South African actress Charlize Theron did it. She won an Oscar for her portrayal of killer prostitute Aileen Wuornos in the movie Monster. During her trial Wuornos was diagnosed by a prison neuropsychologist as being a case of Borderline Personality Disorder (BPD). What is this psychological disorder and how can you recognise it?
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One of the strongest characteristics of Borderline Personality Disorder is frantic efforts to avoid real or imagined abandonment. Some psychologists argue that Wuornos’s desperate fear that her lesbian lover would leave her if the money dries up, and her hate for people, might have been the precipitating factor in the serial killings and robberies.
With BPD, genetic (inherited) and/or environmental factors are thought to play a role in predisposing a person to the disorder. In Wuornos’s case, it is clear that environmental factors played a big role. In a psychology research paper on Aileen Wuornos, researchers argue that “the residual impact of one's upbringing has much more influence upon that individual than many realise. That people are a product of their environment – both good and bad – speaks to the tremendous power one's experiences in childhood and youth have upon one's social, emotional and psychological outlook. Aileen Wuornos reflects the aftermath of a wholly traumatic upbringing, replete with physical abuse and emotional abandonment that ultimately fueled her deep-seated rage in the form of mass murder.”
Whether a diagnosis of BPD fits Wuornos or not, it is important to note that, with treatment, some people with this disorder, can improve over time and lead productive lives. But no condition can be treated before the symptoms are recognised and the condition diagnosed.
What is BPD?
BPD – sometimes referred to as Emotionally Unstable Personality Disorder - is a serious mental illness characterised by pervasive instability in moods, interpersonal relationships, self-image, and behaviour and marked impulsivity beginning by early adulthood. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity, according to the USA’s National Institute of Mental Health.
Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. It affects two percent of adults, mostly young women, but some researchers think that as many as 10 to 14 percent of the general population suffer from this condition.
The frequency in women is two to three times higher than men. This may be linked to genetic or hormonal influences: there may be an association between BPD and severe cases of premenstrual tension.
The increased frequency of borderline disorders among women may also be a consequence of the greater incidence of incestuous experiences during their childhood. This is believed to occur ten times more often in women than in men, with estimates running to up to 25 percent of all women. This chronic or periodic victimisation and sometimes brutalization can later result in impaired relationships and mistrust of men and excessive preoccupation with sexuality, sexual promiscuity, inhibitions, deep-seated depression and a seriously damaged self-image.
There may be an innate predisposition to this disorder in some people. Because of this there may ensue subsequent failures in development in the relationship between mother and infant particularly during the separation and identity-forming phases of childhood.
People with BPD often need extensive mental health services, sometimes after attempted suicide or self-inflicted injury, and account for 20 percent of psychiatric hospitalisations.
Behaviour
According to a patient with BPD, it is hell to live with yourself if you suffer from BPD. The behaviour patterns show why.
The following behaviour may not be uncommon in a person with BPD, but the degrees may differ from person to person:
Relationships with others tend to be intense, stormy and unstable. The person may be manipulative and often has difficulty with trusting others. Emotional instability are often characterised by frequent shifts from an empty lonely depression to irritability and anxiety.
Unpredictable and impulsive behaviour - which might include excessive spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating or physically self-damaging actions such as suicide gestures - is not uncommon.
Inappropriate and intense anger or rage with temper tantrums, constant brooding and resentment, feelings of deprivation, and a loss of control or fear of loss of control over angry feelings, may also be part of the behavioural pattern.
Identity disturbances with confusion and uncertainty about self-identity, sexuality, life goals and values, career choices and friendships, may be present.
There may be a deep-seated feeling that one is flawed, defective, damaged or bad in some way, with a tendency to go to extremes in thinking, feeling or behaviour.
Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms.
Even in less severe instances, there is often significant disruption of relationships and work performance. The depression which accompanies this disorder can cause much suffering and can lead to serious suicide attempts.
How psychiatrists diagnose BPD
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a person showing five or more of the following signs, may have BPD:
1. Frantic efforts to avoid real or imagined abandonment. (Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behaviour
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
What a friend or family member can do
It is not easy to help someone with BPD, but these practical tips may help you to cope:
If a friend or family member shows any of the behaviour patterns discussed above, encourage him/her to get counselling.
Understand the disorder and don’t take his/her rage personally.
Be understanding but set limits to what you will tolerate.
Support his/her efforts to get well, but remember that you cannot be the rescuer.
What a psychologist and psychiatrist can do
Psychotherapy combined with medication can help many people suffering from BPD to feel better about themselves and to live meaningful and productive lives.
Psychotherapy is an essential tool to help a person take better control of his/her behaviour and emotions, while the medication can relieve some of the symptoms. The choice of medication will depend on the person’s particular symptoms and an antidepressant such as Prozac or a mood stabiliser such as lithium may be prescribed.
There are no quick fixes or a single recovery path for all. The condition may gradually diminish with age. Many people with BPD enjoy greater stability from their thirties or forties.
Read more about Aileen Wuornos's past. Click here.
Read more about Borderline Personality Disorder. Click here.
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