I Hate You, Don't Leave Me

Inside the mind of a borderline.

Who's Afraid of BPD (Borderline Personality Disorder)?

Why does the label, "borderline" scare so many people?

If you ask mental health professionals which diagnostic classification they most dread, they won't generally reply "schizophrenia," or "bipolar," or "drug abuse." More often, they will respond with the disdainful (and amorphous) designation, "borderline." Indeed, Borderline Personality Disorder frequently refers to demanding, unstable, and difficult individuals. They may idealize beyond measure those whom they will soon come to revile without reason. Lovers become hated. Disappointment slides into litigation. It sometimes seems that everyone's first wife was a borderline!  Often, BPD becomes a diagnosis of countertransference--the label attributed to a patient who lacks the graciousness to get better, or who just aggravates the doctor.

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Recent research, however, defies the myths that BPD represents willful spoiled brattiness and never improves. Neurobiological and genetic information demonstrates that DNA vulnerability may combine with environmental circumstance to yield distinctive changes in brain function. In such individuals, those parts of the brain associated with impulsivity and emotionality may be overly stimulated. Specific and directed treatment approaches, such as Dialectical Behavioral Therapy among others, have resulted in marked improvement in functioning. Even without any treatment most BPD patients eventually improve significantly.

Although the classic stereotype of BPD is the mutating character played by Glenn Close in the film "Fatal Attraction," less malignant figures fulfill defining characteristics.  Biographers of Princess Diana  reveal that this beloved woman probably suffered from BPD.  Individuals with borderline traits can be attractive, talented people, who, over time, live full and contented lives.

 

Jerold Kreisman, M.D., is a psychiatrist and best-selling author of numerous books.

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