Borderline: Walking the Tightrope of Life

Borderline syndrome is a personality disorder characterized by severe emotional instability and impulsivity. The clinical picture is markedly diverse and ranges from depression to drug, alcohol or sex addiction to massive identity problems, aggressiveness and suicide. For those affected, the disorder means an enormous impairment in dealing with others, but also in relation to one’s own feelings, moods and behavior.

Borderline syndrome: causes

Borderline personality disorder (BPD) is characterized by severe emotional instability. The term, coined in 1938 to mean “borderline,” goes back to the American psychoanalyst William Louis Stern. He saw the disorder as being in a transitional area between neurosis and psychosis, as symptoms from both areas were evident in those affected. Today, borderline disorders form an independent clinical picture, the cause of which psychologists see in childhood, when important interpersonal relationships, for example with the father or mother, were strained in the broadest sense. This includes sexual abuse, maltreatment and neglect. It is in childhood that people learn how to deal with their feelings, and also to trust them. If this development is permanently disturbed, emotional instability develops.

Who is affected by borderline?

There are only estimates on the prevalence of borderline syndrome in the population, as many affected individuals do not seek professional help. About two percent of the population is thought to be affected – most are younger than 30. Only a quarter of patients are male, and mostly girls and women seek therapy. Nevertheless, it is suspected that an equal number of men and women may be affected. More than two-thirds of those affected have attempted suicide.

Borderline and violence

“Sometimes I don’t notice my body anymore. I hurt myself to feel myself again. Anxiety, panic attacks, depression and relationship problems rule my life. I am trapped inside myself!” These and other descriptions can be found in the interviews and personal accounts of borderline patients. Martina Schwarz collected many of these reports as part of her diploma thesis as a graphic designer and used them to create a “tagebuch borderline – borderland”. Among other things, it becomes clear here how much borderline patients also tend to violence – against themselves and others. The murderer of the Swedish Foreign Minister Anna Lindh, Mijailo Mijailovic, is said by experts to suffer from borderline syndrome. More common, however, are self-injuries with knives, razor blades, fire or needles, up to and including suicide.

Between madness and normality – borderliners and relationships.

The diagnosis Borderline is difficult, it seems as if very many symptoms fit the disease. Characteristic are strong emotional fluctuations, which are unpredictable for affected persons as well as their environment. Especially with regard to attraction and hatred, the attitude towards other people can quickly change from one extreme to the other. But not only the feelings towards other people are unstable, also the ego feeling changes rapidly. For borderline patients it is therefore often difficult to understand their own actions in retrospect. This leads to unbearable emotional states of tension. They cannot always tolerate loneliness or closeness, so living with a borderline patient is extremely difficult. Even if it is usually not difficult for them to meet new people, they often have great difficulty in building up and maintaining a circle of friends. Often there is only one reference person onto whom the borderliner projects everything.

Typical behavior patterns in borderline

“Borderline,” says Marie-Sissi Labrèche’s autobiographical novel of the same name, “is a great metaphor. The chance to cross borders, to think differently, to let out all that is bubbling inside. A dance between madness and normality. I’m used to being like on a track between the two.” According to the Diagnostic and Statistical Manual IV (DSM-IV) – a classification system of mental disorders used worldwide – nine behaviors typical of borderline are described. If five of these behaviors are met, a diagnosis of “borderline syndrome” can be made.

  1. Desperate attempts to avoid actual or perceived abandonment – you feel you can not survive without your partner.
  2. Patterns of intense and unstable interpersonal relationships characterized by alternation between the extremes of idealization and devaluation – sometimes you get along well, sometimes the proximity to the partner is threatening.
  3. Identity disorder in the sense of a striking and consistently unstable self-image or self-perception – some people feel that their body is nothing but an empty shell.
  4. Impulsive, self-harming behavior – drug and alcohol abuse, shopping addiction, binge eating or shoplifting are part of the appearance.
  5. Repeated suicidal acts, suicide threats or self-harming behavior – cutting, burning, nail pulling, suicide threats and attempts.
  6. Affective instability – unable to control one’s emotions, vacillating between depression and happiness, sometimes anxiety is added and there is nothing one can do about it.
  7. Chronic feeling of inner emptiness.
  8. Inappropriate, very violent anger or difficulty controlling anger. Some patients cannot control themselves, attack objects or other people, are irritable for days.
  9. Transient, stress-related paranoid ideation or clearly dissociative symptoms. Dissociation is a loss of a sense of reality; all sensory perceptions, including pain, are reduced. Some patients experience hallucinations or “flashbacks” – sudden occurrence of often traumatic experiences from the past.

Therapy – because without help it does not work

Borderline patients belong in psychotherapeutic treatment, which can be both outpatient and inpatient, group or individual therapy. A very common therapy concept is Dialectical Behavioral Therapy (DBT), developed by the American psychiatrist Marsha Linehan. It starts with the symptoms of the illness: First and foremost, therapist and patient work together to try to stop the suicidal tendencies and self-injuries. In group therapy, the focus is on teaching patients to be more mindful of their own experience. Building on this, patients learn appropriate ways of dealing with feelings, i.e. their early perception, non-judgmental description and appropriate expression. Competent behavior in interpersonal relationships is also important. Accompanying this, individual crisis plans are developed, which list, for example, how to calm down or distract oneself. Group therapy also aims to learn behaviors that will help make social relationships more satisfying. Role-playing and video recordings help people become more aware of their own social behavior and increase their confidence in dealing with others. Goals include more positive self-appraisal, improved communication, showing up, engaging and setting boundaries in social relationships.

Forms of therapy for borderline syndrome

Only in a later phase are the traumatic early experiences worked through, followed by the integration phase, in which new perspectives for life are developed. In numerous clinics, there are special borderline therapy wards that additionally use other therapy options such as design, music, dance and sports therapies, autogenic training and progressive muscle relaxation. Movement therapy aims at getting to know better one’s own physical functions and abilities such as breathing, strength, movement. By means of progressive muscle relaxation, patients learn to perceive and release states of tension and to develop a relaxed and serene mood through regular practice. Within the sports group, self-initiative and integration into the group are encouraged, and this offers the opportunity to reduce aggressive impulses in a structured way. However, a sad fact is that 75 percent of all therapies are discontinued – however, the problems do not always lie with the patient, but also with the complexity of the clinical picture for therapists.