The Evolutionary Neurodevelopmental Perspective

In terms of the evolutionary model that unifies this text, borderlines fail to attach themselves strongly to any single polarity. This is signified by their intense ambivalence and inconstancy, emotional lability, behavioral unpredictability, identity diffusion, and tendency to swing from one position or opinion to its opposite. Many readers will assert that, because a personality consists of traits that endure across time and situation, the borderline's lack of consistent traits across time and situation nullifies its classification as a personality disorder. Moreover, it might be argued that because the DSM borderline is defined as much by its symptoms (i.e., self-mutilation) as by its personality traits, as well as containing diagnostic criteria that resonate highly with other personality disorders, it is rarely diagnosed as a personality disorder standing on its own. Finally, they might point out that from the psychodynamic perspective, where the construct was born, the borderline is only a level of personality organization (Kernberg, 1967, 1984, 1985a) that explicitly requires one or more other personality diagnoses for its content. Accordingly in their view, the term borderline makes more sense as a modifier that distinguishes, for example, a well-integrated, neurotic-level histrionic personality (which psychodynamic clinicians would refer to as a hysteric character) from the more emotionally labile infantile histrionic.

We can, however, venture a broader conception, one that argues that the borderline is necessary to the taxonomy of personality disorders, without committing a part-whole fallacy of deriving the construct from a single perspective on personality or simply grafting it to the classification system because it seems pragmatic. Although the preceding criticisms have merit, the integration of personality is only an abstract, academic, idealized conception. Just as individuals differ in terms of the extent to which they resemble a single personality prototype, they differ in the extent to which the elements of their personality are tightly or loosely interwoven. Because the normal personality is well integrated by definition, its elements function harmoniously together. Here, the very notion of personality domains, such as cognition or defense, destroys the whole by reducing the person to parts and making the parts the primary focus of attention.

We have previously argued that valid taxonomies of personality cannot be derived from any single perspective exactly for this reason: A part is no substitute for the whole and cannot function in place of the whole. We may talk about personality from the perspective of cognitive styles or object relations or biology, but we do so with the understanding that every perspective starts with assumptions that both reveal and conceal. The assumptions giveth, and the assumptions taketh away. Eventually, it becomes necessary to return to a more holistic conception or lose something ineffable, the total organization of behavior that is personality. And this is what is lost in the borderline.

By this reasoning, the borderline emerges as a pathology in the level of personality integration, but one not confined to psychodynamic conceptions. In Chapter 1, we noted that in an idealized causal model of personality, every domain of personality influences every other domain, lending the whole the emergent tenacity that makes personality both more than the sum of its parts and personality disorders notoriously difficult to treat. Psychodynamic defenses, interpersonal interactions, cognitive styles, and biological variables interact to form a single, interwoven, dynamic system. Otherwise, it would not be possible to speak about personality at all. By this reasoning, the borderline is, necessarily, characterized by looseness and fluidity, by moments when one part of the personality, or some particular concern, seems to seize control of the whole and then is suddenly usurped by another. The consequence is rapidly shifting emotions and a chain of impulsive behaviors that appears poorly orchestrated or even arbitrary.

As a pathology of the total integration of personality, the borderline construct might be applied to almost any personality disorder. Clinical experience suggests, however, that dependent, histrionic, narcissistic, antisocial, and negativistic personalities are more frequently found in conjunction with a borderline diagnosis. Whatever the actual content, such individuals follow one of two developmental pathways. In the first, the personality develops a significant level of integration but breaks down under conditions of persistent environmental stress. In the second, no significant level of integration develops. Those following the first pathway are best referred to as borderline histrionics, for example, letting borderline modify histrionic; and those following the second pathway might be referred to as dependent borderlines, indicating that the consequences of a lack of integration swamp the contribution of personality traits to organized behavior. Whatever the case, the common feature across borderline personalities is a looseness of organization or looseness of internal regulation and lack of coordination of behavior to environmental exigencies, most easily observed in impulsive action, rapidly changing emotions, and suddenly shifting appraisals. This conception should be distinguished from the DSM borderline, the primary focus of this chapter. A summary of the borderline personality in terms of the eight clinical domains is given in Table 14.2. The following brief summary of the developmental experiences of the subvariants of the defectively structured borderline personality may be supplemented by reference to prior chapter discussions of their more basic personality styles.

Self-destructive and discouraged borderline types perpetuate their plight by abdicating self-responsibility and clinging tenaciously to others. This places them in a most vulnerable position since they are increasingly devoid of capacities for autonomy, and they find themselves viewed with exasperation by those on whom they depend. Failure to achieve support from others may lead either to marked self-disparagement or to frenetic efforts to solicit attention and approval. These erratic behaviors and mood swings foster increased inner disharmony and maladaption, resulting in the loss of intrapsy-chic control and consequent brief psychotic episodes.

The skillful seductiveness of the impulsive (histrionic) borderline may not only foster new difficulties but also falter as an instrumental strategy. These personalities not only are shallow and capricious but give little in return for their subtle though excessive demands on others; as a result, they are unable to establish enduring close relationships. Furthermore, because of their exteroceptive orientation and their intrapsychic repressions, they fail to acquire inner resources from which they can draw sustenance. As a consequence, they are always on unsure footing, constantly on edge and never quite sure that they will secure the attention and esteem they require from others. Anxious lest they be cut adrift and left on their own, they proceed through cyclical swings of simulated

TABLE 14.2 The Borderline Personality: Functional and Structural Domains

Functional Domains

Structural Domains

Spasmodic

Uncertain

Expressive Behavior

Displays a desultory energy level with sudden, unexpected, and impulsive outbursts; abrupt, endogenous shifts in drive state and inhibitory controls; not only places activation and emotional equilibrium in constant jeopardy, but engages in recurrent suicidal or self-mutilating behaviors.

Self-Image

Experiences the confusions of an immature, nebulous, or wavering sense of identity, often with underlying feelings of emptiness; seeks to redeem precipitate actions and changing self-presentations with expressions of contrition and self-punitive behaviors.

Paradoxical

Incompatible

Interpersonal Conduct

Although needing attention and affection, is unpredictably contrary, manipulative, and volatile, frequently eliciting rejection rather than support; frantically reacts to fears of abandonment and isolation, but often in angry, mercurial, and self-damaging ways.

Object-Representations

Internalized representations comprise rudimentary and extemporaneously devised, but repetitively aborted learnings, resulting in conflicting memories, discordant attitudes, contradictory needs, antithetical emotions, erratic impulses, and clashing strategies for conflict reduction.

Capricious

Split

Cognitive Style

Experiences rapidly changing, fluctuation, and antithetical perceptions or thoughts concerning passing events, as well as contrasting emotions and conflicting thoughts toward self and others, notably love, rage, and guilt; vacillating and contradictory reactions are evoked in others by virtue of behaviors, creating, in turn, conflicting and confusing social feedback.

Morphologic Organization

Inner structures exist in a sharply segmented and conflictual configuration in which a marked lack of consistency and congruency is seen among elements; levels of consciousness often shift and result in rapid movements across boundaries that usually separate contrasting percepts, memories, and affects, all of which lead to periodic schisms in what limited psychic order and cohesion may otherwise be present, often resulting intransient, stress-related psychotic episodes.

Regression

Labile

Regulatory Mechanism

Retreats under stress to developmentally earlier levels of anxiety tolerance, impulse control, and social adaptation; among adolescents, is unable to cope with adult demands and conflicts, as evident in immature, if not increasingly infantile, behaviors.

Mood/ Temperament

Fails to accord unstable mood level with external reality; has either marked shifts from normality to depression to excitement, or has periods of dejection and apathy, interspersed with episodes of inappropriate and intense anger, as well as brief spells of anxiety or euphoria.

Note: Shaded domains are the most salient for this personality prototype.

Note: Shaded domains are the most salient for this personality prototype.

euphoria in which they seek to solicit the attention they need and periods of brooding dejection, hopelessness, and self-depreciation. When their dread of desertion reaches monumental proportions, they lose all control and are swept either into a chaotic and manic cry for help or into a deep and intransigent gloom.

Petulant borderlines themselves create inconsistency by their own vacillations, unpredictability, unreasonableness, sullenness, and revengeful nature. Because they have learned to anticipate disappointment, they often jump the gun, alienating others before being subjected to alienation. Moreover, their tensions keep churning close to the surface, leading them to act petulantly, impulsively, and precipitously. Their lack of controls results in endless wrangles with others and precludes their achieving the affections they so desperately seek. Dejected, angry, and pessimistic, they may periodically become violent, exploding with bitter complaints and recriminations against the world or, conversely, turn against themselves, become self-sacrificing, plead forgiveness and contrition, and reproach and derogate their self-worth.

Broad and pervasive sociocultural forces may also play a significant role in the development of all of the borderline personality patterns. This is likely to be found where a society's values and practices are fluid and inconsistent, such as appears increasingly prominent in current Western societies, notably the United States.

An amorphous cultural state, so characteristic of our modern times, is clearly mirrored in the interpersonal vacillations and affective instabilities that characterize the borderline personality. Central to our recent culture have been the increased pace of social change and the growing pervasiveness of ambiguous and discordant customs to which children are expected to subscribe. Under the cumulative impact of rapid industrialization, immigration, mobility, technology, and mass communication, there has been a steady erosion of traditional values and standards. Instead of a simple and coherent body of practices and beliefs, children find themselves confronted with constantly shifting styles and increasingly questioned norms whose durability is uncertain and precarious (Millon, 1987). And yet, because the borderline personality is so clinically common, yet so clinically problematic and complex in its understandings, it is not surprising that biosocial models of the borderline personality are perhaps better developed than for any other personality disorder. Linehan (1993) sees the disorder primarily as a problem of emotional regulation, which involves both emotional vulnerability and the inability to regulate emotional states. Borderlines not only are sensitive to a broad range of emotional stimulation but also react quickly and intensely and take a long time to cool down, meaning that they are easily provoked again. Intense emotional states thus become chronic and self-perpetuating. What is at issue, however, is what developmental factors promote these adult characteristics. As Linehan explains, the regulation of emotion requires that the individual first learn to accurately label emotional states and then deal with the emotional associations these states bring to mind.

Perpetually wrought with the implicit dissonance of dueling forces, the adult borderline represents what happens when the "difficult temperament" (Thomas & Chess, 1977) meets an "invalidating environment," described in detail by Linehan (1993):

Rather than mirror and validate the child's personal experience of the world, the invalidating environment punishes and trivializes. First, it tells the individual that she is wrong in both her description and her analyses of her own experiences, particularly in her views of what is causing her own emotions, beliefs and actions. Second, it attributes her experiences to socially unacceptable characteristics or personality traits. (p. 49)

Rather than recognize and validate personal experience, the environment projects its own emotions, motives, and characteristics onto the future borderline. Linehan (p. 50) gives the examples, "You are angry, but you just won't admit it," and "When she says no, she means yes." At the same time, actual negative emotions are long-standing negative dispositions, such as overreactivity or hypersensitivity. Again, it is the individual who is wrong. Finally, failure is also attributed to negative traits, such as lack of discipline or laziness. To sum up Linehan's view, the developmental environment not only emits erratic and random communications that fail to understand the borderline as a unique individual with genuine potentials but also concurrently dispenses the unending message, "You are bad." Some of this is seen when Georgia, the borderline mom, recalls her own mother saying repeatedly, "I should have abandoned you when I realized what a lousy kid you were."

The consequences of this development pattern are severe. Without adequate mirroring and validation, subjects cannot learn to label their private and emotional experiences accurately, they cannot develop realistic life goals, they cannot develop expectations about what normal interactions might be like, and they cannot learn to interpret their own reactions as valid. Moreover, because their invalidating environment cannot tolerate the expression of negative emotions, borderlines learn that intense displays are necessary if any response is to occur. Family types that engender a borderline personality include the chaotic family, riddled with substance abuse, parental absence and neglect, and a general soap opera lifestyle (Benjamin, 1996), as well as the perfect family, which cannot tolerate negative emotional displays and cannot understand why children cannot simply control their feelings. See Linehan (1993) for a discussion of broader biosocial factors that indirectly contribute to the development of the borderline personality, including sexual abuse and the role of cultural ideals in the lives of women.

Although the family forms the proximal environment in which temperament and the forces of socialization interact, other authors have recognized the sociocultural environment as a powerful but indirect influence on personal development. As noted by Paris (1994b), society varies in terms of its level of integration over time. Individuals who grow up in an integrated society are protected somewhat from developing borderline traits. In contrast, those who grow up in the context of a disintegrating society are more frequently led down pathways that encourage borderline behavior. Our own society, he argues, expects the individual to function independently even while levels of social support and efforts to contain deviant behavior are decreasing. The net effect is an increase in impulsiveness, substance abuse, and, ultimately, other behaviors characteristic of the borderline, such as self-mutilation and suicidal gestures.

Similarly, Millon (1987) holds that traditional societies provide experiences with other persons and institutions that offer some protection against the influence of early abuse within the family. Today, however, the extended family is less coherent, and children have less contact with aunts, uncles, and grandparents—thus diminishing the opportunity of a second chance to develop healthy attachments that might supplant or heal wounds at the hands of parents or siblings. Similarly, the role of traditional institutions, such as church and school where concepts of beliefs, values, and proper conduct are emphasized in conjunction with academic lessons, has decreased. The result is a society as diffusive and fluid as the borderline personalities it creates.

Contrast with Related Personalities

Given its history, it is not surprising that the DSM borderline overlaps a variety of other personality disorders. The first diagnostic criterion, frantic efforts to avoid abandonment, resonates with the dependent and histrionic personalities. The dependent desperately needs an instrumental surrogate, without which feelings of panic quickly rise to the surface. Histrionics need an instrumental surrogate as well, but they also need to feel physically attractive, to be the center of attention, and to believe that they themselves are idealized by their companions. Abandonment is thus double jeopardy for histrionics, being both a separation and a commentary on the insufficiency of their attractive power. The avoidant could be included here because avoidants need a mate who is willing to face a world where they feel shamed, defective, and incapable.

As to the second diagnostic criterion, dependents, histrionics, narcissistics, and nega-tivists are particularly prone to idealize romantic encounters, and narcissists are particularly likely to devalue those who are no longer admiring, who withhold "narcissistic supplies" for any reason. The dependent and histrionic are likely to have a poorly developed sense of self, and the histrionic, narcissistic, and negativistic personalities are beset with a highly unstable sense of self, the third borderline criterion. Narcissistic, histrionic, and negativistic personalities are particularly prone as well to emotional extremes, including anger. More pathological narcissistic and histrionic personalities are also likely to experience chronic feelings of emptiness. Finally, borderline, schizotypal, and paranoid personalities exhibit paranoid fears, and borderline and histrionic personalities are prone to dissociative episodes. The highest overlap may be with the DSM-III-R self-defeating personality (Gunderson, Zanarini, & Kisiel, 1995), perhaps because their interpersonal chaos and self-destructive behavior certainly have the quality of setting borderlines up for painful experiences and failure.

However, contrasts can also be created with many of these same constructs. The regressive thought disorder of the borderline often resembles the schizotypal personality, but the borderline is famous for its unstable mood and its association with depression; the schizotypal is not. Moreover, the borderline disorganizes in connection with interpersonal themes, whereas schizotypal thought may seem eccentric about almost anything. Transient psychotic episodes in the borderline are thus more reactive to the character of external events. Both borderlines and histrionics are emotionally labile and attention seeking. Both may sexualize their relationships, but the borderline more easily gives way to anger and more readily experiences feelings of emptiness and loneliness, which is typically repressed in the histrionic. Both borderline and paranoid personalities exhibit paranoid fears, but the paranoid makes a rigid impression and wants to be left alone. In contrast, the borderline seems labile and fluid and fears being left alone. Moreover, borderlines are often overtly self-destructive and sometimes self-accusing, whereas the paranoid accuses others. Both borderlines and antisocials can be impulsive in self-damaging ways. However, antisocials typically lack remorse for their actions and pursue impulsive gratification as an end in itself. In contrast, impulsivity in the borderline personality is more often used to assuage feelings of emptiness and worthlessness. Finally, both borderlines and dependents fear abandonment. However, dependents react to threats of separation by becoming more submissive and pleasing, whereas the borderline reacts with angry demands intended to coerce nurturance.

Pathways to Symptom Expression

Each personality disorder exhibits a pattern of Axis I vulnerabilities that grows out of the logic of the construct itself. Because the DSM borderline personality has been defined by symptoms as much as by traits, much of its relationship with Axis I has already been implicitly discussed. Because borderlines both habitually distort the meaning of interpersonal events and regularly plunge their relationships into chaos and discord, borderlines often live with ongoing, diffuse anxiety. The perception of loss of support or abandonment sometimes leads to episodes of panic, perhaps accompanied by dissociative symptoms or paranoid ideation. When borderlines can reassure themselves that their attachments are somewhat secured, their symptoms are likely to abate. Dissociative symptoms may be especially prominent in females with a severe abuse history (Galletly, 1997). As you read the following sections, try to identify the connection between personality and symptom.

Depression

Depression and the borderline personality are so strongly associated that many see depression as more than just a lifestyle consequence, arguing instead that borderlines possess a biophysical disposition to depressive episodes, putting the disorder on the affective spectrum (Akiskal, 1981). Whatever the merit of this hypothesis, borderlines often present with a composite of depression, irritability, and hostility, accompanied by a variety of physical complaints. Moreover, they experience a crushingly low self-esteem, intensified by a pervasive sense of the self as bad and worthless, along with global feelings of inefficacy and helplessness. Intense guilt and self-condemnation may be felt at having driven others out of their lives, usually after efforts to control others with hostility. In a pathological attempt to secure shaken relationships, self-mutilation may be used as a means of appeasing vicious introjects (Benjamin, 1996), though it is also apparently used as an antidote to impending dissociation, a means of proving that "something is real."

Other Disorders

Other Axis I disorders may accompany the borderline personality. Individuals with prominent dependent and histrionic traits are especially likely to exhibit somatic symptoms. These establish an objective claim to long wished-for nurturance, thus bonding caretakers more closely to the borderline while reducing threats of abandonment and demands for competent performance. The chaotic families of borderlines often provide models for substance abuse (Feldman, Zelkowitz, Weiss, & Vogel, 1995), and parental substance abuse is a risk factor for the development of borderline pathology in children (Guzder et al., 1996). Any number of substances may be used recreationally with peers or as a means of self-medication in the face of persistent anxiety or depression. Abuse becomes more likely for individuals who carry antisocial traits. Moreover, the presence of substance abuse predicts a higher level of borderline pathology, increased self-destructive and suicidal thoughts and behavior, and poorer clinical course (Links, Hesle-grave, Mitton, & van Reekum, 1995). Finally, borderline personality disorder is often diagnosed in subjects with eating disorders (Kernberg, 1995; Steiger, Jabalpurwala, & Champagne, 1996), linked to specific features of family dysfunction (Waller, 1994), and found to predict weight preoccupation (Claridge, Davis, Bellhouse, & Kaptein, 1998).

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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