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The Frustrating No-Man’s-Land of Borderline Personality Disorder
By Harold W. Koenigsberg, and Larry J. Siever
THE NEUROBIOLOGY OF AFFECTIVE INSTABILITY
In addition to vulnerability to impulsive aggression, people with borderline personality disorder are unusually emotionally reactive. They may be content for a while, then become intensely angry or hopelessly depressed or unbearably anxious—each state, although intense, lasting only a few hours or a day.
To those who are close to them, borderline patients appear to have random and unpredictable emotions. On closer investigation, those emotions often seem to involve heightened emotional reactions to other people. Borderline patients may become distraught at ordinary criticism, which they experience as a blow to self-esteem; may react with rage to a disappointment or minor slight; or may feel terror at a separation that they experience as virtual abandonment. Their emotional, or affective, instability may contribute to their turbulent, often unstable relationships and the inconstancy in their experience of themselves that leads to a confused sense of identity.
Infants who are very emotionally sensitive may respond more intensely to the comings and goings of their mother or caretakers and show much greater distress at separating. This may lead to a more insecure attachment between infant and mother. If the infant is more impulsive and aggressive— that is, likely to express emotions forcefully— he may have crying spells and, later, temper tantrums when frustrated or left alone, which can wear down even the most supportive parents and overwhelm those who are depressed or who themselves have trouble with emotional reactivity and impulsiveness. Parents may become frustrated at their inability to soothe such a child and decide not to respond to its distress; at other times they may try everything to indulge the child to appease its upset and rage. These inconsistent (and, to the infant, unpredictable) responses may make it likely that the child will learn to deal with unpredictability by means of emotional storms or tantrums.
Only by looking at the behaviors of someone with borderline personality disorder in that person’s social milieu do we fully understand their meaning.
As the child matures, he may draw on these interpersonal strategies in order to regain emotional equilibrium. For example, when an upsurge of depression follows a blow to self-esteem, the borderline person may try to bolster her self-esteem by devaluing someone else. When feeling alone and abandoned, she may behave recklessly to stimulate the worry and involvement of others. To onlookers, these behaviors may appear manipulative because their purpose is to bring another person to attend to the borderline’s needs. But because of their heightened sensitivity to the availability of others, people with borderline personality disorder often feel that they are not in charge of their own emotions—their emotions depend on the behavior of those around them. Attempting to control their own feelings, they find themselves trying to control the behavior of people they depend upon and care about. Repeated again and again, these patterns of behavior become ingrained. The borderline person experiences these styles of relating as the only way to survive emotional ups and downs and the feeling that others cannot be trusted to support her.
