CONSIDERED A ‘serious psychiatric disorder’,
patients with borderline personality disorder (BPD)
display patterns of instability in affect regulation,
impulse control, interpersonal relationships and
self-image (Perseius et al 2007). As Westwood and
Baker (2010) describe, patients who are diagnosed
with BPD seek to attract attention through
behaviours or traits such as those listed above,
as well as through deliberate self-harm. Patients
also have symptoms associated with poor selfimage,
feelings of emptiness, being consumed by
feelings of abandonment, engaging in intense and
unstable interpersonal relationships, self-destructive
behaviours and hypersensitivity. These in turn make
the attainment of fulfilment and contentedness in
their lives difficult.
The origins of BPD can be seen as a response
to traumatic life events that might have had an
effect on the individual traits of the illness (Tredget
2001). There are various theories about attachment
and how an individual’s personality is shaped
during developmental years that may explain a
large part of what could be described as a complex
and diverse aetiology.
Experiences of complex trauma – for example,
multiple, chronic and prolonged developmentally
adverse events, namely lack of stable or secure
parental attachment, as well as physical and
emotional abuse, educational neglect, and family
dysfunction – are among the explanations for the
distress seen in some patients with BPD.
Childhood trauma
These forms of maltreatment in childhood can go
on to bring impairment to attachment, self-concept
and behavioural control. Individuals who are not
exposed to complex trauma can communicate
their distress appropriately because adequate
help and support from a parent or carer ensures
that it will be resolved appropriately. Those with
attachment impairment may not be able to rely
on sufficient support through times of distress
or difficulty and cannot regulate their emotional
states. Behavioural traits become evident and are
often seen as troublesome or rebellious. This in turn
creates labelling and stigmatisation, which become
damaging and can exacerbate the situation.
Difficulties arise in keeping the individual safe;
there may be a need to move to an alternative
place of care, with fears of further abandonment
and trauma becoming a major concern. Focus may
well be placed on equipping the individual with
better ways to respond to perceived distress, with
caregivers highlighting unhelpful aspects of the
individual’s situation (van der Kolk 2005).
Care provision aims to treat the symptoms but
must also intervene when a self-destructive path
is followed. This can be difficult for cliniciansto achieve because poor motivation for change
and sporadic participation in treatments all make
for poor therapeutic engagement in long-term input.