What Is Borderline Personality Disorder?

What Is Borderline Personality Disorder?


Consider the following:

Tammy, 19, is calmly sitting in a chair in the exam room of an emergency room. A nurse is putting the final touches on a bandage that covers a three inch long cut on her left forearm. A doctor has already put in eight stitches. The nurse, caring about this young beautiful woman, tries to strike up a dialogue.

“So Tammy. Did you really cut your arm on the door of your apartment?”

“Why? Is that what my dorm counselor said when she brought me in?”

“That’s exactly what she said. Why? Was it something else?”

“Yeah. I was really upset about some problems at school so I cut myself. It feels so good when I do that.”


Seffy closes the door as she leaves Dr. Cohen’s office. Dr Cohen, a psychiatrist, pulls over Seffy’s chart as she begins to write her session notes. She reads over what has been written before. Seffy has been depressed since her fourteenth birthday. She has been expelled from six different schools because of her extreme behaviors. The five psychiatrists and eight psychologists that Seffy has seen have not made any real progress. Seffy has taken over twenty different psychiatric medications in all kinds of combinations. Still, seven years later, at the age of 21, Seffy remains stuck in her misery with no friends and a baffled family. Dr Cohen feels sad and despairing. What can she do to help Seffy?



Thirty year old Meir rocks gently with the subway as it makes its way through the tunnel. Meir however doesn’t really notice it. His mind is rehashing a conversation that he had with his father earlier that afternoon. Actually, it was not much of a conversation since his father did most of the talking. ‘Why aren’t you calling that shadchan back?! What was wrong with that girl?! Haven’t your mother and I tried enough for you? All of your friends are married with kids already! What is wrong with you?!’ As Meir reflected on his father’s words he became confused. What was wrong with him? Even he didn’t understand the thoughts that crisscrossed his mind. Sometimes he got so frustrated with himself, he felt that he and his family would be better off if he were dead.



These three vignettes describe three different experiences of borderline personality disorder. Borderline Personality Disorder is one of the eleven personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). The DSM IV contains a listing of all the psychiatric disorders that have been identified by the American Psychiatric Association. So authoritative is the DSM IV, that only those disorders listed in it are considered official medical conditions by the United States government.

The DSM describes borderline personality disorder as
A pervasive pattern of instability of interpersonal relationships, self-image, and affects , and marked impulsivity beginning by early adulthood and present in a variety of contexts.

In other words, a person with borderline personality disorder has:
Difficulties maintaining positive relationships with others.
Has great difficulty developing an effective sense of identity.
Frequently experiences extreme moods.
Often acts without adequate regard to the consequences.

The DSM offers specific ways that these difficulties are manifest. They are (a separate chapter will be devoted to each of these manifestations):
1. Frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

In order to be diagnosed with borderline personality disorder, an individual must display five out of these nine characteristics. Should he or she manifest less than five, they can be described as having borderline traits. Individuals displaying more characteristics have worse personalities than those with less.

Beyond the level of severity, people with borderline personality disorder are often described as exhibiting one of three subtypes of the disorder. These subtypes are:
Dependent type borderline personality disorder
Histrionic type borderline personality disorder
Narcissistic type personality disorder

Someone with dependent type borderline personality disorder lives in a state of terrible fear of aloneness. Every action and thought is deeply involved in preventing their abandonment by others. They will often undermine their own self interests and future in order to prevent such abandonment. The manifestions of borderline personality disorder are often organized around the feared loss of a relationship.

Tamara, an eighteen year old seminary student, was referred to me by one of her teachers. Over the course of the ninety minute initial consultation a picture of a highly anxious and fragile young person emerges. This is Tamara’s first time away from home and she is adjusting with great difficulty. Her major worried preoccupation is that her best friend, Michal, will abandon her. Because of this worry, Tamara has literally become Michal’s servant and financier. While Tamara recognizes that the relationship is lopsided, she cannot take the risk of abandonment. The anxiety has become so bad that she finds herself feeling more and more desperate. The only thing that seems to relieve the terror is by distracting herself with cutting. Then calmness comes over her.


Someone with histrionic type borderline personality disorder desperately seeks the attention of others. The preoccupation with others’ attention often leads them to act in inappropriate ways so as to become the center of attention. The manifestations of borderline personality disorder are in response to the failures of others to give them the attention so seek.


Menachem was sent for an evaluation by the mashgiach of his yeshiva after a violently angry eruption over a recent in-house Shabbos. From what the mashgiach had shared with me, Menachem had become enraged when his friends had grown tired of his attempts at monopolizing a late night schmooze. Menachem later explained to me that he craved being the center of attention because it was only then that he felt alive. Otherwise, he felt dead. It was at such times that he thought about death.


Someone with narcissistic type borderline personality disorder believe him or herself to be so uniquely special as to deserve to be associated only with others viewed as also uniquely special. The manifestations of borderline personality disorder are in response to the frustration of their attempts to viewed in the manner that they wish.

It was only with great difficulty that Moshe was persuaded to seek treatment. Until the rosh yeshiva intervened, Moshe had rejected the recommendation of both his rebbe and his mashgiach. As he later explained to me, he did not accept the feedback anyone but the rosh yeshiva. His arrogance manner throughout our session belied the emptiness underneath. Moshe was miserably depressed, irritable, and easily enraged. He spoke of feeling empty inside.

Regardless of the exact form that it takes, borderline personality disorder levies a heavy price. The difficult moods and frightening behaviors get in the way of joyful relationships and personal accomplishment. Many people with borderline personality disorder have lives littered with failure and hurt. Feelings of utter despair are not uncommon, rachmana litzlan.

Yet there is good news. Treatment really can help. But first a complete understanding of borderline is needed. The next chapters will explain the concept of personality disorder and the inner psychological world of someone with borderline disorder.