To be diagnosed with BPD*, a person must experience at least five of the following symptoms (APA 2014):

  1. Fear of abandonment
  2. Unstable or changing relationships
  3. Unstable self-image; struggles with identity or sense of self
  4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
  5. Suicidal behavior or self-injury
  6. Varied or random mood swings
  7. Constant feelings of worthlessness or sadness
  8. Problems with anger, including frequent loss of temper or physical fights
  9. Stress-related paranoia or loss of contact with reality

People with this disorder are often misdiagnosed as having bipolar disorder.  The key marker for BPD is fear of abandonment. Their primary modes of relating involve (a) seduction; (b) manipulation. They often lie.

I find it helpful to explain borderline personality disorder by explaining the underlying schemas that are driving the maladaptive behaviors.

Schemas are the memories, emotions, bodily sensations, and cognitions associated with the relational aspects of the individual’s childhood experiences, organized into patterns that repeat throughout life.  The core themes experienced by the borderline person include abandonment, abuse, emotional deprivation, defectiveness, and subjugation.  These are defined below (Young, Klosko, Weishaar, 2003):

  • Abandonment: Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or protection.
  • Abuse: The expectations that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage.
  • Emotional Deprivation: The expectation that one’s desire for a normal degree of emotional support will not be adequately met by others.
  • Defectiveness: The feeling that one is defective, bad, unwanted, inferior, or invalid to such a degree that one is unlovable to significant others.
  • Subjugation: Excessive surrendering to others because one feels coerced – for instance, submitting in order to avoid anger, retaliation, or abandonment.

All people have schemas.  According to the schema therapy approach, personality disorders are created out of the compensatory personality “modes” developed to manage the unacceptable feelings experienced when a negative schema is triggered by an activating event.

According to this theory, the borderline person has five common modes (Young, Klosko, Weishaar, 2003):

  1. Abandoned child– this mode is the suffering inner child. It is the part that feels the pain and terror associated with most of the trauma experienced by the person.  This mode is experienced as an eternal present state, without clear concepts of past or future; this leads to a sense of urgency and impulsivity.  This mode “carries” the borderline person’s core schemas.
  2. Angry and impulsive child – this is the predominant mode experienced when the person is enraged or behaves impulsively. This tends to be their “default” mode of self-protection. This is the mode where they vent their fury and impulsively act out in order to get their needs met.
  3. Punitive parent – this is the internalized voice of the punitive or angry and unaccepting parent. When the punitive parent mode is activated the person usually becomes a cruel persecutor, usually of himself. This is a very destructive mode – particularly self-destructive.
  4. Detached protector – this is when the person shuts off all emotions, disconnects from others, and seems to function in a robotic manner. Borderline individuals tend to spend a lot of time in this mode.  The function of this mode is to cut off emotional needs, disconnect from others, and behave submissively in order to avoid punishment.  They may even appear “normal” while in this mode.  They may do everything they are “supposed” to do and act appropriately.
  5. Healthy adult – this is the healthiest mode and tends to be extremely weak in the borderline personality. As adults they lack the internal resources to sustain themselves and when faced with challenging emotional situations they find themselves with no healthy internalized working models from which to draw.

All of these modes’ jobs are to protect or compensate for the vulnerable child mode.  The vulnerable child is the inner child that was not nurtured or protected in childhood People with BPD, usually lack object permanence.  They cannot summon a soothing mental image of a caretaker unless the caretaker is present.

Realize this, BPD’s lack a healthy adult to internalize.

It is important to remember that borderline people will always need more than what others can provide; this is because they are desperate.  Relationships with BPDs tend to be tumultuous and intense.  They always need more than what others can emotionally provide.  Underneath, usually unconsciously, the borderline person is always looking for a parent.

They are constantly needy and hate boundaries.

*BPD = person with borderline personality disorder

 

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References:

American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders, Fifth  Edition:  DSM-V.  Arlington, VA: American Psychiatric Association.

Giesen-Bloo, J., van Dyck, R. Spinhoven P.; van Tilburg, W. Dirksen, C.; Thea van Asselt, T., Kremers, I., Nadort,& Arntz, A. (2006).  Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy.  Archives of General Psychiatry (63)6.  pp. 649-658.

Young, J.E.; Klosko, J.S.; Weishaar, M.E. (2003). Schema Therapy: New York, NY. Guilford Press.