Here’s a writing I am turning in for class tonight:
An Extended Definition of Borderline Personality Disorder:
The Labyrinth
Jeremiah Hall Palmer
ENG101
Sullivan University
A room. A large room. Not just any room – an expansive room, filled with the absence of light. The room is familiar, and yet, there is something very unsettling about it. The room change, shifts, reconstructs itself. All the basic elements are there – walls, doors, ceilings, floors – everything familiar and known is present. The room changes. The doorway that had been only a few feet from you has now somehow gone ten feet away, and leads to somewhere else. The room changes. The labyrinth grows. You are lost in the maze of darkness, and everything that you should know about the room proves incorrect, yet at other instances all logic prevails, and a bit of light may be shed and you find your way.
While the analogy above may sound more like a partial synopsis of The Navidson Record (Danielewski, 2000), it’s purpose is to serve as a definition of Borderline Personality Disorder (BPD) – and what the sufferers; meaning the person having the symptoms and diagnosis of the mental syndrome; as well as the persons within the life of the diagnosed experience.
According the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), Borderline Personality Disorder (BPD) as a condition where a person’s mentality and emotions vary from the norm by showing instability in overall behavior, self-image, identity, mood, relationships, and the classification of things in terms “black and white”, or “right or wrong.” These aspects are further outlined in the criteria listed in the DSM-IV, and are offered as a guideline for possible diagnosis, where a person suffering from BPD will show five of the nine listed symptoms. (APA, 2004)
Commonly, the BP has issues with interpersonal relationships. This causes tremendous troubles for both the BP and the non-BP. The BP may exhibit a lack of trust in the non-BP, and show violent or irregular changes in attitude toward the non-BP. Reasons for these trust and anger issues may vary, and typically will, for the issue lies deep within the BP’s previous life experiences. The BP may have been a victim of some sort of abuse, be it emotional, physical, or sexual (Wikipedia, 2007). These experiences then influence the attitude of the BP, and the feelings get applied toward the non-BP. This transgression is not done intentionally; meaning that the BP truly wishes to behave in this manner, however; the attitude is brought about as a defense mechanism. The BP has been put on edge – a high alert, and looks for any sign that they might be hurt once more.
The walls. The doors. The floors. Familiar elements of this room. But something is different, something changes, the room has gotten bigger. The doors are further away.
A BP can enter into a relationship not expecting anything more than what any other person may expect. Things may seem fine or normal. Then the BP will start looking for the signs (Harvard, June 2006). The non-BP may make the normal changes within their attitude as everyone is susceptible to doing. This simple change may scare the BP; therefore causing a sudden rift in their attitude, causing a change in the way they look at things, and in turn causing a change in how the non-BP sees their friend/partner.
When people enter into a relationship, they typically show all of their good points, and get comfortable with one another before letting their lesser points slide in. One may be dating a person for a few weeks, going out to dinners and movies, and show full proper manners, and then there will come that one night where someone breaks. While this example may be a bit stretched, it does show how one changes their appearance over time, until they feel comfortable with the other. This simple thing however, may in fact be just enough to make a BP start looking at the non-BP in a different light.
“My ex had terrible gas,” the BP may think, and then start looking for signs and other attributes that this non- has with their former partner. This new non-BP, who has only broke wind, has now become like the others.
Abandonment is also a strong fear of BP’s. Feelings of abandonment stretch outside the walls of a close coupled relationship, and may involve relationships shared among friends. These feelings of abandonment may stem to the root of the BP’s psychosis, or may have come as symptoms of the BPD. In the flatulent example aforementioned, the BP may have eventually gone far in assigning negative attributes to the non-; and the non- simply grew tired of this poor soul’s baggage and left. Whether the non- left on good terms or abruptly left the relationship makes no difference to the BP – they were for all intensive purposes, abandoned. The BP was abandoned because the non- just couldn’t take the c
hanges in personality. The non- had been drawn into the BP’s labyrinth, grew scared, and finally found the door behind them, and ran out.
The room is very dark and grows darker still. The BP searches for a way out.
The BP may become, or may have been long since suicidal. Their life is empty. Nobody sticks around. Not a single soul in the world for them no one to love or trust. Sadly, among 8-10% of BPs find suicide as their way out of this maddening maze (Wikipedia, 2007). Still more turn to other destructive behavior such as drug abuse, alcoholism, promiscuity, and so on, if they haven’t already (Harvard, June 2006). Thankfully, the majority searches for a light.
In the search for a way to light this dark room, the BP may actively search for friends. During this search, the BP will also be desperately searching for various ways to gain approval of the people around them. In the desperate acts of approval seeking, the BP may be viewed as child-like, constantly finding inappropriate times to interject, or add to a conversation, sharing experiences which may have no light on a particular subject, following people, consistent rambling, hyperactivity, and so on. Due to this behavior the BP may just drive the nons- away, thus fulfilling their fears of abandonment once again. A vicious cycle has come complete again, and starts once more.
BPs may find light, however, through therapy. Therapy, however, can become just as troubling as the disorder.
The Grand Hall, just down the corridor from the large darkened room. Even darker. Still no light. A large spiral staircase in the center. The staircase, more frightening, leads to the depths of the issue.
Somewhere along the way, the BP may have been diagnosed, or they may just realize that their symptoms deserve attention, so they seek therapy; where they shall become diagnosed as a person suffering from Borderline Personality Disorder, if not many more psychological disorders (Harvard, 2006). In either case the BP has most likely come to therapy, entered The Grand Hall, to receive help with the symptoms – the trust issues, the anxiety and depression. The counselor (inclusive of therapist, psychiatrist, and psychologist) leads them to the staircase – the disorder itself. This long dark and twisting shaft is lined with many steps, many symptoms. The hole that they lead down is the disorder, and the depth of the hole, the number of steps leading down, can only be influenced by how the BP thinks and chooses to interpret things. A scary walkway to look at for the BP, and the counselor. Truth be told, the counselors are typically more fearful of the treatment than the BP (Harvard, 2007).
Enter the minotaur – the stigma of this labyrinth known as Borderline Personality Disorder.
With all the knowledge that counselors have of BPD, they have the misfortune of having to expect anything and everything from the patient. The counselors know the definition of BPD; unsettling and unstable moods, rage, suicidal thoughts, self-injury, fears of abandonment, intimacy issues; over-all volatile behavior (Harvard, 2007). With this information, it’s hard to enter into a session without some slight. More difficult still, is the nature of the disorder. Personality disorders are just that – a problem entwined within a personality, the very being of a person. Defining a line between the being and the human is difficult, if not nearly impossible. The problem is magnified where the personality is that of a borderline nature, meaning it can change randomly at any given moment, as opposed to its akin; Bipolar, which changes on a more patterned cyclic rate (Wikipedia, 2007). [To continue with illustrative efforts, bipolar persons are more like funhouses. The journey may be scary and fun, and there is a definite end to the cycle before you re-enter.]
The stigma then plays into the BP’s psychosis; the counselor has failed the BP. There is no help or hope. Abandonment, yet again.
There have, however, been several good attempts at therapy, yet these styles of therapy do not show definitive solutions for the disorder. Therapy for the BP has been tried in one on one sessions, as well as in group sessions such as groups of BPs being counseled, or couples therapy for the BP and non-BP. Two forms of therapy have shown good response in BPD diagnosed patients. One therapy style, Schema-Focused Therapy (focuses on childhood, daily life, emotion and defining thereof), has shown full recovery of some patients after a four-year term, while having a larger number “showing clinically significant improvement.” Dialectical behavioral therapy (logic reasoning, weighing and exchanging points and ideas) has shown some use in an effort to stop suicidal and self-injury tendencies, and is more welcomed by BPs in opposition of traditional psychoanalysis; however dialectical has yet to prove any effectiveness in treatment of BPD. (Harvard, June 2006)
There are no medications for BPD itself; whereas a BP can be medicated for certain symptoms or a concurrent mental health diso
rder. Selective serotonin reuptake inhibitors (SSRI) have been used to aid in the improvement of anxiety and depression. Antipsychotics have also been tried in attempts to alleviate impulsivity and suicidal attempts. Anticonvulsants have been used as well, and have shown effects in stabilizing the mood of BPs. (Harvard, July 2006)
Borderline Personality Disorder is an enigma to everyone involved. A large puzzle without a solution. A maze without a map. A deep dark labyrinth. Though the single sufferer may never be completely cured (Harvard, July 2006), they may, however, through therapy and the determined support of trusting friends and partners, be able to make it through without having the house cave in on them.
References
American Psychiatric Association, (2004). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). Washington, DC: American Psychiatric Publishing.
Borderline Personality Disorder. (2007). In Wikipedia [Web]. Retrieved July 6, 2007, from http://en.wikipedia.org/wiki/Borderline_personality_disorder
Danielewski, M (2000). House of Leaves. Toronto, Canada: Random House.
Harvard Health Publications, (2007, January).The stigma of borderline personality. Harvard Mental Health Letter. 6.
Harvard Health Publications, (2006, July).Borderline personality disorder: Treatment. Harvard Mental Health Letter. 3-5.
Harvard Health Publications, (2006, June).Borderline perosnality disorder: Origins and symptoms. Harvard Mental Health Letter. 22, 1-3.