“A borderline suffers a kind of “emotional hemophilia”; she lacks the clotting mechanism needed to moderate her spurts of feeling. Prick the delicate “skin” of a borderline and she will emotionally bleed to death. Sustained periods of contentment are foreign to the borderline. Chronic emptiness depletes him untilhe is forced to
do anything to escape. In the grip of these lows, the borderline is prone to a myriad of impulsive, self-destructive acts—drug and alcohol binges, eating marathons, anorexic fasts, bulimic purges, gambling forays, shopping sprees, sexual promiscuity, and selfmutilation. He may attempt suicide, often not with the intent to die but to feel something, to confirm he is alive”
(from “I Hate You—Don’t Leave Me: Understanding the Borderline Personality” by Jerold Kreisman)
What does it mean to be “borderline”?
Borderline Personality Disorder is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity.
Its prevalence is about 2% of the adult population and varies between 30 and 60% among the clinical population with personality disorders.
Onset occurs in adolescence or in early adulthood.
Epidemiological data show that Borderline Personality Disorder is diagnosed mainly in women (approximately 75%) (DSM IV-TR).
How does Borderline Personality Disorder manifest itself?
DSM IV-TR lists the criteria (at least 5) to make a diagnosis of Borderline Personality Disorder:
- frantic efforts to avoid real or imagined abandonment.
- a pattern of unstable and intense 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 are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
- recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- chronic feelings of emptiness
- inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- transient, stress-related paranoid ideation or severe dissociative symptoms
Individuals who suffer from Borderline Personality Disorder fear (consciously or unconsciously) abandonment by others, therefore they may appear extremely sensitive to signs of rejection (real or perceived) by the significant people they interact with in their lives.
They tend to assume positions of “all or nothing”, “black or white” with no “shades of gray”, both towards the image they have of themselves, and towards their goals, but also, and especially, in relationships , which are frequently characterized by oscillations between moments of extreme closeness and positivity and moments of absolute distance and incompatibility. This is linked to a tendency to “idealize” others (polarizing their qualities) but also, hereafter, to “devalue” (that is, to see only their less appreciable parts that become, at this point, intolerable).
People with Borderline Personality Disorder have great difficulties managing their emotional states, which are often experienced as uncontrollable and overwhelming and can be managed with ways that are aimed to reach a state of tranquillity and emotional well-being but that tend to cause even more suffering in the end (eg as self harm – cut to handle mental pain).
There may be impulsive behaviors (substance use, excessive spending), self mutilating or suicidal behaviors. There can be a tendency to experience strong feelings of anger, which can activate quickly in a reactive way and disappear slowly, feelings of emptiness and consequent behaviors in order to avoid them. Affective instability is often present.
These symptoms can appear quite frequently but it is important to remember that each person lives and therefore expresses its suffering in a unique and different way.
“Borderline Personality Disorder” diagnosis may be useful to define difficulties that may have never had a name, but behind this term there are people with their own history. Only these people can tell their story so it can be fully understood.
DIAGNOSIS AND TREATMENT:
Borderline Personality Disorder may have symptoms similar to those belonging to other psychiatric disorders (eg, mood disorders), and this can make a correct diagnosis difficult.
Books that may interest you on this subject:
- I Hate You—Don’t Leave Me: Understanding the Borderline Personality by Jerold Kreisman
- Girl, Interrupted by Susanna Kaysen
“Medical and scientific information found in this site are for informational use only and can not in any way replace a medical examination.”
– Psychiatrist Licia Lietti +39 338 5019524
– Clinical Psychologist, Martina Trinchieri: +39 393 5564912
– Clinical Psychologist Martina Larsen Paya: +39 349 169627