Hi, friends! It has been a LONG time since I came on here and posted some content. One of my goals this summer was to be more active on this lil blog, so better late than never, right? Below you will find a short paper I wrote back when I was in school longggggg ago (lol jk I graduated just two months ago)! I wrote this paper for my Advanced Clinical Assessment & Diagnosis Course. We were told to pick a mental health disorder and write about what we think life would be like for an individual who has this disorder. This past school year, I interned in an inpatient psychiatric hospital for adolescents. Many of our patients seemed to struggle with or show signs of borderline personality disorder, which led me to want to focus my paper on this disorder. Because I do not live with this condition, the narratives below could be insensitive and inaccurate – or they could be spot on. I don’t really know, but I thought I would share this food for thought. Let me know what you think of it all in the comments below. Let me know where I went wrong and do not be afraid to correct me. I want to have a conversation, learn, and be a better person to serve others. We can own today when we take the time to get to know ourselves, own up to our mistakes, and let ourselves be vulnerable. Hopefully these narratives will stimulate some thoughts on understanding another’s emotions, looking into your own reactions, and hearing a story outside your own.
Here’s the paper!
Personality Disorders come about when an individual develops and lives with persistent, maladaptive patterns of inner experience and behavior that deviates from his or her culture , leading to distress or impairment in their life (Black & Andreasen, 2014). Personality Disorders are divided into three clusters in the DSM-V, which are Cluster A (the “eccentric” disorders), Cluster B (the “dramatic” disorders), and Cluster C (the “anxious” disorders). Borderline Personality Disorder exists within Cluster B, as it is characterized by “dramatic” behaviors, such as excessive emotionality, grandiosity, self-mutilation, and/or angry outbursts. Borderline Personality Disorder is unique from the other personality disorders due to its marker of a severe instability of interpersonal relationships, and the disorder can present itself in adolescence or early adulthood (Black et al., 2014). Four scenarios will be presented to attempt to explain the experiences someone with Borderline Personality Disorder would encounter in their daily life, like going on a date, going to a job interview, visiting family, and attending class. Because women are more frequently diagnosed with Borderline Personality Disorder than men (American Psychiatric Association, 2013), since about seventy-five percent of people diagnosed with Borderline Personality Disorder are women (Salters-Pedneault, 2018), a woman living with Borderline Personality Disorder will be described for the purpose of being a character for these scenarios.
Going On A Date
A woman with BPD may go on a date with a romantic interest and struggle with feelings of abandonment, as she and her partner try to get to know one another. The woman will feel a sense of attachment, wanting to cling to her partner and get to know him or her. However, she may also act with anger (American Psychiatric Association, 2013), wanting to push him or her away, already thinking that he or she will abandon her. As the woman already believes that her partner will abandon her, she becomes resistant, not wanting to open up about deep topics, like emotions or family. She may struggle with intense feelings of emptiness (American Psychiatric Association, 2013; Black et al. 2014), attempting to fill this void within her by avoiding deep discussion and sexually “acting out,” crossing boundaries during the date; she may try to kiss or inappropriately and intimately touch her partner without him or her being ready for that physical connection just yet. Her partner may then reject her, as he or she may feel violated or overwhelmed. Her partner might push her away, causing the woman to emotionally beat herself up, possibly causing her to self-harm by cutting her wrists (or through other violent acts) or engage in substance abuse during or after her date.
If the woman were to go on a job interview, she may feel instability and intense anxiety (American Psychiatric Association, 2013; Black et al. 2014), as she may be afraid of the outcome of the interview. If she obtains a job offer, she may not want it anymore, panicking that it may not be the right fit for her, that she will mess up, or that the overall job experience will be horrible. On the other hand, she may be afraid of not obtaining a job offer; she may become increasingly angry towards the employers and towards herself, as she has trouble understanding how she might not qualify for the position. She may think that a job denial is personal and revolves around her being a terrible person, when in reality, the denial is more about her work experience. She may leave the interview in tears, recklessly driving herself back home.
When visiting family, this hypothetical woman with Borderline Personality Disorder may be superficially pleasant and happy, attempting to hide her feelings of self-hatred and anger towards her family and overall life situations and circumstances. As she enters a family gathering, she may seem extremely excited to see everyone. She may cling to her mother, for example, idolizing her and treating her as if she is the best person in the world. The woman becomes affectionate towards her mother, constantly wanting to be around her and give her love. As the family gathering continues, the mother says something off-putting and offensive to the woman, causing the woman to switch from obsessively loving her mother to impulsively stating that she wants her mother to die, devaluing her. She may cut her own wrists in front of her family members to show them how she feels, pushing her limits to see if her family will still love her despite her aggressive, violent, impulsive behaviors. Those with Borderline Personality Disorder undergo a pattern of unstable interpersonal relationships that cause them to alternate between idealizing and devaluing others and themselves, leading to these behaviors and actions without thinking through their decisions (American Psychiatric Association, 2013; Black et al. 2014).
Going to Class
The woman may also experience identity disturbance, meaning that she may battle with unstable self-image or sense of self (American Psychiatric Association, 2013; Black et al. 2014). In a classroom setting, the woman may respond to questions with incorrect answers, causing her to feel extremely frustrated at herself; she may feel like she is the most stupid person on the planet and will amount to nothing, simply because she got one or a few questions wrong in class. This can develop an irrational, terribly negative self-image, as she feels worthless and starts becoming irritable, which disrupts her learning throughout the class and repeats the cycle of her self-hatred. In response to her anger towards herself and the class environment, she may throw a tantrum, destroying the instructor’s property and ruining the learning experience of other students, which will naturally hurt her interpersonal relationships with her fellow classmates. Those with Borderline Personality Disorder may display the utmost difficulty in controlling anger and stress, resulting in temper tantrums and aggressive destruction of property and potentially hurting others (American Psychiatric Association, 2013; Black et al. 2014).
Diathesis-Stress Model & Resilience
The Diathesis-Stress Model is a psychological theory that posits that there are two major components that impact those with mental health disorders; the two components are (1) the diathesis, that provides a biological and genetic predisposition for mental illness, and (2) the stress response, which includes the life events that moderate or worsen the symptoms of the disorder. The diathesis-stress model helps mental health professionals explore the interaction between biological and genetic factors (diathesis) and environmental influences (stress) that can potentially produce various mental illnesses (Diathesis-Stress, 2017; Hosier, 2017). In the case of Borderline Personality Disorder, an individual’s innate temperament impacts their predisposition, or diathesis, to the disorder (Hosier, 2017). As for their stressors, childhood trauma(s) can highly impact the development of Borderline Personality Disorder (Hosier, 2017). Other stressors or environmental influences could be the individual’s substance use, adaptive or maladaptive coping skills, and the society or culture’s relationship with the individual.
To help reduce maladaptive stressors in an individual who is living with Borderline Personality Disorder’s life, developing strong resilience is key. Goelitz and Stewart-Kahn (2013) emphasize that resilience comes from healthy coping and self-care, which creates a foundation of safety for individuals who are struggling with emotional and behavioral regulation. Resilience can be developed through discovering one’s own unique healthy calming choices, or coping skills, and finding the proper medication to help regulate symptoms like depression, anxiety, and impulsivity. To assist in strengthening resilience, Dialectical Behavior Therapy is a psychotherapy that actively teaches behavioral and cognitive coping skills, specifically for those with Borderline Personality Disorder (Black et al., 2014). Dialectical Behavior Therapy consists of individual and group therapy that teaches the following skills: interpersonal effectiveness, distress tolerance/reality acceptance, emotional regulation, and mindfulness (Ackerman, 2017). By learning and enhancing these resilience and coping skills, those with Borderline Personality Disorder can develop resilience that will assist them in regulating and balancing the extremes and ambivalence that they often feel, combating against the negative environmental influences and stressors they may come across in their day-to-day life. Going on a date, to a job interview, to a family gathering, or to class may eventually become less stress-provoking over time with the help of therapy and medication to build a repertoire of healthy habits and better controlled emotions and behaviors.
American Psychiatric Association. (2013). Cautionary statement for forensic use of DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. https://dx.doi.org/10.1176/appi.books.9780890425596.CautionaryStatement
Ackerman, C. (2017, March 14). Dialectical behavior therapy: Your #1 DBT resource (12 skills + PDF). In Positive Psychology Program. Retrieved October 31, 2018, from https://positivepsychologyprogram.com/dbt-dialectical-behavior-therapy/
Black, D.W., & Andreasen, N.C. (2014). Introductory textbook of psychiatry (6th ed.). Washington, D.C.: American Psychiatric Publishing.
Diathesis-Stress Model. (2017). Retrieved October 31, 2018, from http://www.psychologyconcepts.com/diathesis-stress-model/
Goelitz, A. & Stewart-Kahn, A. (2013). From Trauma to Healing: A Social Work Guide to Working with Survivors. New York, New York: Routledge.
Hosier, D. (2017, December 11). Explaining BPD in terms of the diathesis-stress model. In Childhood Trauma Recovery. Retrieved October 31, 2018, from
Salters-Pedneault, K. P. (2018, May 3). Borderline Personality disorder statistics: Borderline personality disorder is more common than you think. In verywellmind. Retrieved October 31, 2018, from https://www.verywellmind.com/borderline-personality-disorder-statistics-425481