Borderline Personality Disorder

Before I get to the text about the main subject of this missive, a relatively new term emerged to the public this week. The term is ‘callous unemotional traits’. This is the term that psychiatrists give to a set of symptoms that they see in some children – children who go on to be over-represented in prison populations and sometimes, in extreme cases, become what we call ‘psychopaths’. The term was used to describe a young man who exhibits behaviour that his parents find extremely challenging. This behaviour includes him hitting his sister and being prepared to say whatever is required to get his own way. Despite this, his parents still describe him as ‘highly charming’. As I listened to the interview he gave to the Today Programme last Wednesday morning, I was intrigued by the psychiatrists’ research which showed how these early signs can turn into psychosis later in life. This can result in two extreme types of people: those who end up murdering other people, and those who might end up in boardroom positions. To hear the interview I refer to please click here.

A few years ago, whilst writing a short series on personality disorders, I had the highest ever number of people contact me for more information on the subject. A while back, I was invited to help in a case which included someone who had been diagnosed with Borderline Personality Disorder (BPD). As I prepared for the case, I immersed myself into reading about the condition. During the case, a HR manager came to me confidentially and described how she also suffers from the condition. In doing so, she commented on how she was ‘usually fine’ but that another side would often surface and take control. This would often emerge when she was alone and during times of solitude she would feel particularly abandoned, which she attributed to what she described as her unworthiness. Anxiety would overwhelm her unless she found some type of release. Sometimes this would come in the form of eating binges. Her behaviour could switch in a second from charming and ingratiating to manipulative and hostile. She often talked of, what I later learned to be, imposter syndrome. She wondered how her colleagues could keep coming to her for HR advice but somehow never discover who she really was. She said that, whilst she craved closeness, whenever someone got too close, she ran.

Who are the borderline people you might meet in everyday life?

She is Nancy, your son’s girlfriend. One week, she is a ray of sunshine, the next the whole world is against her. She breaks up with your son today, only to be back tomorrow pledging endless devotion.

He is Tom, one of the line managers at your organisation. One day he lavishes you with praise for your efforts, and the next he berates you for an insignificant error. Sometimes he is quiet and reserved, and then he becomes animated and wants to be seen as ‘one of the boys’.

She is Rebecca, a long-time friend. Over a minor misdemeanour she accuses you of stabbing her in the back and tells you that you were never really friends at all. Weeks later, she is back and blasé, as if nothing ever happened.

Inconsistency is the hallmark of BPD. The chances are that you have spouse, a relative, a friend or colleague with BPD. Perhaps you recognise one or two of the characteristics described within yourself. Mental health professionals suggest that the number of people with BPD is growing.

Although the term ‘borderline’ was first use in the 1930s, it didn’t feature in the Diagnostic and Statistical Manual of Mental Disorders (the Bible for psychiatrists) until 1980. The nine categorical criteria for the condition are:

  • Frantic efforts to avoid real or imagined abandonment
  • Unstable and intense personal relationships
  • Lack of a clear sense of identity
  • Impulsive and potentially self-damaging behaviours such as abuse, casual sex, shoplifting, reckless driving and binge eating
  • Recurrent suicidal threats or gestures, or self-mutilating behaviours
  • Severe mood shifts and extreme reactivity to situational stress
  • Chronic feelings of emptiness
  • Frequent and inappropriate displays of anger
  • Transient, stress-related feelings of unreality or paranoia

The workplace can become a place of refuge for those with BPD, where they can put substantial personal difficulties and challenges behind them for a short period of time. They are quite likely to be able to consistently perform well at work. However, one might find that when a change is announced or even out of sheer boredom they might sabotage their position and seek to move on elsewhere.

Most reputable organisations will have occupational health departments for people who need support. BPD is a serious condition.