Girl, Interrupted: A Study Of Borderline Personality Disorder Essay, Research Paper
A Study of Borderline Personality Disorder
It s 1967, and 18 year old Susanna Kaysen is like a lot of American teenagers her age confused, insecure, and lost within a rapidly changing world. After a half-hearted suicide attempt, she goes to a psychiatrist who quickly diagnoses her with Borderline Personality Disorder, and whisks her away to McLean Hospital. The next year and nine months would change her life forever.
When Susana arrives at McLean, she is immediately introduced to a completely different lifestyle. A regimented daily schedule complete with checks and security screened in windows became a reality. If she showed signs of improvement and good behavior, she would be able to walk to the opposite side of the building without a nurse following her around. Perhaps the most intriguing aspect of her new life was the women she met. Here, Susanna meets an eclectic group of troubled young women who not only become her closest friends, but also light Susanna s way back to someone she had lost herself. Susanna s roommate, Georgina was a timid pathological liar. Polly, who as a young girl was burnt severely when she set herself on fire, had low self-esteem but a heart of gold. Daisy had an eating disorder and a fetish for chickens and laxatives. And then there was Lisa. Lisa-a junkie on the outside, high-strung sociopath on the inside-was probably the biggest turn around for Susanna. Lisa was a consistent troublemaker. She constantly picked fights with the other girls, screamed and cussed at the nurses, and tried to escape the hospital on numerous occasions. Many times, she actually succeeded but she always ended up right back where she started. In the beginning of Susanna s stay, she was attracted to Lisa s loud personality. She became friends with her and found amusement in her ability to stir-up the entire hospital. It was during this time that Susanna seemed to be static.
Slowly Susanna began to learn from her fellow patients. At first, she is angry and antisocial, and gravitates naturally towards Lisa. Eventually, however, she learns that Lisa’s cruel streak has a vicious edge in which she doesn’t want to associate. So she concentrates on making a conscious effort to rehabilitate. Not only does Lisa aid in Susanna s turn around, but there is also one nurse in particular that has an enormous impact. Valerie is a one-of-a-kind nurse who has the patient s best interests truly at heart. She is stern and doesn t respond to anyone s outbursts. While she may not be the most entertaining, she has a significant impact on her patients. As Susanna partakes on a life-altering nearly two-year journey through group ice-cream trips, late night chats in the TV room, and fifteen-minute checks, she discovers her lost self and manages to restart a fairly normal life.
Susanna was diagnosed with Borderline Personality Disorder. The DSM-IV
defines B.P.D. as the following:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called “splitting.”
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Etiologically, Susanna fits Borderline Personality Disorder beautifully. She is a young adult of eighteen. Seventy-five percent of borderline patients are women. Susanna also fits many of these criterions. However, several of them were not seen out in the open. For example, she practiced wrist-banging, which corresponds with symptom number five as self-mutilating behavior. She would sit in her butterfly chair and bang her wrists on a sharp edge. She did this almost religiously every evening. For a while before she discovered wrist banging, she scratched her face. This proved to be too obvious, so she switched. Her pain brought comfort. It was the only way I could get through to myself ( counteract feelings of numbness )(Kaysen, 1993, 153). I think that self-mutilation and suicidal ideation and attempts go hand in hand. Susanna, before she was admitted to McLean, made a mild attempt at killing herself. She also said that she thought about suicide a lot. While she is lucky that she never made a fatal attempt, her ideation was still a large factor in her disorder and diagnosis.
Chronic feelings of emptiness, criterion number seven, was a definite for Susanna. She felt that she was living her life based on her incapacities. Basically, she didn t want to and felt she couldn t do pretty much anything. She liked boys and poetry, nothing more. School was a waste of her time. She didn t really have any friends. She didn t think she fit in anywhere. I saw myself, quite correctly, as unfit for the educational and social systems (Kaysen, 1993, 154). All of these feelings led her to more than emptiness and boredom. She sums this whole idea up beautifully in one statement: Emptiness and boredom: what an understatement. What I felt was complete desolation. Desolation, despair, and depression (Kaysen, 1993, 157). No wonder she was suffering!
Borderline Personality Disorder s most significant causal factors lie in the biological and psychosocial categories. All personality disorders show increasing evidence of genetic contribution. Patients with borderline also show differences in the levels of many neurotransmitters. For example, lower functioning in certain neurotransmitters such as seratonin can lead to the impulsive-aggressive behaviors that are common to so many borderline patients. Deficits in the levels of dopamine may predispose the person to psychotic symptoms. Also, trouble with the regulation of noradrenergic neurotransmitters can be found in borderline patients, which is also observed in those with chronic stress conditions. Psychological factors also play a major role in the formation of borderline personality disorder. Around ninety percent of borderline patients report a history in child abuse. Emotional, verbal, physical and sexual abuses were also reported and each contributed to a fifty five percent occurrence of emotional withdrawal among the patients. It is clear that abuse and neglect during childhood is severely damaging.
People with personality disorders are extremely difficult to treat. Because of their trouble forming interpersonal relationships, they have difficulties establishing a therapeutic relationship with a therapist. Treatment is generally effective if the psychological and biological treatment models are used in conjunction with eachother. This type of treatment often involves the use of certain medications: antipsychotics to help with depression, anxiety, suicidality, and psychotic symptoms, antidepressants from the class of SSRIs and MAO inhibitors, and lithium to reduce irritability and angry behavior. These drugs are used in combination with psychological treatment. Psychosocial treatment focuses in strengthening the weak ego. This treatment is based on the idea that these individuals suffering from borderline have weak egos and the primary focus of the treatment is on the defense mechanism splitting. This treatment is not usually effective and is also very expensive and time-consuming. The most promising hope for borderline patients is a newly developed therapy called dialectical behavior therapy. The central focus of this therapy is to help the patients accept negative affect without responding to it with maladaptive or self-destructive behaviors. This treatment is based on a hierarchy of goals which are clearly explained by clearly by Carson, Butcher, and Mineka (2000):
(1) decreasing suicidal behavior; (2) decreasing behaviors that interfere with therapy, such as missing sessions, lying, and getting hospitalized; (3) decreasing escapist behaviors that interfere with a stable lifestyle, such as substance abuse; (4) increasing behavioral skills in order to regulate emotions, to increase interpersonal skills, and to increase tolerance for distress; (5) other goals the patient chooses.
This therapy also combines individual with group components. While Susanna was in McLean, she received daily medications and had daily meetings with her therapist as well as with a group.
On January 3, 1969, Susanna Kaysen was discharged. She was declared recovered. Her time in McLean and the newfound friendships cured her. While drugs, therapists, and daily checks made a contribution to her recovery, I believe that her biggest awakening was the people she lived with. Living with and watching the other women come in and out of the hospital, go through their own respective problems, and create their own paths to recovery. Ultimately, people make the difference in other people s lives.