BORDERLINE DISORDERS

A group of psychological disturbances which exhibit various combinations of normality, neurosis, functional psychosis, and psychopathy.Schmideberg (1959) believes these disorders comprise a distinct clinical entity, since borderline patients do not usually develop outright neuroses or psychoses: “The patient, as a rule, remains substantially the same throughout his life. He is stable in his instability, whatever ups and downs he has, and often even keeps constant his pattern of peculiarity.” The category includes a number of different subgroups: “depressives, schizoids, paranoids, querulents, hypochondriacs, antisocials (representing attenuated forms of psychopathy), mixed cases etc.”The outstanding characteristic of the borderline patient is a severe personality disturbance that affects practically every aspect of his life—his attitudes, relationships, values, work habits, emotional responses, and sexual behavior. There is wide variation in the characteristic reactions of the different subgroups. The schizoids tend to be nonsocial and detached; psychopaths are more antisocial, tending to be aggressive and defiant; selfrighteous querulents collect grievances and are overaware of social injustices; hypochondriacs suffer from a variety of physical complaints; depressives are pessimistic and unable to enjoy themselves; paranoids cannot get along with others due to mistrust, arrogance, and oversensitivity to criticism.Beneath these differences are a number of basic similarities. Schmideberg stresses the following tendencies, noting that they may be more prominent in one patient than another: (1) lack of empathy, consideration, and deep feeling in their relations with other people;(2) low tolerance for frustration; inability to accept rules, routines, and a steady job; (3) poor judgment, lack of common sense, inability to concentrate and learn from experience; (4) general unhappiness and emptiness, leading to excessive need for money, sex, food, or thrills, but without a full capacity for enjoyment; (5) inability to establish healthy sexual and love relationships: promiscuity, impotence, frigidity, etc.; (6) inconsistency and changeability: obsessively clean at one time, utterly neglectful at another; (7) lack of repression: “The patient cannot forget and forgive, he cannot repress his hurts, the injustices he suffered, the little aches and pains he felt, as would the ordinary person and also the neurotic” (Schmideberg). In the light of these characteristics it is understandable that many borderline individuals do not have the drive or the ability to establish constructive work and personal relationships. They therefore give up one job after another, and some drift into unemployment, alcoholism, or crime.Treatment of borderline patients is a difficult matter, not only because they often have no desire for therapy, but because the standard procedures such as suggestion, hypnosis, shock treatment, and orthodox psychoanalysis are ineffective. Experience has shown that the free association technique is likely to encourage them to think au-tistically and withdraw even further from reality; and release of repressed material may push them over the borderline into delinquency, addiction, or psychosis. Moreover, the detached, passive attitude of the classical analyst simply encourages them to express their impulses without helping them control their behavior. For these and other reasons, Schmideberg has developed a direct, active approach which aims to “improve the borderline’s relationship to people, develop his reality sense, judgment, sense of continuity, foresight, and awareness of the consequences of his actions; in short, socialize him and develop control.”Schmideberg describes her therapy as a form of re-education in which the patient’s healthy behavior is strengthened and his pathological reactions discouraged. The key element in the process is the establishment of a friendly, interested relationship so that the patient will openly discuss his immediate situations and needs and the way he is tackling his problems, and will accept direct, authoritative guidance which will show where he has gone astray and where he is on the right track.The therapist does not attempt to make him aware of basic conflicts or repressed experiences that are influencing his behavior. However, “We can deal with the underlying conflict without revealing it to the patient; for example, if it concerns his unconscious hostility toward his father, we can find other acceptable outlets for his aggression, make him less sensitive to guilt, improve realistically his relation to his father and to father substitutes, make him more independent, and remove some of the causes of his resentment.” As this statement indicates, each patient must be treated according to his own inner needs. Some need more freedom, others more control; some need higher standards, some greater flexibility; some need direct advice on finding a job or meeting eligible male or female friends; others need help with relationships within the immediate family.In any case, the therapist proceeds step-by-step, utilizing the actual situations of the patient’s present life—for instance, his need for a job or his desire to make a good impression on a probation officer—to “get him moving” in the direction of stronger motivation, better controlled behavior, and more constructive relationships. As the patient tests out new approaches and finds them to his advantage, he may be motivated to build on them. In this way, a short-term approach may achieve long-term results.

Cite this page: N., Pam M.S., "BORDERLINE DISORDERS," in PsychologyDictionary.org, November 28, 2018, https://psychologydictionary.org/borderline-disorders/ (accessed March 24, 2019).
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