By Dr Marcel de Roos (Psychologist PhD, the Netherlands)
When you have a healthy personality you are capable to adjust your behaviour according to the circumstances. When somebody has extreme variations of “normal” personality traits and he or she can’t adjust to the environment we label that with the term “personality disorder”. People who are for example extremely jealous, extremely shy or extremely sensitive to criticism can experience all kinds of problems in their daily lives. But if they have extreme personality traits and they function well in society then they have NO disorder. Only a professional can diagnose a personality disorder.
Borderline Personality Disorder (BPD) is a label that is given to people who have certain symptoms. Because of the huge variety of symptoms and behaviour, people with a BPD differ a lot from each other. There are similarities too: with BPD you often feel unstable and you can react sometimes in a unpredictable way. You tend to see the world in a polarised, over-simplified, all or nothing way. You quickly feel not accepted and you are afraid to be abandoned by people who are important in your life. When this appears to happen, you can behave in a strong emotional way. You distrust other people and it’s hard to maintain friendships and relationships. Anxiety, depression, suicidal threats and self-harm are quite common with BPD.
But personality disorders like BPD (as is the case with all mental disorders) are just labels without any biological/genetic causes. It’s an agreement between mental health professionals that a certain number of observations (4 out of 7, 5 out of 9, etc) can be attributed to a label. On top of this, “personality disorders” are quite vague and imprecise constructs and they tend to “blur” into another.
Many mental health professionals often talk about BPD patients as if they show certain behavioural and interaction patterns BECAUSE they suffer from BPD. This the classic mistake of reification. Reification is the fallacy of treating an abstraction as if it were a real thing. BPD is just a definition; there exists for example no “subtle signs” of it. Only if you change the definition into a broader sense then more people will be included.
The diagnosis “Borderline Personality Disorder” is very ambiguous. A person must have 5 out of the 9 described DSM-criteria (the Diagnostic and Statistical Manual of Mental Disorders) in order to acquire this label. This means that according to the DSM one can be “Borderline” in 256 different ways (a colleague who excels in Maths explained it to me). It’s possible that two “Borderliners” can have only one out of the nine described criteria in common and that they differ completely from the rest.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It’s much better to listen to the whole story of the client, determine the root causes of client’s present issues and treat those (instead of the standard brief “cognitive behaviour therapy”) with an effective form of long term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Countless research studies have demonstrated that in more than 80% of the cases people with the label BPD have been chronically abused in their childhood. This means that there is sufficient evidence that their symptoms have been developed as a result of their traumatic history. It’s much better to speak of a complex post traumatic stress disorder than to label it with BPD. The treatment should be in line with this.