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Section 16
BPD Stormy Relationship Case Study

Question 16 | Test | Table of Contents

Characterized by stormy relationships, self-mutilation, and rage, the borderline personality bewilders family, friends, and the psychiatric community itself.

After a busy day at work, Bob was looking forward to a quick shower, light supper, and a concert with his new girlfriend, Amanda. But outside his apartment, he froze. On his door the word "CHEATER" had been spray-painted in large black letters. Embarrassed, he scanned the hallway, quietly unlocked the door, and slipped inside.

"Did anyone see who did this?" Bob asked the superintendent.
"Your neighbor said that she recognized the car in the parking lot," he answered. "This is the fourth time somebody's damaged your apartment. Shouldn't we call the police?"
"No," Bob said. "I'll handle it."
He knew who had been there. It was Jennifer.

When he first met Jennifer at a bookstore, he was immediately attracted to the pretty, outgoing 21-year-old. Their first few months together were fantastic. She always wanted to be with him, calling him two or three times a day at the office just to let him know she was thinking about him. Over time, Bob learned more about Jenny--the early sexual assault she had suffered, a broken home, and the barely visible scars on her wrists from a suicide attempt when she was just 17. She had been through a lot in her short life, yet seemed to survive it well.

When the accounting firm where Bob worked picked up a new client, Bob began working late hours. At first, Jenny understood, was even supportive. But as the weeks passed, she became more demanding, wanting to know why he "wanted" to be away from her and if "another woman" was involved. She telephoned him throughout the day, monitoring his every move. One night after work, he joined old fraternity buddies for a basketball game at the local Y. Jenny unexpectedly showed up. After delivering a barrage of jealous accusations in front of his teammates, she left. Bob thought the flat tire after the game was just a coincidence. On another late night at work, he found her parked alongside him in the garage, and she acted hurt when he questioned her motives.

Jenny's jealousy and demands continued, and soon Bob realized that something about the relationship just wasn't right. He decided to break it off. The decision wasn't mutual. Jenny began showing up at his office, at first begging for another chance. When he refused, she flew into a rage in front of his coworkers. When his appointment book came up missing, he chalked it up to forgetfulness until someone canceled his plane reservations to an important business conference and canceled his doctor's appointments. A late-night phone call from Jenny resulted in a trip to the emergency room and an all-night suicide vigil. Bob now realized that Jenny needed professional help. But when he spoke with her the next day about therapy, she became furious, blaming her hospitalization on him and men like him. He left, feeling ashamed and, for some reason, responsible.

For the next two months, Jenny phoned him at all hours of the night and at the office. She left scathing, often harassing messages on his answering machine. When the office disruptions threatened his job, Bob took out a restraining order against Jenny. Even then, Jenny persisted. On more than one occasion, he saw her peering through restaurant windows or parked outside his apartment building. His mailbox had been tampered with, his tires slashed, an anonymous basket of funeral flowers sent to his office, appointments cancelled, and a defamatory letter sent to his boss. Still, no one would suspect that the pretty, outgoing' girl was capable of, much less responsible for, the havoc in his life.
When will it end? Bob thought. Can I take much more of this?

Rage, impulsivity, self-mutilation, guilt, overwhelming fears of abandonment, and volatile relationships--Jenny's life is a tattered scrapbook of broken relationships, suicide attempts, uncontrollable anger, substance abuse, and violent mood swings. Jenny is a "borderline," short for someone with borderline personality disorder. Five million Americans fit the profile of the borderline personality disorder (BPD), according to the latest estimate. One moment calm and engaging, the next tempestuous and combative, borderlines bewilder those around them, straining relationships to the breaking point. It is this unpredictability and loss of control that baffles both people who love them and the psychiatric community that treats them. BPD is a mysterious malady of the personality that one psychiatrist defines as "a problem with who you are."
The case of Susan Smith, the South Carolina mother who murdered her two children by driving her car into a lake with the children left inside, brought national focus on the subject of personality disorders and the frightening consequences that often result when the disorders are left unchecked.

Unlike depression, a disease frequently episodic in nature and which most people can understand and empathize with, BPD is characterized by enduring and persistent ways of behavior and thought. As such, BPD lies in a unique classification of psychiatric illnesses called personality disorders. According to the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, (DSM-IV), a personality type is looked upon as a disorder when the traits, or personal habits, that constitute the personality are inflexible and damaging, causing serious distress or impaired function. The DSM-IV classifications of personality disorders include: borderline, antisocial, paranoid, narcissistic, avoidant, dependent, obsessive-compulsive, and passive-aggressive.

Janice M. Cauwels, Ph.D., presents an in-depth look at BPD, exploring the causes and current theories and offering personal histories of patients suffering from the disorder. Dr. Cauwels discovered that many psychiatrists refuse to see these patients because borderlines are seen as provocateurs and expert manipulators. Dr. Cauwels cites a facetious report on BPD patients as "notorious for late-night irrelevant 'emergency' phone calls, no common sense, no redeeming qualities, no income, and no health insurance." The author also noted that one of the supreme ironies in BPD is that borderlines are the neediest people in the world, yet alienate all from whom they crave love.

BPD is the subject of mounting research, innumerable studies, and various theories. While therapists may differ on theory and origin, few would argue with the statement that BPD appears to be one of the most complicated forms of mental illness.
- Perry, Patrick, Personality Disorders: Coping with the Borderline, Saturday Evening Post, Jul/Aug 1997, Vol. 269, Issue 4.

Personal Reflection Exercise #2
The preceding section contained information about a borderline personality disorder case study.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Understanding a Mutually Destructive
Relationship Between Individuals
With Borderline Personality Disorder
and Their Favorite Person

- Jeong, H., Jin, M. J., & Hyun, M. H. (2022). Understanding a Mutually Destructive Relationship Between Individuals With Borderline Personality Disorder and Their Favorite Person. Psychiatry investigation, 19(12), 1069–1077.

Peer-Reviewed Journal Article References:
Harpøth, T. S. D., Kongerslev, M. T., Moeyaert, M., Bo, S., Bateman, A. W., & Simonsen, E. (2020). Evaluating “mentalizing positive affect” as an intervention for enhancing positive affectivity in borderline personality disorder using a single-case multiple-baseline design. Psychotherapy, 57(4), 580–586.

Hepp, J., Lane, S. P., Wycoff, A. M., Carpenter, R. W., & Trull, T. J. (2018). Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension. Journal of Abnormal Psychology, 127(2), 183–189.

Hope, N. H., & Chapman, A. L. (2019). Difficulties regulating emotions mediates the associations of parental psychological control and emotion invalidation with borderline personality features. Personality Disorders: Theory, Research, and Treatment, 10(3), 267–274.

QUESTION 16
Why do some psychiatrists refuse to see borderline patients? To select and enter your answer go to Test.

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