In clinical psychology, when examining personality, it is basically at what level the person is; It is first evaluated whether it is neurotic, psychotic or borderline. Borderline personality can be expressed in its most summary form as the state of being between neurosis and psychosis. To put it in more detail, we can talk about a structure that has both psychotic and neurotic features, is more severe than neurosis, but does not have intense dissociations like psychotic.
This term (borderline personality) has been discussed for many years and other Since it is defined in the same group as personality disorders, it has caused it to be perceived as a type of personality disorder. In fact, borderline organization aims to express the level of pathology. Analysts have differed on whether the borderline state indicates the type of pathological personality (borderline personality disorder) or the level of pathological personality (borderline personality organization). If we accept that the concept of borderline expresses the level of pathology, we can create a concept such as borderline narcissistic personality and thus express the level of pathology (McWilliams, 2013). In this case, we can understand that borderline narcissistic personality is a different situation from the known narcissistic personality, and that the person has a narcissistic structuring that is both psychotic and neurotic.
The difference between borderline personality type and borderline personality disorder is explained by Köroğlu and Bayraktar, Personality Disorders Book. They mentioned it in . Accordingly, a person who is enthusiastic, committed, tends to be attached to the other person in all his/her relationships, takes his/her relationships very seriously, experiences his/her emotions intensely, is reactive, fond of fun, is brave, creative and active may show a borderline personality type. On the other hand, those with inconsistent relationship styles; Borderline personality disorder is defined as a state of exaltation and deprecation, impulsive behavior in at least two areas, rapid emotional changes, frequent feelings of emptiness and anger, uncertainty and identitylessness in at least two areas, and a constant effort to avoid abandonment (Köroğlu). and Bayraktar, 2010). As it turns out, when defining the difference between borderline personality type and borderline personality disorder, the emphasis is actually on the dosage of the behaviors. is being done. If we look at it from this perspective, we can even group the dose of borderline personality disorder according to the severity of the symptoms of the disease.
As in other pathologies, we can talk about bio-psycho-social causes in borderline state structure. However, unlike others, especially in borderline organizations, childhood traumas and abuse are talked about more. In addition, the effect of the difficulties that occur in the process of separation and individuation defined by Mahler is mentioned. Although we talk about bio-psycho-social causes, neglect, abuse, multiple traumas and attachment-related problems, especially in childhood, can create a borderline personality.
As can be understood from the characteristics of borderline people, in fact, a safe and healthy attachment process in early childhood is mostly It did not happen. When a history is taken from the client, who usually has a borderline personality, they describe inconsistent and traumatic relationship stories with their caregiver (usually the mother). It is common to encounter stories that begin in early childhood, where needs are not fully met and thus attachment is not formed. In addition, as we mentioned, traumatic childhood and life stories are evident.
They often have the feeling that they will be abandoned in their relationships. They think they will be swallowed when they feel they are getting close, and they will be abandoned when they feel they are moving away. When we look at it this way, the blockage in separation and individuation in the borderline state is quite evident. The limit state is that a person is good or bad through the person's eyes. In addition, from the perspective of the borderline person, one person may be good and on another day the same person may be very bad. It can exalt a person very much and then devalue him. Similarly something is all or nothing. When we look at all these as a whole, transference is evident in borderline personalities and is evaluated as good or bad. On the other hand, countertransference processes can also be challenging. Most of the time, the therapist may engage in the role of a punitive or self-sacrificing parent by countertransference.
Borderline personalities may generally have an ongoing state of depression. In the borderline state, dissociations and distortions in reality assessment may occur because psychotic features may also occur. There may be some. Suicide attempts may occur frequently. They have a constant fear of abandonment, and therefore they often get abandoned, even though they make a mad effort not to be abandoned. Easily angered, impulsivity (may occur in many areas such as sexuality, substance use, spending money), manipulative behaviors, identity inconsistency, and variable affectivity are the most prominent features. As mentioned before, trauma is often cited as the cause. In addition, causes such as brain damage at birth or in an accident are also mentioned. They tend to evaluate people as either completely good or completely bad. There is a lack of self-love, extreme feelings of worthlessness, and self-disgust. Deterioration in ego strength occurs. Their behavior changes mood frequently and suddenly. It can fluctuate between completely opposite moods. These people may develop regret after impulsive behavior. Borderline individuals can also be highly dependent. In addition, as mentioned before, he tries very hard not to be abandoned. Related to this, separation anxiety also becomes evident. Those with borderline personality disorder experience much more confusion than other personality disorders.
Borderline personality disorder can be confused with other personality disorders because it has common features. For example, sudden emotional changes, manipulative behaviors, immature and dependent structure can be seen in histrionic personality disorder, just like borderline personality. However, what should be noted here is that borderline people, in addition to these behaviors, have distinct states such as intense anger, feelings of worthlessness and emptiness, and suicidal tendencies or attempts. Another example is borderline personality disorder, they fear abandonment, such as dependent personality disorder. Although there are so many similarities, borderline personality disorders differ from other personalities with their outbursts of anger and their frantic efforts to avoid being abandoned. Since it has common features with many other personality disorders, many other examples like these examples can be mentioned (Öztürk and Uluşahin, 2016). It may also be difficult to distinguish between borderline patients and psychotic patients. The reason for this is that borderline people may sometimes fall apart and have psychotic features. That's because it shows. But of course, borderline people often do not have doubts about their existence, like psychotic people. Borderline people know that they exist and often realize the truth. Although they may be able to realize the truth at some times, suicide attempts due to intense feelings of worthlessness may be common. Defense mechanisms in borderline personality organization are primitive defenses such as denial, splitting, and projective identification. In addition, there is no integrity of identity in the limit state. It is easy to see these features of the borderline state in projective tests such as Rorschach.
Since identity problems are especially evident, we, as clinicians, can recognize borderline individuals more easily than other tests and evaluations, since they cannot define identity integrity in projective tests such as Rorschach. At the same time, since we can see the distortions in evaluating reality in the cards in this test, we can diagnose borderline people well. Despite this, it may be appropriate to follow the person for a few sessions, sometimes even longer, to diagnose the person.
The clinical decision regarding therapy with borderline people varies depending on which extreme the borderline person is closer to. If the person is closer to the psychotic end, supportive therapy will be functional, and if the person is closer to the neurotic end, other expressionist psychotherapies that increase insight will be functional. Essentially, the goal is to create a positive sense of self. Borderline personality can be treated with long-term psychotherapy, just like other personality disorders. In addition to psychotherapy, pharmacological support can be received in collaboration with psychiatry to balance impulsivity and psychotic features. For borderline people, treatments that combine medication and psychotherapy may yield more positive results.
Read: 0
