The second of the more extreme personality disorders and one that has received considerable attention recently is the borderline personality. It is not very aptly named because it suggests that someone has a personality that is only acceptable in a borderline way. However, the borderline is between neurotic traits (extreme anxiety, emotional instability) and psychotic tendencies (as in schizophrenia).
The keynote of this disorder is instability; instability is all aspects of personality. Moods and emotions might swing from anxiety to depression to anger, all in the extreme. The person's view of themselves swings from huge self-aggrandisement to equally large self-abasement. Relationships with others are appalling, swinging from believing the other person to be wonderful to loathing and rejecting them to the full. Relationships (say, with a new therapist or a new acquaintance) tend to start off in a completely committed way, as though offering new hope for the future. But then, with a hyper-vigilant attitude, the person seems to be looking for the smallest sign (a glance, a cancelled meeting) that can be taken as rejection. The reaction is extreme anger and depression.
At even more extreme moments, persons with the borderline personality disorder may engage in self-mutilation (usually cutting themselves). They also occasionally suffer psychotic withdrawals from reality in which they lose all sense of time and place. Because of the extremes to which 'borderline' cases swing, they also tend to be diagnosed with other disorders such as depression, generalised anxiety, agoraphobia, and so on. Whereas the anti-social personality disorder is more common in men, the borderline disorder is more common in women.
Borderline personality disorder is not well understood. The usual accounts of it stress it as involving a build-up of huge defences and as deriving from very unsatisfactory early relationships, particularly those in which the child is not encouraged to develop a sense of self. It is for this reason, perhaps, that they are so sensitive to the reactions of others - it is as though they are reacting to themselves, even rejecting themselves (hence the self-mutilation).
Finally, again it is instability that is at the core of this disorder. 'Borderlines' tend to see themselves and others as either all good or all bad and never put the two together; they simply veer from one to the other. Everything is at the extremes and those extremes vary from moment to moment. It is easy to see why those with a borderline personality are very difficult to deal with, either by their families and friends or by health professionals.
The other personality disorders will be dealt with in less detail than the two so far considered. They are, perhaps, less interesting than the anti-social and the borderline, although, when extreme, they can be just as difficult to deal with. It is worth noting that there is some overlap between some of these disorders and some that were discussed previously, for example, there is an obsessive-compulsive personality. The difference is that those that are described below are all concerned primarily with personality.
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