"You abandoned me", says the Borderline client as they stand before you with fresh self-harm cuts. "But you agreed not to slash up during the two week break between sessions", replies the psychologist. This is a common scenario faced by any mental health professional who is dealing with Borderline Personality Disorder.
The DSM-IV-TR defiens Borderline Personality Disorder as a pervasive pattern of instability of interpersonal relationships, self-image, and afects, with marked impulsivity beginning by early adulthood and present in a variety of contexts. This is indicated in five or more of the following:
(1) Frantic efforts to avoid real or imagined abandonment,
(2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation,
(3) Indentity disturbance: markedly and persistantly unstable self-image or sense of self,
(4) Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, subtance abuse, reckless driving, binge eating).
(5) Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour,
(6) Affective instability due to a marked reactivity of moood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours but rarely more than a few days),
(7) Chronic feelings of emptiness
(8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights),
(9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
Treating an individual with Borderline PD is incredibly difficult. They do not cope well with change and progress is often very slow, with frequent relapses, either in mood swings or self-harming behaviour. They will test the limits of the person working with them, to determine exactly how far they can go. They also display a frequent drop-out rate in therapy.
Borderline PD occurs predominately in females, however it also occurs in males. It is incredibly difficult for the family and friends of the individual, and often results in highly passionate and overly destructive relationships. Due to the frequent self-harming behaviour, treatment is very important and it has been found that Dialectic Behaviour Therapy is one of the most effective forms of treatment for this disorder, as it creates awareness and support, as well as monitoring of moods and behaviours, until the individual is able to control certain impulses.