A Disorder of Diffusion: Contemporary Perspectives on Borderline Personality Disorder

Presenter: Alexander Kriss, PhD

Borderline personality disorder (BPD) is one of the most misunderstood and stigmatized diagnoses in the world of mental health. This talk presents a contemporary psychoanalytic overview of BPD's diagnosis and treatment, rejecting the stereotypical "outside-in" portrait of a wild and hard-to-manage patient for an "inside-out" view rooted in the patient's subjective experience. BPD is framed, at its core, as a condition of pathological diffusion occurring chronically and across multiple domains, from the cognitive and emotional to the relational and cultural. Drawing pluralistically from objective relational, relational, and attachment theory and research, the presentation seeks to show how borderline phenomena is a part of the human condition that is relevant to everyone, and how it becomes a disorder when the development of selfhood is severely disrupted beginning early in life. Specific treatment considerations for the BPD population are considered, highlighting the importance of individualized care while acknowledging major contributions from two manualized psychodynamic treatments, Transference-Focused Psychotherapy (TFP) and Mentalization-Based Therapy (MBT). Future directions for understanding BPD are also addressed, as we take up issues of reducing stigma and better integration of psychoanalytic ideas with the more mainstream perspectives from the cognitive-behavioral paradigm.