Development Interrupted: Borderline Personality Disorder

“I’m so good at beginnings, but in the end I always seem to destroy everything, including myself.” ~ Kiera Van Gelder, The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating.

Some of you have already heard of Borderline Personality Disorder (BPD). But, if you haven’t, you’ll connect quickly to the seriousness of this disorder by the dramatic films that portray this type of personality, like Girl Interrupted (Winona Ryder and Angelina Jolie), Single, White Female (Jennifer Jason Leigh), and Sleeping With the Enemy (Julia Roberts).

Although Hollywood’s rendition of BPD is quite extreme, you can find examples of these more dramatic, dangerous borderline persons in real life.  Some of them are capable of carrying out a grudge far beyond most of us could ever imagine. I’m sure many of you know of the infamous La Jolla, California socialite Betty Broderick (1989) who, in a fit of rage, killed her ex-husband and lawyer, Dan Broderick III and his new young wife Linda Cohenia. This story of borderline abandonment and revenge captured Hollywood’s attention (Betty Broderick: A Woman Scorned, with Meredith Baxter). It is such a popular television movie that Lifetime TV is still running it 20 years after Broderick killed her ex-husband.

There is also Jodi Arias who is on trial right now for repeatedly stabbing (30 times), almost decapitating, and then shooting her cheating lover. From what I know of the case thus far, Arias appears to fit the criteria for the more dangerous type of BPD. And, I’m sure Arias’ story will soon make its ways into Hollywood too, as we are ever fascinated by people who act out their impulses murderously.

But, unlike the infamous borderlines in the news, most borderline people harm themselves, rather than hurt other people. There are many contributing factors to the borderline personality condition (biology, early developmental experiences, and other personality features, like narcissism and antisocial impulses) that creates differences between borderline people. The weight of one factor over another can determine the extent of the borderline pathology and treatment outcome.

But, before I go further in helping you to understand BPD, let’s consider why these types of personality are called borderline in the first place.

Why Borderline?

Psychiatry called this disorder BPD, because these persons function somewhere in between a state of neurosis and psychoticism. They are not obviously crazy. But, they are dictated mostly by inner impulses, which makes their behavior fantasy-based, self-centered, and, at times, antisocial.

Nonetheless, the line between the real world and their inner processes is a fragile one, indeed. This is because borderline persons have limited to no ability to use the executive area of the brain (Frontal Lobes) to consider the effect of their impulses on themselves and other people. They are limited greatly in the ability to self-govern themselves through mental processes, so that they rarely reflect upon, learn from, or give meaning to experience that can grow them. They have what is clinically referred to as a fragile, immature ego, which is essentially to say that the capacities of the brain’s frontal lobes are insufficiently developed.

Their fragile ego is also why they have great difficulty defusing powerful emotions of hurt, sadness, and anger through reasoned thinking. Thus, their reactions are often self-centered, destructive, and out of control, which can lead them to threaten harm to themselves or to other people. It’s no wonder that people experience them as self-indulgent. And, only adding to the perception that they are self-absorbed is their inability to consider how their behavior impacts other people. But, their lack of empathy is less from self-preoccupation than it is from an inability to reflect upon other persons’ frustration and pain (See Mirror Neuron Explanation in Article: Can You Strengthen The Empathy Muscle).

If you have a friend or family member who has such difficulties, you know too well the affect of their self-indulgence on them and you. But, unless, you are clinically trained, you may think that their self-destructive behaviors are just to spite you and to resist growing up, rather than an expression of their inability to learn from experience.

Hallmarks of BPD

Early development plays a strong role in the making of a borderline personality. Either through neglect or spoiling of the child, caretakers did not provide sufficient teaching experiences for the child to learn how to regulate his or her impulses and emotions. Hence, the child’s intense needs overwhelm their ability to think through, reason and learn from experience, which frustrates their psychological growth. They experience each situation as new, with little to no connection to the past, and no anticipation of what their behavior means to their future functioning. They fluctuate between feeling bored, empty, and deprived, or highly anxious – craving excitement, attention, and emotional connection to quell this yearning. Food, drugs, alcohol, or even cutting on themselves are ways to allay the unbearable anxiety that they feel, at such times.

Sadly, this vicious cycle of need fulfillment stops them from learning how to cope with life’s problems on their own. They require things outside of themselves to soothe their frustrations, just like young children do. Only, instead of running to mommy for help and comfort, they turn to substances, risky people and activities, and self-injurious cutting on themselves, to calm down. These comforting agents are a life source to the borderline person, like a mother is to a young child. Without them, they feel afraid, empty, and abandoned. Can you imagine just how difficult it is to free a borderline person of people and activities that they view as a life source? It’s like taking a young child away from his or her mother.

BPD In Treatment

It’s critical that the treating therapist assesses accurately all of the contributing factors that are preventing the borderline person from learning through experience, as the main therapy challenge is to get the patient to use his or her frontal lobes to process what happens to them. This can be a challenging, lengthy, and frustrating task of having to reparent the borderline person. The therapist has to essentially connect up the borderline person’s inner world with outer reality. We become the patient’s frontal lobes until theirs are strong enough to take over. And, like a good parent, the therapist must be empathic, patient, and signed up to treat the patient for the long haul (at the least, two to five years). As I said, the good news is that borderline people can learn and grow, especially as they mature with age.

Nonetheless, borderline people are difficult to treat. It’s not easy to loosen them from destructive people and activities that soothe their anxiety and frustrations. The therapist must become the soothing agent, so that these destructive sources lose their appeal.

Additionally, as many as 75% of borderline persons hurt themselves and approximately 10% will commit suicide. This is an extraordinarily high suicide rate, by comparison to the 6% suicide rate for mood disorders (Borderline Personality Disorder: Mental Illness on the Rise? Time Magazine). Thus, therapists have to be continually alert to the risk of suicide in such patients.

As you can see, treating a borderline condition is no easy task and requires a special course of treatment to serve the patient well. Many people are wrongly diagnosed either because of the therapist’s lack of skill and knowledge in diagnosis or the patient’s underlying pathology is hidden until uncovered by therapy. This is unfortunate, as there’s nothing worse for the therapist and the patient than missing the risk of suicide.

The recent revision of the Diagnostic Statistical Manual of Psychiatric Behavior from its 4th to 5th edition made radical changes in the diagnosis of personality disorders, to avoid misdiagnosis as much as possible. Now, for a BPD diagnosis to be made, there has to be significant impairments in identity, self-direction, empathy and intimate relations and also the presence of emotional lability, anxiousness, separation fears, impulsivity, risk-taking and hostility. Additionally, the impairments of personality development and functioning must be stable over time, not due to stage of development or social and cultural influences, or solely due to drug or medication use (DSM V).

I’m glad for this attempt to refine the diagnostic process, so that there’s less chance of misdiagnosis and so that the public is better served. The more serious personality types, like the avoidant, borderline and narcissistic personality disorders can be a hard pill to swallow for those people who are receiving the diagnosis. Thus, it is so important to understand the great variability within the group of people who are given a specific diagnosis. And, that it is the level of the symptoms that heighten the probability of having a personality disorder.

The abstract features of a diagnosis do not say much about the concrete strengths and weaknesses of the person you are thinking about. I have treated several borderline people throughout the years. Their weaknesses can also be their strengths. They are often highly creative, intuitively sensitive, and intelligent and capable of bonding to people. With the proper diagnosis, treatment, and therapist, there is much possibility of them maturing and leading productive and happy lives.

I hope you liked today’s post. If you did, please let me know by selecting the Like icon that immediately follows. You can also Tweet or Google+1 this post to let others know about it. Warm regards to you, Deborah.



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28 Responses to “Development Interrupted: Borderline Personality Disorder”

  1. avatar romel says:

    I need some suggestion about my mom …

  2. avatar Shaheen Islam says:

    Yes, I do agree that their inability to learn from experience need to be focused in dealing with them.Acceptance will help them to come out of their fear of abandonment. Highest social support helps them to grow and make positive changes.

    • avatar Dr. Deborah Khoshaba says:

      Hello Shaheen, good to see you here today. Acceptance is definitely a part of these personalities maturing. And, also, I agree very much that the more they associate with people who are mentally healthier than they are–the more chance for them to learn from these people and to make positive changes. Thank you for your wisdom here Shaheen. Warmly Deborah.

  3. avatar Hoor khan says:

    I had Done Msc in psychology I like ur page
    Send us more than disorders their symptoms an treatment thank you

    • avatar Dr. Deborah Khoshaba says:

      Hello again Hoor. Congratulations on your degree in Psychology. I’m very happy to post more articles on disorders and their symptoms in treatment. You found me through Facebook, am I right? Make sure you go to my FB page for this website regularly, as I’m always posting my articles and also have many discussions on various personality disorders. i very much look forward to your wisdom, expertise and contributions here. Warmly Deborah.

  4. avatar Hoor khan says:

    I like ur page

    • avatar Dr. Deborah Khoshaba says:

      Hello Hoor, I’m so glad you like my page and I very much look forward to seeing you here again. Thank you. Warmly Deborah.

  5. avatar Muhammad Abbas says:

    dr i am a student of psychology. your articles r so informative and i always got lot of knowledge. thanks for sharing this treasure of knowledge. blessings for u.

    • avatar Deborah says:

      Thank you Muhammad Congratulations on going into the field of psychology. It is a great field gives to others and to you in many ways.. Im glad you find my posts helpful. Blessings Deborah.

      • avatar Dr.Salahuddin Khan says:

        Madam, ◇I am a medical doctor and s hospital administrator.Thank you for your efforts in educating the general public as well as professionals like was enlightened by your blog on BPD.I think I have a near relative who may be a patient.I can understand her behaviour more clearly now.Plz keep up the good work.May God bless you for your kindness.Dr.Salahuddin Khan , Lahore, Pakistan

        • avatar Dr. Deborah Khoshaba says:

          Hello Dr. Khan, welcome and thank you for valuing the information that I provide in this site. My goal is to help people to understand the mental health conditions better so that they can get the help they need and also live in a way that gives them more fulfillment. I look forward to seeing you here again. Blessings to you too Dr. Khan for all you do to help people. Warmly Deborah.

  6. avatar Najda says:

    Hello Dr, Deborah. It’s a really informative article but I have a question these kinds of patient can also develop negative attitude towards their therapist?? Since they have instability in their relationships and they also show this trait during their therapy process with their therapist. We can cure them but we cannot fully treat them, is that so??

    • avatar Dr. Deborah Khoshaba says:

      Hell Najda, what a good question. You are right. Yes, they do develop negative attitudes toward their therapists. This is a high probability, because of the problems talked about in the article. It takes a skilled and empathic therapist to work with such patients, so the therapist knows hw to deal with their hostility and doesn’t overwhelm their fragile defenses. Again, a good question Warmly Deborah.

  7. Why was Julia Roberts in Sleeping with the Enemy a Borderline? I thought she was a victim of a disordered husband’s violence.

    • avatar Dr. Deborah Khoshaba says:

      Hello Louise, it’s a very good question and I know exactly why you are asking. We don’t always have a lot of information to make a clear diagnosis of people in the movies. Sometimes, it’s easier than other times. Julia Robert’s role in this movie is not so clear cut. You are right. She could actually look like a dependent personality too. And, you are very right that domestic abuse can wear down someone so much that the victim of the abuse looks more ill than they really are. Now that being said, let me say why I categorized her as borderline in this role. It was the unclear identity (weak ego strength). She didn’t know who she was, which is why she was attracted to this Narcissistic Personality Disorder, in the first place. Not everyone could so easily become a hostage to this man. It takes a much weaker personality for this to occur.

      I love this movie because she evolves after she fakes her death. She finds a healthier man with an emotional life, and he symbolizes the emotional development in herself. Further, Julia Robert’s mother in the movie was a borderline mother, which can produce borderline children (but not always). But, that being said, I have to agree with you it is unclear. And, the addition of domestic violence complicates diagostic issues.

      Thanks for a great question. Warmly Deborah.

  8. avatar Tracy says:

    My many therapists have speculated that my mom is BPD but now after much reading I think I may be BPD. My current long term therapist has never mentioned it to me. What should I do?

    • avatar Dr. Deborah Khoshaba says:

      Hello Tracy, first, let me say that it’s very easy for people to see themselves in many psychological disorders. The first thing I’d do is ask your long-term therapist if you have some symptoms of this disorder. Many therapists do not come out and tell someone they are borderline personalities. The reason is that people tend to not fit exactly into one personality versus another. Also, remember, your therapist may see some of your behaviors at times as symptoms of borderline, but perhaps you are higher functioning most of the other times. So, again, I think you need to ask your therapist about this, so you can better understand what she or he is treating you for. Thank you Tracy for visiting. Warm regards to you Deborah.

      • avatar Alam zeb says:

        I like your page and this is much more informative and i pray u to write better in future. thinks

        • avatar Dr. Deborah Khoshaba says:

          Hello Alam, I’m so glad you found us. I look forward to writing more all of the time. Warmly Deborah.

  9. avatar Piper says:

    Dear Dr. Deborah :
    Dont even knownbow i just came upon this wonderful article? sometimes web-surfing does a body good. 😉 II have been diagnosed with BPD, here in NYC. Would you reccommend a program, like the: Post Graduate Center ( individual DBT therpist for 45 minutes a week and group sessions 1.5 hrs/wk) or a private therapist. St. Luke’s hospital doesn’t take my insurance. …And NYP Cornell hospital, doesn’t even answer their voicemail anylonger – they are so over crowded! Also, my husband dof 27 yrs is definitely 699% suffering from NPD; What a combo. I guess we were made for oneanother? I feel, at 51… It’s just been too long with all of this. Thanks

    • avatar Dr. Deborah Khoshaba says:

      Hello Piper. I’m so glad you found us and hope to see you here regularly. Yes, sometimes web surfing produces things helpful to us. I know I find the same, Piper.

      Okay, I see you are talking about Dialectical Behavior Therapy (DBT). First, it is a very good therapy for what you describe here. You ask an interesting question as to whether group versus individual therapy is best. I’m going to say they are both good but it depends on what you want to desire. The thing I like about group therapy is that you get a lot of interactional feedback and chances to try out new social and coping skills with the group. But, the group is only as good as the group leader, so make sure you get an expert in DBT who is a skilled leader who is really educating and leading the group. If the group is laissez-faire–it is not a good learning situation.

      Now, the nice thing about individual therapy is that you get a lot of attention on issues unique to you. Piper, you may want to try the group and if it’s not exactly right for you, then individual treatment may be the way. The Post Graduate Center of Mental Health has a very good reputation ( ).

      I hope this helps you for now. Let me know how it goes for you Piper. Warmly Deborah.

  10. avatar Indie says:

    Thank you for writing that we also can bond and do have abilities to use our defects as our strengths. I am so sick of reading how we are some evil succubuses that will mess you up completely and how there is no cure, how people just have to run away from us. People write such midnless generalizations about this condition.

    • avatar Dr. Deborah Khoshaba says:

      Hello Indie, you are very welcome. Yes, much of the literature on BPD is very negative and does not consider the person who usually has so many gifts and strengths to use toward their growth. You take good care. Warmly Deborah.

  11. avatar Evangeline Alphonse says:

    Dear Deborah,

    I liked most of your article but there was one part that really bothered me. You state that people with BPD are highly unlikely to be empathetic and yet in my experience and research I feel like they can be some of the most empathetic people out there. A lack of empathy is more suitable for disorders where the individual is not concerned with the state of their loved ones (mental, physical, emotional, etc) while those with BPD are more concerned with how people are reacting to them than anything else. This extreme interest in how others perceive them often makes them exceptional at reading facial cues and body language. Personally I believe that it’s not that they are not empathetic (they are, very much so, and often cannot help it due to their intense need to constantly assess their place in someone else’s life), but rather that they misunderstand the reason the other person is feeling that way.

    For example, since empathy is the ability to place oneself in another’s place, a person may be able to easily do that since they understand exactly how the other person is feeling but they may resent them for feeling that way or hate themselves for ‘making’ the other person feel that way.

    This is very similar to those ‘secondary feelings’ of guilt and hate that they may feel towards themselves when they realise they are depressed or hurting themselves. It’s not that they can’t feel the emotions of others (I believe narcissistic, antisocial, and sociopathic behaviour more suits that), but that they understand others extremely well and drive some sort of negative connotation from it all (ie. A bored friend = you’re not good enough because you can’t even keep your friend interested in you) . This then prompts anger and rage which others see as a lack of understand and selfish behaviour in them.

    Please feel free to correct me if I’m incorrect or not quite on track here.


    • avatar Dr. Deborah Khoshaba says:

      Thank you Evangeline. You make a great point here. I should have also stated that yes–they can be very empathic (and intuitive), but that their empathy is often very self-oriented; their empathy is the ability to gauge people well to avoid abandonment. You describe this so well in your comment (facial cues and body language–and to assess their place in a person’s life). You are soooo right. This is different than mature empathy that can empathize not as radar for abandonment. Thank you for the excellent understanding. Have a blessed New Year. Warm regards to you Deborah.

  12. avatar Anita says:

    What do you make of BPD in the case of those who are adopted? Many of the BPD traits seem to directly correlate to Reactive Attachment Disorder, is there any way to differentiate between the two in cases of those who have been adopted and thus suffered trauma at a primal stage in development?

    • avatar Dr. Deborah Khoshaba says:

      Hi Anita. I’m sorry for the long delay in responding to your excellent question. You are very right to see the connection of BPD traits to Reactive Attachment Disorder. I think what you are highlighting in your question is that defining personality issues/traits is not an easy task, even for the trained clinician. For the most part Anita, psychological features/symptoms/traits overlap with several different personality disorders and issues. Borderline Personality Disorder is a combination of genetic and environmental issues. The biology can ready one to act out impulsively and to resist learning from one’s mistakes. That said, environment (parenting) can bring about or diminish these issues as a result of parenting style.

      There are many articles addressing the relationship between BPD and reactive attachment disorder. You’ve most likely investigated them already. But, if not, take a look. Thank you for an excellent question. Warm regards, Deborah.


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