Forming a mental picture of someone with Borderline
Personality Disorder is extremely difficult. It has been likened to
staring at a lava lamp where the different liquids are constantly
changing shape. Trying to grab onto one constant shape in a lava
lamp is impossible. The purpose of finding a new name for this
disorder is to provide a “handle” that we can “see” and grab onto
with our minds in order to form a mental picture of this condition.
Yet, with this disease two people can act in totally opposite ways
and still have the same diagnosis. It has been ruefully noted
that for every rule about Borderlines, the opposite will also be
correct. Another frustration is that their differences are often
more obvious than their similarities. Clinicians commonly make the
diagnosis instinctively because the patient makes their “hair stand
on end” when they first meet.
Borderline Personality Disorder is one of the most irritating,
common, deadly, and difficult to diagnose mental illnesses. A
Borderline patient, Rachel Reiland, called it the “monstrous, metastatic
malignancy of psychiatry.” Author Janice Cauwels said, “It is impossible to
overemphasize how serious this illness is and how much pain
The term “borderline” was originally used to designate an ill-
defined group of mentally ill patients that seemed to “border”
the area between psychosis and neurosis. In the 1970s this border
theory was abandoned, but a suitable replacement name has not
been found. There is displeasure with the term “borderline”
among many psychology professionals. All other psychiatric
diseases have a name that gives some clue as to what symptoms the
patient is suffering. For example, in attention deficit hyperactivity
disorder (ADHD) the patient has difficulty concentrating and is
excessively active. Borderline by contrast gives no help in forming
a mental picture of this ailment. “Borderline” is a terrible term and
the single greatest impediment to a better understanding of this
mental illness by the public.
The World Health Organization’s name for this condition,
emotionally unstable personality disorder, is better but still too
generic and does not make an adequate connection between the
term and the patient’s actions. True, these patients are emotionally
unstable, but so are many people with other mental illnesses who
have extreme mood swings. Emotionally unstable ranks as the
third most important diagnostic criterion behind their faultfinding
tendencies and impulsivity. However, high-functioning Borderlines often
appear stable and totally normal in public. “Invisible borderlines”
is another descriptive name. They know how to suppress their
rage when necessary. Their negative and critical nature is more
socially acceptable and they may be happy to let it show in public.
Their infectious griping can gain them like-minded friends. It may
be virtually the only way they know to maintain a conversation.
This character trait is likely to be observed in their everyday lives.
When Borderlines let loose with their tirades, it is usually based upon
anger or fear from a fault they find in themselves or someone else.
Where did the idea of calling this disease Faultfinding
Personality Disorder come from? When I first learned about this
illness, I talked to a psychologist who said these individuals were
most recognizable by their highly negative and critical natures.
Later I read the works of John G. Gunderson, M.D., a professor of
psychiatry at Harvard Medical School and the father of the official
Borderline Personality Disorder diagnosis. He ranked the nine
criteria for this mental illness according to their relative diagnostic
importance. Based on his many years of clinical and research
experience, the first and most important criterion is “A pattern of
unstable and intense interpersonal relationships characterized by
alternating between extremes of [over] idealization and devaluation
[emphasis added].” Gunderson found the idealization of
others to be infrequent but devaluing by demeaning, criticism, and
faultfinding was common. A likely explanation is that Borderlines’
baseline state is to be angry and critical of most everyone and everything.
Borderlines are constantly searching for that perfect all-giving individual
to be in their life. When a new prospect comes along, they switch to over
idealizing the person. They may heap all their hopes and expectations
onto them, then dole out copious compliments. This is usually a
transitory phase. As soon as the new person is no longer living
up to the unrealistic expectations, they are reclassified as all-
bad. People with this illness then lapse back into their baseline
critical/devaluing mode. The good times are over. The long trek
across the endless harsh emotional desert of condemnation has
begun. Thus, an appropriate name appears to be Faultfinding
Personality Disorder. The average person could easily understand
the connection between the individual’s actions and their diagnosis.
No extensive training such as a medical degree or doctorate in
psychology would be required to recognize the probability that
someone has the condition. Simplicity and clarity is essential to
greater public awareness.