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Borderline personality disorder
Borderline personality disorder
Lindsey Rasmussen
Introduction to Community Mental Health
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Borderline personality disorder
According to Seligman, Walker, & Rosenhan (2001), personality disorders are
“fundamentally disorders of traits; they are enduring, maladaptive ways of perceiving,
relating to, and thinking about the world and oneself” (p.372). These dysfunctional
personality characteristics and behavioral patterns are also pervasive, manifesting
themselves in a variety of situations, leading to significant distress for the individual or
others, and impairing social or occupational functioning. It is important to note that
comorbidity is very high among people with personality disorders; about half of all
people who meet diagnostic criteria of one personality disorder also meet that of
another personality disorder. Comorbidity with substance abuse is also exceptionally
high – one study found that 60% of patients with substance use disorders also had a
personality disorder (Seligman et al., 2001, p.373).
The DSM-IV classifies personality disorders into three categories or clusters.
Cluster A disorders are characterized by odd, eccentric ideas or behaviors and include
schizotypal, schizoid, and paranoid personality disorders. Cluster B disorders are
characterized by dramatic, emotional, or erratic behaviors and include antisocial,
histrionic, narcissistic, and borderline personality disorders. Lastly, Cluster C disorders
are characterized by fearful behaviors, and included avoidant, dependent, and
obsessive-compulsive personality disorders (Seligman et al., 2001, p.375). The focus of
this paper is on the personality disorder that occurred most often in the dually
diagnosed AODA clients I used to work with – borderline personality disorder.
Generally speaking, borderline personality disorder is characterized by emotional
instability that affects many aspects of an individual, including behavior, mood,
interpersonal relationships, and self-image. This emotional instability is the result of an
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Borderline personality disorder
individual’s significant fluctuation of feelings, which is often the result of just the slightest
provocation, and also contributes to an increased risk for suicide, substance abuse,
unsafe sex, self-mutilation, and intense (but unstable) relationships (Seligman et al.,
2001, p.401). Other characteristics of borderline personality disorder include the
following: intense fear of abandonment, cannot tolerate being alone, frequent feelings of
emptiness and boredom, frequent displays of inappropriate anger, impulsiveness (such
as with substance abuse or sexual relationships), and repeated crises and acts of selfharm, such as cutting one’s wrists or overdosing (PubMed Health, 2013).
Some people with severe borderline personality disorder experience brief
psychotic episodes. Because of this, mental health professionals originally considered
this disorder as an “atypical” or “borderline” version of psychotic or neurotic behavior
(National Alliance on Mental Illness, 2012). As a result, people suffering from the
aforementioned symptoms or characteristics and who didn’t meet the criteria for any
other known mental illness were diagnosed as having “borderline personality disorder”.
However, experts generally now agree that this name is misleading, but unfortunately a
more accurate name for this particular disorder does not yet exist (National Institute of
Mental Health, 2013).
Borderline personality disorder is the most prevalent personality diagnosis in
inpatient and outpatient mental health settings, which is noteworthy for a couple of
reasons. First, borderline personality disorder is a relatively “new” mental illness, having
appeared for the very first time as a diagnosable illness within the Diagnostic and
Statistical Manual for Mental Disorders, Third Edition (DSM-III) in 1980 (National
Institute of Mental Health, 2013). Second, what causes borderline personality disorder is
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Borderline personality disorder
still unknown; although, like other personality disorders, genetics and environmental
factors are thought to play a role. As a result, risk factors for the development of
borderline personality disorder have been identified and include the following:
abandonment in childhood or adolescence, disrupted family life, poor familial
communication, and sexual, physical, or emotional abuse (PubMed Health, 2013).
Although less known than Axis I disorders like schizophrenia and bipolar
disorders, borderline personality disorder is just as common, affecting approximately 1
to 2% of the general population (National Alliance on Mental Illness, 2012). According to
Richard Corelli, M.D. of Stanford University, borderline personality disorder occurs two
to three times more often in women than in men, a difference which can perhaps be
explained by any one or more of the following: (1) hormonal influences; (2) an
association with severe cases of premenstrual tension; and/or (3) women are sexually
abused as children more often than men, thereby increasing their frequency of
borderline personality disorder as adults. I think each of these explanations are
plausible; it could be one of these or more likely, it is the interaction of a number of risk
factors that ultimately increases a woman’s lifetime chances of developing borderline
personality disorder by two-, sometimes three-fold. Hopefully more research into its
causes will reveal the exact factors that are responsible for this disorder of emotional
dysregulation.
It is a common misconception that borderline personality disorder is difficult to
treat; however, recent research has shown that borderline personality disorder can be
effectively treated, and furthermore, many people with this illness are able to improve
over time. Typically, the key to successful treatment is a “good fit” with a primary
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Borderline personality disorder
therapist, which is especially true in the case of borderline personality disorder. This is
because the most effective treatment tends to be structured and consistent
psychotherapy. There are also instances when a mental health professional may
recommend medication for certain patients or during particular times during the course
of treatment. There are two reasons for this. First, medications are helpful in stabilizing
emotional reactions, which helps reduce impulsiveness and enhance an individual’s
thinking and reasoning abilities. Second, medications are effective in treating other
emotional disorders that frequently co-occur with borderline personality disorder, such
as depression and anxiety (National Alliance on Mental Illness, 2012). But because
borderline personality disorder is still a relatively “new” mental illness, research on
treatment is still in the early stages. Therefore, more studies need to be conducted to
determine the effectiveness of treatments, who may benefit the most, and how to best
deliver them (National Institute of Mental Health, 2013).
Overall, borderline personality disorder continues to be somewhat of a
misunderstood mental illness characterized by pervasive emotional instability that
negatively affects an individual’s behavior, mood, interpersonal relationships, and selfimage. This generally causes distress for the individual or others, as well as social or
occupational problems. Although there has been significant progress in the
understanding and treatment of borderline personality disorder since its inclusion in the
DSM-III in1980, there remains much to be discovered. Therefore, more research needs
to be conducted, especially into the causes of borderline personality disorder so that
treatment may be optimized and any person suffering from the illness has the greatest
possible chance at improving their mental health and consequently, their life.
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Borderline personality disorder
Corelli, R. (n.d.). Borderline personality disorder. Retrieved from
http://www.stanford.edu/~corelli/borderline.html.
National Alliance on Mental Illness (2012). What is borderline personality disorder?
Retrieved from http://landing.nami.org/bpd.php?gclid=CNurseT2grYCFSmo
PAod3BEAug.
National Institute on Mental Illness (2013). Borderline personality disorder.
Retrieved from http://www.nimh.nih.gov/health/publications/borderlinepersonality-disorder/what-is-borderline-personality-disorder.shtml.
PubMed Health (2013). Borderline personality disorder. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/.
Seligman, M., Walker, E., & Rosenhan, D. (2001). Abnormal psychology. New York:
W. W. Norton & Company.