Welcome to a New Blog About Borderline Personality Disorder (BPD)
What is Borderline Personality Disorder, and how can it affect someone's life?
Posted Apr 09, 2009
What is Borderline Personality Disorder (BPD)?
BPD is perhaps the most misunderstood and stigmatized of all psychiatric disorders, making it a timely and important focus for a Psychology Today blog. This curiously named diagnosis seems to contain "an adjective in search of a noun," as one psychiatric article famously noted.
Some in the mental health community do not conceive of BPD as a valid diagnostic entity. Even if they have taken the diagnosis seriously, clinicians have often used the diagnosis as shorthand for patients who challenge them and make them uncomfortable, largely due to the recurrent suicidality and difficulties with treatment engagement and collaboration, which people with BPD frequently exhibit.
"Borderline" personality has its origins in the 1930s, when a psychoanalyst, Adolf Stern, noted that there was a group of emotionally troubled people who did not clearly fall into the two major clusters of the psychopathology of that era: "neurotic" and "psychotic." So, he called them a "borderland" group. The label, with slight modification, stuck. The BPD diagnosis has evolved considerably over the last 70 years, and it is now recognized as one of the Personality Disorders in the DSM-IV, the current diagnostic system in American Psychiatry.
But what are the essential characteristics of BPD? In brief, people with BPD are profoundly sensitive to perceived abandonment and rejection by people in their lives. People with BPD also have emotions that can quickly spiral out of control, leading to intense states of anxiety, tension, and anger.
Moreover, turbulent emotional states are often at the center of stormy relationships with friends, family members, and romantic partners. When emotionally stressed, feelings of being harshly judged by others or experiences of dissociation (feeling mentally detached from one's physical body) can occur. While interpersonal relationships are problematic in BPD, there is also a disruption in the sense of self that is not readily apparent. This confusion about the self wreaks havoc on the capacity to pursue meaningful work and interests, the maintenance of a consistent view of oneself across time and situations, and the establishment of a consistent set of values.
Not surprisingly, many people with BPD also struggle with a chronic sense of emptiness and alienation. The most high-risk aspect of BPD is poor impulse control. Impulsive, destructive behavior in BPD most often takes the form of suicide attempts, non-suicidal self-injurious behavior (such as cutting), substance abuse, and high-risk behaviors (such as reckless driving).
Who am I?
For the last several years, I have been fortunate to be a part of the research team at Columbia University-New York State Psychiatric Institute that investigates Borderline Personality Disorder and its treatment.
However, my first clinical and research experiences with individuals with BPD were at New York Hospital in the Westchester Division. The Westchester Division holds an important place in the history of BPD research. At the Westchester Division, specialized treatment and research into BPD have been conducted since the 1970s. During my training there, I was exposed to various treatment approaches and theories that attempt to explain the difficulties associated with BPD.
What I have learned in my work with people with BPD over the last 10 years is that, while there is truth to the notion that some in this group are difficult to treat, even with specialized training, I have also learned that the challenges are greatly overshadowed by the resilience of individuals with this diagnosis, and the meaningful changes that these individuals can make in their lives when they are given access to high-quality treatment by committed clinicians.
What is the blog about?
I named this blog Science at the "Border" to emphasize not just the topic of BPD, but also the "border" between mind and brain. In modern scientific psychology and neuroscience, the Cartesian dualism that separated our minds from our physical selves is dissolving at an accelerating rate. An emerging scientific discipline called social cognitive and affective neuroscience (SCAN) is rooted in the notion that the mind and brain are intertwined and shape each other throughout development. This blog will emphasize research that attempts to understand BPD at the border of mind and brain science.
In sum, the overall aim of the blog is: 1) To dispel myths and educate readers about BPD, 2) to inform readers about latest scientific advances in the understanding and treatment of BPD, and 3) to integrate the study of mind and brain when understanding the behaviors associated with BPD and its treatment. To achieve these aims, I will periodically invite others to contribute. Also, I will strive to be objective and open to multiple interpretations of data rooted in diverse theoretical perspectives, even when I have a personal opinion on an issue.
For the next post, I will summarize and editorialize on some of the data that supports and questions BPD as a valid diagnostic entity.