According to the DSM-IV, borderline personality disorder is generally defined by a “pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” (DSM-IV 2000) with these symptomatic elements of the disorder emerging in many situations and with varying degrees of severity and length.
As the hypothesis and research questions around the topic go, fears of being abandoned form the core of many of the responses that are cited in the criteria for borderline personality disorder. When confronted with the real or imagined possibility of being left or denied care and attention, many of the symptoms related to anger emerge and a person with this diagnosis can have intense, angry outbursts, talk about or attempt suicide (even though the DSM-IV notes that it is only carried through with between 8-10% of the time) and other self-destructive behaviors.
Due to the fact that they feel they are inherently “evil” these self-destructive behaviors occur according to this mental illness theory. For instance, those with borderline personality disorder often have highly conflicted relationships and move from the extreme of idealizing a loved one to alternately feeling they are worthless or not valuable. For example, to take the self-destruction one step further, they might come close to being in an ideal relationship but at the last minute, they may sabotage it. People with borderline disorder are sensitive to their environments and feel best when assured they are loved and wanted. When they do not feel this way, they are prone to short-lived but intense angry outbursts—even if the situation does not seem to warrant it (i.e. being told their time is up at the clinician’s). It should be noted that while this is often similar to other mood disorders, there are unique markers that identify it in the criteria from other related and often co-existing disorders.
The typical age of onset of borderline personality disorder is at early adulthood. While this disorder often manifests in young adulthood, those who seek treatment often can see a reduction in the behaviors that meet the criteria for borderline personality disorder and there is also a marked decline in the number and persistence of the symptoms later in life. There is a large divide in terms of the gender ratios, with 75% of these cases being seen in females. The DSM-IV (2000) notes prevalence is quite small in terms of the overall population, with only 2% of the general population, 10% in outpatient treatment and 20% among those seeking in-patient treatment. “It ranges from 20% to 60% among clinical populations with personality disorders” (DSM-IV 2000).
In line with the general statements about borderline personality above, there are several diagnostic criteria associated with it that can be easily confused with other disorders without scrutiny and longer-term attention to symptoms. The main diagnostic criteria include the fear of abandonment, whether it is impending or imagined. This base issue complicates their relationships and another criteria is the list of “unstable and intense” relationships that are extreme in nature; from adoration and idealization to shunning and devaluing the other person. Furthermore, those who exhibit the criteria for borderline personality disorder have distorted self image and express an extraordinary range of extreme of emotions, from intense anger to intense happiness, and back to the chronic sense of being empty—all of which tend to be short-lived and rarely last more than a few days. More dangerously, other criteria include the self-destructive behaviors, such as self-mutilation, over-eating, substance abuse, and other risky actions that demonstrate their high level of impulsivity. Those with borderline personality disorder do not manage extreme change or stress well and often exhibit dissociative behaviors when placed under duress, including paranoid thoughts. The diagnostic criteria overlap with other disorders, but with time, these factors emerge over others when the underlying causes for the actions become clearer.
Compare and Contrast on Selected Articles on Borderline Personality Disorder
Theoretical Perspectives & Hypotheses
One important research article on the topic of borderline personality disorder and its possible course of effective treatment takes a distinctly biological theoretical approach to the disorder (Rinne et al. 2002). This article examines the use of the selective serotonin reuptake inhibitor (SSRI) fluvoxamine to treat borderline personality disorder and puts forth the hypothesis that, based on other studies using these medications to treat this disorder, with a more comprehensive population for the study, treatment using this method might improve affect lability, impulsivity, and aggression in these patients.
Another study (Bohus et al. 2004) examined treatment options for borderline personality as well, but took a distinctly behavior theoretical perspective, arguing in its hypothesis the sustained use of dialectical behavioral therapy (DBT) in an inpatient would demonstrate that this would produce improvement, especially when compared to those who were on the waiting list (the control group) and who were receiving treatment, although within the community as opposed to in the context of this study.
The theoretical approach that examines the behavioral aspects of those with borderline personality disorder was also the subject of another study (Weinberg 2006) that examined the use of cognitive behavioral therapy to treat the disorder. This form of cognitive therapy is called “manual assisted cognitive treatment” (MACT) and is a short-term treatment option. The hypothesis of this study is that through this approach, patients would see a lessened occurrence of suicidal ideation or attempts. Just as in the case with the above study by Bohus, this focus on self-mutilating and suicidal behaviors is the main context of the study’s aim. It should be noted that in line with the study by Bohus, the MACT treatment program “is a six session therapy that incorporates elements of DBT, cognitive behavior treatment, and bibliotherapy. Compared to the other two studies discussed here, this is a shorter-term program and includes a more integrative approach as far as combining different proven ideas about treatment for borderline personality disorder.
The methodology used for the Rinne study (2002) that examined the use of SSRIs to treat symptoms of borderline personality disorder such as affect, impulsivity, and aggression had an extensive underlying methodology, particularly since the study was reliant on a larger population than in past studies. The study used a random sample of patients who had been screened for borderline personality disorder and who had moderate to severe cases. This was a double-blind study that used a placebo as a control. Following the gathering of inconclusive data, the methodology was adjusted with a larger group, resulting in “a double-blind, placebo-controleed, randomized trial using fluvoxamine for 6 weeks followed by a blond half-crossover for six weeks” (Rinne et al. 2002) with a follow-up after 12 weeks. Only females were used in this study, which was advertised in major media. They were taken off of all medication for several weeks, for months if they were already taking fluvoxamine so the study would not be complicated by other medications in the participant’s system. As the authors note, however, the study required a great deal of consent-signing and close attention to the subjects as it was risky to take them off of their medications and leave a control group untreated throughout the course of the study.