The core disorder in BPD is emotional dysregulation. Emotional dysregulation is viewed as a joint outcome of biological disposition, environmental context, and the transaction between the two during development. The theory asserts that borderline individuals have difficulties in regulating several, if not all, emotions. This systemic dysregulation is produced by emotional vulnerability and by maladaptive and inadequate emotion modulation strategies. From: Skills Training Manual for Treating Borderline Personality Disorder. By Marsha Linehan. 1993
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.
Borderline people also 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 was that they typically look for help from a therapist and then suddenly quit in terrible disappointment and anger. Underneath all these symptoms, therapists 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. What best defines the "borderline" personality, is great difficulty in holding on to a stable, consistent sense of one's self: "What 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 drug abuse 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. 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.
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.
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I found the most straightforward discussion of the effect of childhood abuse in
a book about poverty. I discovered snippets of information about BPD throughout the book, although the term BPD was never mentioned in the book.
Sexual abuse is one reason, among others, for the failure to create healthy partnerships. An abused child’s sense of powerlessness may lead to surrender and to a method of escape that psychiatrists term “dissociation”, in which the victim mentally stands aside watching the assault occur. The same phenomenon has been observed in victims of other trauma including war. The out-of-body experience generates protective feelings of indifference and emotional detachment that can remain for years after the event, even for a lifetime. Children are especially vulnerable. “Repeated trauma in adult life erodes the structure of the personality already formed,” notes Dr. Judith Lewis Herman, a psychiatrist at Harvard Medical School, “but repeated trauma in childhood forms and deforms the personality.”
The survivor’s intimate relationships are driven by hunger for protection and care and are haunted by the fear of abandonment or exploitation. In a quest for rescue, she may seek out powerful authority figures who seem to offer the promise of a special caretaking relationship. By idealizing the person to who she becomes attached, she attempts to keep at bay the constant fear of being either dominated or betrayed.
Inevitably, however, the person fails to live up to her fantastic expectations. When disappointed, she may furiously denigrate the same person whom she so recently adored. Ordinary interpersonal may provoke intense anxiety, depression, or rage. In the mind of he survivor, even minor hurts evoke past experiences of deliberate cruelty… Thus the survivor develops a pattern of intense, unstable relationships, repeatedly enacting drams of rescue, injustice and betrayal.
