Borderline Personality Disorder
Borderline Personality disorder is characterized by a long-lasting, rigid pattern of maladaptive thoughts, feelings, and behaviors. This enduring pattern of inner experience and behavior deviates markedly from the expectations of the individual’s culture. The inflexibility and pervasiveness of these patterns cause serious relational problems and impairment of functioning for the afflicted individual. Characteristic symptoms of the personality disorders fall into four categories:
Distorted Thinking is an extreme and inaccurate pattern of perceiving and interpreting one’s self, others, and the world around you. Patterns include idealizing then devaluing other people or one’s self; extreme black-or-white thinking; distrustful, suspicious thoughts; unusual or odd beliefs that are contrary to cultural norms; and thoughts that include perceptual distortions and bodily illusions.
Emotional dysregulation is an inability to modulate the range, intensity, lability, and appropriateness of emotional responses. For some, this is characterized by emotional sensitivity and a tendency to experience intense feelings. Other disordered individuals show little or no emotional response, regardless of the circumstance or situation; one moment overwhelmed with intense emotions, the next, numb and disconnected.
Impulse control is the degree to which a person can regulate their internal drives or impulses to act. Some personality disorders are characterized by behavioral over-controlled (an inability to act), while others are characterized by a lack of behavioral control (acting spontaneously without forethought).
Interpersonal difficulties are common to all of the personality disorders. As would be expected, the three characteristic symptoms described above (i.e., distorted thinking, emotional dysregulation, and impulse control problems) make it difficult for personality disordered individuals to form and maintain healthy relationships.
Types of Personality Disorders
The DSM-5 lists borderline personality disorder as one of the dramatic-emotional (also called Cluster B) personality disorders. While each of these personality disorders is a distinct diagnosis, they all share a number of overlapping and related symptoms, including problems with emotional expression and difficulty forming stable, healthy relationships.
In addition to borderline, the other dramatic-emotional personality disorders are antisocial, histrionic, and narcissistic.
ANTISOCIAL PERSONALITY DISORDER (ASPD)
Antisocial Personality Disorder (ASPD) is characterized by a pattern of behavior that involves the manipulation, exploitation, or violation of the rights of others. Individuals with ASPD are often deceitful, lack remorse for their actions, and show an unwillingness to conform to social norms and laws.
BORDERLINE PERSONALITY DISORDER (BPD)
Borderline Personality Disorder (BPD) is characterized by a persistent pattern of emotional instability, volatile interpersonal relationships, unstable self-image, and self-destructive impulsive behaviors.
HISTRIONIC PERSONALITY DISORDER (HPD)
Histrionic Personality Disorder (HPD) is a pattern of excessive emotional expression and attention seeking. Individuals with HPD often behave dramatically in situations that do not justify this type of reaction. They have an excessive need for approval and are often inappropriately sexually seductive or provocative.
NARCISSISTIC PERSONALITY DISORDER (NPD)
Narcissistic Personality Disorder (NPD) is characterized by extreme feelings of self-importance, a high need for admiration, and a lack of empathy. Individuals with NPD often exploit others for their own gain and are overly sensitive to criticism, judgment, or defeat.
Prevalence and Age of Onset
Personality disorders are usually recognizable during adolescence or early adulthood. Some dramatic-emotional personality disorders (antisocial and narcissistic) are diagnosed more frequently in males while others (borderline and histrionic) are more frequently diagnosed in females. Individuals with personality disorders are likely to have co-occurring major mental disorders, including anxiety disorders, depressive disorders, bipolar disorders, posttraumatic stress disorder, attention deficit/hyperactivity disorder, and substance-use disorders.
Treatment & Support
The American Psychiatric Association recommends long-term psychodynamic therapy or dialectical behavior therapy. In the psychodynamic approach, the therapist attempts to link present feelings, thoughts, and symptoms to unconscious meanings derived from early life experiences (e.g., childhood sexual abuse). By linking the present to the past, BPD patients are given a new understanding that allows them to change their behavior.
DIALECTICAL BEHAVIOR THERAPY (DBT)
Dialectical behavior therapy (DBT) is a psychosocial treatment developed specifically for BPD. DBT usually has individual and group therapy components. In the individual therapy sessions, the therapist develops an environment in which the patient’s feelings are recognized as legitimate and acceptable, combined with an insistence on the need to change. In the group sessions, the patient works on specific coping skills that are divided into four modules: core mindfulness (being aware of what is going on within one’s self), interpersonal effectiveness, distress tolerance, and emotion regulation.
Medications have been found to be only moderately effective in treating the symptoms of BPD. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to help control depressive symptoms. Mood stabilizers such as lithium or certain anticonvulsant agents may be used to help control impulsiveness and explosive anger. Neuroleptic (antipsychotic) drugs may also be used when the individual shows distortions in thinking or psychotic symptoms.
A Spiritual Perspective
BPD is a disorder built upon the hidden pain of past abuse, abandonment, or invalidation. The lack of self-worth in the person with BPD make forgiveness feel impossible. When ministering to a person with BPD, the total and complete forgiveness of God that is available only through Jesus Christ (Ephesians 1:7–8; Colossians 1:13–14) is a great place to start. Understanding God’s forgiveness leads to the realization that God truly loves us (John 3:16); and if the Creator of the universe loves us, then we must have worth despite our past or what we might think of ourselves.