BORDERLINE PERSONALITY DISORDER
Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relation-ships, self-image, and affect as well as marked impulsivity. About 2% to 3% of the general population has borderline personality disorder; it is five times more common in those with a first-degree relative with the diagnosis. Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men. Under stress, transient psychotic symptoms are com-mon. Between 8% and 10% of people with this diagnosis commit suicide, and many more suffer permanent dam-age from self-mutilation injuries, such as cutting or burning (APA, 2000). Typically, recurrent self- mutilation is a cry for help, an expression of intense anger or help-lessness, or a form of self-punishment. The resulting physical pain is also a means to block emotional pain. Clients who engage in self-mutilation do so to reinforce that they are still alive; they seek to experience physical pain in the face of emotional numbing (Mangnall & Yurkovich, 2008).
Working with clients who have borderline personality disorder can be frustrating. They may cling and ask for help one minute and then become angry, act out, and reject all offers of help in the next minute. They may attempt to manipulate staff to gain immediate gratification of needs and at times sabotage their own treatment plans by purposely failing to do what they have agreed. Their labile mood, unpredictability, and diverse behaviors can make it seem as if the staff is always “back to square one” with them.