Candles in the Wind

“You have lived your life like a candle in the wind, never knowing who to cling to when the rain sets in” -Elton John

People with borderline personality disorder have been among the most engaging as well as the most challenging of my patients.

Most of us have likely had at least one encounter with someone with BPD, as it afflicts so many people, mostly women. These women usually spend much of their life unhappy or afraid, unable to sustain long lasting relationships. They repeatedly engage in self-defeating, injurious ( recurrent suicidal gestures or threats and self mutilation) and impulsive behavior such as spending, sex, substance abuse, reckless driving and binge eating.

While it is beyond the scope of this column to discuss the hypothesized origins of this disorder, it is fitting to say that much of the emotional pain that is so difficult for these people to bear stems from their inability to connect the fragmented memories from their past.

To be borderline is to have little sense of who you are and having to turn to others for cues in order to know. It may mean embracing a person or an idea one day and the next having no use for it at all. This lack of a constant picture of one’s self, values and desires is at the heart of the borderline personality.

Individual therapy is the cornerstone of treatment for BPD. Selecting a compatible therapist is crucial, since successful treatment depends on developing a trusting and mutually respectful alliance between therapist and patient.

Therapy is an active partnership. It is not something that is “ done to the patient”. Both therapist and patient share responsibility for the outcome. It is a cooperative investigation into the emotional life of the patient. The therapist provides a safe and caring environment for talking and the patient must be open and honest about all aspects of her emotional life. It is the relationship that ultimately cures.

Treatment with A BPD person is longterm, and the principal goal is to develop a stable sense of identity with an enduring set of values and beliefs. From this accomplishment comes a sense of continuity that makes it possible for the BPD person to tolerate distress.

Once a person can tolerate painful feelings and no longer needs to run away from pain in impulsive and self-defeating ways, that person can then no longer be considered BPD.