Today Jane E. Brody of the New York Times walked bravely into the troubled, misunderstood waters of borderline personality disorder. She quotes a PhD student, Georges Han describing BPD as “a serious psychiatric disorder involving a pervasive sense of emptiness, impulsivity, difficulty with emotions, transient stress-induced psychosis and frequent suicidal thoughts or attempts.” This is all true, however, in my experience this description captures a severe form of the disorder. It is possible to have BPD and not experience suicidality, for example.
The National Institutes of Mental Health define BPD more generally: “Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.” I like this definition better. My patients with BPD are people in deep pain, subject to emotional tsunamis they have no idea how to control. They will simultaneously push away loved ones, make them miserable and pull them in with declarations of love and devotion. The ‘I hate you, don’t leave me’ syndrome.
People with BPD are found in all social and educational strata. Housewives, college students, CEO’s, teachers, factory workers, come to my office for mood or relationship troubles. After a bit of digging a more fully formed diagnostic picture emerges. It is not an easy diagnosis to share. Insight is often blurred by the very defenses that he or she needs to keep from falling completely apart.
In graduate school my professors encouraged us to be careful when considering this diagnosis. Just because we found a patient annoying or difficult didn’t mean they had a personality disorder. Many of my colleagues state clearly they will not treat BPD or any personality disorder. Until experience proved me wrong, I was among that camp. Today I find work with people with personality disorders very rewarding thanks to Dr. Marsha Linehan.
Treatment for BPD is most effective if the therapist is knowledgeable in Cognitive Behavioral Therapy and trained in Dialectical Behavioral Therapy. Dr. Linehan developed DBT in response to frustration with CBT’s limited ability to help her borderline patients. DBT is like CBT married to eastern philosophies; a kinder, gentler CBT that “helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting.”
Here are seven links to learn more about borderline personality disorder:
Photo courtesy of cmbellman via Flickr