Borderlines are characterized by their unstable relationships and emotional reactions. Everything about them seems frantic, chaotic, and impulsive. They swing rapidly from adoration to hatred within minutes and seemingly without provocation. The very construct and term borderline personality has remained controversial throughout the years and has produced an extensive literature with each new incarnation.
Given the severity of this disorder, it is difficult to imagine a normal variant of the borderline, but indeed there is such a thing. Oldham and Morris (1995) describe the mercurial style, who always need to be in a passionate relationship, possess an urgency to their closeness, and have a roller coaster kind of life, usually processing life emotionally rather than logically. Normalizing DSM-IV criteria also gives us a more normal variant that may be very sensitive to anything that may impact their relationships or sensation seeking, but in a way that enriches their life, not destroys it.
The borderline overlaps with many other personality styles and has some interesting variations. The discouraged borderline is mixed with aspects of the dependent or avoidant personality, who attaches to usually just one or two significant others. The impulsive borderline is a mixture of histrionic or antisocial traits and often becomes extraordinarily behaviorally hyperactive. The petulant borderline is a blend of negativistic features and may never get their needs met or feel insecure in their attachments. The self-destructive borderline is peppered with masochistic traits that cause them to turn their destructive feelings inwards on themselves.
Intuitively, it seems logical that the borderline must possess some fundamental temperament of high emotional reactivity that disposes them to the intense and volatile relationships that later develop. A "cyclothymic temperament" has been suggested as a possible biological predisposition to developing the borderline personality. Other researchers have been exploring a link between borderline personality and certain neurotransmitters.
Freud identified patients who were not psychotic but were resistant to his type of therapy. Stern later characterized these types as a "borderline group of neuroses." These patients often projected internal anger to sources in the environment. Later analysts believed borderline personality was more than a blending of neuroses and psychoses. In the 1950s, the term borderline began to be applied to people whose normal ego functions were severely weakened by traumatic events and pathological relationships. As a result, aspects of the self may fuse with aspects of others. Borderlines develop a split between good and bad images of things, forming two separate identification systems, hence facilitating a rapid fluctuation between adoration and hatred toward the same object. Since this formulation, the object relationists have dominated the discussion of borderline personality in dynamically oriented circles, including Masterson and Adler.
Interpersonally, borderlines are characterized by their stormy relationships with others. They are famous for their adoration of and intense emotional connection with a partner and then rapidly changing to hatred and resentment. They seem to sabotage their relationships with the chaos they bring to every relationship. Their intense fear of abandonment distorts their perceptions of the actions and communications of others. Depression, suicide ideation, and suicide attempts are a natural outgrowth of the kinds of dynamics that play out for the borderline. Benjamin's SASB model cites four features that lead to the development of borderline personality: family chaos; traumatic abandonment; family values that thwart autonomy, expressions of happiness, and accomplishment and encourage dependency and misery; and a family that offers nurtur-ance only when the individual is miserable.
Cognitively, borderlines can be described as fluid. The degree of fluidity usually depends on the quality of their relationships and with the amount of structure in the task to be performed (i.e., solid attachments make for better judgment). Their cognitions may also be characterized by their split object-representations, often leading to their seemingly paradoxical behaviors. Dichotomous thinking also seems to be present in the borderline, which may help account for much of the rapid change in behaviors and affective expression. Other cognitive characteristics of the borderline have led some to assert a connection between PTSD and the borderline personality.
An evolutionary neurodevelopmental synthesis provides a well-developed theory of the borderline. Linehan sees borderlines as primarily a problem of emotion regulation that leaves them vulnerable not only to be quickly aroused but also slow to cool down. Developmentally, Linehan believes that the child with a "difficult temperament" meets an "invalidating environment" that punishes and trivializes the child for his or her emotions; thus, the child fails to learn to label experiences accurately and trust his or her feelings. Millon argues that the structure of modern society fails to provide opportunities for children to have a "second chance" to develop healthy attachments if their parents fail to provide this necessary element. Borderlines fail to attach to any polarity, signifying their profound ambivalence and lability. From this perspective, it has been argued that the borderline personality is pathological with respect to the level of personality integration.
Although many borderline patients first present as relatively healthy individuals, they promptly become difficult and complex to treat. Often revealed in the course of therapy is their inherent inclination to developing depressive symptoms as well as somatic symptoms, substance abuse, and eating disorders. They often recreate their chaotic patterns in interpersonal relationships with the therapist and constantly try to overrun the therapist's personal boundaries. The therapist must also be aware of comorbid personality disorders and be savvy of the borderline's attempts at manipulation. One of the most critical goals in therapy is to bring calm to the borderline's chaotic relationships. Their dichotomous thinking must also be addressed but is complicated by their position of general mistrust. It is generally believed that supportive therapy only serves to perpetuate the pathology and that a more confrontive therapy should be more effective. However, this often incites the borderline to quit therapy. Hence, some combination of providing consistent support to build a therapeutic relationship and a gentle and thoughtful confronting will provide the best results.
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