Articles: Medical Topics
Borderline personality
 Ever
since I became acquainted with two nurses with borderline
personality disorders (BPD), I have been fascinated by this
disorder. It is possible that attorneys have one or more
BPD clients or employees, as it is estimated that one in
fifty of the general population suffers from this disorder.1 A
person with BPD often experiences a repetitive pattern of
instability in self-image, mood, behavior and close personal
relationships.2 Individuals with BPD have
several of the following symptoms:
Marked mood swings with periods
of intensive depression, irritability, and/or anxiety
lasting a few hours to a few days
Inappropriate, intense or
uncontrolled anger
Impulsiveness in spending,
sex, substance abuse, shoplifting, reckless driving, or
binge eating
Recurring suicidal threats
or self-injurious behavior
Unstable, intense personal
relationships with extreme, black and white views of people
and experiences, sometimes alternating between “all
good” idealization and “all bad” devaluation
Marked, persistent uncertainty
about self-image, long term goals, friendships and values
Chronic boredom or feelings of emptiness
Frantic efforts to avoid
abandonment, either real or imagined.
The borderline personality
acquired this label because the syndrome was originally
thought to border on schizophrenia. BPD now appears to be
more related to serious depressive illness.2
The causes of BPD are unclear. It may be rooted in neglect,
abuse, or inconsistent parenting during childhood. The frequency
in women is two to three times greater than in men. Quite
often people with BPD have a very hard time controlling
their emotions. People with BPD are like patients with third
degree burns over 90% of their bodies. Lacking emotional
skin, they feel agony at the slightest touch or movement.BPD
is also called “emotional hemophilia”. A BPD lacks
the clotting mechanism needed to moderate his spurts of
feeling. Stimulate a passion, and the borderline emotionally
bleeds to death.
BPD clients create specific
problems for the personal injury attorney. These clients
over-react to the stress caused by injuries sustained in
an accident. The stress accentuates the already fragile
and chaotic life of the BPD client. Although fearing abandonment,
the BPD’s behavior seems almost designed to drive people
away. Periodic angry outbursts of the BPD client may alienate
the office staff and the attorney. The “black
and white thinking” of the BPD poses particular difficulties
for the attorney. The BPD client may view the attorney handling
her case as the best attorney who ever lived. When a problem
occurs with the case, the attorney is now seen as the worst
attorney who ever lived. The attorney should remain on guard
and avoid falling into the trap of being idealized by the
client.
Careful, detailed documentation
of actions taken by the attorney to handle the BPD client’s
case are important for the attorney’s self-protection.
The attorney and office staff will also find it helpful
to set limits on the behavior of the BPD client. For example,
the BPD client will need explicit rules about how often
she may call about her case or the use of the attorney’s
cell phone number.
The BPD who is applying for
work at a law firm is not always easy to spot during a job
interview. Bright, funny and the center of attention at
a party, these individuals are often identified as extroverts.
Review of their employment histories may show difficulty
maintaining a job for any length of time or completing an
educational degree. Provided one can get past the usual
barriers when it comes to talking to former employers, the
attorney should be alert to reports that the individual
was associated with stormy relationships at work. This personality
disorder can create turmoil in a work environment by black
and white thinking, poor impulse control, poor ability to
enjoy work, chronic depression, angry outbursts, being manipulative,
feelings of entitlement, and dependency.
The BPD is remarkably resistant
to treatment. Outpatient psychotherapy and medications are
used to treat brief psychotic episodes, anxiety, depression
and sensitivity to rejection. Short-term hospitalizations
occur during periods of extreme distress, suicidal behavior,
or substance abuse. Long-term psychotherapy may have some
success in altering the symptoms of this syndrome. Over
time, provided the person sticks with treatment and does
not alienate the therapist, most individuals achieve a significant
reduction in symptoms and improved functioning.
1. Borderline
Personality Disorder Research Foundation
2. www.palace.net/~llama/psych/bpd.html
(accessed 01/05/04)
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