Imagine a 28-year-old single woman who struggles with maintaining relationships, especially with men. When she first meets a man she is attracted to, she idolizes him; he is the "perfect" man. However, over time he falls off of the pedestal she pictured him on. Now, he is the most contemptible man she ever met. She reacts to this fall from grace by screaming at him and verbally attacks him for what strike her friends as trivial matters.
Tired of her frequent rages and devaluing comments, he breaks off the relationship. This is a repeated pattern in her life. She tends to view the world in black and white terms, either all good or all bad.
She is subject to periods of depression that sometimes lead to suicidal thoughts. In fact, she has taken overdoses of pills in the past. Looking closely at her, you can see delicate scars from cutting her arms with razor blades when she is feeling miserable (Dysphoric). This cutting seems to make her transiently feel better.
When asked, she will tell you that her emotions are like being on a roller coaster with rapid and often intense shifts in mood. She struggles with her self identity and often thinks that she is just a mirror of her sister. At her core, she basically feels empty.
She sometimes is a bit paranoid and will project her own unconscious thoughts and feelings onto others. She then treats them as if they were really like that such that they end up feeling the way she does. She is a master at pitting one person against another, telling falsehoods about each one to the other.
It is difficult to befriend her, but, when you learn that she was severely physically, sexually, and verbally abused by her parents throughout her childhood, you develop sympathy for her. She acknowledges that she has shared her terrible childhood stories with a therapist who told her that her personality type is often formed as a result of severe childhood abuse.
This imaginary woman would be diagnosed by her therapist as having a Borderline Personality Disorder. Many mental health authorities think of it as an Emotional Dysregulation condition (they can't regulate their emotions the way a person without the disorder can).
The name for this personality disorder arose when psychoanalytic terminology was dominant among psychiatrists. In those days, mental disorders were roughly divided between psychotic disorders (break from reality) and neuroses. People with the set of symptoms described above seemed to have features of both psychosis (especially when severely stressed) and neurosis. So, they considered the condition to be on the borderline between the two. Hence, the name. It no longer is an appropriate name, but for historical reasons it has never been changed.
It is more prevalent in women than men who are more likely to be diagnosed with antisocial personality disorder. However, men and women can have either one. Both of these personality disorders are listed in the same cluster of personality disorder types (Cluster B).
Treatment for this disorder is primarily psychotherapy, especially ones designed to help the features of the disorder. Sometimes, medication can help by reducing the severity of the symptoms, e.g., depression, irritability, transient psychosis, impulsiveness, anxiety, and self cutting. Most people with borderline personality disorder find that their symptoms improve to some degree once they reach middle age and beyond.
Peter M. Hartmann, MD
Psychiatry & Family Medicine
