I had an idea for introducing the personality disorders after I went through some of the others, but I also take requests, as I said in one of my previous posts. Via Facebook, a request came in for me to write about Borderline Personality Disorder. So I’ll be moving into the Personality Disorders a little earlier than I expected.
That having been said, personality disorders are what we consider “bigger” in therapy. Personality disorders are deeply ingrained into the personality of the client. They are invasive, pervasive, and ever-present.
I live in Georgia. Here in Georgia we have an invasive plant called kudzu. It’s everywhere. It grows all over the place and it can’t just be cut down or even burned (burning is illegal anyway because duh, we’re in a drought most of the time and the place would go up in flames faster than Michael Jackson’s hair in that Pepsi commercial). It has to be uprooted from the ground by its root crown.
That’s exactly what personality disorders are–they’re the kudzu of our personalities. They strangle the existing plant and take over completely. They become the plant itself.
So when we’re dealing with a personality disorder, it takes a long time to get to that root crown and eliminate it so that the person can be less miserable and learn to function better so that the people around them can have improved relationships with them. With several of the personality disorders, close relatives and friends grow weary of the “antics.” It makes it difficult to sustain and maintain relationships.
Personality disorders can also interfere with work relationships and productivity, as well as the general day-to-day functioning of the patient. While the same can be said for any disorder in the DSM-5, with a personality disorder, it is much more treatment resistant, prone to severe relapse, and is lifelong.
A patient has a personality disorder for life. They are never cured. But they can manage it, find relief, improve their relationships, and even help themselves hold down steady employment. They can work towards stability if they work hard enough. It takes a demanding amount of work.
Borderline Personality Disorder (BPD) falls into “cluster B” of the personality disorders. If you don’t count Personality Change due to Another Medical Condition or Other Specified Personalty Disorder and Unspecified Personality Disorder (which we don’t), you have ten personality disorders in three clusters:
- Cluster A: This is know as the odd or eccentric cluster. It includes Paranoid Personality Disorder, Schizoid Personalty Disorder, and Schizotypal Personality Disorder.
- Cluster B: This is the dramatic, emotional, erratic cluster. It includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
- Cluster C: This is the anxious and fearful cluster. It includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder (which is not the same as OCD).
Borderline is considered to be in the dramatic, emotional, erratic cluster. It is characterized by a lifelong pattern of of instability in interpersonal relationships, self-image and affects, and marked impulse control issues (DSM-5, p. 645).
So what the hell does that mean? That means the patient has little to no stability in their relationships with others (professional and personal), erratic behavior and lack of self-control to the point where self or others are harmed.
According to the DSM-5, the signs and symptoms of BPD are a pervasive pattern (as stated above)–but what makes up these patterns? The DSM-5 reports that for a person to be diagnosed with BPD, they must have five (or more) of the following (which I will give in plain English):
- Frantic efforts to keep from being abandoned, whether that threat of abandonment is real or imaginary. This does not include suicidal behavior or self-mutilation as that is a separate criterion.
- Repeated unstable and intense relationships that alternate between extremes of idealization and devaluation. Going from “you’re perfect” to “you’re the scum of the earth.”
- Unstable sense of self. This instability is marked and persistent and goes to extremes. Not only does the love-hate relationship apply to other people, it applies to themselves and their self-image.
- Recklessness/lack of impulse control in at least two areas of life that will cause them harm, such as unprotected sex with strangers that could result in STIs, overspending, substance abuse, reckless driving, binge eating, etc.). This still doesn’t include suicidal behavior or self-harm.
- Recurrent suicide attempts, threats, gestures and behavior, or self-mutilation.
- ‘Affective instability due to a marked reactivity of mood.’ This one’s a bit hard to explain. Imagine the worst overreacting you’ve ever seen. Now imagine it could happen at any time for any reason. You run out of cotton balls and the person has a massive anxiety attack and the anxiety affect lasts for a few hours. It’s a bit like that.
- Chronic feelings of emptiness. (Exact words from the DSM. Self-explanatory.)
- Difficulty controlling anger. Intense anger fits. Inappropriate anger to the stimulus. Imagine telling the person you’re out of donuts and they smash a table in response, demand to see your manager, threaten to sue, and threaten to kill you. While that might be funny and unbelievable, yes, it is that extreme.
- Stress-related paranoia or severe dissociative symptoms that are transient. In other words, it doesn’t last, but the person will abruptly become paranoid, or they’ll dissociate (the world isn’t real, people are inhuman or automatons, etc.).
Now, writing a character with BPD is actually a challenge. Sure, you can go through all nine of the criteria, but I could almost guarantee you that you’ll create a caricature instead of a character. Even with black-and-white perceptions that many people with BPD have, they are still human beings. Avoid making a cookie cutter. You’ll want to add lines of sympathy to that character. He or she didn’t get there on their own. In many cases of BPD, there is not just a genetic component–there is often a history of abuse–sexual, physical, etc.
The person with BPD does not mean to do these things. They cannot help it. That’s why Dialectical Behavior Therapy helps so much. Patients learn from a system of mindfulness and awareness. DBT was developed by Marsha M. Linehan, who has successfully managed the disorder herself. Bear in mind that if you are writing someone with BPD, remember, they cannot help themselves when they do these things. Yes, some of the behaviors are purposefully manipulative, but they are not malingering. Until they get professional help, they are often unaware that these things are not acceptable, because even though people tell them so, they are often focused on assigning blame to others for their reactions.
Always remember, you are still writing a human being, though these are the extremes of the human condition.
If you came here looking for help with BPD, know that it’s out there. Start with this article here and then search for a therapist in your area who specializes in DBT.
Anne is a former supervised therapist and current author. You can read her books, stare at her Twitter, or stalk her on Facebook if you want.