Focus on Borderline personality disorder

If we translate the term into French, it would be "a borderline state", but what does this mean, why do we speak of limits in this disorder?
It's not easy for the person affected, their family and friends, or the practitioner to understand where they are.

As caregivers, we can feel caught up in different emotions belonging to the person, with the impression of taking one step forward, two steps back and six steps to the side. In other words, to be caught up in a whirlwind of comings and goings within the therapeutic work, over which we have little control.

The patient seems to be playing with the therapist, just as he plays with his own limits and those of others. By "playing", I mean testing and straining without being aware of it, and yet feeling great suffering in the process.

The DSM-V, which provides a differential diagnosis of various psychological disorders, mentions certain dimensions specific to this personality type, which illustrate the above-mentioned sentiment. Professor Van Gijseghem H., in his course on the subject, describes them as follows:

- An initially terrible fear of abandonment (real or imagined), which the individual tries to avoid relentlessly, without really considering the object (the person) being abandoned. There is often a latent psychotic anguish (of fragmentation), existential and/or identity-related→ ".the fear of no longer being, or of being who without the Other?"

- Interpersonal relationships are rather unstable and intense, as the person alternates between extreme positions: he or she may move from a position of devaluation to one of excessive idealization (of Self and Others) - seduction is very present in borderline-type behavior.

- Disruption of identity through marked instability of self-concept and self-image (in contrast to structured internal organization).

- Impulsivity, exuberance in damaging areas such as spending, sexuality (which may be hyper or non-existent), via also dangerous behaviors (comorbidity with substance abuse or bulimia-type OCD)

- A fantastical relationship with death, like a flirtation with it. Suicidal threats, self-mutilation or attempts may often be used as a means of approaching the rupture (of ties, relationships or life).

- Emotional instability too, marked by mood reactivity: episodic dysphoria, mood highs, excitement, then depression. These moods alternate very rapidly (rather than over long phases, as in bipolar disorder).

- The presence of a chronic feeling of emptiness - which attempts to be filled by affect and/or the instrumentalized object.

- Rapid irritability, often inappropriate anger that is difficult to manage → because ready to destroy his object (where a histrionic person wants to maintain the relationship, preserve his object)

→ This sometimes leads the person to self-sabotage before reaching a goal → but also to fulfill his need for affection by attracting the attention he wants.

To those around them, they may be perceived as rather theatrical, emotional, capricious, dramatic and/or seductive.

These types of behavior are present from adolescence onwards. They affect 9% of the general population and account for 20% of people hospitalized in France.

Psychotherapy (either cognitive-behavioral or relational) can help the borderline sufferer, particularly by providing an anchoring and refocusing point. Holding on in spite of movements - quite an adventure! We may be shaken, but the challenge may be to limit the suffering?

Article written by Manon Reynaud, clinical psychologist at Centre Pensées.