Borderline personality disorder cuts a wide swath of destruction. Slowly, the condition is yielding to new understanding—provided patients get the correct diagnosis.
It had been an idyllic day celebrating a cousin’s wedding until Steve’s wife turned to him during the reception and said she was having a panic attack. The loud music in the room seemed to be engulfing her, heightening her anxiety. After the main course was served, Steve and his wife got up to go for a drive and get some air. To respect his wife’s privacy, Steve did not tell anyone why they were leaving, including his half-sister, Klara, who was seated at their table.
Minutes after the two left the wedding, as Steve later learned, Klara started approaching family members to claim that Steve and his wife had stormed off over something she did—and that they’d refused to tell her what she’d done wrong. She marched from table to table sharing the story, adding more drama with each telling. She ended up in the ladies’ room a few minutes later, sobbing, and it took Steve’s mother, other sister, and several close friends to calm her down so she wouldn’t disturb the festivities.
While trying to help his wife through her panic attack, Steve had stopped paying attention to his cell phone. When he next looked at the screen, he faced a torrent of messages from Klara, each more indignant than the last. “I deserve better… what the **** is wrong with you!… I HATE YOU!… Never call me again. You’re dead to me!” Steve still marvels at how quick Klara was to erupt in response to her perception of events. “Despite there being no argument, no unpleasant words exchanged,” he says, “our absence was presumed to be a slight directed at her and her alone.”
Klara’s spontaneous emotional combustion at the wedding would probably seem totally unremarkable to the 14 million adults in the U.S. who are estimated to have borderline personality disorder (BPD). They make up 2 percent of the general population but 20 percent of psychiatric inpatients. Most are women, and they typically turn the ups and downs of everyday life into a roller-coaster ride of moods. In doing so, they don’t just alienate others around them, they subvert their own life trajectory. Explosively reactive, and often struggling to get a grip on themselves, borderlines have difficulty maintaining stable relationships or even holding down a job.
Borderlines are interpersonal tornadoes. Some men are even romantically drawn—at least for a while—to the drama such women create around them and the helplessness they often display. For decades, however, it has been an open secret that psychiatrists dislike dealing with borderline patients. In large part, their reluctance has been fueled by their own frustrations: There was little help to offer. And borderlines often become hostile to their helpers. But the availability of dialectical behavior therapy, an emerging understanding of the roots of the disorder, and a disentangling of the behaviors that characterize it have all begun to brighten the outlook for borderline patients.
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