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Abandonment personality disorder


Borderline Personality Disorder (BPD) - Mental Health Disorders

By

Mark Zimmerman

, MD, Rhode Island Hospital

Medically Reviewed May 2021 | Modified Sep 2022

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Borderline personality disorder is characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment.

  • People with borderline personality disorder fear rejection and abandonment, partly because they do not want to be alone.

  • Doctors diagnose borderline personality disorder based on specific symptoms, including frequently changing relationships, self-image, and mood and self-destructive, impulsive behavior.

  • Psychotherapy can reduce suicidal behaviors, help relieve depression, and help people with this disorder function better, but drugs are sometimes used to lessen symptoms.

Personality disorders Overview of Personality Disorders Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function... read more are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with borderline personality disorder often have difficulty tolerating being alone and may resort to self-destructive actions to cope with or to avoid being alone. They may make frantic efforts to avoid abandonment, including creating crises. For example, they may attempt suicide as a way to communicate their distress and to get other people to rescue and care for them.

Estimates of how common borderline personality disorder vary. It probably occurs in between 2% to almost 6% of the general population in the United States. It is diagnosed more often in women than in men. With time, symptoms tend to lessen in most people.

Other disorders are also often present. They include

  • Depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more

  • Anxiety disorders Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more (such as panic disorder)

  • Posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) involves intense, unpleasant, and dysfunctional reactions beginning after an overwhelming traumatic event. Events that threaten death or serious injury can... read more

  • Eating disorders Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more

  • Substance use disorders Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more

Genes and environmental factors may contribute to the development of borderline personality disorder.

Certain people may have a genetic tendency to react poorly to life stresses, making them more likely to develop borderline personality disorder as well as other mental disorders. Also, borderline personality disorder tends to run in families, further suggesting that this tendency may be partly inherited. First-degree relatives of people with this disorder are 5 times more likely to have the disorder than the general population.

Stresses during early childhood may contribute to the development of borderline personality disorder. Many people with borderline personality disorder were physically or sexually abused, separated from caregivers, and/or lost a parent when they were children. The insecurity of their attachment to their caregivers contributes to the symptoms of borderline personality disorder.

People with borderline personality disorder often appear more stable than they feel inside.

People with borderline personality disorder fear abandonment, partly because they do not want to be alone. Sometimes they feel that they do not exist at all, often when they do not have someone who cares for them. They often feel empty inside.

When people with this disorder feel that they are about to be abandoned, they typically become fearful and angry. For example, they may become panicky or furious when someone important to them is a few minutes late or cancels an engagement. They assume these missteps are caused by how the person feels about them rather than by unrelated circumstances. They may believe that a cancelled engagement means the other person rejects them and that they are bad. The intensity of their reaction reflects their sensitivity to rejection.

People with borderline personality disorder can empathize with and care for another person but only if they feel that other person will be there for them whenever needed. Although they desire intimate relationships and care for others, it is difficult for them to sustain stable relationships. They tend to have very high expectations of how the people they feel close to should act, and their feelings about a relationship may fluctuate rapidly and intensely.

People with borderline personality disorder have difficulty controlling their anger and often become inappropriately and intensely angry. They may express their anger with biting sarcasm, bitterness, or angry tirades. Their anger is often directed at close friends, romantic partners, family members, and sometimes doctors because they feel neglected or abandoned.

After the outburst, they often feel ashamed and guilty, reinforcing their feeling of being bad.

People with borderline personality disorder tend to change their view of others abruptly and dramatically. For example, they may idealize someone early in the relationship, spend a lot of time together, and share everything. Suddenly, they may feel that the person does not care enough and become disillusioned. Then they may belittle or become angry with the person.

They may be needy one minute and righteously angry about being mistreated the next. Their attitude fluctuates based on their perception of the availability and support of the others. When feeling supported, they can be vulnerable and needy, and when feeling threatened or let down, they can become angry and devalue others.

People with borderline personality disorder may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, values, opinions, careers, or friends.

The changes in mood usually last only a few hours and rarely last more than a few days. Mood may change because people with this disorder are so sensitive to signs of rejection or criticism in their relationships.

Many people with borderline personality disorder act impulsively, often resulting in self-harm. They may gamble, engage in unsafe sex, binge eat, drive recklessly, have substance use problems, or overspend.

Suicide-related behaviors Suicidal Behavior Suicide is death caused by an intentional act of self-harm that is designed to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation. Suicide usually... read more , including suicidal attempts and threats and self-injury Nonsuicidal Self-Injury Nonsuicidal self-injury is a self-inflicted act that causes pain or superficial damage but is not intended to cause death. Although the methods people use to hurt themselves, such as cutting... read more (for example, by cutting or burning themselves), are very common. Although many of these self-destructive acts are not intended to end life, risk of suicide in these people is 40 times that of the general population. About 8 to 10% of people with borderline personality disorder die by suicide. These self-destructive acts are often triggered by rejection, perceived abandonment, or by disappointment in someone they are close to. People may also harm themselves to express their feelings of being bad or to revive their ability to feel when they are not feeling real or feeling detached from themselves (called dissociation Depersonalization/Derealization Disorder Depersonalization/derealization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of one's life (depersonalization)... read more ). Sometimes, people with borderline personality disorder engage in self-harm to distract themselves from painful emotions.

People with borderline personality disorder often sabotage themselves when they are about to reach a goal, so that others will perceive them as struggling. For example, they may drop out of school just before graduation or ruin a promising relationship.

When these people feel very stressed, they may have brief episodes of paranoia, symptoms that resemble psychosis (such as hallucinations), or dissociation. The stress is usually caused by feeling that no one cares for them (that is, feeling abandoned and alone) or feeling broken and worthless. Dissociation Depersonalization/Derealization Disorder Depersonalization/derealization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of one's life (depersonalization)... read more includes not feeling real (called derealization) or feeling detached from their body or thoughts (called depersonalization). These episodes are temporary and usually not severe enough to be considered a separate disorder.

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 Classification and Diagnosis of Mental Illness In 1980, the American Psychiatric Association published the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), marking the first attempt to approach the diagnosis. .. read more ), published by the American Psychiatric Association.

For doctors to diagnose borderline personality disorder, people must have a history of unstable relationships, self-image, and mood, and act impulsively, as shown by at least five of the following:

  • They make desperate efforts to avoid abandonment (actual or imagined).

  • They have unstable, intense relationships that alternate between idealizing and devaluing the other person.

  • They frequently change their self-image or sense of self.

  • They act impulsively in at least two areas that could cause them harm (such as unsafe sex, binge eating, or reckless driving)

  • They repeatedly engage in suicide-related behavior, including attempting or threatening to commit suicide and hurting themselves.

  • They have rapid changes in mood, which last usually only a few hours and rarely more than a few days.

  • They chronically feel empty.

  • They become inappropriately and intensely angry or have problems controlling anger.

  • They have temporary paranoid thoughts or severe dissociative symptoms (feeling unreal or detached from themselves), triggered by stress.

Also, symptoms must have begun by early adulthood.

In most people with borderline personality disorder, symptoms lessen dramatically and often resolve. However, these improvements do not necessarily translate into being able to maintain stable relationships or to hold a job. Treatments aim to help people function better as well as to reduce symptoms. However, symptoms typically improve more than overall function.

  • Psychotherapy

  • Drugs

General treatment Treatment Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function. .. read more of borderline personality disorder is the same as that for all personality disorders.

Identifying and treating coexisting disorders is important for effective treatment of borderline personality disorder.

Treatment includes psychotherapy and certain drugs.

The main treatment for borderline personality disorder is psychotherapy. Specific psychotherapies for borderline personality disorder can reduce suicide-related behaviors, help relieve depression, and help people function better.

These therapies include the following:

  • Dialectical behavioral therapy

  • Systems training for emotional predictability and problem solving (STEPPS)

  • Mentalization-based treatment

  • Transference-focused psychotherapy

  • Schema-focused therapy

  • General psychiatric management

Dialectical behavioral therapy provides weekly individual and group sessions and a therapist who is also available by telephone. The therapist acts as a behavior coach. The aim is to help people find better ways of responding to stress—for example, to resist urges to behave self-destructively.

STEPPS involves weekly group sessions for 20 weeks. People learn skills to manage their emotions, to challenge their negative expectations, and to better care for themselves. For example, they learn to distance themselves from what they are feeling at the moment. They learn to set goals, avoid illegal substances, and improve their eating, sleeping, and exercise habits. People are also asked to identify a support team of friends, family members, and health care practitioners who are willing to coach them when they are in crisis.

Mentalization refers to people's ability to reflect on and understand their own state of mind (what they are feeling and why) and the state of mind of others. Mentalization-based treatment helps people do the following:

  • Effectively regulate their emotions (for example, calm down when they are upset)

  • Understand how they contribute to their own problems and difficulties with others

  • Reflect on and understand how other people are thinking and feeling

It thus helps them relate to others with empathy and compassion, which also helps others understand and support them.

Transference-focused psychotherapy centers on the interaction between the person and the therapist. The therapist asks questions and helps the person examine exaggerated, distorted, and unrealistic self-images and reactions to various situations. The current moment (including how the person is relating to the therapist) is emphasized rather than the past. For example, when a timid, quiet person suddenly becomes hostile and argumentative, the therapist may ask whether the person noticed a shift in feelings and then ask the person to think about how the person was experiencing the therapist and self when things changed. The purposes are

Schema-focused therapy focuses on identifying lifelong maladaptive patterns of thinking, feeling, behaving, and coping (called schemas) and replacing negative thoughts, feelings, and behaviors with healthier ones.

General psychiatric management is designed for the general practitioner, rather than a specialist. It uses individual therapy once a week and sometimes drugs. To enhance self-reliance, therapy prioritizes the ability to work over improving relationships. It also teaches people with borderline personality disorder how to make sense of their symptoms and to understand what the goals and expected results of treatment are.

Supportive psychotherapy is also useful. The therapist's goal is to establish an emotional, encouraging, supportive relationship with the person and thus help the person develop healthy defense mechanisms, especially in interpersonal relationships. However, supportive treatments alone may not reduce the more immediate problems of borderline personality disorder (such as suicidal behavior and self-harm) as effectively as the other, more specific psychotherapies for borderline personality disorder.

When needed, drugs are used to treat specific symptoms. These drugs include

  • Drugs that help stabilize mood Treatment In bipolar disorder (formerly called manic-depressive illness), episodes of depression alternate with episodes of mania or a less severe form of mania called hypomania. Mania is characterized... read more : To help lessen depression, anxiety, mood swings, and impulsive tendencies

  • Newer (second-generation) antipsychotic drugs Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more : To help lessen anxiety, anger, and stress-related distortions in thinking (such as paranoid or very disorganized thoughts)

  • Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (SSRIs), a type of antidepressant: To lessen depression and anxiety

However, SSRIs are only slightly effective in people with borderline personality disorder.

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Borderline Personality Disorder and Projected Abandonment

How to identify projected abandonment.

Source: Image by Myléne from Pixabay

A pronounced fear of abandonment is very often found in individuals who suffer from symptoms of borderline personality disorder (BPD). This frequently results in frantic efforts to avoid abandonment—which may include manipulative behaviors or lashing out, which damages relationships and paradoxically increases the chance of abandonment.

Why? It pushes their loved ones away. Loved ones often feel wrongly accused of abandoning them and become defensive. The tendency for individuals with symptoms of BPD to project their feelings onto others may account for some or all of their experience with abandonment. Understanding how to identify projected abandonment from actual abandonment offers tools to improve relationships.

Projected Abandonment

In intimate relationships, individuals with symptoms of BPD often project their feelings onto the target of their affection. The projection of the fear of abandonment onto the loved one causes them to suspect their loved one of planning to abandon them at any time.

This causes the BPD symptom sufferer to scrutinize every interaction looking for evidence that abandonment is imminent. They often react by either trying to manipulate the loved one to pay more attention to them or by lashing out in anger at the anticipated rejection. This often results in the loved one feeling attacked and getting defensive, which makes the BPD symptom sufferer more fearful of abandonment.

In the following dialogue Dee Dee, who has symptoms of BPD, tries to manipulate her father, to reassure her that he will not abandon her.

Dee Dee: Dad, I need to call you every night before I go to sleep.

Dad: Why do you need to do that?

Dee Dee: Oh! So it’s a problem for you?

Dad: I didn’t say that. I was just wondering why you're asking for this now.

Dee Dee: Forget it. You don’t want to do it.

Dad: I'm just trying to understand what you want me to do.

Dee Dee: I get scared about being alone—especially at night.

Dad: And it makes you feel better to talk to me?

Dee Dee: Yes. Anyone. I'm just afraid to be alone.

Dad: I can’t promise to be available every night, but I'll take the call whenever I can.

Dee Dee: Forget it! I need someone who actually cares about me. Guess I'll have to look elsewhere.

Dad: That’s not a nice thing to say.

Dee Dee: You deserve it! You're the worst father ever.

At this point, Dad hung up the phone to stop her from lashing out. Dee Dee felt that her father hanging up was a confirmation of her fear that he would abandon her like everyone else.

She projected her fear of abandonment onto her father, which caused her to try to manipulate him to speak to her every night. When he would not agree to be available every night, she lashed out at him. This caused him to disconnect from her, which became a real abandonment. A fait accompli.

The ability to distinguish between projected abandonment and real abandonment offers tools both to Dee Dee and her father.

Tools for the Person with BPD

The emotional dysregulation associated with BPD causes sufferers to experience emotions very strongly, making them more difficult to regulate. As part of the difficulty with dysregulation, their emotions become disconnected from the source and attached to other people. This is what causes projection.

For individuals with symptoms of BPD, the feelings that cause them to fear abandonment or fear being alone are sometimes unrelated to their relationships with others. These feelings can come from within but are projected onto others, causing conflict and confusion.

Tool 1: Differentiate projected abandonment from real abandonment.

Dee Dee can learn to examine feelings of abandonment for possible projection before acting on these feelings. In the above example, she can review the exchange with her father and recognize that he is trying to offer some of what she needs, rather than rejecting her altogether.

Tool 2: Negotiate needs instead of making demands on others.

Once Dee Dee can recognize that her fear of abandonment was not from her father’s behavior, but rather from her own insecurity, then she can take advantage of Dad’s offer of partial gratification. She can find someone else to call on nights when Dad is unable to take her call. Or she can learn to comfort herself when feeling afraid and become more tolerant of those feelings knowing that they are transient.

Tools for Loved Ones

Tool 1: Don’t take it personally.

To use this tool, Dad will also have to learn how to differentiate projected from real abandonment. One way he can do this is to review his transactions with her to see if he inadvertently acted in a way that might be taken as abandonment. Dad can also see if Dee Dee has similar issues with abandonment with others, such as her brother or her boyfriend.

Tool 2: Return the projection.

Once Dad has identified projected abandonment, he can return the projection by validating her feeling. It might sound like this:

Dad: Dee Dee, I understand that you're afraid to be alone and I will try to be available whenever I can. I love you and I want to help you.

The best outcomes occur when individuals with symptoms of BPD and their loved ones both work towards defeating the destructive force of the illness and band together in healing and growth.

Personality disorder - causes, types, types, symptoms, signs, diagnosis (test), treatment

Features

Causes

Symptoms

Diagnosis

Treatment

Personality disorder, the causes of which are not always obvious, used to be called constitutional psychopathy. This is a mental disorder that accompanies a person throughout life. The main changes affect the character, thinking and behavior, which causes difficulties in social adaptation. The psychopath breaks the norms and rules accepted in the social environment. The severity of the changes is different - from everyday inconsistency to criminal acts with subsequent restriction of freedom.

Features of personality disorder

World statistics of diseases states that about 10% of the world's population suffers from psychopathy. Each type of personality disorder accounts for an average of about 2% of cases. A distinctive feature is that the first manifestations are noticeable already in early childhood, practically unchanged throughout life.

Psychopathy is not quite a disease in the usual sense of the word. The disease has a beginning, progression and consequences in the form of organic (irreversible) disorders of the function and structure of organs. Psychopathy is a special, painful personality structure that does not undergo any changes in the changing conditions of life. This prevents the psychopath from adapting to the environment. Relatively speaking, a person with a personality disorder will behave in the same way with a first grader and a scientist, in a tram and a living room, not realizing that different people and situations require different behavior.

The problem of psychopathic personalities, anomalies of character was thoroughly studied by the Soviet and Russian psychiatrist Pyotr Borisovich Gannushkin, whose definitions of personality disorders have not lost their relevance to this day.

Causes of personality disorders

Experts consider several main reasons:

  • genetic factor - practice shows that pathological character traits are found in representatives of different generations of the same family;
  • an established vicious system of interpersonal relationships - the child does not have before his eyes an example of a normal, sympathetic and empathetic family;
  • a psychopathic pattern (template, model) of behavior that the child unconsciously copies due to the lack of other examples;
  • pathological pregnancy, difficult childbirth and diseases of early childhood;
  • childhood abuse, physical or psychological;
  • difficult childhood, unfavorable developmental conditions.

Researchers believe that genetic factors are of paramount, determining importance. This theory is confirmed by the twin method: identical brothers and sisters, separated in early childhood and raised in different families, behave exactly the same in adulthood. Twins who have never interacted with each other show the same types of personality disorder.

Personality disorder symptoms

Gannushkin identified 7 types of psychopathy. Since the 90s, when the 10th revision of the International Classification of Diseases, Injuries and Causes of Death came out, the condition has been called a personality disorder, but the essence has not changed. Each type of psychopathy has its own distinctive features.

Schizotypal personality disorder is distinguished by the minimization of social contacts, lack of need for communication, coldness, lack of empathy (the ability to empathize). Schizoids are attracted to fantasies, various distant theories, they are unable to perceive life directly, sensually. Teamwork is not for them, they can be more or less successful in individual activities. Their main feature is indifference, both to themselves and to others. Such people sincerely do not understand what pleasure and joy are, because they have never experienced them.

Bipolar personality disorder according to Gannushkin includes 3 types: depressive, agitated and cyclothymic. Depressives are lifelong pessimists who are able to see only sad, gloomy sides in all the diversity of life. Excited - easy-going, carried away, often unable to foresee the consequences of their actions. The vast majority of gamblers and swindlers are of this type. Cyclothymics combine both of the above features, they are characterized by undulating mood swings, lack of stable attachments, blurring and diversity of interests.

Dissociative identity disorder in Western culture is called a split identity. It is believed that several personalities coexist in one person, which are periodically activated. We have been using this diagnosis since 2000, but it does not take root well. Domestic psychiatrists consider this disorder a kind of psychological defense of a person who has experienced extreme, unbearably painful emotions. At the same time, a person perceives the events of his life as something that happened to others.

Narcissistic personality disorder refers to the Greek myth of Narcissus, a young man who preferred the love of a real girl to looking at his reflection in the water of a stream. Like the hero of a myth, a narcissist is convinced of his exclusivity and originality, and this applies to everything from appearance to achievements. The narcissist believes that real achievements are hindered by the envy of others who put up all sorts of obstacles. Own uniqueness requires constant confirmation, so the narcissist maintains relationships only with those who admire him.

Organic personality disorder - a consequence of damage to the brain tissue by various hazards: trauma, intoxication, infection. Such a disorder occurs in the clinic in patients who have had a stroke, encephalitis, in alcoholics and drug addicts. In the latter, the condition is aggravated by the consequences of closed craniocerebral injuries, which they receive when falling from a height of their own height in a state of intoxication.

In a mild form of the disorder, the patient is disturbed by frequent headaches, weakness, fatigue, tearfulness, intolerance to stuffiness, meteorological dependence. Over time, thinking is disturbed, thoroughness, viscosity, concentration on minor details joins. Such a patient cannot separate the main from the secondary, speech becomes impoverished, emotions coarsen, periods of an evil-dreary mood (dysphoria) occur. An intellectual decline occurs, the patient cannot cope with the previous work, criminal episodes with fights and bodily injuries to the “offender” are not uncommon.

Borderline personality disorder is manifested by unstable mood, fluctuating from overestimation of oneself to humiliation. Patients are impulsive, commit rash acts, anxious, suicidal. Any little thing causes a feeling of emptiness, fears of being unnecessary, "thrown out of life." This disorder is the basis for the formation of drug addiction and eating disorders.

Personality disorder diagnostics

It is desirable to carry out such a diagnosis as early as possible, because the disorder accompanies a person all his life. Problem children should be under the supervision of a child psychiatrist in order to overcome teenage difficulties with minimal losses. Even a single consultation with a specialist will allow parents to correct the behavior of the baby, as they will understand the motives of his actions.

A variety of tests for personality disorder are used in adolescents and adults. Popular tests based on the work of Eysenck, Beck, Freeman. The test is a questionnaire with several standardized answers, a lie scale is provided so that the subject cannot be misled. The tests are fairly objective and are widely used in the clinic.

Personality disorder treatment

The basis of treatment is the choice of a life path, profession and occupation suitable for the type of personality. This is where a clinical psychologist can help. An occupation corresponding to a personality type can make a person so successful that no one will notice the disorder.

In severe cases, when the time for professional orientation is missed, medications (antidepressants, tranquilizers, nootropics), psychotherapeutic methods, including psychoanalysis, are used. Treatment options for advanced personality disorders are limited, especially in patients with addiction or irreversible brain damage.

The best solution for suspected psychopathy is timely consultation with an experienced psychiatrist.

Article author:

Novikov Vladimir Sergeevich

psychotherapist, clinical psychologist, kmn, member of the Professional Psychotherapeutic League

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