Personality Disorders (Part 3)

Dramatic and Emotionally Erratic Personalities

From last week we learned that there are three groupings of personality disorders.  Cluster A, odd or eccentric Cluster B, dramatic and emotionally erratic, and Cluster C, anxious or fearful.  Last week we looked at the Cluster A grouping in which we discussed paranoid, schizoid, and schizotypal personality disorders.  This week we will examine Cluster B.

PERSONALITY DISORDERS CLUSTER B: “Dramatic and emotionally erratic.”

Antisocial Personality Disorder” is a pattern of blatant disregard for, violation of the rights of others that starts in childhood, develops in adolescence and carries into adulthood.  Its prevalence is 3% of the general population but in clinical (counseling offices and psychiatric hospitals), judicial (courts and jails) and addiction treatment settings the prevalence of the populations being managed can be up to 30-40%.  Three or more of the following criterion are necessary for diagnosis:

  • Lawbreaking and arrests.
  • Deceitfulness, lying, conning others for personal profit.
  • Impulsivity and failure to plan ahead.
  • Irritability and aggressiveness and fighting.
  • Recklessness and disregard for safety of self and others.
  • Consistent irresponsibility and failure to sustain consistent work or honor financial obligations.
  • Lack of remorse and rationalizing their hurting of others.

Borderline Personality Disorder” is a pattern of instability of interpersonal relationships, self image, mood & emotional fluctuations and impulsivity. It has a prevalence of 2% of the general population, 10% of outpatient / therapy settings, and 20% of inpatient settings.  It is estimated that 75% of all persons with BPD are female. A diagnosis can be made when a client has five or more of the following:

  • Frantic efforts to avoid real or imagined abandonment.
  • Pattern of unstable and intense interpersonal relationships characterized by extremes of idealization and devaluing.  Tendencies toward fusion or enmeshment with others and a lack of boundaries or separation.
  • Identity disturbance (self image obsessions) and resulting modification of body (obsessive exercise, dieting, plastic surgery etc.)
  • Self destructive impulsivity in sexuality, spending, substance abuse, reckless driving, binge eating.
  • Recurrent suicidal gestures, behavior, threats or self mutilating behavior.
  • Affect (moods and emotions) instability with high levels of reactivity including depression, anxiety, and irritability.
  • Chronic feelings of emptiness.
  • Inappropriate intense anger outbursts and difficulty controlling anger and fighting.
  • Temporary moments of stress related paranoid thoughts or dissociation episodes.

This is a common disorder which presents frequently in couple’s therapy where the highly conflictual couple has been to many different counselors who have quickly been rejected when the therapist confronts the BPD.

Their marriage is characterized by high states of conflict and violent and combative behaviors alternating with emotionally intense sexualized make up sessions where life is “wonderful”.  Borderlines are often into marriage 3-4 before they begin to notice that they are the common denominator.  These highly sexualized females seem like a “guy’s dream”, but they end up being their worst nightmare.

A severe “Vacillator” may in fact be a BPD.  Why the term “borderline”? In their extremely agitated reactive states, the BPD person’s thoughts are so distorted that they are literally on the borderline between reality and “imagined” reality (“psychosis”).   They have very poor self reflective skills and thus always imagine thatothers are the cause of their relational problems.   They can be very high functioning in careers and capacities, yet when triggered emotionally, they decompensate within seconds and become “internally immature” and become very difficult to work with.

As a pastor, I was ignorant of these various personality disorders and found myself trusting and getting burned by people I thought I knew fairly well.  Now as a Pastoral Counselor who specializes in couple’s therapy, I see this disorder fairly frequently.

There are two kinds of BPD’s… those who do not want to listen to the diagnosis and run from therapy and those who are tired worn out and find relief through diagnosis.  This latter group is more willing to do the hard work to try to grow.

Sometimes I am left working with the spouses of unwilling BPDs and our therapy consists of learning to love, confront, set boundaries, manage emotional reactivity, listen to deep hurts from the past and speak loving truth into their tormented souls.  Strength and containment help to create security and eventually the BPD male or female may begin to listen to someone who stays with them as opposed to abandoning them.   They can be redeemed with grace and truth and lots of patience.

“Therefore, do not let sin reign in your mortal body that you should obey its lusts, and do not go on presenting the members of your body to sin as instruments of unrighteousness;  but
present yourselves to God as those alive from the dead,
and your members as instruments of righteousness to God.
For sin shall not be master over you,
for you are not under law but under grace (Romans 6:12-14).”

Yes, with time, truth, insight, understanding, teaching, emotional empathy, grief and anger work, the believer can learn to control their minds and behaviors.  It is the redemptive hope for this lifetime.  It is the redemptive hope for eternal life as well.

Recommending reading:  Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Mason. (Please Click the title to find out more about this book)

Thanks and blessings,

Love,

Milan & Kay

Next week: We will talk about the last two disorders within Cluster B, “Histrionic Personality Disorder” and “Narcissistic Personality Disorder