A personality disorder is a mental illness that can be described as a disruption of the psyche that distorts a person’s perception of him/herself, others, and relationships. These distortions prevent the person from achieving genuine satisfaction in love, work, or play. These distortions make these individuals particularly difficult to treat; however, because individuals with personality disorders are treatable, their future have become more hopeful over the past two decades.
Borderline Personality Disorder is one of the 9 different personality disorders categorized in the latest Diagnostic Statistical Manual (V) published in 2013 (and one in 12 according to dimensional criteria). It is critical that we gain a better understanding of the internal experiences of the suffering BPD individual, considering their often time confusing and dramatic manifestations. We have to keep in mind that their internal experience can be vastly different from the external behaviour they display. The more dramatic their behaviour the more we find ourselves paying more attention to our own internal experience to cope with their dramatic and intrusive displays and provocations.
The BPD individual has four main areas of difficulty: 1) They experience rapidly shifting emotions in their extreme and raw form, often in dramatic ways; 2) they experience relationships that are chaotic, conflictual, difficult, frustrating, unsatisfying and not harmonious over time; 3) they engage in acting out behaviours that are often impulsive, often self-destructive, like cutting or overdosing, abusing substances, promiscuous or dangerous sex, and also exhibiting a form of eating disorder. Since these are the most dramatic manifestations of the illness, they get the most attention, and often get mistaken for being the illness. Rather, these are the outer signs of the illness, perhaps even attempts to cope with the illness but not the illness itself.
So what is the core concept of the BPD illness? It is the fourth are of difficulty: the individual’s sense of identity. This c an be understood as the individual not having a coherent, integrated sense of self. They have a fragmented sense of self without continuity over time, very reactive to whatever happens in the moment. A trigger event can lead them to the depths of despair or something good happens and they can become elated. Without a clear, coherent or cohesive identity, it’s hard to know how to navigate your way through life. If you don’t have a consistent set of goals and values, everything becomes very distressing. There is often a concomitant sense of emptiness inside, which is one of the most distressing parts of the condition. BPD individuals have particularly high standards and their experiences carry a kind of absolute quality—all or nothing. They are very uncompromising about others and about themselves.Their internal standard is not seen as their own mental creation that this is what a person has to be in order to feel good about themselves.
The value of psychotherapy lies in assisting the BPD individual to engage in the process of learning and integrating the realization that their distorted views of themselves and others are of their own creation, and that they could question the accuracy of their own perceptions, and have the capacity to modify them so that they can come to a more realistic image of what it is to be an okay as a person. The therapeutic goal is to assist the individual to master this integration of their urges and how to fit them into a system that is socially and morally acceptable and develop a fuller sense of who they are.