The Personality Series Examines BORDERLINES
The Borderline Personality: Unique Psychiatric Challenges
by Helen Borel, RN,PhD
In my experience, during over two decades as a psychotherapist - providing successful therapeutic outcomes for a wide spectrum of personality types and psychiatric disorders with a broad range of life-disabling symptoms - Borderline Personalities are often the most challenging and most difficult to treat.
This is because, not only are such patients largely defenseless - not in the ordinary meaning of that word - instead, lacking boundaries for the development of normal emotional defenses, they're unable to separate themselves from others. A Borderline hasn't a clue where her psychological boundary is (let alone where it ends in relation to others) so she can't distinguish the difference between her Self and your Self.
Borderlines are Secretly Hostile, Even When Appearing Compliant
So, since she can't sense where your boundary begins, she crosses it time and time again - usually in a fulminatingly hostile manner. (Or obsequiously, fake-smilingly, false-amiably yet ready to pounce angrily, even though unprovoked.)
This type of person tries to do and say everything to engage his or her therapist in battle, and verbally attempts loud brow-beating in sessions by misdirected harangues and severe over-reactions, often to something said in an empathic or praising manner. Such paradoxical behavior is a difficult hurdle for any experienced mental health professional to deal with, not to mention the widespread distress this kind of personality inflicts on family members, co-workers and people trying to be their friends.
Disruptive, Self-Sabotaging Behaviors are Common
The frequency of the Borderline's disruptive, counterproductive behaviors includes the aforementioned loud and verbally vicious browbeating which any good therapist must curtail or put an immediate stop to. That, at the risk of course of the Borderline storming out of therapy and losing a good opportunity to get the emotional support she needs. As well as the opportunity for some psychological growth which could have strengthened her coping capacities and helped her regulate her fleeting and fluctuating emotions and positively modify her deep reservoir of anger.
Additional disruptive actions on the part of the Borderline Personality include: (1) frequently missing appointments without calling the therapist in advance, then without concern for the other's time, not even bothering to apologize; (2) usually blaming others, from childhood on, for everything unpleasant in her life as well as for unpleasant happenings and relationship disruptions she herself manages to create; and, finally (3) blaming her therapist for everything and anything that impulsively comes to her mind at any given dysregulated emotional moment.
A Probable Brain-Chemical Imbalance May be Causative
In other words, the Borderline blames her therapist and others for her own internal distressing feelings that normally arise in everyone. But, because of the Borderline's core inability to modulate her uncomfortable feelings (which are neurochemically based), her approach to family, friends and co-workers is generally from a hostile and judgmental perspective - albeit usually masked by a phony smile or by the servile, obsequious behavior mentioned above.
This mask of "fake amiableness" toward others is a weak attempt to appear to comply with others' needs while, just below the surface, despising the other and not really accepting that other people have needs and feelings too.
But, when the Borderline patient does manage to develop some closeness to another person, she invariably does or says something to destroy, sabotage, obliterate - anything to eliminate this positive relationship. Often these behaviors grow from nothing, no incident, to become out-of-the-blue rages that have no basis in reality. Meaning: Nothing is apparent in the Borderline's current life or work situation, or in the patient-therapist alliance that could account for such an enormous and rageful reaction. It is a matter of lability of feeling states, poorly modulated by the patient's neurotransmitter (brain chemical) system - plus the Borderline's frequent disinclination to control behaviors despite feeling uncomfortable, as normal people usually manage to do.
Intensive Psychotherapy, Both Individual and Group, Can Help
One of the goals of psychotherapy, if the Borderline sticks around long enough and regularly enough to obtain the benefits of it, is to teach and guide and assist the Borderline patient in certain thought-management techniques and in how to develop actions and new habits that can pacify uncomfortable feelings when they arise seemingly uncontrolably. So it's possible, in time, for the Borderline person to achieve some measure of control, while minimizing her characteristic impulsivity and hostility.
Risks of Suicide and Other Causes for Hospitalization of Borderlines
Sadly, sometimes Borderlines hurt themselves, like making dramatic, call-for-help suicide attempts or cutting themselves. These behaviors require psychiatric hospitalization. Worse yet, sometimes Borderlines complete the suicide, so they account for a certain number of suicide statistics nationwide.
These personalities are fragile types with high trait-levels of envy, jealously, sabotaging of Self and others, sabotaging of their own therapists' best efforts. Efforts intended to improve their emotional lives by breaking the negative feedback between neurochemical imbalance, poor feeling control and poor coping mechanisms that produce the life-destructive behaviors.
Cause Unknown: You Might Say the Borderline Never Grew Up
This is a very difficult personality for family and friends to interact with. In many ways, you might say, Borderlines never grew up. Importantly, no one yet knows the cause of this emotionally weakened personality.
I believe, whatever happened to the person to contribute to it must have happened very, very early in life. Undoubtedly in infancy - between newborn and maybe two years of age - because these are the stages of cerebral (brain) and psychological (mind) growth when personal boundaries (defenses, for example) are being formed. When the infant comes to learn there is a "you" and an "I." That we are separate beings and somewhat safe within our own physiologic and psychological skin. But, I hypothesize that something happened to intercept, indeed interrupt, that normal process to produce the Borderline Personality.
On the horizon, recent research is honing in on the probability of a cerebral defect that may have early unbalanced brain chemical homeostasis, leading to the emotional lability and excessive anger boiling inside Borderlines. If such a defect can be definitively isolated and understood behaviorally and neurochemically, I predict pharmaceutical industry scientists will have a field day researching and developing new prescription psychotropic medications in an attempt to precisely target this purported defect and modulate the Borderline's neurotransmitter imbalance. Ultimately, such research and drug development could one day help the Borderline benefit more cooperatively from psychotherapy, and live more comfortably, with more mature behavior, in the world.
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