In the popular 1999 movie Girl, Interrupted, Winona Ryder portrays a young woman who tries to commit suicide, then spends nearly a year in a psychiatric hospital with a diagnosis of borderline personality disorder.
The film, based on a 1993 memoir by Susanna Kaysen, was gripping. But experts say it oversimplified this common yet poorly understood mood disorder.
Georges Han, a recovered patient now studying at the University of Minnesota for a PhD in psychology, describes borderline personality disorder as “a serious psychiatric disorder involving a pervasive sense of emptiness, impulsivity, difficulty with emotions, transient stress-induced psychosis and frequent suicidal thoughts or attempts.”
Moods can change quickly and unpredictably, behaviors can be impulsive (including abuse of alcohol or drugs, reckless driving, overspending or disordered eating), and relationships with others are often unstable. Many patients injure themselves and threaten or attempt suicide to relieve their emotional pain.
People with the disorder are said to have a thin emotional skin and often behave like two-year-olds, throwing tantrums when some innocent word, gesture, facial expression or action by others sets off an emotional storm they cannot control. The attacks can be brutal, pushing away those they care most about. Then, when the storm subsides, they typically revert to being “sweet and wonderful,” as one family member put it.
In an effort to maintain calm, families often struggle to avoid situations that can set off another outburst. They walk on eggshells, a doomed effort because it is not possible to predict what will prompt an outburst. Living with a borderline person is like traversing a minefield; you never know when an explosion will occur.
MISLEADING LABEL
The name of the disorder was coined in the 1930s, in a misleading reference to the border between neurosis and psychosis. Experts say it has nothing to do with either condition.
Rather, affected individuals seem to be born with a quick and unduly sensitive emotional trigger. The condition appears to have both genetic and environmental underpinnings. Brain studies have indicated that the emotional center of the nervous system — the amygdala — may be overly reactive, while the part that reins in emotional reactions may be underactive.
As children, people who will develop the disorder are often “hyperreactive, hypervigilant and supersensitive,” Valerie Porr, a therapist in New York, said in an interview. Typically they receive a host of misdiagnoses and treatments that are inappropriate and ineffective.
“Some children need more than others in learning to regulate their emotions,” said Marsha M. Linehan, a psychologist at the University of Washington who devised the leading treatment for borderline disorder.
“These kids require a lot of effort to keep themselves emotionally regulated,” Linehan said in an interview. “They do best with stability. If the family situation is chaotic or the family is very uptight, teaching children to grin and bear it, that tough kids don’t cry, these children will have a lot of trouble.”
Even in a normal family, such children need extra help. Linehan told of one mother who said: “I was an ordinary mother, and my child needed a special mother. I took training and became the special mother he needed.”
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