What is Borderline Personality Disorder?

The symptoms of borderline patients are similar to those for which most people seek psychiatric help: depression, mood swings, the use and abuse of drugs and alcohol as a means of trying to feel better; obsessions, phobias, feelings of emptiness and loneliness, inability to tolerate being alone, problems about eating.

But, in addition, borderlines show great difficulties in controlling ragefulness; they are unusually impulsive, they fall in and out of love suddenly; they tend to idealize other people and then abruptly despise them. A consequence of all this is that they typically look for help from a therapist and then suddenly quit in terrible disappointment and anger.

Underneath all these symptoms, therapists began to see in borderline people an inability to tolerate the levels of anxiety, frustration, rejection and loss that most people are able to put up with, an inability to soothe and comfort themselves when they become upset, and an inability to control the impulses toward the expression, through action, of love and hate that most people are able to hold in check. And, furthermore, what most defines the "borderline" personality, is great difficulty in holding on to a stable, consistent sense of one's self: "Who am I?" these people ask. "My life is in chaos; sometimes I feel like I can do anything - other times I want to die because I feel so incompetent, helpless and loathsome. I'm a lot of different people instead of being just one person."

The one word that best characterizes borderline personality is "instability." Their emotions are unstable, fluctuating wildly for no discernible reason. Their thinking is unstable - rational and clear at times, quite psychotic at other times. Their behavior is unstable - often with periods of excellent conduct, high efficiency and trustworthiness alternating with outbreaks of babyishness, suddenly quitting a job, withdrawing into isolation, failing.

Their self control is unstable - ranging from the extreme self denial of anorexia to being at the mercy of impulses. And their relationships are unstable. They may sacrifice themselves for others, only to reach their limit suddenly and fly into rageful reproaches, or they may curry favor with obedient submission only to rebel, out of the blue, in a tantrum.

Associated with this instability is terrible anxiety, guilt and self-loathing for which relief is sought at any cost - medicine, drugs, alcohol, overeating, suicide. Sadly, oddly, self mutilation is discovered by many borderline people to provide faster relief than anything else - cutting or burning themselves stops the anxiety temporarily.

The effect upon others of all this trouble is profound: family members never know what to expect from their volatile child, siblings, or spouse, except they know they can expect trouble: suicide threats and attempts, self-inflicted injuries, outbursts of rage and recrimination, impulsive marriages, divorces, pregnancies and abortions; repeated starting and stopping of jobs and school careers, and a pervasive sense, on the part of the family, of being unable to help.

Sometimes, severe and chronic chaos in the family life plays an important role, but one has to differentiate the objective behavior of the family from the patient's subjective experience.

And, of course, the effect of the illness upon the life of the patient is equally profound: jobs are lost, successes are spoiled, relationships shattered, families alienated. The end result is all too often the failure of a promising life, or a tragic suicide.

continue: Diagnostic Criteria for Borderline Personality Disorder

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Reviewed: 04/2006