According to Kernberg, the symptoms of BPD can be divided up into four major categories. These categories are as follows:
- DIFFUSE ANXIETY
- MULTIPLE PHOBIAS
- LITTLE CONSTANCY IN SEXUAL BEHAVIOUR
- IMPULSIVITY OR ADDICTION PROBLEMS OR BOTH
Additionally, Kernberg asserts that those with BPD vacillate between dependence and self-assertion depending upon how threatening or good-willed s/he perceives those with which s/he is interacting at any one time.
Furthermore, Kernberg believed that those with BPD were on the border between neurosis and psychosis and that, under stress, they may be tipped into an ephemeral psychotic state.
KERNBERG’S THEORY OF ‘UPPER’ AND ‘LOWER’ BPD:
Kernberg believed that those suffering from BPD could be split into two main groups:
- Those who are able to function reasonably well (CATEGORIZED BY KERNBERG AS SUFFERING FROM UPPER BPD)
- Those whose functioning was severely impaired (CATEGORIZED BY KERNBERG AS SUFFERING FROM LOWER BPD)
Let’s look at UPPER and LOWER BPD in a little more detail:
Individuals who fall into this category tend to fear engulfment and their defence is to withdraw and keep distant from others. They have reasonably good ‘reality testing.’
Individuals who fall into this category tend to suffer from depersonalization, transient psychotic episodes, paranoia, extreme emotional lability
HIGH AND LOW FUNCTIONING:
Kernberg’s work dates back to the 1970s. However, many psychologists still differentiate between high and low functioning individuals with BPD so let’s look at more recent ideas about how these two groups may be differentiated from one another today:
Just as there are high functioning and low functioning alcoholics, so, too, are there high and low functioning individuals who suffer from the serious psychiatric condition known as Borderline Personality Disorder (BPD). In other words, some people with BPD cope relatively well with the usual demands of day to day living (such as having a successful career, for example) whilst others are severely impaired in relation to their ability to cope with every day and so may need special care and financial support from the government.
Of course, many people with BPD do not neatly fit into one category or the other, but fall somewhere in between (for example, they may be high functioning at times, but low functioning when subjected to significant stress).
Characteristics Of Low Functioning BPD Sufferers:
1) Might be unable to work or have their capacity to work severely restricted by their condition.
2) Often suffer from co-morbid conditions such as eating disorders and harmful addictions (alcohol, drugs, gambling etc)
3) May frequently require psychiatric, in-patient, hospital care (by both voluntary and involuntary admissions). Such hospitalisations may, frequently, be due to attempted suicide or a preoccupation with/intention to carry out suicide.
4) May seem to stagger from crisis to crisis; no sooner is one over, another takes its place.
5) Prone to a variety of self-destructive behaviours (drinking very heavily, binging on drugs, gambling, getting into fights and unnecessary confrontations, self-harming – by means of cutting self with razor blades/burning self with cigarettes and other methods – or even suicide attempts. Such self-destructive behaviour is particularly likely to occur during periods of significant stress, particularly if s/he has no, or limited, social/familial support.
Characteristics Of High Functioning BPD Sufferers:
1) Probably likely to work most of the time – indeed, may have a successful career.
2) Likely to appear, for want of a better phrase, ‘pretty normal’ to those with whom s/he is not intimately connected.
3) Is likely to have little or no insight into his/her condition due to unconsciously employing the psychological defence of complete, impregnable denial. Due to this, whenever in conflict with others, will invariably view themselves as absolutely in the right and the other as entirely in the wrong, irrespective of what any objective and rational analysis of the conflict may suggest.
4) As implied above, tend to only show the symptoms of their condition to those they know intimately (eg family members. partners). These symptoms may include explosive rage, excessive and inappropriate criticism, vitriolic verbal abuse, threats of violence or actual violence.
5) Tend not to seek psychiatric help due to their psychological state of denial (see point 3, above). Researchers have therefore termed such individuals ‘invisible’. In other words, they cannot usually be included in research studies (as the researchers are unaware of their existence) and, also, are not included in the statistics which must inevitably lead us to the supposition that estimates of the number of individuals suffering from BPD are likely to be significantly too low.
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David Hosier BSc Hons; MSc; PGDE(FAHE).