A New Approach to Borderline Focuses on Identity Disturbance

Asking people with borderline disorder to tell their stories gives new insight.

Posted Mar 02, 2021 | Reviewed by Abigail Fagan

  • People with Borderline Personality Disorder (BPD) often have a fragmented or distorted sense of identity.
  • Researchers had people with symptoms of BPD complete an autobiographical task, involving a turning point in their life. Their autobiographical abilities correlated with scales of BPD. 
  • Narrative tasks may therefore be a useful tool to identify BPD and explore the inner lives of people with the condition.

Psychologically healthy people have a clear sense of identity that forms a coherent and key piece of their personalities. You know who you are on a day-to-day basis, and can function according to your inner sense of self with the confidence that you’ll be the same person tomorrow as you are today, and were yesterday. In borderline personality disorder, this sense of identity becomes fragmented and distorted.

If someone were to ask you to “tell your story,” you’d have little difficulty constructing a narrative that draws the pieces of your life together in a unified manner. For people with borderline personality disorder (BPD), a lack of clear identity complicates greatly the telling of this story.

Identity disturbance indeed is one of the defining features of the disorder. The authors of the psychiatric manual DSM-5 considered changing the diagnostic criteria for borderline personality disorder to shift a major focus onto this key area. However, they ultimately landed on retaining the existing set of symptoms, ranging from instability of sense of self to inability to regulate emotions. Moving forward, researchers believe that lack of a stable sense of identity will gain in prominence, becoming one of two dimensions clinicians use for diagnosing not only the existence of the disorder, but its severity as well.

University of Otago’s Seyedeh Fatemeh and colleagues (2021), emphasizing the role of identity disturbance in BPD note that “For many researchers, BPD symptoms are seen as a result of maladaptive defenses against the distress that arises from poorly integrated identity” (p. 1).

To tap into and understand this disorganized identity, the New Zealand researchers maintain, requires switching gears from the usual questionnaires or even clinical interviews measuring BPD symptoms. Instead, what is known as a “narrative,” or autobiographical story, obtained directly from individuals with BPD, can provide insights into the “dysregulation, impulsivity, chronic feelings of emptiness, and intense and unstable interpersonal relationships [that] are associated with fragmented self-narratives” (p. 1).

Autobiographical narratives have an interesting history in personality psychology. The idea behind this approach is that when individuals tell their life stories, they reveal the underlying themes that reflect their sense of identity over time. Think for a moment about how you would tell your story. When would it start? What would be your major organizing principles? How would you distill your many years of life experiences into, say, a 30- or 60-minute retelling to someone else? Ordinarily, researchers trying to grasp your identity from this story would look for major themes, such as relationships or worklife, high points and low points (and why), and the extent to which your sense of self tends to coalesce and be easily recognizable. How would your story rate along these criteria?

As you try to answer these questions, furthermore, you might also think about how you would approach this task if you couldn’t even figure out where to begin. This is what the experience might be like, Fatemeh et al. believed, for people with BPD. In their study, the first of its kind, participants were undergraduates and not a clinically diagnosed sample. The 211 women and 89 men averaged just under 22 years old, and were recruited via an online website. Although lacking clinical features, the participants nevertheless showed a range of scores on clinical screening measures and standardized personality inventories designed to tap into BPD symptoms.

The autobiographical narrative task consisted of what’s called a “turning-point interview” in which participants recorded their response to a prompt reading, in part, as follows:

“Please identify a particular episode in your life story that you now see as a turning point. If you cannot identify a key turning point that stands out clearly, please describe some event in your life in which you went through an important change of some kind. Please describe what happened, where and when, who was involved, and what you were thinking and feeling.”

The research team turned next to coding the audio recordings based on this prompt, focusing on the three dimensions they believed would relate most strongly to high BPD scores on the standardized measures. The theme of identity was broken down into sense of agency, or control over one’s life, and agency fulfillment, representing the extent to which participants believed they were able to meet their needs for control.

The second theme involved intimacy, with subcategories reflecting the nature of the participant’s close relationships particularly around communication and sharing. The third theme of coherence reflected continuity and timing of the major turning point narratives. Additionally, the recordings were coded for the “meaning-making” of the stories, reflecting the extent to which the narrative told a distinctive story.

Now go back and see how your own narrative would stack up against these criteria. Did you see yourself as in charge of your life’s turning points? How much of your story reflects close and rewarding relationships with others? Finally, does your description of the turning point tell a story that hangs together? What does that turning point say about you as a person? Perhaps your turning point involved a failure in which you were thwarted in achieving one of your life’s goals. Were you able to separate your role in this failure from the influence of forces outside your control? Just as importantly, can you derive meaning from that failure as you think about your life moving forward?

Turning now to the findings, the authors reported consistent, though weak, relationships among the borderline scale scores and the three basic narrative coding ratings, suggesting that narrative identity impairment is an important feature of BPD. As the authors note, “BPD individuals are likely less able to perceive the world in the form of well-made stories” (p. 9). Their narratives lack a distinct beginning, middle and end.

Moreover, they don’t see themselves as the central subject of their own stories and see themselves as lacking control over the events in their lives. Tapping into the narrative tales told by participants makes it possible to see BPD symptoms, in other words, as part of an individual's larger personality and particularly, sense of self. All of these can provide a valuable perspective to the inner life of individuals with BPD.

To sum up, the research team’s work serves the important function of viewing BPD as a deviation rather than as a deficit. People with BPD have life stories to tell. Helping them narrate those lives in a coherent fashion could help them start to put the pieces of their identity back together.

References

Sajjadi, S. F., Gross, J., Sellbom, M., & Hayne, H. (2021, January 7). Narrative Identity in Borderline Personality Disorder. Personality Disorders: Theory, Research, and Treatment. Advance online publication. http://dx.doi.org/10.1037/per0000476