Personality Disorders

Borderline Personality Disoder

Borderline personality disorder (BPD) is characterized by marked instability in many realms of an individuals functioning including affect, relationships, self-image, cognition, and behavior. Individuals with BPD experience emotional pain and are unable to effectively manage their emotions, which may include feelings of emptiness and difficulties with anger. Impulsive behaviors (such as self harm, risky sexual behavior, binge eating, spending) may be viewed as problematic attempts to cope with emotions. People with BPD often have difficulties with relationships. Feelings toward others may shift dramatically and frequently. BPD is a serious and life threatening illness. Approximately 75% have a history of suicide attempts and 10% of individuals with BPD commit suicide.

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Approximately 2% of the general population has BPD. The term “borderline” arose in the 1930s to describe individuals who were on the border between neurotic and psychotic. While the meaning of the diagnosis has changed, the name has remained. Today, according to the biosocial theory (Linehan, 1993), BPD is caused by the ongoing reciprocal interaction between an emotionally vulnerable temperament and an invalidating environment. In other words, when a person is biologically highly sensitive to emotions and others respond by punishing or dismissing feelings, a person never learns how to manage or trust one’s internal experience, and difficulties in regulating emotions arise.
Dialectical Behavior Therapy (DBT) is considered the treatment with the most scientific support for individuals with BPD. DBT evolved from standard cognitive behavioral therapy and Zen practice. The goal of DBT is to not only to treat BPD, but to also create a life of meaning. DBT includes a focus on teaching a person skills, including mindfulness, emotion regulation, distress tolerance, and interpersonal effectives.

The Varieties of Personality Styles

Psychologists have found that people often have individual styles of thinking about themselves and relating to others. These are sometimes referred to as “personality disorders”. Another way of thinking of this is that they simply reflect the wide variation of how we experience the world. However, your habitual style of thinking of yourself or relating to others may make you vulnerable to problems in your life. Personality styles might lead to repetitive problems in your life–problems not helped by medication. Your cognitive therapist can help you identify your particular pattern, trace its history to your experiences growing up, review how these patterns may have kept you from achieving greater fulfillment in your life, and help you develop new ways of thinking and behaving. Let’s take a look at some typical patterns.

  • Avoidant — Sensitive: People with this style often have low self esteem and are sensitive to criticism. They can form relationships with people and open up with them—once they have established that they can trust them.
  • Dependent — Devoted: People with this style will often cling in relationships and do a lot to keep the relationship going. They are concerned about being abandoned and left alone. They often feel that they cannot function without someone else in their lives—often someone that they feel will take care of them. They can be very devoted and loyal.
  • Passive Aggressive — Leisurely: These people  have mixed feelings about going along with things. They may say that they will do something, but they often don’t follow through. They appear to have a casual attitude about deadlines and rules.
  • Compulsive — Conscientious: These people are highly devoted to work and productivity. They often make lists, keep a tight schedule and have high standards for themselves and other people. They are often viewed as reliable and honest, but sometimes they can be seen as overly devoted to work. Some of these people hoard things because they believe that they might have some use in the future.
  • Anti-Social — Adventurous: These people like excitement and taking risks. They often believe that the rules do not apply to them and they may break the rules just to get what they want. They seek out wild times and can sometimes seem charming and fun to be with. They seem not to care about the rights and needs of other people.
  • Narcissistic — Self-Confident: These people believe that they are superior to other people and deserve special attention and admiration. They often can be insensitive to other people—sometimes they are unable to understand how they can offend people. Because they often have a lot of confidence they may be able to achieve things, although their confidence may not be based on reality.
  • Histrionic — Dramatic: These people are very dramatic and try to impress people with their glamour and personality.  They can seem very emotional—which can add to how interesting and exciting they may be. They have a lot of imagination and energy and often focus on their appearance—they try to be sexually attractive and seductive.

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Cognitive Therapy
Substance Abuse Miniseries by
Dr. Graham Reynolds