Thank you for your great comments on the first post of this series about understanding psychopathology as a means of providing more depth for your characters. Today the focus is on Borderline Personality Disorder. I wanted to cover this diagnosis not only because Joanna St. James asked me to but also because I can sum up Borderline Personality Disorder (BPD) in one word: DRAMA! What better traits can you achieve for your character?
The term “borderline” refers to the time in the early 1900’s when individuals were diagnosed as either neurotic or psychotic, yet some patients seemed to be right in between: teetering on the borderline between neurotic and psychotic.
Which famous character is the poster child for BPD?
For a discussion about BPD I must reference the brilliant work of Marsha Linehan, Ph.D., the creator of Dialectical Behavior Therapy specifically for the treatment of BPD.
Emotional instability wreaks havoc for individuals with BPD, who have impairments in three main areas: emotional regulation, interpersonal effectiveness, and crisis management.
Emotional dysregulation: heightened emotional sensitivity, quick and intense emotions, wide mood swings, insecure self-image, often feeling empty or bad; heightened anxiety, depression, and anger. “I can’t handle this feeling!”
Interpersonal ineffectiveness: turmoil in social life, love-hate relationships (idealizing people and thinking they are the scum of the earth), black-and-white thinking, intense fear of abandonment. “You’re a bastard . . . but please don’t leave me!”
Chaos and crisis: suicide attempts, self-injury (like cutting), engagement in impulsive and risky behaviors such as unsafe sex, compulsive spending, drug use, reckless driving, and gambling. “If you leave me I’ll kill myself.”
If you’re feeling helpless and manipulated in a relationship, the other person might be exhibiting symptoms of BPD. So how does this exhausting, painful disorder develop?
Dr. Linehan’s theory is that individuals with BPD experienced an invalidating environment as children. They are highly sensitive, perhaps starting as “difficult” babies and continuing with anxious or “touchy” temperaments. This sensitivity in itself is not a problem if the family can understand and nurture this special child. However, if family members are not as emotionally sensitive, they may have trouble with comprehension and acceptance, and may unwittingly reject the child, creating an environment that fosters BPD.
I like this theory because it doesn’t blame the individual or the family, but rather the poor fit between the two. Family members often believe the loved one is choosing to “overreact” when in fact the individual is wired to feel emotions more intensely, and needs to develop skills to cope with this increased stress.
Dialectical Behavior Therapy is a skills-based approach, targeting the most destructive behaviors first and incorporation Eastern teachings like mindfulness.
Joanna asked a great question: “Can any of these disorders be treated without therapy?” As a therapist, I’d have to say that therapy is one of the best ways. But I don’t want to be so narcissistic as to claim it’s the only way. A psychiatrist would say that medication can assist with some symptoms of these disorders. A minister would say that faith is the way to heal. I just watched a fabulous movie, I’ve Loved You So Long, about a woman released after serving 15 years in prison for the death of her son. Instead of prison rehabilitating her, it was connecting with her sister and her family, new friends, and fine art that healed her. I think we can find healing in many different places.
So, how about you? Would you like to create a Teddi Forrester character in your novel? God help us!
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