Borderline Personality Disorder (BPD) And The Fear Of Not Being Loved
Currently, uncertainty, precariousness, and instability have become predominant parameters that find explanation and reflection in all areas of social life.
Currently, identity and personality are not fully supported by one’s own values, achievements or personal history, but also in relation to the products consumed and in comparison with others. This in itself is a problem because identity is a key issue in the personality disorders
For a person to have adequate and adapted psychological functioning, they must have a positive self-concept, be emotionally stable and self-regulated, with satisfactory and reciprocal interpersonal relationships. On the contrary, a person with a personality pathology has poor and disorganized and/or conflicted psychological functioning, almost always a poor self-concept, a tendency toward negative emotions, and poor interpersonal relationships.
Personality disorders could be described in relation to how the subject relates to the context. In the case of borderline personality, their basic need is affection and their fundamental fear is loss, which is why people with borderline personality show intense reactions to the anticipation of loss and subject others to constant tests to ensure that affection What they feel for them is unconditional. The prevalence percentages of Borderline personality disorder They are experiencing a significant rise compared to past statistics. It is not clear whether this growth may be due to better diagnosis and/or socio-environmental issues.
The determining elements of Borderline personality disorder They are established at an early age and usually coexist with the experience of traumatic situations. The most relevant environmental factors are those determined by the family. Two types of family environments are described: chaotic-unstable and neglectful families that subject to emotional abuse.
The first is characterized by families with continuous family disputes, marital crises or divorces, impulsivity, alcohol or other substance dependencies and in some cases, use of children as a weapon of throwing or blackmail. The other type of families have as characteristic features coldness, invalidation, neglect, early separation from attachment figures, or long phases of depression on the part of the parents. Only between 20-25% of families cases diagnosed as borderline personality disorder They come from structured family environments.
He Borderline personality disorder It can begin in adolescence and even in childhood and manifests itself with a chronic course; in any case, it is revealed before reaching the age of 25. Poor prognostic factors are that the symptoms manifest early, that there is substance abuse in adolescence or self-destructive behaviors, that the symptoms manifest frequently, intensely and long-lasting, that there are autolytic behaviors or dissociation.
On the contrary, signs of a good prognosis are that symptoms appear in late adolescence or youth (between 20 and 25 years), that there is no substance consumption, the absence of suicidal behavior, and that there is therapeutic adherence. In many cases the person does not accept the problem and refuses to undergo any treatment. Therapeutic and pharmacological adherence is a key aspect for stabilization of the disorder The years in which the disorder is most virulent are usually between the ages of 20 and 35. From that age onwards, many of the symptoms soften, especially impulsivity, as long as during the course of the pathology significant deterioration has occurred.
The people with borderline personality disorder present pathological symptoms in five or more of the following traits, with at least one being impulsivity, hostility, and risk-taking.
Affective instability (anxiety, irritability or dysphoria)
Vacuum sensation
Hostility (inappropriate and intense anger)
Transient paranoid or dissociative ideas linked to stress
To be considered psychopathological, at least two of the following areas must be involved:
Identity and self-concept: Feelings of emptiness, often with self-criticism
Self-control and self-direction: Changing goals and aspirations
Empathy: The empathy deficit contrasts with hypersensitivity to the behaviors of others
Interpersonal relationships: Deficits in establishing interpersonal ties, intimacy or collaboration with others
Emotional activity: Intense, unstable, conflictive, anxious and extreme.
How does borderline personality disorder affect relationships?
People who suffer from this disorder may present the following difficulties regarding the interpersonal relationships they establish with others.
Emotional instability: They present instability of self-image, personal goals, interpersonal relationships and emotions, combined with impulsivity. Mood changes and emotional lability are common, accompanied by risky behaviors, anxiety, suicidal ideation, and hostility. In many cases they are triggered by issues that may seem insignificant. These mood changes can occur in the same day.
Dependence: In people who have Borderline personality disorder Their relationship remains focused on dependence on the other, which presupposes the need to rely on the other, placing themselves in a condition of continuous expectation to receive gratifications and put them into practice. These are continuous manipulations to avoid losing the indispensable companion. The subject with borderline disorder is consumed by the attempt to establish exclusive relationships in which the risk of abandonment is not contemplated, but once intimacy and the desired relationship are achieved, the anxiety of being absorbed by the other person comes. The result is a continuous search for intense but highly unstable interpersonal relationships.
Fear of abandonment: The fear of not being loved by adults is linked to feelings of being inadequate, inferior. They are people capable of making desperate efforts to avoid abandonment and the perception of separation or rejection can lead them to profound alterations in self-image, a profound alternation of mood, acting out or a disproportionate reaction. It is not a situation that has to do with internal conflict, but rather it is used as an excuse.
Vacuum sensation: The generalized feeling of emptiness is experienced by the subject as a physical disorder and not as a psychological state, to which they must immediately take refuge. Acting, therefore, allows you to find ephemeral compensation. However, each person is a unique case, even after a detailed analysis of their history, different diagnoses can be established throughout their life, since the disorder evolves from adolescence to adulthood.
Treatment is usually a combination of psychotropic drugs and psychological therapy.
Four general objectives of therapy could be defined:
Reduction of symptoms
Regulate or modulate temperament
Reduce impairment in both social and occupational functioning
Modify personality schemes
There are techniques that can be effective for treatment such as relaxation, modeling, exposure to imagination, social skills and reinforcement techniques. However, these techniques address symptoms more than global patterns. To address these patterns, more complex programs are required, although the techniques described can be part of them.
In this sense the dialectical behavioral therapy (DBT) developed by Linehanen in 1993, is based on a biosocial model combining cognitive-behavioral techniques with techniques derived from Buddhist meditation, focused on the acceptance of reality (here and now), mindfulness and values.
The theoretical foundations of DBT are based on the fact that emotional lability would have a biological basis, although not necessarily hereditary, for its part, the disabling environment contributes even more to emotional dysregulation, because it has not been taught to identify emotions from early stages. Abuse, neglect, and trauma are elements of extreme disabling environments.
The people with BPD They show dichotomous and extreme thoughts, behaviors and emotions and this polarity is precisely what makes the therapeutic process difficult. The patient must accept himself as he is at that moment, and be willing to change. He must overcome the fear of losing support to get what he wants if he becomes more competent. He needs to learn skills to overcome his difficulties, which is why therapeutic adherence is so important. It is about him being able to validate and understand his feelings and behavior, avoiding self-reproach for mistakes. His invalidating environment has made him think that what he feels and does is erratic. Ultimately, the goal is for him to accept his weaknesses and rely on his strengths for change.
The therapy consists of a treatment protocol focusing mainly on the characteristic aspects of BPD such as emotional instability, impulsivity and identity confusion and problems in interpersonal relationships. The protocol includes training in social skills, crisis attention, and individual and collective therapy, to modulate the high emotional reactivity derived from lack of regulation. He is attended to by a coordinated group of therapists and maintains periodic supervision meetings.
We also work with the family unit because they are usually part of the problem and in any case they do not usually understand their suffering and resort to the famous phrase that they do it to get attention. The therapist begins by normalizing and validating the emotional experiences of people with BPD The process of self-acceptance is fundamental, but that acceptance is not passive, but is committed to change.
The skills worked on in therapies are:
Awareness: The objective is for the patient to learn to control the mind instead of the opposite happening. For this purpose, mindfulness is used to control attention and focus on the “here and now.”
Discomfort tolerance: The people with BPD They have difficulty tolerating abandonment, which is why they give aggressive responses towards themselves (self-lysis) or towards others. The objective of developing these skills is to be effective in interpersonal relationships.
Regulation of emotions: People with BPD have few resources to deal with emotions such as anger, frustration, sadness and anxiety; in addition, these emotions present themselves intensely and with lability. They are aware that the reactions are disproportionate and they do not want to feel so intensely. As a consequence of their maladaptive responses, they experience shame and anxiety. The therapist’s goal is for the patient to tolerate her emotions, but for him to be able to control them. To do this, you learn to identify emotions and name them, as well as analyze the function they perform. It also focuses on aspects of a healthy life (physical exercise, sleep and nutrition), works to increase positive emotions (plan of pleasurable activities) and reduce negative ones by developing an action opposite to the emotion.
To identify and name emotions, in addition to describing them, it is analyzed in the context where they occur: the situation, the interpretation given to the stimulus, the physical sensation it produces, the behaviors in response to the emotion, the consequences.
Interpersonal effectiveness: Patients must analyze the situations and set the objectives, then analyze which factors can favor the desired effectiveness and finally work on specific assertiveness skills. These skills can be acquired through modeling, shaping and role playing.
