Borderline Personality Disorder



Today I want to go over just briefly borderline personality disorder, BPD, also known as emotionally unstable personality disorder. There’s some perhaps changes in the works to change the name of borderline personality disorder as some people feel that it stigmatizes the person suffering from this difficulty, and so one of the suggested possibilities is emotionally unstable personality disorder. Basically you have someone with BPD who is suffering from an unstable and highly chaotic personality, especially in their mood swings, and usually those mood swings are not associated with circumstances in their life, they’re not consistent with the things around them, so they can swing from everything is great to everything is dismal. The world is perfect and now the world is going quickly to destruction. People are either all good or all bad. You are perfect. You are evil. I love you. I hate you. And it’s this back and forth pendulum swing that makes it very difficult for those around the person with BPD to relate to them because there’s no way to predict what person you’re going to receive. Today you may meet a good person who’s perfect and great, tomorrow you may be the most evil person on the planet and they hate you, and there’s been no context, no change to make that reasonable or understandable. So basically you’ve got unstable, highly chaotic mood swings, you have extreme anger often is the indicative here. Extreme anger with no context to justify the anger. The person is just ballistic with anger and you’re trying to figure out why, what happened. I know of a particular case where a family member perhaps had something along these lines, but essentially what happened was whoever showed up last was the good person. So someone shows up to visit, they’re the first person there, well they’re good until the second person shows up and now a switch takes place. The first person who arrived is now the bad person and the new person who arrived is now the good person. So this person with the difficulty would say Oh good you’re here to help me, they’re trying to kill me. And then a third person would come, now those two are in a conspiracy to kill them and that person is now the good person. And there’s no rhyme or reason to it in many ways, it’s just this quick transference, this black and white thinking about people without real proper context to it. So extreme outbursts of anger with no proper context, extremely unpredictable, and often this idea of splitting is there, this all or nothing thinking, black and white thinking, mostly as it relates to people and how they are perceived and judged. So one minute the person that’s trying to help them is there to save them and they’ll say things like I love you and you’re here to rescue me and I just can’t live without you. But then suddenly because they can’t draw a line between their identity and this person that now they suddenly love’s identity, they get afraid. And to deal with the anxiety and to create distance, they don’t move just a little bit down the scale, they run all the way to the other end of the scale, and they say no you’re here to kill me aren’t you, you hate me, and so now they’re suddenly in the bad area and sometimes it will cycle back, no I can’t think about that, if they’re bad and we have this relationship then maybe I’m bad, and I don’t want to be bad so no they’re good now. And it goes around and around. So this idea of splitting is there. When we think in terms of treatment for people with BPD, one of the most important things to remember is to maintain self-control in the situation and don’t get upset by anything the patient says or does. So the person who has this, you know they don’t have a lot of control, that this is what you’re in store for, as you go to work with them they’re going to say and do things that ordinarily from other people on the street would be highly inflammatory and aggressive and upsetting, you must maintain control and not get upset about anything they say or anything they do. Realize this is part of what they’re struggling with and you’re there to help them. Next, you need to establish rules and guidelines. Clear rules and guidelines. We’re going to work together and here’s behavior I will not accept and things I will not accept, and here are the consequences if you breach these rules and guidelines. And so establish the rules and guidelines, spell them out clearly, and then spell out your expectations. I expect you to talk to me, to sit here quietly, and to behave in this particular form or fashion, and then be firm. Once you’ve established the expectations, established the rules and guidelines, be firm. Don’t be harsh, but be firm. The person will probably try to test, is this really what you mean, and as long as you back it up kindly but firmly, often they’ll get the point. Remember you’re still dealing with a person who, at least in their emotions, is highly chaotic, and yet they understand these sorts of things, so you maintain control, you establish rules and guidelines, you spell the expectations, you’re firm with those, and then you want to set a consistent schedule. Consistent scheduling actually helps in the process. We’re going to meet every other day at 3. And so every other day at 3 you’ve got to be there, they kind of count on that, that sort of regularity assists them. And then finally when they do make progress, when they do keep within the bounds of the expectations, the rules, and the guidelines, reward them, and give them positive reinforcement. Rewards and positive reinforcement go a long way towards helping them. It takes time, but they can be helped. This has just been a cursory overview of some of the things related to borderline personality disorder, one possible name change to emotionally unstable personality disorder. The unpredictable nature of it, the idea of splitting, all or nothing thinking, you’re either all good or all bad, and then some of the treatment overview here that can be very beneficial and helpful.

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Last updated: 07/25/2017
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