Borderline pesonality disorder (BPD; although bipolar disorder is also called BPD), in this case we’re talking about what is called “borderline” personality disorder.
The whole field of personality disorders is highly problematic diagnostically because it was developed in the 1930s – 1960s, before we had a good understanding of what caused these types of characteristic “personality” patterns.
Beginning in the 1960s through to the 1990s we have come to learn that narcissistic and borderline “personality” pathologies are actually variants of the same underlying pathology, and both are the product of unresolved childhood attachment trauma, called complex trauma.
So the field of professional psychology in the 1990s and 2000s began to turn away from the “personality disorder” construct and began to anchor more fully into trauma, and unresolved trauma.
For borderline personality pathology, the unsolved trauma is often sexual abuse victimization as a child. The other prominent source for developing the symptom pattern of “borderline” personality pathology is from being raised by a borderline mom (dads too, but women are more common for this type of symptom pattern, probably because women are more frequently victims of sexual abuse during childhood).
So for a large majority of the “borderline” pathology we may be looking at unresolved sexual abuse victimization in the childhood of the now-adult person. If not sexual abuse, there is some other complex trauma in the background that is leading to the symptoms.
The symptoms are primarily a huge disturbance in self-concept, there’s a black hole of deep-insecurity and self-hatred that is extremely painful. Its origins lay in the absence of parental love during childhood that would serve as the core to the child’s and then adult’s sense of fundamental self-value and self-worth.
The other primary symptom features is emotional dysregulation, particularly in intimate relationships, when the unresolved trauma from childhood creates such extreme anxiety that the person’s ability to regulate their emotions and behavior become disorganized.
One of the principle experts in borderline personality pathology is Dr. Marsha Linehan. She was actually diagnosed as “borderline” in her young adulthood, and the field of professional psychology had zero understanding for what the pathology was and what to do about it.
So Marsha Linehan set about developing a treatment based on her personal path of recovery by combining CBT therapy (cognitive-behavioral therapy of skills instruction and development) with components of Eastern zen practice, particularly “mindfulness” practice that would release the person from certain elements of the complex trauma consequences.
Together, this Dialectic Behavior Therapy (DBT) helps the person process and resolve the otherwise unresolved trauma that disrupts their functioning. DBT is considered evidenced-based practice, it is shown to be effective, and it is considered the standard of care for treatment of “borderline” personality disorder (unresolved complex trauma from childhood).
So I do not like the construct of “borderline” personality disorder. The DSM-5 tried to get rid of the personality disorder categories, but the Personality Disorder Subcommittee proposal was too radical for the general DSM-5 Committee, and it was rejected and placed as an Appendix in the DSM-5 for “further discussion.”
I use the construct because it has descriptive value, especially since it is a variant of the narcissistic personality pathology (unresolved childhood trauma with a different set of choices as to how the child coped).
I use them both to help organize people’s understanding of the pathogenic parenting, particularly… why we see five specific narcissistic personality traits in the child – they are the beliefs of the allied parent about the other… spouse… that are being transferred to the belief systems of the child (the shared persecutory delusion originating in the unresolved trauma anxiety of the parent triggered by the divorce; rejection and abandonment).
I would like to move away from those personality disorder diagnostic labels, and shift instead to discussing the trans-generational transmission of attachment trauma… but I’m facing such profound professional ignorance that I have to take them step-by-step into the established knowledge of professional psychology.
So if I’m talking about “personality disorders,” I’m using professional information sets from the 1960s to 1980s – nothing from the 1990s on. I wish I could be talking from 2010s on, or even the 2000s. But I can’t. These people in forensic psychology are simply too ignorant to have a professional conversation with them.
I have to first educate them before I can have a professional-level of discussion with them. That should NOT be the case… but it is,
I apologize that my using information sets from the 1960s to 1980s will tend to misrepresent the complexity of the issues. I’ve worked trauma and foster care. The people who are being identified as “borderline” are very often my sexually abused little girls that I treated in foster care through my clinic, who are now all grown up.
They are trauma survivors, and if not from childhood sexual abuse, then from some other form of complex trauma – relationship-based trauma – in childhood. That childhood trauma is now rippling into the next generation… because it is not yet resolved.
We need to resolve the unresolved trauma in the family. That’s my focus, it’s time to end the trauma moving from generation to generation. Moms are vital to the healthy development of their children. Dads are vital to the healthy emotional development of their children. Let’s make that happen.
I agree with you.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857