Introduction

Borderline personality disorder is experienced in individuals in many different ways. Often, people with this disorder will find it more difficult to distinguish between reality from their own misperceptions of the world and their surrounding environment. While this may seem like a type of delusion disorder to some, it is actually related to their emotions overwhelming regular cognitive functioning, which is likely to create many conflicts with others.

People with this disorder often see others in "black-and-white" terms. Depending upon the circumstances and situation, for instance, a therapist can be seen as being very helpful and caring toward the client. But if some sort of difficulty arises in the therapy, or in the patient's life, the person might then begin characterizing the therapist as "bad" and not caring about the client at all. Clinicians should always be aware of this "all-or-nothing" lability most often found in individuals with this disorder and be careful not to validate it.

Another feature of this disorder is a strong fear of being abandoned by others in relationships. Unfortunately, because those with Borderline personality disorder often have poor interpersonal skills, in which they ultimately tend to push those that they care about away from them. This situation results in a self-fulfilling prophecy in which they fear the person leaving them, so they engage in many extreme and confusing behaviors of over-possessiveness or being unavailable, which ultimately makes their partner leave them in the end. These dynamics create many challenges in the therapeutic relationship for the therapist for a careful balancing act must be done to avoid giving any cues of possible emotional abandonment to the client while also setting down firm therapeutic boundaries.

Therapists and doctors should learn to be a "rock" when dealing with a person who has this disorder. That is, the doctor should offer his or her stability to contrast the client's lability of emotion and thinking. Many professionals are turned-off by working with people with this disorder, because it draws on many negative feelings from the clinician. These occur because of the client's constant demands on a clinician, the constant suicidal gestures, thoughts, and behaviors, and the possibility of self-mutiliating behavior. These are sometimes very difficult items for a therapist to understand and work with.

Psychotherapy is nearly always the treatment of choice for this disorder; medications may be used to help stabilize mood swings. Controversy surrounds overmedicating people with this disorder.