Borderline Personality Disorder

The word personality refers to a complex of attributes that determine how a person behaves in the world. According to the American Psychological Association “ Personality is the combination of behavior, emotion, motivation, and thought patterns that define an individual. Personality psychology attempts to study similarities and differences in these patterns among different people and groups.”

Some researchers believe that humans are born with a set of attributes that are uniquely blended to produce the individual personality. This theory is supposed in the Myers-Briggs Type Indicator ® personality inventory. Other researchers believe that when an individual with their innate personality is born into a certain environment, perceptions are formed. These perceptions define how a person perceives him or herself, how they perceive others and how they perceive the world, be it a safe place or a dangerous place. These perceptions may be called “first cause” with the “effect” being a pattern of thinking that drives emotions and behaviors.

A person described by others as having positive personality attributes including energetic, friendly and humorous may experience a happy safe world filled with meaningful relationships. Conversely a person described by others as having negative personality attributes including moody, mistrusting and angry may experience a dangerous world filled with unstable conflicted relationships. The number of negative attributes and their severity determine if the individual has a personality disorder.

Psychologists have identified clusters of maladaptive behaviors that define certain personality disorders including but not limited to Obsessive Compulsive Personality Disorder (preoccupation with rules, orderliness and control), Narcissistic Personality Disorder (inflated sense of self and self importance) and Borderline Personality Disorder. This article will focus on Borderline Personality Disorder or BPD.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders describes BPD as follows (condensed and paraphrased): Unstable interpersonal relationships, self-image and impulsivity beginning at early adulthood and marked by five of the following.

1. Avoidance of real or imagined abandonment
2. Unstable interpersonal relationships
3. Unstable self image
4. Self damaging impulsivity including substance abuse
5. Suicidal gestures or self-mutilating
6. Irritability and anxiety episodes
7. Feelings of emptiness
8. Difficulty controlling anger
9. Stress related paranoia

The causes of BPD maladaptive behaviors are the subject of continuing debate. However many researchers point to three possible influences: 1) genetics 2) parenting 3) peer influences. Genetic researchers are seeking to identify genes with a relationship to fear, aggression and anxiety as these three attributes are foundational for most personality disorders. Childhood trauma offers clues that link the experiences of a child with their adult propensity to develop personality disorders including BPD. Childhood trauma includes verbal abuse as children who were screamed at, told they were not loved or were threatened with abandonment were three times more likely to develop personality disorders including BPD.

Therapy may improve and even cure BPD. It may be a difficult process since BPD patients are mistrusting, including mistrust of their therapist, and are prone to drop out of therapy. However a professionally trained therapist can help the patient reshape their world view by recognizing the underlying reasons for their pain. Severe and intense mood swings may be minimized through awareness of the condition and mindfulness. The patient can be taught to manage and communicate anger in a non-harmful manner. Finally a therapist may help redefine a patient’s self image. Self defeating beliefs such as “I have no value or I am bad or I am helpless” can be reshaped through practice, patience and commitment to transform problematic behavior to healthy behavior.

Dr. Jeffrey S. Ditzell is a Diplomate of the American Board of Psychiatry and Neurology. Dr. Ditzell enjoys practice as a General Adult Psychiatrist working in Private Practice in New York City. Dr. Ditzell’s depth and breadth of clinical experience is unique, having served as the Chief of an inpatient Dual Diagnosis Unit, as the lead attending in two Psychiatric ER’s, and as the Lead Physician of an Assisted Community Treatment team. Dr. Jeffrey Ditzel is a Adult ADHD Psychiatrist in New York City.