Borderline personality disorder is considered a personality disorder, which by definition consists of enduring and inflexible patterns of behavior that cause significant distress and impairment socially, occupa-tionally, or personally. Borderline personality disorder is considered one of the most serious of the personality disorders and was historically considered the borderline between the milder mental problems (neuroses) and the more severe mental disorders (psychoses). Characteristics of borderline personality disorder include emotional instability with wide mood swings, instability in relationships, self-injurious behaviors, identity disturbance, impulsivity, and inappropriate and intense anger. This disorder has been stigmatized historically by mental health professionals, who have often considered those with the disorder manipulative, difficult to treat, resistant to treatment, or hopeless. Individuals with borderline personality disorder may require long-term therapy and may have a difficult relationship with the therapist.
Trauma
While a history of childhood abuse or other trauma has long been associated with borderline personality disorder, more recently this strong relationship has received heightened attention. Borderline personality disorder is frequently associated with childhood histories of serious sexual and/or physical abuse, extremely chaotic home environments, or both. Research on the brain has added to the understanding of borderline personality disorder. When trauma occurs in younger children, a number of different events occur in the brain, some of which lead to heightened emotional expression and hyperreactivity to abuse events. Over time, individuals react with these heightened responses to lesser and lesser stimuli, until eventually these heightened responses become generalized to stimuli not associated with the trauma. This response to trauma may be related to some of the symptoms of borderline personality disorder.
Complex Posttraumatic Stress Disorder
The most recent conceptualization of borderline personality disorder for survivors of childhood abuse is as a posttraumatic response to trauma. Complex post-traumatic stress disorder (PTSD), a recently defined diagnosis, subsumes some of the traits of PTSD and borderline personality disorder. Individuals with this disorder are likely to experience long-term emotional and relationship instability; suicidal ideation; post-traumatic symptoms such as avoidance, hyperarousal, and intrusive symptoms; and other traits associated with borderline personality disorder. Individuals with the disorder may experience remission from these severe symptoms with appropriate trauma-focused treatment. Thus, leading trauma professionals and researchers who are working to understand the brain’s responses to trauma strongly recommend this more hopeful conceptualization for traumatized individuals with symptoms previously associated with borderline personality disorder.
