DRHOOK- Border patrol: Personality disorder hard to treat

the handsome doctor John Hong of Charlottesville

"Borderline" is the first Madonna song I ever heard. Glenn Close's femme fatale in Fatal Attraction is the first borderline character I ever saw. Joaquin Phoenix starred in Walk the Line, although lately he seems more like Walk the Borderline. 

The brilliant comedienne Julie Brown did an amazing spoof on Madonna's Truth or Dare. As "Medusa," the world famous pop star, she tells her psychologist she expects him to go on tour with her. When he says no, she screams something like, "Other patients? You're seeing other patients? Hello, Mr. Man– or excuse me, doctor Man. C'mon, you said I was borderline. I even wrote a song about it." 

Is someone with borderline personality disorder (BPD) ruining your life?

Perhaps up to three percent of Americans have BPD. But I would say at least 50 percent of us have borderline traits– hmm– maybe 80 percent. There are nine borderline traits, and one needs at least five of them to be classified as having the "official" disorder. 

The worst trait (and the best at times) is splitting. Splitting means everything is either 100 percent good or 100 percent evil. So if you're "the best friend ever" one day, but then "Attila the Hun" the next, your friend just split his/her feelings about you. (Sounds so Paris Hilton with her "BFFs"!) 

Mood instability can cause that special, wonderful relationship to go sour as fast as milk in 100-degree weather. The borderline person usually has a bad temper and lashes out at others, often ruining relationships. If mad, stressed, or desperate enough, the person can become somewhat psychotic (ergo, a person is on the border between sanity and psychosis).

Have you ever had a long voice mail or email that progressively gets meaner and makes less sense as it goes on? 

A chronic feeling of emptiness usually makes the borderline person become frantic over the fear of abandonment. So if you call your doctor, and he doesn't call you back ASAP, you might feel like you've been abandoned or that your doctor is basically telling you to find someone else. 

Unlike all the "modest and kind" models on ABC's True Beauty, borderline folks have an identity disturbance. I know finding self-truth is a lifelong search (do I sound like Confucius?). But in BPD, the sense of self is really off. Perhaps that's a reason for recurrent suicidal behavior or self-mutilation. I knew someone who cut herself because she said it reduced the enormous pain, numbness, or anger she felt. Unfortunately, 10-15 percent of BPD persons do kill themselves. 

BPD can easily be confused with bipolar disorder because of the extremes in personality, and also the impulsivity that leads to potentially self-damaging actions. Going out drinking and driving, having unsafe sex with random people, going on spending sprees, binge eating– hmmm, that sounds like stories from the cover of Us magazine.

There's no medicine to treat BPD, though sufferers usually do have anxiety, depression, and other psychiatric illnesses. Counseling is pretty hard as well, because as with other personality disorders, borderline folks don't think it's their problem. They think the problem is everyone else. 

Doctors who have to treat patients with BPD face a challenge. Besides physical injuries that can occur from impulsive and angry behavior, unplanned pregnancies and STDs, substance abuse, and suicide attempts, borderline people usually alienate healthcare providers with their inappropriate actions. And frankly, it's hard to avoid feeling bad when a borderline person attacks you– especially when they were nice to you before.

A friend of mine was dating a woman with BPD and asked for my advice. I wanted to say, "Run! And hide your rabbit." The question is, where do you want to draw the line? At the borderline?