Cluster B personality disorders
Borderline personality disorder is diagnosis outlined by the American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, or DSM-IV-TR. This diagnosis falls under the general heading of personality disorders, within the sub-category of cluster B personality disorders. The personality disorders that are classified as cluster B, including borderline, histrionic and antisocial personality disorders, are known for their dramatic and emotionally erratic presentation.
The cause of cluster B personality disorders is the subject of much debate in the mental health literature, with many pointing to early developmental patterns of unstable relationships and exposure to traumatic situations.
Each of the cluster B personality disorders are characterized by a tendency to dissociate or deny reality, making individuals with this diagnosis particularly prone to lying and abuse. These individuals are highly likely to engage in splitting or triangulating behaviors in relationship with others, somatization, conversion and acting out when dissatisfied.
Features of borderline personality
Borderline personality disorder typically begins to emerge in later adolescence, although it is not to be diagnosed until after a person turns 18 years of age. This diagnosis most often occurs in women, with over 75% of those diagnosed with this illness being female.
According to the DSM-IV-TR, borderline personality is characterized by a pattern of unstable relationships and poor self-image. There are nine common features of the disorder, of which a person must meet at least five in order to receive the diagnosis of borderline personality disorder. Additionally, an individual must experience these symptoms in a variety of areas, such as work, family and social spheres.
The criteria are as follows:
- Frantic attempts at avoiding abandonment, whether real or imagined.
- A recurrent pattern of unstable and intense interpersonal relationships, varying between idealization and devaluation
- Persistently unstable self-image
- Impulsivity in at least two self-damaging areas such as sex, substance abuse, and overeating
- Recurrent suicidal ideation and self-injurious behavior
- Unstable effects related to emotional instability/reactivity
- Ongoing feelings of intense loneliness and emptiness
- Intense angry outbursts, often inappropriate
- Paranoia or dissociation in response to stress
What to expect
A family member of someone with borderline personality disorder can expect to experience many of the aforementioned symptoms first hand, as they are one of the few major, significant relationships in that individual’s life. In truth, they are likely to be the only consistent relationships in that person’s life. Family of a person diagnosed with borderline personality disorder will know all too well the impact of the impulsivity, intense anger and relational instability.
So, how does one support an individual who will continuously try to push them away, and who will at some moments behave incredibly abusive? It is known that those with a borderline personality disorder diagnosis who have strong family support have better chances of recovery, and a faster recovery at that. One of the most important ways to support a loved one with this mental disorder is to set clear and constructive limitations or boundaries. Boundary setting is not easy at first; however, with some training and support, family members can learn how to do this appropriately.
Family members may be tempted to put a great deal of effort into celebrating successes; however, too much positive reinforcement can actually promote relapse. Family members need to heed caution around showing excessive enthusiasm over progress; as such excitement may prompt a characteristic shift towards self-sabotaging behavior. Family members are well advised to suggest caution to their family member, reinforcing previous boundaries and acknowledging that there are likely to be many obstacles ahead. Family members can model positive and appropriate reinforcement, responding to both positive and negative events in a less reactive manner.
Clear communication is important for both the family and the individual coping with borderline personality disorder. Make time for everyday conversations around neutral topics, this will create an opportunity for the individual to experience neutral and effective communication. Although it may be difficult to remain neutral in times of conflict, particularly if the individual is verbally abusive, neutrality and calmness is an efficient technique to use with a family member with this disorder.
Wherever possible, create a routine. This will help the family member with the diagnosis of borderline personality disorder to anticipate events and create positive experiences. It is very important that the family’s life has more to it than coping with the experience of mental illness.
Although neutrality is touted as a preferred approach, there are definitely times where this is impossible. If the individual is voicing thoughts of wanting to harm themselves or others, family is put in the position of needing to respond. If a family member is diagnosed with borderline personality disorder and has a history of threatening to harm themselves or others, be ready with emergency numbers and local crisis services.
References
BPD Today: Borderline Personality Disorder DSM IV Criteria
http://www.borderlinepersonalitytoday.com/main/dsmiv.htm
Family Practice Notebook: Cluster B Personality Disorder
http://www.fpnotebook.com/psych/Behavior/ClstrBPrsnltyDsrdr.htm
Facing the Facts: Supporting a Loved-One with Borderline Personality Disorder
http://bpdfamily.com/tools/articles5.htm
