Until recently, experts estimated that two to three percent of Americans suffer from borderline personality disorderâ€”over seven-million people. A recent study has upped the estimate to an astounding six percent. That would total around eighteen-million Americans, over three times the number of Alzheimerâ€™s patients. (Schizophrenia and bipolar disorder occur in about one percent of the population.) When you factor in family members affected by the disease, the numbers are as high as thirty-million people or more.
So, itâ€™s surprising that so few books about BPD are available. A shelf devoted to BPD would contain only a few dozen books, mostly targeted at professionals. Few are geared toward a popular audience, and even fewer are memoirs. Only two concern borderline parents. Books about depression, autism, bipolar disorder, and schizophrenia, in contrast, fill the shelves of bookstores and libraries. When I began to connect my motherâ€™s enigmatic, frustrating behavior with BPD, I read everything I could find hoping to understand her. Only two booksâ€”Surviving a Borderline Parent by Kimberlee Roth and Freda Friedman and Understanding the Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship by Christine Ann Lawsonâ€”directly concerned the mother with BPD.
BPD is a frustratingly variable phenomenon. Certain symptoms, though, are hallmarks of the disorder. A person with BPD forms intense relationships and tries frantically to prevent the other person from abandoning her. (Three times as many women are diagnosed with BPD as men.) When that other idealized person inevitably falls short, the person with BPD suddenly reverses her high opinionâ€”the other person is no longer loved, but despised. The person on whom theyâ€™re focusing all of their energies becomes either a devil or angel.
These extreme shifts show up in other borderline reactions. â€œBlack-and-white thinkingâ€ causes sufferers to feel that theyâ€™re in more pain than anyone else in the world and that theyâ€™ll trust therapy only if it cures them completelyâ€”at which time theyâ€™ll be completely happy, like the people they imagine surround them. The emotions of people with BPD are erratic, and rage is common; itâ€™s possible that many borderline men, diagnosed far less frequently than women, are incarcerated for violent crimes.
The term â€œborderline,â€ coined in 1938 by psychoanalyst Adolph Stern, describes a middle ground between neurosis and psychosis. Most experts trace borderline symptoms to a sense of emptiness and a lack of a strong sense of selfâ€”sometimes traceable to a childhood trauma such as abuse. (Some mental-health professionals consider BPD a manifestation of post-traumatic stress disorder.) Lacking a sense of self, the patient may also resort to impulsive activities, like spending irresponsibly or sexual acting out, to fill the void. She has difficulty feeling empathy.
Much of the literature presents BPDâ€™s prognosis as dire. Thereâ€™s hope in new therapies, however. Dr. Marsha Linehan, director of the Behavioral Research & Therapy Clinics at the University of Washington, has developed a promising treatment for BPD called Dialectical Behavior Therapy. She focuses on the inability to regulate emotion properly. The therapist must directly confront, in a caring and accepting manner, the patientsâ€™ emotions and dysfunctional behavior. Linehanâ€™s compassionate approach involves reassuring patients that the therapist wonâ€™t abandon them and trying whenever possible to validate their feelings instead of contradicting them. Her approach also requires therapists to work together to share the stresses of their work and honestly to face their own frustrations and emotions.
Dialectical Behavioral Therapy, along with other innovative cognitive therapies and pharmaceutical research, is giving hope to those suffering with this painfully misunderstood and stigmatized disorder.