Borderline personality of our age Dusica Lecic Tosevski Institute of Mental Health Belgrade

2 De natura hominis  It is more important to know what person has a disease, than to know what disease a person has.

3 Content Borderline personality disorder Borderline personality disorder Borderline personality of our age Borderline personality of our age Our borderline age Our borderline age

4 Crisis of meaning 1  Civilised world is mortal  “Malady of death” - our most hidden inner recesses governs: - the military and economic domains, social and political bonds - once noble realm of the mind

5 Crisis of meaning 2  Power of destructive forces within the individual and society  Destruction of nature, life and economic resources  Outbreak or a more patent manifestation of psychosis, depression, anxiety and personality disorders  Disaster of the mind

6 Disaster of the mind Greater prevalence of personality disorders?

7 Literature Classical theatre - conflicts of neurotic disorders Classical theatre - conflicts of neurotic disorders Theatre of the absurd - borderline conditions Theatre of the absurd - borderline conditions Samuel Becket - Waiting for Godot Samuel Becket - Waiting for Godot Albert Camus - The Fall Albert Camus - The Fall J. P. Sartre - Hell is other people J. P. Sartre - Hell is other people

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9 Personality disorders - modern concepts and controversies  Classification  Definition/diagnostics (borderline personality disorder)  Aetiology

10 Classification DSM-III and IV Disputable personality disorders schizotypal (sch spectrum) schizoid (no patients) avoidant PD (social phobia?) dependent (a separate entity?) depressive(masochistic) (defense mechanism) passive-aggressive (defense mechanism)

11 Classification Classification ICD-10 Advantages schizotypal PD schizotypal PD enduring personality changes enduring personality changes passive-aggressive PD passive-aggressive PD Disadvantages narcissistic PD narcissistic PD borderline PD - emotionally labile PD borderline PD - emotionally labile PD

12 Borderline personality disorder A non-discriminatory synonym for all personality disorders (Kroll, 1983) Diagnostic “grab bag” “An adjective in search of a noun” (Akiskal et al., 1985)

13 Three concepts of BPD Borderline personality disorder (Gunderson & Kolb, 1978) Borderline personality disorder (Gunderson & Kolb, 1978) Borderline personality organisation (Kernberg, ) Borderline personality organisation (Kernberg, ) Borderline level of functioning (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & Divac-Jovanovic, ) Borderline level of functioning (Berelowitz & Tarnopolski, 1993; Lecic-Tosevski & Divac-Jovanovic, )

14 Borderline personality disorder Most BPD patients - other cluster B diagnoses Most BPD patients - other cluster B diagnoses Dissociative identity disorder Dissociative identity disorder Affective instability - comorbid mood disorders Affective instability - comorbid mood disorders Five of nine criteria - arbitrary Five of nine criteria - arbitrary

15 Borderline personality organisation Structural criteria diffuse identity diffuse identity primitive defences primitive defences intact reality testing intact reality testing

16Splitting clinical marker of severe personality disorders clinical marker of severe personality disorders defence of neglected child defence of neglected child pre-ambivalence pre-ambivalence chaotic interpersonal relationships chaotic interpersonal relationships contradictory emotions and cognition contradictory emotions and cognition perceptive alterations of self and objects perceptive alterations of self and objects

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18 Borderline level of functioning level of dysfunction of personality disorders level of dysfunction of personality disorders a non-specific marker of severity of PDs a non-specific marker of severity of PDs dynamic, transitory dimension dynamic, transitory dimension masks of borderline personality disorder (“chameleon style”) masks of borderline personality disorder (“chameleon style”) manifestation of depression (Lecic-Tosevski, 1993) manifestation of depression (Lecic-Tosevski, 1993) attenuated (subclinical variant) of affective disorders (Akiskal) attenuated (subclinical variant) of affective disorders (Akiskal) core BPD core BPD

19 Impulsivity Affective instability Biological risk factorsPsychological risk factors BPD Loss Trauma Parental failure Social disintegration Social risk factors Biopsychosocial model of borderline personality disorder (J. Parris, 1994)

20 Social influences Personality disorders - growing violence? Personality disorders - growing violence? Guiltless participation in sadistic behaviour (Milgram,1964) Guiltless participation in sadistic behaviour (Milgram,1964) Severe and chronic criminality - Licensed Mass Murder (Dick, 1972) Severe and chronic criminality - Licensed Mass Murder (Dick, 1972) Malignant narcissism Malignant narcissism Social disintegration - episodic antisocial behaviour Social disintegration - episodic antisocial behaviour

21 Borderline age Personality disorders - sociocultural phenomena? Personality disorders - sociocultural phenomena? Culture of narcissism - “Me culture” Culture of narcissism - “Me culture” Collective diffuse identity Collective diffuse identity Globalization and creation of a new Babylon Globalization and creation of a new Babylon Regression to primitive levels of functioning Regression to primitive levels of functioning Development of borderline personalities? Development of borderline personalities?

22 Disaster of the mind? Moral behaviour depends upon the social structure (social corruption) Moral behaviour depends upon the social structure (social corruption) New age favours: New age favours: a) prevalence of personality disorders? b) the expression of personality disorders?

23 “ Ήθος ανθρώπου δαίμων” Ηράκλειτος Σκοτεινός Fragment 117