602 CHAPTER 13
Distinguishing Between Borderline Personality
Disorder and Other Disorders
Symptoms of borderline personality disorder overlap with symptoms of other psy-
chological disorders. Borderline personality disorder and posttraumatic stress dis-
order, for instance, share the symptoms of dissociation, a feeling of numbness, and
quickly shifting emotions. However, for people with borderline personality disorder,
the most common emotion is anger; for people with posttraumatic stress disorder, it
is fear or anxiety.
People with borderline personality disorder may occasionally have psychotic
symptoms, such as hearing voices, but in contrast to people who have schizophre-
nia, they recognize that the voices are produced by their own minds and so they
don’t respond to them (Paris, 1999). Bipolar disorder and borderline personality
disorder share the symptom of mood alteration. However, with borderline person-
ality disorder, a mood change typically occurs over a period of hours, not weeks
or months. Moreover, for people with borderline personality disorder, the mood
changes come about in response to a clear trigger, such as feeling rejected or aban-
doned or disappointed by someone’s behavior, as Reiland was when her husband
didn’t return home the moment she asked him to do so. Once triggered, the pre-
dominant unregulated emotion is anger (Paris, 1999).
Borderline personality disorder and antisocial personality disorder share the
symptoms of impulsivity, instability in relationships, and manipulation of others. In
general, people with borderline personality disorder manipulate others in order to
meet emotional needs, whereas people with antisocial personality disorder manipu-
late others for personal gain. However, people can engage in both sorts of manipula-
tion. In fact, up to 15% of people diagnosed with borderline personality disorder are
also diagnosed with antisocial personality disorder (Grilo & McGlashan, 2005).Understanding Borderline Personality Disorder
The neuropsychosocial approach allows us to appreciate the complexity of border-
line personality disorder. In fact, this approach underlies the most comprehensive
analysis that has been made of the disorder and its treatment (Linehan, 1993). Let’s
examine the elements of what Linehan (1993) calls the biosocial theory of border-
line personality disorder and also consider research related to it.Neurological Factors: Born to Be Wild?
Considerable research has been reported on the neurological bases of borderline
personality disorder.Brain SystemsFirst, the frontal lobes, hippocampus, and amgydala are unusually
small in people with borderline personality disorder (Driessen et al., 2000; Lyoo,
Han, & Cho, 1998; Schmahl, Vermetten, et al., 2003; Tebartz van Elst et al.,
2003). Second, these structures are part of a network of brain areas that functions
abnormally in people with this disorder; this network includes the orbitofrontal
and dorsolateral regions of the frontal lobe, the anterior cingulate, the amygdala,inconveniences to most people, were perceived by Donna as outrageous mistreatments or
exploitations. Even when she recognized that they did not warrant a strong reaction, she still
had tremendous diffi culty stifl ing her feelings of anger and resentment. Her tendency to mis-
perceive innocent remarks as being intentionally inconsiderate (at times even malevolent)
further exacerbated her propensity to anger. She acknowledged that she would often push,
question, and test her friends and lovers so hard for signs of disaffection, reassurances of af-
fection, or admissions of guilt, that they would become frustrated and exasperated and might
eventually lash out against her. She would often fi nd herself embroiled in fruitless arguments
that she subsequently regretted. She had no long-standing relationships, but there were nu-
merous people who remained embittered toward her. Three marriages had, in fact, all ended
in acrimonious divorce.
(Widiger, Costa, & McCrae, 2002, p. 443)