Tuesday, July 01, 2014
A Disorder That Does Not Specialize
What I notice to be a "disorder that does not specialize," BPD or borderline personality disorder, according the DSM-IV/V, is characterized by at least five of the following: 1. Impulsivity; 2. Unstable and intense interpersonal relations; 3. Inappropriate or intense anger; 4. Identity confusion; 5. Affective instability; 6. Problems being alone; 7. Physically self-destructive acts; 8. Chronic feelings of emptiness and boredom.
Individuals with BPD often experience unprocessed emotional wounds. That's why BPD is also called and known as "emotionally unstable personality disorder." Underneath the madness lies a deep emotional abandonment trauma. I'm reminded of a book on borderlines by Dr. Jerold Kreisman. His book's title aptly describes a lurking overwhelming emotion inside a BPD: "Don't Leave Me, I Hate You." Because of the depth of abandonment wounds, clinicians working with BPD must walk a narrow path between giving support without rescuing and encouraging independence without signaling abandonment.
BPDs are known in mental health care to be one of the most difficult of patients to care for. There is usually a lot of work ahead to explore unconscious wounds that fuel breakdown on the surface. A lot of structure, consistency, and trust-building over time are needed to reach significant progress that leads to a point of stability and wholeness. There is no other way.