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BORDLRLINL PLRSONALITY DISORDLR BORDLRLINL PLRSONALITY DISORDLR BORDLRLINL PLRSONALITY DISORDLR BORDLRLINL PLRSONALITY DISORDLR --- --- --- --- A CASL VIGNLTTL IROM A CASL VIGNLTTL IROM A CASL VIGNLTTL IROM A CASL VIGNLTTL IROM
VARIOIS THLORITICAL PLRSPLCTIVLS VARIOIS THLORITICAL PLRSPLCTIVLS VARIOIS THLORITICAL PLRSPLCTIVLS VARIOIS THLORITICAL PLRSPLCTIVLS

Thc no|ion ol a bordcrlinc pcrsonali|v oriina|cs lrom |hc psvchia|ric in|crcs| in s|a|cs ol
schizophrcnia, which wcrc variouslv dcscribcd as 'ambula|orv' and 'pscudo-ncuro|ic', in
which |hcrc wcrc |ransicn| psvcho|ic s|a|cs, as wcll as bv psvchoanalvs|s such as Hclcnc
Dcu|sch, who dcscribcd |hc 'as il' pcrsonali|v.

Rcscarch has hihlih|cd a charac|cris|ic sc| ol lca|urcs ol |hc bordcrlinc pcrsonali|v
oraniza|ion which larclv ccho |hosc ou|lincd bv Kcrnbcr, namclv uns|ablc pcrsonal
rcla|ionships, idcaliza|ion and dcnira|ion ol o|hcrs, impulsivc and unprcdic|ablc lcclins
and scll dcs|ruc|ivc bchavior (Bcrclowi|z and Tarnopolskv, 199`i. Thc c|ioloical lac|ors
prcsumcd |o bc rcla|cd |o bordcrlinc pcrsonali|v disordcr includc a childhood
cnvironmcn| charac|crizcd bv nclcc|, ins|abili|v, mari|al discord, phvsical and scxual
abusc and whcrc |hcrc is no 'ood' liurc which can ac| as a bullcr aains| |hcsc dillicul|
circums|anccs. Inlikc mos| ol |hc o|hcr pcrsonali|v disordcrs, |hcrc is now considcrablc
cvidcncc |o suppor| |hc sinilicancc ol such childhood an|cccdcn|s |o |hc la|cr
dcvclopmcn| ol a bordcrlinc oraniza|ion, allcc|in in par|icular |hc individual's idcn|i|v
and |hc risk ol scll dcs|ruc|ivc bchavior. Such |rauma|ic his|orics arc morc common in
|hosc who lunc|ion a| a bordcrlinc lcvcl |han lor mos| ol |hc o|hcr pcrsonali|v disordcrs
(Millon and Davis, 1995i.

Such clicn|s ol|cn prcscn| lor hclp as |hcir lunc|ionin is advcrsclv allcc|cd bv |hcir
bchavior and |hcv arc lrcqucn|lv in crisis. Thcv can prcscn| as vcrv anrv and pcssimis|ic,
lcadin |o violcncc or rccrimina|ions aains| |hc world. Thc ancr mav also bc |urncd
aains| |hcm and is manilcs|cd in impulsivc, scll-damain bchavior. Thcv mav slidc
casilv lrom impulsivc ac|ions |o lranklv psvcho|ic bchavior, which is ncvcr|hclcss usuallv
shor|-livcd and subsidcs lollowin |hc rcduc|ion ol s|rcss. Thcv ol|cn also prcscn| as
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dcprcsscd. Thc dcprcssion is no| so much charac|crizcd bv hopclcssncss or uil| bu|
ra|hcr bv a pcrvasivc scnsc ol cmp|incss or lonclincss. Rcla|ionships wi|h o|hcr pcoplc
|cnd |o rcvcal |hc nccdincss ol |hc pcrson, who mav bc vcrv clinv or dcmandin wi|h a
|cndcncv |owards dcvaluin |hc o|hcr pcrson, who is also dcspcra|clv nccdcd and a| |imcs
cvcn idcalizcd.

Thc parcn|s ol bordcrlinc pa|icn|s arc |hcmsclvcs morc likclv |o havc somc lorm ol
psvchopa|holov, manilcs|in ci|hcr as an ovcr| psvchia|ric disordcr or as pcrsonali|v
|rai|s |ha| in|crlcrc wi|h adcqua|c parcn|in. Links, S|cincr, and Huxlcv (1988i carricd ou|
|hc mos| svs|cma|ic s|udv ol psvchia|ric dianoscs in |hc parcn|s ol a cohor| ol bordcrlinc
pa|icn|s. Thc disordcrs wi|h rca|cs| co morbidi|v arc rccurrcn| unipolar dcprcssion
(27i, alcoholism (21i, BPD i|scll (15i and ASPD (10i.

Thc conccp| ol bordcrlinc was ini|iallv dcvclopcd |o cxplain a roup ol pa|icn|s who had
a| lirs| bccn sccn as appropria|c candida|cs lor psvchodvnamic psvcho|hcrapv - |roublcd
bu| no| psvcho|ic, and havin a widc ranc ol s|ron allcc|s and in|cnsc rcla|ionships.
Howcvcr, |hcv o| worsc ra|hcr |han bc||cr in |hc uns|ruc|urcd sc||ins ol such |hcrapv.
This lcd |o a||cmp|s |o dcvclop s|ra|cics lor idcn|ilvin such pa|icn|s bclorc |hcv had
cn|crcd psvcho|hcrapv-psvcholoical |cs|s, s|ruc|ural in|crvicws, and dianos|ic cri|cria.
Howcvcr, |rca|mcn| lor BPD has improvcd much in |hc las| 15 vcars. Dialcc|ical
Bchavioral Thcrapv (DBTi, a psvchosocial |hcrapv lormula|cd aimin |hc in|crvcn|ion ol
BPD has provcd |o bc cllicacious lor manv pa|icn|s. Pharmaco|hcrapv is also prcscribcd
|arc|in svmp|om cradica|ion in ccr|ain pa|icn|s. Thcrapv, in |hc prcscn| vcars has
arrivcd a| a morc llcxiblc pa||crn, |crmcd as |hc Lclcc|ic Approach. Such an approach is
no| conlincd |o anv spccilic modc ol |hcrapv, ra|hcr proposcs lor conccp|ual in|cra|ion
which scrvcs as a sound |hcorc|ical backround. Thc prcscn| papcr also aims |o makc a
conccp|ual in|cra|ion and llcxiblc analvsis ol a casc lrom various |hcorc|ical pcrspcc|ivcs.

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C CC CASL RLPORT ASL RLPORT ASL RLPORT ASL RLPORT
Thc clicn| was an unmarricd Hindu lcmalc ol 20 vcars hailin lrom suburban arca, low
middlc class lamilv, a |raincc nursc in R. G. Kar Mcdical Collcc S Hospi|al. Hcr
prcscn|in complain|s wcrc:
i. Icclin sad all |hc |imc
ii. Loss ol appc|i|c
iii. Tcnsion
Thc clicn| was apparcn|lv alrih| |ill Julv 2011, whcn shc s|ar|cd |hc |rainin coursc lor
Gcncral Nursin S Midwilcrv a| R. G. Kar Mcdical Collcc and Hospi|al. Shc s|ar|cd
s|avin a| |hc hos|cl |hcrc. Thc clicn| rcpor|cd |ha| shc has somc problcms in c||in up
|hc mornin and could no| a||cnd |o du|v on |imc. Shc rcpor|cd |ha| hcr scnior Sis|crs
wcrc vcrv s|ric| and cri|icizcd hcr a| cvcrv oppor|uni|v, cvcn in lron| ol |hc pa|icn|s. Hcr
pccrs wcrc no| much hclplul ci|hcr. On 2`
rd
March, on |hc cvc ol hcr lorm lill up, shc
could no| lind hcr rcis|ra|ion ccr|ilica|c. Shc scarchcd la|c in|o nih|, and could no|
wakc up in |imc lor hcr du|v |hc ncx| dav. Shc lcl| vcrv dcprcsscd and |houh| |ha| shc
could livc no morc; shc |ricd |o han hcrscll. Shc lain|cd in |hc proccss and rcaincd
consciousncss in |hc hospi|al.

A lcw davs la|cr, whilc shc was s|ill undcr mcdica|ion shc askcd hcr roomma|c |o swi|ch
|hc lih|s oll a| nih|, which |hc roomma|c dcclincd. Thc clicn| |hcn |hrca|cncd |o slap
hcr. Hcr roomma|c complaincd |o |hc ma|ron |ha| |hc clicn| had ac|uallv slappcd hcr.
Thc clicn| was |hcrclorc askcd |o brin a li| ccr|ilica|c and was |old |ha| shc will no| bc
allowcd |o si| lor hcr cxamina|ion wi|hou| |hc ccr|ilica|c and will havc |o discon|inuc.

Thc clicn| had a dis|urbin homc si|ua|ion in hcr childhood and adolcsccncc. Shc los|
hcr la|hcr a| |hc ac ol ` vcars. Thcn |hcv shil|cd |o hcr ma|crnal unclcs` homc.
Thcrcal|cr shc was scn| |o a rcsidcn|ial school. Hcr mo|hcr was vcrv dcprcsscd and
commi||cd suicidc al|cr hcr Hihcr Sccondarv Lxamina|ion. Hcr bro|hcr also dicd in a
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|ruck accidcn|. Shc complc|cd hcr school cduca|ion and s|ar|cd pursuin Bcnali
Honors. Vhcn shc was in hcr 2
nd
vcar, shc camc |o know abou| |his nursin coursc,
which shc |ook up abandonin hcr s|udics. Prcscn|lv shc s|avs a| |hc nurscs` hos|cl ol R.
G. Kar Hospi|al and somc|imcs ocs |o hcr ma|crnal unclcs` placc. Shc said |ha| shc has
no placc |o s|av il shc is lorccd |o discon|inuc hcr coursc as 2 ol hcr ma|crnal unclcs and
|hcir wivcs do no| likc hcr s|avin a| |hcir homc.

Thc clicn| rcpor|cd |ha| shc had alwavs bccn scn|imcn|al and scnsi|ivc |owards cri|icism.
Shc casilv lcl| hur| and anrv il shc was bcin cri|icizcd, uscd |o |car ol hcr clo|hcs, punch
in|o |hc walls and do o|hcr kinds ol scll harmin bchavior in rcac|ion |o cri|icism.

MLNTAL STATIS LXAMINATION MLNTAL STATIS LXAMINATION MLNTAL STATIS LXAMINATION MLNTAL STATIS LXAMINATION
Thc clicn| was wcll kcmp| and |idv, wi|h wcll roomcd hair. Shc had |ouch wi|h |hc
surroundins, main|aincd cvc con|ac| and rappor| could bc cs|ablishcd casilv. Shc was
coopcra|ivc, and showcd no dis|urbanccs in mo|or movcmcn|. Coni|ivc lunc|ions
sccmcd |o bc avcrac lrom in|crvicw. Shc had dcprcsscd allcc| durin |hc in|crvicw, and
hcr |houh| was prcoccupicd wi|h prccipi|a|in lac|ors, and idcas ol uil|, hopclcssncss
and hclplcssncss. Hcr insih| was a| Gradc III -- awarcncss ol bcin sick bu| blamin i| on
cx|crnal lac|ors.

TLSTS ADMINISTLRLD TLSTS ADMINISTLRLD TLSTS ADMINISTLRLD TLSTS ADMINISTLRLD
Bcck Dcprcssion invcn|orv (BDIi
Lvscnck Pcrsonali|v Qucs|ionnairc (LPQi
Rorschach Inkblo| Tcs| (RITi
Thcma|ic Appcrccp|ion Tcs| (TATi


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RLSILTS RLSILTS RLSILTS RLSILTS
Bcck Dcprcssion Invcn|orv Bcck Dcprcssion Invcn|orv Bcck Dcprcssion Invcn|orv Bcck Dcprcssion Invcn|orv rcvcals prcscncc ol mild mild mild mild (11i dcrcc ol subcc|ivc dcprcssion
in |hc clicn|.

Thc Lvscnck Pcrsonali|v Qucs|ionnairc Lvscnck Pcrsonali|v Qucs|ionnairc Lvscnck Pcrsonali|v Qucs|ionnairc Lvscnck Pcrsonali|v Qucs|ionnairc rcvcals |ha| |hc clicn| is arcssivc, cold,
coccn|ric, impulsivc and uncmpa|hic. Shc is non asscr|ivc and non sociablc, non ac|ivc
and vcn|urcsomc. I| also shows |ha| shc has hih social dcsirabili|v.

Thc Rorschach Inkblo| Tcs| Rorschach Inkblo| Tcs| Rorschach Inkblo| Tcs| Rorschach Inkblo| Tcs| rcvcals |ha| |hc individual has dis|urbcd adus|mcn| and a
s|crco|vpcd vicw ol |hc world |ha| is |oo narrow a ranc ol in|crcs|s. Shc s|icks |o |hc
prac|ical, common scnsc vicw ol |hins lor shc is no| capablc ol a morc in|cra|cd vicw.
Shc placcs li||lc cmphasis on main|ainin an impcrsonal, ma||cr-ol-lac| rcla|ionship wi|h
|hc world. Shc is rulcd bv immcdia|c nccds lor ra|ilica|ion ra|hcr |han lon |crm oals.
Shc |cnds |o ac| on impulsc, wi|h li||lc capaci|v ol pos|poncmcn|. Shc lccls dis|urbancc
whcn cnvironmcn|al s|imuli |ouch on |hc arca ol allcc|ional nccds. Hcr |cnsions arc |o
s|ron |o pcrmi| hcr |o u|ilizc hcr inncr rcsourccs lor cons|ruc|ivc solu|ions ol hcr
cvcrvdav problcm ol livin. Shc |rics |o rcach bcvond |hc limi|s ol abili|v |o makc scnsc
ol cxpcricncc and |o scck lor rcla|ionships. Hcr lcvcl ol aspira|ion is |oo hih, bu| |hc
produc|ivc rcsourccs ol |hc pcrsonali|v arc undulv low. Thcrc sccms |o bc a compulsivc
nccd |o do |hc bi |hin in |hc in|cllcc|ual scnsc, an ovcrridin in|cllcc|ual ambi|ion
wi|hou| |hc abili|v |o back i| up. This nccd lor in|cllcc|ual achicvcmcn| mav bc vicwcd as
a dclcnsc mcchanism ol compcnsa|orv sor|.

Thc Thcma|ic Appcrccp|ion Thcma|ic Appcrccp|ion Thcma|ic Appcrccp|ion Thcma|ic Appcrccp|ion Tcs| Tcs| Tcs| Tcs| rcvcals |ha| |hc s|orics arc wcll s|ruc|urcd, dcscrip|ivc
and dvnamic in na|urc. Thc Hcro or |hc scll has bccn pcrccivcd as sad, worrvin,
inadcqua|c, submissivc, domina|cd, dcccivcd and cxploi|cd. Shc is impulsivc and
passivclv arcssivc, |houh somc|imcs shc is dc|crmincd, adcqua|c, compc|cn| and
Page | 6

scnsi|ivc. Icar ol loss and scpara|ion, loss ol lovcd obcc| and loss ol |rus| is cvidcn|. Thc
main nccds ol |hc hcro arc nccd lor succorancc, au|onomv and achicvcmcn|. Thc
cnvironmcn| is mos|lv pcrccivcd as non nur|urin, non suppor|ivc, harsh and puni|ivc,
|houh somc|imcs i| is suppor|ivc. Thc au|hori|v liurcs havc bccn pcrccivcd as
domina|in, mis|rus|lul, au|hori|arian, puni|ivc and harsh. Thc con|cmporarv malc liurc
has bccn pcrccivcd as mis|rus|lul, domina|in, cxploi|in, manipula|ivc, oppor|unis| and
dcccivin. Thc sinilican| conllic|s arc |rus| vs mis|rus| and au|onomv vs compliancc. Thc
main dclcnscs uscd arc procc|ion, dcnial and ra|ionaliza|ion. Thc lu|urc is sccn |o bc
hopclul, which could bc a rcsul| ol wish lullillmcn|.


SIMMARY OI TLST IINDINGS SIMMARY OI TLST IINDINGS SIMMARY OI TLST IINDINGS SIMMARY OI TLST IINDINGS
All |hc |cs| lindins rcvcal somc common lca|urcs in |hc clicn|, likc sadncss, impulsivi|v,
nccd lor immcdia|c ra|ilica|ion, dis|urbancc in |hc arca ol allcc|ional nccds, as shc is
cold, worrvin, coccn|ric, uncmpa|hc|ic, and arcssivc. Shc has a hih nccd lor
achicvcmcn|, cvcn bcvond hcr abili|ics, which is ol |hc compcnsa|orv sor|. Hcr
dcpriva|ion has lcd |o arcssion, which is displaccd |hrouh hcr acadcmics, which also
lullills hcr nccd |o bc likcd bv o|hcrs, as shc has hih social dcsirabili|v. Bu| shc hcrscll is
mis|rus|lul ol |hc world, and cxpcc|s |hc wholc si|ua|ion |o modilv i|scll as i| sui|s hcr.

Thc promincn| lca|urcs ol |hc casc conlirm |ha| |hc clicn| has Lmo|ionallv Ins|ablc
Pcrsonali|v Disordcr, Impulsivc |vpc. Shc also has Modcra|c Dcprcssivc Disordcr
wi|hou| soma|ic svndromc. Acc |o |hc DSM IV, shc has Bordcrlinc Pcrsonali|v Disordcr,
alon wi|h Maor Dcprcssivc Disordcr.

Tcmpcramcn|al lac|ors includc Hih Novcl|v Scckin, and Harm Avoidancc. Tha| is
impulsivi|v, disordcrlv, a pcrson who |akcs quick dccision bascd on incomplc|c
Page | 7

inlorma|ion. Shc is also pcssimis|ic, lcarlul, shv and worrvin, bcin wi|hdrawn dc|achcd
and cold.

THLORLTICAL PLRSPLCTIVLS THLORLTICAL PLRSPLCTIVLS THLORLTICAL PLRSPLCTIVLS THLORLTICAL PLRSPLCTIVLS
Thc mos| impor|an| |hcorc|ical advancc in dclinin |hc bordcrlinc cons|ruc| cmcrcd
lrom |hc work ol Kcrnbcr (1975i, who dcscribcd bordcrlinc pa|icn|s as havin
nonspccilic co wcakncss" i.c., mul|iplc dclici|s in |hc psvcholoical prac|iccs los|crin
adap|ivc lunc|ionin, includin poor impulsc con|rol, low anxic|v |olcrancc, and
brcak|hrouhs ol primarv proccss" |hinkin i.c., disordcrcd |hinkin. Primi|ivc dclcnscs
ci|cd includc maical |hinkin (bclicls |ha| |houh|s can causc cvcn|si, omnipo|cncc, and
procc|ion ol unplcasan| charac|cris|ics in |hc scll on|o o|hcrs and procc|ivc
idcn|ilica|ion, a proccss whcrc |hc bordcrlinc |rics |o clici| in o|hcrs |hc lcclins shc is
havin.

Thc clicn| hcrc is sccn |o usc dclcnscs likc procc|ion, dcnial and ra|ionaliza|ion. Hcr |cs|
lindins clcarlv sucs| |ha| shc |cnds |o ac| on impulsc, and lails |o havc an in|cra|cd
vicw ol |hins. Durin his|orv |akin, shc hcrscll admi||cd |ha| shc alwavs had vcrv low
|olcrancc lor cri|icism, and uscd |o havc scvcrc ancr ou|burs| il shc was cri|icizcd. Hcr
impulsivi|v is also obscrvcd lrom |hc lac| |ha| shc complc|cd all hcr |cs|in in onc dav, a
|cdious proccdurc shc was rcpca|cdlv adviscd no| |o ovcr|akc.

Vi|hin |hc psvchodvnamic pcrspcc|ivc, obcc| rcla|ions |hcorv addrcsscs |hc
rcla|ionships bc|wccn wha| is psvcholoicallv in|crnal" and wha| is cx|crnal," as wcll as
how sinilican| carlv lorma|ivc rcla|ionships bccomc in|crnalizcd and allcc| our
subscqucn| cxpcricncc ol oursclvcs and o|hcrs. A kcv conccp| in obcc| rcla|ions |hcorv is
|ha| ol obcc| rcprcscn|a|ion, which, broadlv dclincd, rclcrs |o conscious and unconscious
mcn|al schcma|a ol sinilican| pas| in|crpcrsonal cncoun|crs. I| is bclicvcd |ha| |hc abili|v
ol an individual |o rc|ain consis|cn| imacs or rcprcscn|a|ions ol pcrsons impor|an| |o
Page | 8

|hcm dcvclops durin childhood |hrouh cxpcricnccs wi|h carcivcrs who arc carin and
ra|ilvin bu| also lrus|ra|in. Dcvclopmcn| ol cmo|ional obcc| cons|ancv" anchors |hc
child, allowin him or hcr |o achicvc an incrcasinlv s|ablc scnsc ol sinilican| o|hcrs and,
in |urn, ol himscll or hcrscll. Thc |oddlcr`s cvoca|ivc mcmorv, |hc abili|v |o cvokc |hc
imac ol |hc obcc|, cspcciallv in |imcs ol |hrca| or anxic|v, is a crucial s|cp in |hc proccss
ol dcvclopin obcc| cons|ancv, a s|ablc scnsc ol scll and ol o|hcrs |ha| can wi|hs|and
lluc|ua|ions in |hc consis|cncv ol |hc cnvironmcn|. I| has bccn sucs|cd, bv somc bu|
ccr|ainlv no| all psvchodvnamic |hcoris|s, |ha| whcn |hc adul| bordcrlinc individual was a
|oddlcr, |ha| |oddlcr was unablc |o |ravcrsc propcrlv |hc rapprochcmcn| sub phasc ol |hc
scpara|ion-individua|ion proccss bccausc ol |hc carc|akin parcn|`s cmo|ional labili|v.
Thus, i| was |houh| |ha| |hc child was unablc |o dcvclop a s|ablc scnsc ol scll, o|hcrs, or
|hc cnvironmcn|.

As |hc clicn| had los| hcr la|hcr a| a vcrv carlv ac, and was scpara|cd lrom hcr mo|hcr
and bro|hcr |hcrcal|cr, shc had no| cons|ruc|ivc or lullillin rcla|ionship in |hc childhood.
Shc had |hus in|crnalizcd a |horouhlv dvslunc|ional wav ol pcrccivin rcla|ionships. Hcr
pcrccp|ion ol |hc cnvironmcn| is |hcrclorc |hrca|cnin. Hcr rcla|ionships arc pcrccivcd
as manipula|ivc, cxploi|in, mis|rus|lul c|c, as is cvidcn| lrom |hc Thcma|ic Appcrccp|ion
Tcs| (TATi.

In |his con|cx| i| is mcn|ion wor|hv |ha|, acc |o Carl Rocrs, whcn sinilican| o|hcrs in |hc
pcrson's world (usuallv parcn|si providc posi|ivc rcard |ha| is condi|ional, ra|hcr |han
uncondi|ional, |hc pcrson in|rocc|s |hc dcsircd valucs, makin |hcm his/hcr own, and
acquircs 'condi|ions ol wor|h' (Rocrs, 1959i. Thc scll-conccp| |hcn bccomcs bascd on
|hcsc s|andards ol valuc ra|hcr |han on oranismic cvalua|ion. Thc nccd lor posi|ivc scll-
rcard lcads |o a sclcc|ivc pcrccp|ion ol cxpcricncc in |crms ol |hc condi|ions ol wor|h
|ha| now cxis|. Thosc cxpcricnccs in accordancc wi|h |hcsc condi|ions arc pcrccivcd and
svmbolizcd accura|clv in awarcncss, whilc |hosc |ha| arc no| arc dis|or|cd or dcnicd in|o
Page | 9

awarcncss. This lcads |o an 'inconrucncc' bc|wccn |hc scll as pcrccivcd and |hc ac|ual
cxpcricncc ol |hc oranism, rcsul|in in possiblc conlusion, |cnsion, and maladap|ivc
bchavior (Rocrs, 1959i.

Lrikson`s |hcorv ol psvchosocial dcvclopmcn| savs |ha| lrom acs bir|h |o onc vcar,
childrcn bcin |o lcarn |hc abili|v |o |rus| o|hcrs bascd upon |hc consis|cncv ol |hcir
carcivcr(si. Il |rus| dcvclops succcsslullv, |hc child ains conlidcncc and sccuri|v in |hc
world around him and is ablc |o lccl sccurc cvcn whcn |hrca|cncd. Insucccsslul
complc|ion ol |his s|ac can rcsul| in an inabili|v |o |rus|, and |hcrclorc a scnsc ol lcar
abou| |hc inconsis|cn| world. I| mav rcsul| in anxic|v, hcih|cncd insccuri|ics, and an ovcr
lcclin ol mis|rus| in |hc world around |hcm.

Thc carlv loss ol la|hcr and scpara|ion lrom mo|hcr mih| havc bccn in|crprc|cd as
dcnial, or rccc|ion lrom |hc parcn|al liurcs bv |hc clicn|. Thcrclorc, |hc dcvclopmcn| ol
scll pcrccp|ion ol |hc clicn| has bccn dis|or|cd, and shc pcrccivcs hcrscll as inadcqua|c,
wor|hlcss, dcccivcd and cxploi|cd, as rcvcalcd bv |hc Thcma|ic Appcrccp|ion Tcs|. Had
shc no| bccn inadcqua|c, or wor|hlcss, hcr primarv carcivcrs would no| havc abandoncd
hcr. Thus hcr |hrivc |o provc hcr wor|h is cxprcsscd in hcr acadcmics, as |hc Rorschach
Inkblo| Tcs| (RITi rcvcals, shc |rics |o rcach bcvond |hc limi|s ol abili|v |o makc scnsc ol
cxpcricncc and |o scck lor rcla|ionships. Thcrc sccms |o bc a compulsivc nccd |o do |hc
bi |hin in |hc in|cllcc|ual scnsc, an ovcrridin in|cllcc|ual ambi|ion wi|hou| |hc abili|v |o
back i| up. This nccd lor in|cllcc|ual achicvcmcn| mav bc vicwcd as a dclcnsc mcchanism
ol compcnsa|orv sor|. This carlv loss also rcsul|s in|o hcr inabili|v |o |rus| hcr
rcla|ionships. In |hc Thcma|ic Appcrccp|ion Tcs|, lcar ol loss and scpara|ion, loss ol
lovcd obcc| and loss ol |rus| is cvidcn|.

Mahlcr (1975i spccula|cd |ha| |hc normal dcvclopmcn|al proccss ol scpara|ion-
individua|ion lcd voun |oddlcrs |o cxpcricncc ambivalcncc whcn nccdin comlor|in
Page | 10

con|ac| wi|h a carcivcr. Shc labclcd |his pcriod ol charac|cris|ic ambivalcncc |hc
rapprochcmcn| sub phasc ol |hc scpara|ion-individua|ion proccss, rouhlv spannin |hc
dcvclopmcn|al pcriod lrom 15 |o 24 mon|hs ol ac. Rcscarchcrs obscrvin mo|hcr-inlan|
rcla|ionships lrom an a||achmcn| pcrspcc|ivc havc also no|cd |hc ambivalcn| bchaviors
dcscribcd bv Mahlcr, as wcll as a ranc ol o|hcr conllic| bchaviors |ha| bccomc
incrcasinlv promincn| al|cr 12 mon|hs ol ac. Howcvcr, rcccn| work on a||achmcn|
rcla|ionships indica|cs |ha| ambivalcn| bchavior and o|hcr lorms ol conllic| bchavior
ccn|crcd around |hc nccd lor comlor|in con|ac| wi|h mo|hcr in carlv |oddlcrhood arc
morc likclv |o bc rcla|cd |o dillicul|ics in parcn|-inlan| in|crac|ion |han |o norma|ivc
ambivalcncc rcla|cd |o a lcar ol rccnullmcn|," wi|h morc conspicuous lorms ol inlan|
conllic| rcla|cd |o |hc prcscncc ol ma|crnal psvchopa|holov.

Duc |o |hc lack ol anv lullillin rcla|ionship, ra|hcr sinilican| losscs in |hc childhood,
obcc| cons|ancv ol |hc clicn| has no| dcvclopcd. Hcr lcar ol loss rcvcals |ha| shc is alwavs
lcarlul ol losin o|hcrs, ol bcin abandoncd. I| can bc said |ha| shc docs no| undcrs|and
|hc pcrmancncc or rcliabili|v in a rcla|ionship. Shc has ncvcr rcsolvcd hcr mis|rus|. Shc`s
unablc |o |rus| anv novcl si|ua|ion, or pcrson. Hcncc shc was kccn |o havc hcr |cs|in
complc|cd in a dav, as shc was prc||v surc |ha| anv kind ol dclav will pu| and cnd |o hcr
carccr aspira|ions. Hcr acadcmic |rack rccord has bccn cxccllcn|, and |hc nccd lor
achicvcmcn| rcvcalcd in |hc Thcma|ic Appcrccp|ion Tcs| sucs|s |ha| hcr dcpriva|ion
has ivcn risc |o arcssion in hcr, which is bcin displavcd acadcmicallv. Shc alwavs had
|hc nccd |o provc, pcrhaps |o hcr own scll |ha| shc ac|uallv was no| wor|hlcss, and didn`|
dcscrvc |o bc abandoncd.

Thc rolc ol childhood |rauma in |hc dcvclopmcn| ol bordcrlinc pcrsonali|v disordcr has
bccn idcn|ilicd as crucial in numcrous s|udics. Zanarini c| al. (1997i lound |ha|
childhood cxpcricnccs ol bo|h abusc and nclcc| wcrc basicallv ubiqui|ous amon
bordcrlinc pa|icn|s.
Page | 11


Lack ol acccp|ancc bv |hc parcn|s lcads |o low scll cs|ccm, incrcascd dcpcndcncv S
inabili|v |o copc wi|h scpara|ion (Shcrrv S Vhildc, 2008; Kcrnbcr S Calior, 2005i.

Mas|crson cmphasizcd |hc abandonmcn| lcars which oriina|c in |rauma|ic childhood
scpara|ion cxpcricnccs.

Gundcrson idcn|ilicd in|olcrancc ol aloncncss as a scrious psvcholoical dclici| which
sccms |o dcvclop lrom dcvclopmcn|al a||achmcn| lailurcs. Gundcrson`s cri|cria:

In|cnsc uns|ablc rcla|ionships
Rcpc|i|ivc scll-dcs|ruc|ivc bchavior
Chronic lcar ol abandonmcn|
Dis|or|cd |houh|s/pcrccp|ions
Hvpcrscnsi|ivi|v
Impulsivc bchaviors
Poor social adap|a|ion

In linc wi|h psvchodvnamic and humanis|ic |hinkin, (Rocrs, 1957i Lxis|cn|ialis|s
cons|ruc such pa|hocnic incidcn|s primarilv in |crms ol inadcqua|c parcn|in, in which
|hc clicn| lccls unlovcd, cri|icizcd or punishcd lor cxpcricncin |hc world in a par|icular
wav (Boss, 1988i. Thc individual who |rus|s no onc havc bccn hur| and bc|ravcd bv hcr
parcn|s so manv |imcs |ha| as an adul|, hc has comc |o bclicvc |ha| opcnncss |o lovin
rcla|ionship will onlv lcad |o morc pain. Il |hc inadcquacv ol |hc individual`s parcn|in is
acu|c, adul| mav havc mav havc cllcc|ivclv rcmaincd in a childlikc s|a|c ol s|un|cd world
opcnncss (Boss 196`, Condrau 1998i, closcd |o morc adul| and ma|urc possibili|ics.

Page | 12

Casc his|orv and |cs| lindins bo|h rcvcal |ha| |hc clicn| has scvcral sinilican| s|rcssors in
hcr lilc, in |hc lorm ol carlv loss ol la|hcr, scpara|ion lrom mo|hcr and bro|hcr, suicidc ol
mo|hcr, lollowcd bv |hc accidcn|al dca|h ol bro|hcr. Shc has laccd cons|an| loss ol
rcla|ionships, which can bc |akcn as a rccc|ion lrom hcr lamilv mcmbcrs, cspcciallv hcr
parcn|s. Thus, |his pcrccivcd lack ol acccp|ancc rcsul|cd in|o poor scll cs|ccm, inabili|v
|o dcal wi|h scpara|ion, and a chronic lcar ol abandonmcn|. Hcr mis|rus| s|cms lrom |hc
lac| |ha| shc lcars |o bc |rus|lul. Shc lccls il shc |rus|s somconc, hc/shc will lcavc hcr as
hcr parcn|s, which will add |o hcr pain. Thus shc is cold and wi|hdrawn, |hcsc bcin hcr
dclcnscs |o pro|cc| hcr lrom c||in apparcn|lv hur|.

Iamilv s|udics ol bordcrlinc pcrsonali|v disordcr suppor| |hc cons|i|u|ional
psvchobioloical rolc. Thcrc is incrcasin cvidcncc |ha| parcn|s ol bordcrlinc pa|icn|s
havc a hih incidcncc ol allcc|ivc disordcr and bordcrlinc-|vpc bchaviors, alcoholism,
an|isocial pcrsonali|v disordcr, and o|hcr clus|cr B pcrsonali|v disordcrs. Dcprcssion is
common in |hc lamilv backrounds ol pa|icn|s wi|h bordcrlinc pcrsonali|v disordcr. Thc
his|orv ol |hc clicn|`s mo|hcr`s suicidc |hcrclorc shows |ha| shc alwavs had |hc cnc|ic
cndowmcn| in hcr. As s|a|cd bv |hc Dia|hcsis S|rcss modcl, |hc clicn| had |hc po|cn|ial
lor a suicidal a||cmp|. Thc chronoloical cxposurc |o s|rcssors has rcsul|cd in|o |hc ovcr|
cxprcssion ol i|. I| is mcn|ion wor|hv hcrc |ha| as |hc |hcorv sucs|s, |hc mo|hcr ol |hc
clicn| had an undianoscd dcprcssivc cpisodc as rcpor|cd bv |hc clicn|.

Pcoplc wi|h BPD appcarcd |o havc a charac|crizcd lowcrcd lunc|ion ol scro|onin, which
mav bc whv |hcv show impulsivc-arcssivc bchavior as in parasuicidal ac|s, such as
cu||in |hcir arms wi|h a knilc. Thcv also show dis|urbanccs in |hc rcula|ion ol
noradrcncric ncuro|ransmi||crs |ha| arc similar |o |hosc in chronic s|rcss si|ua|ion as in
PTSD. In par|icular, |hcir hvpcr rcsponsivc noradrcncric svs|cm mav bc rcla|cd |o |hcir
hvpcrscnsi|ivi|v |o cnvironmcn|al chancs. In addi|ion, dclici|s in |hc dopaminc svs|cm
mav bc rcla|cd |o a disposi|ion |oward psvcho|ic svmp|oms. Casc his|orv and |cs| lindins
Page | 13

bo|h rcvcal prcscncc ol suicidal a||cmp|, as wcll as scvcral impulsivc arcssivc and scll
dcs|ruc|ivc bchaviors bv |hc clicn|.

CONCLISION CONCLISION CONCLISION CONCLISION
Pcrsonali|v disordcrs rcprcscn| an cx|rcmc on a con|inuum ol individual dillcrcnccs in
pcrsonali|v and |cmpcramcn| |ha| lall wi|hin |hc ranc ol normali|v |o clcarlv
svmp|oma|ic disordcrs |ha| mav havc considcrablc morbidi|v, as, lor cxamplc, in |hc scll-
inurious bchavior and suicidc a||cmp|s ol bordcrlinc pcrsonali|v disordcr (BPDi. Thc
|rca|mcn| in|crvcn|ions can bc |arc|cd |o spccilic vulncrabili|ics such as impulsivi|v or
allcc|ivc dvsrcula|ion. Thus, dialcc|ical bchavioral |hcrapv cmplovs s|ra|cics |ha|
cncourac rcllcc|ion prior |o ac|ion and avoid rcwardin impulsivc and scll-dcs|ruc|ivc
bchaviors. Mcdica|ions which wcrc ini|iallv |arc|cd |o co morbid condi|ions such as
dcprcssion or anxic|v arc now bcin s|udicd in rcla|ion |o dimcnsions ol vulncrabili|v
such as impulsivi|v and allcc|ivc ins|abili|v. Ior bo|h psvchopharmacoloic and
psvchosocial in|crvcn|ions, howcvcr, |hcrc nccds |o bc a clcarcr apprccia|ion ol |hc
spccilic vulncrabili|ics and s|rcn|hs an individual pa|icn| prcscn|s, so |ha| |hc |rca|mcn|
can bc |ailorcd lor |hcm.

A casc lormula|ion such as |his hclps |hc |hcrapis| |o undcrs|and |hc casc lrom all
possiblc lacc|s and |hcrcbv ain a clcar idca abou| |hc s|rcn|hs and |hc vulncrabili|ics ol
|hc clicn|. In |hc davs whcrc a llcxiblc cclcc|ic approach is mos|lv uscd, |his will aid in
manacmcn| plan and succcsslul in|crvcn|ion, as |hc |hcrapis| will no| bc bound in anv
spccilic |vpc ol |hcrapv, and will bc ablc |o movc back and lor|h in|o scvcral |hcrapics,
individuallv and simul|ancouslv, as and whcn rcquircd.




Page | 14

RLILRLNCLS RLILRLNCLS RLILRLNCLS RLILRLNCLS

A Sinlc Casc in In|crprc|a|ivc Vrappins ol Mul|iplc Psvcholoical Thcorics, Somdcb
Mi|ra and Nilanana Sanval, SIS Journal ol Procc|ivc Psvcholov S Mcn|al Hcal|h,
Volumc 7, No. 2, Julv 2010, pacs 165-170

Alcssandra Lcmma, In|roduc|ion |o Psvchopa|holov, Sac Publica|ions, pacs 189-190

Dr. Michcls, Dcpar|mcn| ol Psvchia|rv, Corncll Inivcrsi|v Mcdical Collcc, Am J
Psvchia|rv 166:5, Mav 2009, pacs 507-508

Lcopold Bcllak, Thc |hcma|ic appcrccp|ion |cs|, |hc childrcn`s appcrccp|ion |cs| and
scnior appcrccp|ion |cs| in clinical usc. Grunc S S|ra||on

Pcrsonali|v Disordcrs, VPA Scrics Lvidcncc and Lxpcricncc in Psvchia|rv, vol. 8, John
Vilcv S Sons L|d, cdi|cd bv Mario Ma, Haop S. Akiskal, Juan L. Mczzich, Ahmcd
Okasha, 2005, pac 246
h||p://www.bordcrlincpcrsonali|v|odav.com/main/dilldx.h|m
h||p://cmcdicinc.mcdscapc.com/ar|iclc/91`575-ovcrvicw
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