Borderline personality disorder - onset, characteristics and treatment

However, as early as the late 17th century, the English physician Thomas Sydenham, in a letter about a number of his patients, wrote a now-often-quoted sentence: "They love those whom they will hate without reason beyond all measure." In the letter, he described their sudden outbursts of anger, pain, and fear.

Although Thomas did not give the name Borderline Personality Disorder (he chose the name Hysteria for women and Hypochondriac for men), his description even then captured the symptoms for making a diagnosis of Borderline Personality Disorder.

Borderline Personality Disorder

This type of disorder today causes many controversies and conflicts among many researchers—from how it originates, how it develops, to whether it can even be classified as a disorder or just as a part of adaptation and developmental arrest.

However, the very fact that a great debate is being created around this condition among psychologists makes it worthwhile to pay attention to the characteristics of this disorder (in the text, we will refer to it as a disorder), which is presumed to affect about 1% to 2% of the world's population and is about twice as common in women as in men.

There are numerous theories that describe the possible causes of Borderline Personality Disorder. The cause is explained through genetic factors, social factors, the quality of interaction in early family development, and psychological factors.

Psychoanalytic Interpretation of the Origin of Borderline Personality Disorder

The psychoanalytic interpretation of the origin of borderline disorder is that it is created somewhere between the 18th and 36th month of life. Thus, it involves very early years in which the child, as a being that gradually begins to develop an awareness of its existence, did not succeed in separating from the mother, which should normally happen during this developmental period.

The failure of separation often occurs because the mother, probably due to personal problems, did not react approvingly to the child's separation, but reacted with anger, rejection, or depression to every attempt at "self-reliance" (exploring the environment, researching...). However, in that period, the child desperately needs stability and love that would reinforce them for future independent, successful, and normal emotional development.

Characteristics of Borderline Personality Disorder

Although there are numerous disagreements, it would be good to try to systematize some key points on which the majority agree and provide some kind of picture of borderline problems.

Identity Diffusion

The main problems boil down to the instability of self-perception, interpersonal relationships, and mood. What can be noticed first in this personality type is a triad of emotions: Aggressiveness; Depression; Diffuse identity.

In interpersonal relationships, everything that happens is pushed to the extreme. When they love, they love to the core, but the same happens when they hate someone (the wholeness of the object with virtues and flaws is fragile and easily split). This image of the other person is often changeable, whimsical, and unstable. A person they fiercely loved at one moment can be hated with the same intensity. What is this about? Not about love and hate, but about a pattern of unstable and intense interpersonal relationships that vary between two extremes—idealization and devaluation of the other person.

They find it especially difficult to adjust to the fact that they have mixed feelings towards themselves and other close people, or people in their environment. What they expect to get from their partner is for the partner to regulate their own tension, and for their presence and love to fill an internal sense of emptiness. And sometimes, in a state of great euphoria, they may think they have reached that stage, but when disappointment occurs (which usually happens), the person is devalued, and they look for another "ideal" partner to patch and complete that lack.

In a relationship, they constantly look for signs that their partner doesn't love them and will leave them. If this is confirmed, they can respond with a wide range of emotions: they get angry, cry, plan revenge, hurt themselves, cheat on their partner, or do something similar.

These people desperately want closeness and intimacy, but the way they try to get it most often pushes people away. Their ambivalence towards their partner can be reflected in their sentences where both love and hate for the same person appear ("I love him, the disgusting pig..."). Their view of the world and the people in it is "black and white." Someone is perfectly good or completely bad, without any balance. If they take the position that someone is completely bad, no arguments can change their view, but it is quite possible for them to suddenly change their position to the complete opposite. People in a more intimate relationship with them are often left hurt, not knowing exactly what happened.

Borderline individuals seem to have "lost their compass" with their identity. They often feel "headless" or without clear boundaries for their own and others' identities. They have temporally changeable moods that can lead from high energy to extreme passivity and stagnation—moments of feeling that "the whole world is theirs," and then that same world turns upside down in a short period into a feeling of complete worthlessness and helplessness.

The mood is inconsistent with the external environment, and they often live in an atmosphere of catastrophe and doom. The line between depression or excitement, anxiety, apathy, anger, disappointment, and euphoria is thin. It often happens that their anger escalates into a physical confrontation. However, borderline individuals are, in fact, mostly dysthymic. Dysthymia is a chronic depressive disorder that lasts for at least two years and is characterized by a depressed mood and a general loss of life satisfaction. They often behave childishly, impulsively, and manipulatively.

The Great 'Internal Emptiness'

They are recognizable by a leitmotif verbalized as a "great internal emptiness."

Internal emptiness can have at least two meanings—it can refer to the physical and the psychological. In the first sense, a person can be empty when they are hungry, for example. In the second sense, emptiness refers to affect, feeling, or the absence of feeling. But if emptiness refers to "nothing," how can someone feel this "nothing"? It would be logical that when something is not there, it cannot be felt. To feel nothingness means to feel a significant, inexplicable amount of something for which we have no words, something dead inside us, something that has died and left its bad aspects inside us, or something that has never come to life for us to feel alive inside. The very feeling of emptiness in Borderline Personality Disorder leads to acting out (acting out is a term that represents the repetition of unconscious patterns from childhood, in order to master them in the present and to relieve the tension caused by the feeling of emptiness).

Impulsivity is present in at least two of the following activities:

• Sexuality—careless, promiscuous, and excessive.
• Substance abuse, overeating, excessive drinking, or overspending.

All this impulsivity gives a feeling of fullness and a re-experiencing of oneself and one's identity. Suicidal tendencies or suicide attempts may be present. Instead of suicidality, the borderline type can self-harm in various other ways (psychophysical self-injury).

But despite all this, an interesting phenomenon is that they show great resilience, a sense of humor, and "phoenix moments"—persistently getting up and continuing after frequent falls.

Borderline Personality Disorder at Work

In case of failure in activities important to them (job, university, emotional relationships, socializing), they often tend toward self-destructive behavior.

This disorder often occurs in combination with other mental disorders. In a leadership position, problems most often arise due to their unpredictability. They can delegate a task to a subordinate who performs it flawlessly, only to then be told that the task should not have been done at all. At the same time, a group leader of this personality type is not lying or trying to exploit their employee; they simply changed their mind in the meantime.

Borderline individuals will often show deep respect and admiration for their leader and group because they are part of them and share their identity and greatness with them. However, when the slightest imperfection or mistake is shown, which happens even in the best companies, they will feel anger, rage, and resignation, and completely vilify those who were perfect.

Psychotherapy for Borderline Personality Disorder

Psychotherapy can be long and difficult, but not unsuccessful. The first thing a therapist must offer is empathy (compassion), acceptance, as well as showing that they will be there and will not abandon the client, even in difficult moments. They must be prepared to tolerate sudden changes in mood and feelings. Therefore, both the therapist and the client must "endure" the therapy.

Progress happens slowly, but if the person is determined to help themselves, they will build the missing parts of their personality step by step and succeed in connecting their internal and external experiences of themselves and the world.

Author: Nemanja Kurlagić – psychotherapist using the O.L.I. method