I had the opportunity to interview Dr. Frank Yeomans, therapist, psychiatrist and professor for Transference Focused Therapy, an evidenced based treatment for borderline personality disorder. Here is the first one in a series of videos discussing BPD through the lens of Transference Focused Therapy.
“We see BPD as a condition that has four areas of difficulty. First of all, emotions. Extreme and rapidly shifting emotions — life is like a roller coaster. Second, relationships. Relationships tend to be chaotic and conflictual and difficult and unsatisfying and frustrating, not harmonious and continuous over time. Third: acting out behaviors. These can be impulsive — not always impulsive but often impulsive behaviors are often self-destructive, things like cutting or overdosing, could be substance abuse, promiscuous, dangerous sex, some form of eating disorder, and I always emphasize that since these are the most dramatic manifestations of the illness I think they get the most attention. and often people think that is the illness.
But we see these as the outer signs of an illness. As other people have said, these are actually attempts to cope with the illness. They are attempts to feel better — they’re not the illness itself.
So what is the core concept for us? It’s the fourth area of difficulty: which is the person’s sense of identity. The way we understand BPD, people don’t have a coherent, integrated sense of self. They have a very fragmented sense of self, they don’t have a sense of continuity over time, they’re very reactive to whatever happens in the moment, so a trigger event can lead them to the depths of despair or something good happens and they’re elated.
There isn’t this kind of sewing together the different parts of the person into a kind of solid foundation so that they tend to be reactive to what happens in the moment — kind of like a ship at sea without a keel. so whatever happens kind of tosses them in this direction and that direction. And without a coherent and cohesive sense of identity, it’s hard to know how to navigate your way through life if you don’t have a clear and consistent set of goals, a sense of values. Everything becomes distressing. There’s often a concomitance of emptiness inside, which i think is one of the most distressing parts of the condition.
We would see the lack of the coherent and well integrated identity as the core feature.”