Saturday, January 21, 2012

Borderline Personality Disorder: Definition

We have just wrapped up a brief exploration of Narcissistic Personality Disorder, and now are going to shift gears slightly and address another psychological condition, Borderline Personality Disorder.

In 1987, there was a popular movie, Fatal Attraction, which drew the public’s attention to Borderline Personality Disorder. The main character, Alex Forrest (Glenn Close), portrayed an individual suffering with a serious form of this disorder. To quickly recap the plot of Fatal Attraction, Alex meets Dan Gallagher (played by Michael Douglas), a married business man, and has a weekend affair. Dan sees their relationship as a brief fling and attempts to break it off. Alex, however, views their relationship much differently. She becomes obsessed with Dan and is threatened by his desire to discontinue their relationship. She makes increasingly bizarre efforts, such as stalking Dan and killing his daughter’s pet rabbit, to keep him connected to her. When all these attempts fail, Alex’s rage escalates, and she attacks Dan and his family. It is important to note that Alex displayed an extreme and rare example of BPD. This disorder has many different clinical presentations with varying degrees of severity. According to American Psychiatric Association (2000), approximately one to two percent of the population meets the diagnostic criteria for BPD.

What is Borderline Personality Disorder (BPD)? 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) identifies nine different criteria for BPD, and requires five of the nine to be present for diagnosis. They are:
  • Frantic efforts to avoid real or imagine abandonment
  •    A pattern of intense and unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  •  Identity disturbance: markedly and persistently unstable self-image or sense of self
  •  Impulsivity in at least two areas that is potentially self-damaging
  •  Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  • Affective instability due to marked reactivity of mood
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger
  • Transient, stress-related paranoid ideation or severe dissociative symptoms

Dr. Marsha Linehan, who developed Dialectical Behavior Therapy, proposes that the nine symptoms fall into five main categories: (1) emotion dysregulation, (2) interpersonal dysregulation, (3) behavioral dysregulation, (4) identity or self dysregulation, and (5) cognitive dysregulation. The key word is “dysregulation” or not having it under control. People with BPD have trouble controlling various arenas of their psychological and interpersonal life. These individuals tend to struggle with interpersonal relationships, have an erratic emotional life, and often behave impulsively and rashly.

What causes Borderline Personality Disorder? In the next article we will review the current understanding of BPD, including possible causes and characteristics

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