Borderline disorder

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Borderline disorder

Post  counselor on Mon Oct 15, 2012 10:23 am

[b]
Borderline [disorder]



The BPD, which contains a universe pathological "borderline" between
psychoneurosis and psychosis, is a concept indefinable and unstable, which then presents the
same characteristics attributed to the borderline.
As proof of this statement there are other non-trivial.
This term originated in psychoanalysis when people started to treat diseases
the most serious of the classic psychoneurosis, was then extended until after the
psychiatry. Moreover term is little used in a psychiatry objectifying (such as that
forensic or that psychopharmacological). And last but not least is a term never entered
in common parlance, unlike many other terms such as schizoid, paranoid,
narcissist etc..
All this suggests that the term "borderline" is very elusive, and that
its use, useful in an early stage, could be considered, in diagnosis
countertransference as a sign of indecision in the therapist.
It still continues to be used for over 50 years and a number
growing conference bears testimony to the relevance and importance of which means that, while
with some ambiguity, is a term that has to perform functional purposes even if
probably different.
Certainly the most obvious is to have a unified set of labels
diagnostic as "impulsive" Reich, "atypical schizophrenia" or
"Schizoaffettiva" of Kasanin, "personality as Self" Deutsch, "latent psychosis" of
Federn, "schizophrenia pseudonevrotica" Hoch and Polatin, "psychotic character" of
Frosch, and "personality abandoning" the French school.
A second important factor is that the concept of borderline implies a
not only necessary deepening of the distinction between neurosis and psychosis, but also
between psychopathology and normality.
And finally, the treatment of borderline allows you to highlight some of the dynamics
psychopathology in their turn and evolve, dynamics, psychosis, are
instead already structured and frozen.
Despite, or perhaps because of all these reasons, the concept of borderline remains
quite indefinite. Therefore, I would like to start looking into a few lines of
widely shared tendency to try to better define this entity.
The first author who has investigated this issue was Grinker1 that, in a
series of studies, came to identify the borderline as an autonomous entity with
following characteristics are mainly based on behavioral data: hypersensitivity
to criticism, fear or inadequacy towards intimacy, identity disorders,
low self-esteem with a tendency to depression, suspiciousness, presence of anger and
very intense emotions.
Factor analysis suggested the possibility of providing four subtypes: the limit
psychosis, with diffuse identity with psychopathic behavior, and finally as
narcissistic structure.
Then Kernberg, implementing a blend of ego psychology and theory
object relations, came to define the borderline as "a mode of
essentially intrapsychic functioning, specific and stable over time,
characterized by: a) identity diffusion, b) an examination of reality preserved c)
very primitive defense mechanisms and pathological: as splitting, denial,
projective identification '.
These three points are used not only to delineate the borderline, but also for
differentiate these from the neurotic and the psychotic.
Subsequently Gunderson et al. Continuing the work of Grinker, are joints
a further definition and demarcation of border-line, developing a
questionnaire that emphasizes the following behaviors: low productivity at work,
impulsivity, suicidal gestures of manipulative, good level of socialization also
if superficial, vulnerability to depression and difficulty in establishing relationships
intimacy.
As pointed out sharply L. Bellodi, M. Battaglia, P. Migone, data
Kernberg and Gunderson are then merged in DSM III-R so that defines the
Borderline
a) unstable and intense interpersonal relationships (derived from Gunderson);
b) impulsivity (derived from both Kernberg that Gunderson);
c) mood instability (derived from Gunderson);
d) intense anger and inappropriate (derived from Gunderson);
e) self-injurious behaviors physically (derived from Gunderson);
f) identity disorder (derived from Kernberg);
g) chronic feelings of emptiness and boredom (described by Kernberg in many of its
written on the borderline, though not explicit in its diagnostic criteria);
h) difficulty tolerating loneliness (derived from Gunderson).
Among the Italian authors who have dealt with this disorder seems significant to me the
contribution of Callieri.
He raises a fundamental triad consists of:
a) the truth of the borderline is a truth "nomadic";
b) its phenomenal is the "existential phenomenology of the one."
c) his "speech" is a precognitive speech, in which vision and desire
set and combine so discordant.
This last point is then expanded by the following notations.
In borderline there is a stop psycholinguistic which leads to a "foreclosure
alternative visions "and involves two aspects.
Opacity and approximation of the language and the characteristic that the speech of
borderline takes place on the 'something else', that is the tendency to constantly move
the center of the problem.
This mode of expression is in my opinion an important point and qualifying.
Because if one part reveals a fundamental characteristic of the psychodynamic
Borderline (the tendency to miss the intimacy of the relationship), the other open to the
problem of the possible presence of a disturbance of thought, aspect not
evidenced by most authors.
Except that instead Searles2 the highlights and describes the thought of
borderline is not fragmented, but is stiff in the ring content in the form;
and finds it difficult to connect significant events is often focused on a
single problem of emotional, not "jam" the thought, but it often makes
little fluid and repetitive, sometimes invischiante.
This disorder of thought is closely connected to two dynamic
fundamentals of borderline splitting as a defense mechanism and the basic
presence of intense emotions, unable to integrate into the structure
total of the subject, remain elements stray and hardly controllable.
I think at this point we have a descriptive picture of the borderline
quite accurate and outlined.
They are people with identity problems, difficulty in establishing relationships with
intimate, with fears of abandonment, with a tendency to acting-out, with oscillations
mood, temper tantrums violent and unjustified, and finally with a marked susceptibility
and mistrust. Characteristic, it is closely connected with another part
character, never described as I understand, but which seems to me
essential.
The borderline presents, albeit not always obvious, the experience of a
grave injustice, which, together with a sense of exaggerated and idealized
justice leads him to live the behaviors of others as unjust, harmful, sometimes
frankly persecutors. It should be noted that all these traits "pathological"
are evident in emergency situations or in situations where emotional are at stake
affective dynamics. Otherwise the surface may appear as a borderline
sufficiently normal person.
To better explain how and how this experience can be a decisive factor I
not refer to clinical cases, but two examples from the literature.
The first is a long tale of von Kleist set in the sixteenth century by
Michel Kohlaas3 title.
This horse breeder of Saxony is well described by the author
"This man is not common could take up to thirty years for the model
the good citizen ":
Horse breeder, married with children, lives a quiet and serene. A
day, as had happened to in the past, he leads his horses in Dresden
the fair and while crossing the lands of Baron Wenceslas Tronka is
stopped. The men of the baron say that the laws have changed if he wants to
continuing need a pass and must also pay a toll. Kolhaas
note that it is in good faith and that he knows nothing of these new rules: therefore calls
that this time it is left free passage.
The Baron does not agree and ostentatiously claims that had been left in
two hostage the splendid horses Kolhaas agrees and entrusts them to his servant to
take care of them. A few weeks later, back at home, he learns that the boy was
beaten and kicked, but especially the two beautiful horses were used
by men of Baron to carry the corn in the fields. The Wrath of Kolhaas increases
further when he hears the Court of Dresden, which sent a petition,
that there is no provision in respect of a permit. He will therefore
realizes that it is a will of the baron. From this moment Kolhaas
will demand justice. Asks that the situation is restored, that the offense is
canceled. And in what way? Baron, at his own expense will have to grease the new
his two horses then return them to the initial conditions. This request is
very indicative: Kolhaas not want compensation, claims that the offense is repaired and
injustice deleted. Which suggests that the offense is seen as seriously
detrimental, so as to endanger his own identity.
However, after a year, when he realizes he can not get justice
because the Baron has not only provided as required, but he persevered
behavior, Kolhaas sell all his possessions, will arm a dozen people
and assalterà the castle, destroying it. Baron manages to escape and therefore
Kolhaas can not feel satisfied and is forced to continue his revenge
chasing him all over Germany that will be put to fire and sword. What do you want
Kolhaas? And here it shows the brilliant intuition of the artist: Kolhaas claims that Baron
recognizes his faults and especially of the face move grease the two horses.
It does not claim another, and does not even accept acts of justice for repair replacement
the grievance: injustice should be deleted, just so the offense suffered cease to
be seen as destructive. In this Kolhaas seems implement the theory Hegelian
Justice: Justice is the negation of a negation (right).
Injustice has disturbed the order of the world and has created chaos: it is clear that the
chaos is a reflection of what is happening inside Kolhaas, but he throws him out and asks
that the cosmos is reinstated. Otherwise chaos continues, it will become certainty
when he will realize the impossibility of obtaining justice. And to get
Justice is only one way to eliminate the fault through the restoration of order,
eliminating injustice. There is no other possibility: there is no forgiveness,
understanding or otherwise repair by other means such as punishment
of the perpetrator or the reward of damages.
This dynamic is of great interest. If on the one hand shows the low threshold to
frustration, which makes the injustice highly prejudicial to the personality of the subject
the victim, the other also indicates a severe stiffness: there is no other possibility for
repair the wrong, not money or return of some other horses. One of which has Kolhaas
need is that injustice is abolished by an opposite behavior to
that were considered offensive.
If an experience of this kind is related to events in the distant past (childhood) is
evident the impossibility to repair the offense, and therefore, the persistence
the unquenchable need for "justice."
Still remaining in the field of literature I would like to briefly refer as J.
J. Rosseau4 says about an episode of injustice suffered. He lived an orphan
become a mother at the age of eight years, who had at Fratelli Lambercier
a kind of college. The relationship with Miss Lambercier were characterized by
a morbid affection which already showed the masochistic aspect of Rousseau. A
day the maid had put to dry on the combs of Miss Lambercier
pediment of the fireplace in the room where the young Rousseau was studying. When
the owner came back to pick them up he found one with a whole row of broken teeth. Of
Who is to blame? No one had entered the room, the evidence condemning Rousseau,
accused defended himself desperately. Suffered the penalty, but agreed to confess
something he did not commit.
"You could tear the confession that was demanded. I would have preferred death, and there
I decided ... Eventually I came out of that cruel test pieces, but triumphant. It has been
Fifty years after that adventure ... and declare, in sight of heaven, that I was innocent,
I had not broken or touched the comb. Imagine the reader a timid character and
educated who can not conceive even injustice and that, for the first time, it undergoes a
so terrible and precisament and the people he loves and respects more: that
reversal of ideas! Which subversion in his heart and in his mind, in all
his little intelligent and moral ... Ended so the serenity of my life
child. "
So far Rousseau. It is evident that in this case we find the description of a
specific episode, while generally in the clinic we are faced not only to
episodes little detailed and precise, but especially to a series of injustices, rather than to
a single.
The autobiographical memory of Rousseau, unlike the story of von Kleist,
emphasizes an important aspect: the trauma of injustice is not only due to the fact
is unexpected, but most of all that comes from people whom you trust and the
which is strongly and emotionally attached.
That said, I would avoid a simple argument: that the life
injustice is not pathognomonic of the borderline, but through much of the
psychopathology and that may indeed be the ridge that divides the world of persecution
from that of guilt. I agree, and in fact it is important to highlight
the injustice, but to examine what are the modes of defense used by the
subject borderline. If we refer to Rousseau, we can say that in life
by this author (both by the stories of acquaintances who from his Confessions) is
highlight some of the characteristics of the borderline.
One very obvious is the split between the rational and the emotional sphere: it is
Everyone knows that one of the most popular teachers, the author of the famous Emilio is the same as
leave her five children in an orphanage.
No less obvious is its susceptibility and hypersensitivity to criticism which led him,
in the last years of his life, to develop a true delirium of persecution.
Was dependent and destructive interpersonal relationships: just remember how
indifference treated when found herself poor and alone, Madame de Warens, the same
person who had welcomed and cared for and that he used to call "Mom." Without
doubt we can find in Rousseau other characters typical of Borderline rage
intense and inappropriate, mood instability, its preservation of the relationship
with reality (except in recent years).
We can define a borderline Rousseau?
Yes and no! Certainly for psychopathological features and character, with no
certainty because he never asked for help, and so it is impossible to examine the
relational dynamic that gives us a safe diagnostic criterion.
And with this we come back to the borderline in the analysis of these patients find
often experienced during a severe injustice suffered in childhood.
It is not always the memory of a very specific episode. Often this experience
emerges indirectly: as the tendency to feel betrayed, as distinct trend towards
suspiciousness which, combined with a very aggressive in interpersonal relationships,
evidence of the unconscious need to punish the other.
But the most important is how the borderline processes this trauma base: and
just the way computing that characterizes borderline compared to other
psychopathology.
This process takes place in three basic trends: a) splitting, b)
mask, c) the tendency to blowin the other.
The first is a dynamic intrapsychic and serves to withstand the trauma and the third is
a relational dynamic expression of the tendency to avenge the wrongs they have suffered, and the
second represents a sort of hinge between the two.
The split
The split is a dynamic very different from removing the affect anger,
is not removed, but covered and managed.
There is no transformation of anger into lust, but the affection is conscious even though
can not always be done continuously, otherwise the loss of the object: this
explains how anger can explode contextual situations or more
frequently must be repressed.
The mask
The management of the internal dynamics explains the presence of the mask. Mask
then generates the most immediate feelings towards the borderline of the
inauthenticity.
The mask represents the behavioral mode that covers the split
of the self, the split that contains hostile and destructive aspects. Furthermore the mask
explains another aspect of the borderline to have, at least on a social level, a
proper examination of reality and often the proper management of the same, which is not to
means to have a healthy relationship with reality especially in relationships
affectively significant.
An important problem is to understand when and how they form the mask.
At a certain point in its development the child begins to realize not
only the existence of the inner world of the other, that is, the other has feelings, emotions
like her, but also that this world can affect the other, influence the
own.
At this point it is essential that the child can feel that there is
correspondence between what he is able to perceive the inner world of the other and
as these visibly manifested through facial expression, behavior,
language.
Only a match can provide the child with further confidence not only
in its ability to intuit-perceive, but also in the other, in another that is so
as shown.
But if you experience an indecipherable other, or worse still a mismatch
between internal states and external expressions will feel disoriented, confused. Can not
understanding if and why the other hides an inner reality that he still felt and
perceives beyond the behavior and facial expressions. Also at this point he does not
can not even rely on his feelings. May feel that the other is
hostile, but your eyes are smiling, the other is absent, yet materially
close. At this point can not discern whether their feelings, often imbued with
hostility because of the ambiguity of the other, are correct or not. Must listen to what
he sees or what he feels?
In this dilemma, the child may think of the other as the bearer of a
form: a kind of mimicry stereotyped nacondere to the inner world.
Faced with this situation, especially if repeated over time, the child tends to
defend themselves in a way imitative ("I can also have a mask"), or
can implement a training primary defensive and self ("I can not understand
what I feel. So I have to take a picture ").
However, with two different Mechanisms comes to structure his mask
hide his emotional states that often, precisely because of this dynamic, are
imbued with hostility.
The tendency to go crazy the other.
With the growth, a new trend: the tendency to go crazy the other.
This dynamic has two functions: one is to take revenge for the wrongs done to
previously, the other to get rid of their negative dimensions.
The way you blowin 'the altro5 are numerous, but I would like to emphasize two
in particular.
a) The first is to highlight and criticize the negative aspects of the other, something that the
borderline can easily guess why, by itself, negative dimensions
more or less removed and of which the other is not very consciously. Highlight these aspects
serves above all to be able to continually criticize: it shows a good look
fundamental borderline to be critical in a merciless.
b) The second is the tendency to deny the identity of the other: that is, not to see, or
transform the contrary, those which may be positive characteristics or
however important than the other.
Until he is able to manage the split, the mask and the attack on the other, the
borderline behaves as a "normotico", ie as an individual
generally well adapted to social life, even if deeply disturbed
on the affective.
For normotico shall mean a person who, by those who know
surface, is called normal person, and sometimes even funny, to
different opinion are people who have with her, meaningful relationships
and emotionally important.
Only when no longer able to manage these dynamics, the borderline tends to
get help: request for aid that can have the characters of the urgency and
drama, because he understands the risk of a rupture very serious.
Sometimes however, the borderline can express a request for help through
rationalizations (do a job to get to know better, save a relationship that is
Frantumandosi etc..). But the therapist understands that behind this careful questions or
less neutral there is much more: through the cracks of the mask, must decide
What is the borderline. He can highlight the cynical gaze of the psychopath, that
Almighty manic, that annihilated the depressed, the anaffettivo the
schizoid, or the sardonic paranoid.
If this intuition remains vague and indistinct the psychotherapist anguish because
fears that we suddenly once broken is completely
mask and the defensive mechanisms useful in front of a psychopathological structure
much more serious.
So I think that the diagnosis of BPD is fundamentally a
diagnosis countertransference: the therapist to address the risk of a break
psychopathological prefers to keep to the generic, vague. "It's a patient
borderline "As if to say: let's see, would be a neurotic or even a
severely psychotic.
Èevidente that this diagnosis may be useful in the early meetings and will have well
soon turn into more accurate. And, as will be more exact diagnosis, the more
effective the therapy.
Because the diagnostic capability expresses the ability of the therapist to go beyond the
mask, to address the core psychopathology that tends to mask
hide.
1 The quotations from various authors reported on borderline personality disorder are taken from: L.Bellodi -
M.Battaglia - P.Migone Disorder, borderline, in the Treaty of Psychiatry, Masson,
Milan 1994.
2 H. Searles F. (1986), The borderline patient, Basic Books, London 1988.
3 Kleist (von) H. (1826), Michel Kolhaas, in Complete Works, Sansoni, Florence 1959.
4 J.-J. Rousseau (1782), The Confessions, Einaudi, Torino 1955.
5 H. Searles F. (1986), op. cit.
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