Borderline personality disorder from a psychopathological-dynamic perspective

As is well-known, borderline personality disorder is a highly variegated clinical constellation, so that it might be better pictured as an area rather than a line. It is in this clinical area that we encounter particularly difficult patients who, subject to emotional dysregulation and tendency to impulsive action, cause much trouble to clinicians and health workers committed to their treatment. The contribution of psychopathology becomes essential whenever it allows the clinician to move from the level of symptoms to that of lived experience. When this shift is not attempted, the clinician’s gaze remains dominated by the triad of stigmatisation, intractability and chronicity. To ask “what is it like to be a person with BPD” means, for example, to identify the characteristics of a perpetually dysphoric mood condition that forces the subject to look for ways to quickly reduce such uncomfortable state. Psychopathology allows us to shed light on the dynamics of dysphoric mood and the transformation of dysphoria into anger: this knowledge can also help reduce the risk of emotional mirror-involvement in the clinician.