they read each action of people in their lives as if there were no prior context; they don't have a sense of consistency and continuity about people in their lives. In other words, people are defined by how they last interacted with the borderline.

Other primitive defenses cited by Kernberg include: magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others and projective identification, a process where the borderline tries to elicit in others the feelings he/she is having.

Kernberg also includes as signs of BPO: chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; denial; transient psychotic episodes; and emotional amnesia.

Gunderson is a psychoanalyst who is respected by researchers in many diverse areas of psychology and psychiatry. His focus tends to be on the differential diagnosis of Borderline Personality Disorder. Following is Gunderson's criteria in order of their importance:

• Intense unstable relationships in which the borderline always ends up getting hurt.
• Repetitive self-destructive behavior, often designed to prompt rescue.
• Chronic fear of abandonment and panic when forced to be alone.
• Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
• Hypersensitivity, meaning an unusual sensitivity to nonverbal communication.
• Impulsive behaviors that often embarrass the borderline later.
• Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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