Borderline Personality

Ryder and Jolie in Girl Interrupted (1999)

Hollywood is rich in mainstream movies with characters with Borderline Personality Disorder (BPD)- Winona Ryder in Girl Interrupted, Penelope Cruz in Vicky Cristina Barcelona, and Uma Thurman in My Super Ex-Girlfriend to name a few.  Even celebrities themselves have been associated with the disorder- Angelina Jolie, Megan Fox, Lyndsey Lohan, Amy Winehouse, and Christina Ricci to name several. I wouldn’t be surprised if the list of celebrity borderlines ran longer than that of their fictional counterparts.

So what is Borderline Personality Disorder?

Borderline originally earned its name in psychiatry from being thought to be on the “border” between psychosis and neurosis. In lay terms- almost but not entirely crazy (now refer to the aforementioned celebs to see if you get an aha reaction). The disorder is characterized by pervasive instability in mood, self-image, behavior, and interpersonal relationships. This typically means people suffering from BPD have chronic feelings of emptiness and low self-esteem, suicidal thoughts and gestures (cutting), anger issues, and even bisexual tendencies. Marsha Linehan, an expert on BPD, describes borderlines as “the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Relationships tend to be very intense and unstable. I don’t watch much reality TV, but I’d bet network executives cast borderlines primarily to inject drama into their shows to boost ratings. Borderlines are capable of switching from deep affection and adoration to hostile rage and contempt quicker than you can say Britney Spears.  Breakups are especially difficult. Due to fear of abandonment, borderlines may threaten to hurt themselves if their partner wants to move on or date others.

The cause of BPD is unknown, but almost certainly there is a history of childhood trauma. This includes parental abandonment and neglect, poor communication and disruption in the family, and physical and sexual abuse. Clinically, BPD is often misdiagnosed as Bipolar Affective Disorder (BAD) because of the overlap in mood instability symptoms. The main difference is that borderline symptoms are triggered by interpersonal difficulties while bipolar symptoms are autonomous and independent of relationship stressors. Medications are far less effective for treatment of BPD than BAD.

The treatment of choice for BPD is Dialectical Behavioral Therapy (DBT). It’s a form of talk therapy that helps borderlines learn to manage intense emotions to minimize self-destructive, maladaptive behaviors and thus function better in relationships. The goal is to promote acceptance, yet encourage change, which is inherently contradictory and confusing.

For simplicity’s sake, let me use Bruce Banner and his emotional self-destructive alter ego, the Hulk, as a case in point to illustrate the theory behind DBT. In order for Bruce to have a functional relationship with any woman, he cannot transform into the Hulk. But the Hulk is an inseparable part of Bruce, which he can never truly get rid of.  Similarly, borderlines can never get rid of their childhood trauma. DBT will help Bruce learn to accept that he is the Hulk, while concurrently teaching him to harness his emotions so he will not become the Hulk.

BPD can be quite a severe and debilitating disorder. Relationships are particularly intense and unstable. In the entertainment world where steady relationships are already few and far between, an aging celebrity borderline probably stands a better chance of sustaining a career without needing cosmetic touch-up surgery than maintaining a lasting marriage.

Good luck Brangelina.