In general, personality disorders alone are difficult to diagnose, and more than most, borderlines are those frequently misdiagnosed (Bockian, 2002). Both theory and research argue that the DSM borderline pattern overlaps nearly every other personality disorder, with some exceptions. Because most subjects diagnosed as borderline are female by a ratio of 2 to 1 or even higher, subjects with dependent, histrionic, avoidant, depressive, and negativistic features are common, though for different reasons. In general, any personality pattern that makes others the center of life is at risk to develop a borderline personality. The desire to magically fuse with others who will support you emotionally and meet your every need is evidence of both ego weakness and identity disturbance, leading to instability in interpersonal relationships and feelings of emptiness and desperation when others seem to separate. In contrast, a DSM borderline diagnosis is probably less likely for male compulsive, sadistic, paranoid, and some narcissistic personalities, for whom dogmatism, righteous indignation, or grandiosity artificially boost the coherence of the self, giving it rigid boundaries inconsistent with those of the more permeable borderline. A summary of the borderline subtypes is given in Figure 14.1. Actual cases may or may not fall into one of the combinations described in the following sections.
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