Borderline personality disorder: characteristics and clinical implications

Borderline Personality Disorder (BPD) is characterized by repetitive instability in behavior, close personal relationships, mood, and self-image (Corelli). Attachment styles among those with BPD tend to be unstable, characterized by intense shifts in feelings, resulting in difficulty maintaining close relationships. Individuals with BPD often demonstrate impulsivity, as seen in inappropriate and intense displays of rage, and brooding (Corelli). Essentially, BPD can be seen as a failure to successfully integrate the entire personality. BPD can be operationally defined as "a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior" (National Institute of Mental Health).

The integration of developmental and abnormal psychology is important in understanding BPD. There is a clear relationship between early experiences (as noted in more detail below) and the development of BPD. As such, while the domain of abnormal psychology provides an understanding of the disorder at the present time, a focus on the developmental aspects of BPD helps to further reveal the etiology of the disorder.

Further, this integration between developmental and abnormal psychology advances the knowledge base of BPD. A clear understanding of both the abnormal psychology and the early development of the BPD patient can lead to a deeper understanding of both the disorder's etiology, the current presentation of the disorder, and also opens up potential avenues for research and treatment.

Early family development is clearly linked to the development of BPD. Primitive defense mechanisms such as splitting and projective identification play a large role in muting the empathic response of BPD patients in early development. Further, such responses play a role dampening empathic responses during family interactions in adolescence (Shapiro).

Sexual and physical abuse during childhood is a common characteristic of many individuals with BPD. Between 40 to 71% of patients with BPD report sexual abuse during childhood. Many others report a history of separation, neglect, or abuse (National Institute of Mental Health).

Recent research suggests that the neural correlates of BPD behaviors can be seen in impaired regulation of neural paths that modulate emotion. This includes impaired functioning of the amygdala and the prefrontal cortex, and disturbances in serotonin, norepinephrin and acetylcholine (National Institute of Mental Health).

Personal Insights and Future Directions

There are a number of interesting approaches to the treatment of understanding of BPD. Within ten years, many of these approaches will become closer and closer to reality.

Currently, research into the biological basis of BPD is in its infancy. A great deal of concerted research is necessary to ascertain the specific impairment in the regulation of neural paths that modulate impulsivity, mood instability, aggression, anger, and negative emotions seen in the BPD patient. These are complex pathways, and it will require a significant amount of research to determine the precise changes that occur in BPD.

One of the more interesting and promising areas for research will be in the area of brain imaging. Recent research in this area shows that the ability to suppress negative emotions can be correlated with individual differences in the ability to activate areas of the prefrontal cortex involved in inhibition. Clearly, more research in this area will likely help to broaden our understanding of the impulsivity in BPD.

Future directions for treatment of BPD include combinations of behavioral and medical treatments for the disorder. Further, results from the first longitudinal study of BPD personality treatment are expected to reveal a great deal about the effect of treatment. Future directions for treatment will undoubtedly incorporate many of the results from research into the biological basis of BPD.