Borderline personality disorder

Publication2Borderline personality disorder [All in the mind programme; Radio National; Broadcast date: 23/11/14]

1. – People who have real difficulties managing relationships
– Relationships are typically Tumultuous
– Relationships can swing from being highly valued & idealised to being devalued & discarded, & then reconciled & highly-valued again
– Wild swings in the quality of their relationships are highly characteristic
2. – Emotional instability
– Significant mood swings triggered by an external factor such as a comment, a look
3. Impulsivity
– Such as drinking, sex, spending, all of which are typically done to a level that is self-damaging
4. Feelings of emptiness – Not knowing who they are – lack a Sense of self – often hate themselves
5. Paranoia when under stress
6. Fear of abandonment [Typically comes up in intimate relationships]

Outward manifestations can include: suicidality, self-harm

– Borderline: Term first used in the era of psychoanalysis; Term used to describe someone believed to be on the border between psychosis and neurosis
– Affects approximately 3% of young people
– Affects up to 2% of the adult population
– One scholar believes the disorder should realistically be called an “inter-personality disorder”

– In the past, borderline personality disorder was thought to be a result of childhood abuse or neglect
– Now the disorder is also believed to have a genetic component
– Research is increasingly showing the problems associated with tension anxiety mood and disruptive behaviour increase the risk of developing borderline personality disorder later in life

– Borderline personality disorder is a highly stigmatised disorder/mental illness
– In the 1920s the condition was regarded as being untreatable

– Borderline personality disorder sufferers are usually anything but compliant & conforming (making them even more difficult & potentially confronting to treat)

– It is now known to be an eminently treatable disorder (DBT; Schema Therapy; Mentalisation-based therapy; Cognitive Analytic Therapy)

– Individual therapy is important to establish an attachment relationship with the borderline personality disorder sufferer
– Helps the person understand what’s going on in their mind and in the mind of others
– Reflection about what is going on in our minds is important for emotional regulation
– Also known as mindfulness makes a huge difference in relation to their ability to function in relationships

DBT is skills-based & has 4 components:
– Interpersonal effectiveness
– Learning to relate to other people and develop healthy relationships
– Distress tolerance skills (In particular learning to tolerate the high emotional states)
– Learning to regulate
– Learning to recognise
– Learning to decrease the painful, emotional response
– Mindfulness (grounding techniques so as to be in the moment – not In the past or future)

People can recover if they choose to

Nonetheless the disorder has a suicide rate approaching 10%



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