Treatment Tuesday - Borderline Personality Disorder

Photo by photobunny. No one was harmed for this photo.

This week’s assessment comes from Sarah. Here’s her quick character sketch:

At six, Janice* lost her mother. She lived with her abusive father and her brother who molested her for five years. She became angry, belligerent and tough; ran away at 16, lived on the streets and turned to drugs. Placed in a mental hospital at 23, she resented the controls placed on her and fights the system until a series of events and an encounter with a Christian causes her to let her guard down. Her life slowly begins to change.

* Names have been changed to protect the fictional.

Sarah had a few questions she wanted me to consider:

• How do I pull the reader to become a part of Janice's world and to feel what she feels? I want them to feel the powerlessness she feels.
• Is her character believable?
• How do I show her reactions to the other patients and staff in such a way that the reader gets inside her head and understands from her point of view?

I believe the first and third questions stem from the second question, which is where I’ll start. To me, believable and realistic are synonymous. To make Janice realistic, you need to know some common consequences of early abuse in life that you might want to incorporate into your book.

1) Dissociation – at times, the human mind splits off from itself to protect itself while experiencing trauma. This is a diagnosis in and of itself called Dissociative Identity Disorder (formerly Multiple Personality Disorder). 2) PTSD – see last week’s assessment here. 3) Drug/Alcohol abuse – as a way of self-medicating through the pain, guilt, shame, etc. 4) Self-harm – a little different than self-harming through drug abuse. This is cutting behaviors where the client will cut (usually on their upper thighs, forearms) as a way to override the emotional pain. They would rather experience physical pain than the torturous pain of their memories and thoughts. 5) Suicidality. Sometimes the depression drowns and the emotions overwhelm to the point life is too difficult to continue. Know ahead of time just how dark you want to let her struggle get.

Just a few options you have to think about.

But since I like to work within a diagnostic framework, the one diagnosis that keeps coming to mind for Janice is Borderline Personality Disorder. As you may or may not know, a personality disorder is pervasive – encompassing every aspect of a person’s life. Think of it as putting on a pair of sunglasses that tint everything you see. You mentioned Janice was angry and belligerent, which definitely would qualify. And since she grew up with no mother, a woman-hating father (your term from our ongoing emails) and an incestuous brother, she likely would have an unstable sense of self or self-image. But the other symptoms you might want to layer in your book, to really flesh out this diagnosis (if you want to, that is). ☺

She would need to exhibit impulsiveness in at least two areas of life (definitely her drug use would fit here). Other areas might be her sex life, reckless driving or binge eating. She would try to avoid real or imagined abandonment (even more so because of her mother), and she would be frantic about this. As mentioned in the above, if you choose to give her suicidal or self-harm behavior, this would be a big-ticket symptom for this diagnosis. A chronic feeling of emptiness is also common.

One other big-ticket symptom to include would be a pattern of unstable and intense interpersonal relationships that alternate between extreme idealization and devaluation. Think Glenn Close in Fatal Attraction, loving Dan Gallagher one minute, hating him the next. It is for this very symptom that I want to caution you about the “encounter with a Christian.”

If your novel will lose credibility anywhere, this would be the likely place. One of the most frustrating things about treating a person with Borderline is their pattern of undermining their own treatment. Usually, this happens in therapy just as a goal is about to be realized. For example, after a discussion about how well the client is doing, they would severely regress back into old behaviors. At the moment when the reader is thinking the Christian is just about to get through to Janice and change her life, Janice would probably regress in real life. So I’d make the Christian go through a few different scenes with Janice before she actually reaches her. Otherwise, readers could write off your book as unrealistic and not suspending belief enough.

Another thing to consider including in your book is some inanimate object/possession, or perhaps a pet, that Janice feels close to, comfortable with, and secure when she is around it. Often time, people with Borderline feel more sheltered with something like this rather than a person.

That’s all for now! From the sounds of it, though, you were at least half-way to a Borderline diagnosis on your own. So hopefully this helps you think through some additional layering you can add to your novel should you choose to go this route fully.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.