Neurotic lacks awareness
Borderline lacks clarity
Psychotic lacks sense of identity

The Borderline relational disorder is characterized by an individual’s feeling of confusion when confronted with their own experiences. They lack clarity regarding to whom these experiences belong. This leads to a diminished self-esteem accompanied by a fear of abandonment, extreme emotions, and maladaptive mechanisms to regulate them.

Borderline individuals struggle with their feelings of being dependent and autonomous at the same time.

“Can’t live with you, and can’t live without you” – these are dramatic borderlines experiences.

Their relationships make them swing from idealization to devaluation. They often feel chronic emptiness and have a sense that nobody understands them because they are different. They feel lost in their relationships with others, as if they don’t belong. Often, they find it difficult to comprehend that they are understood by others, even if they speak the same language.

In addition to the feeling of confusion, one important criterion is poor control over aggressive impulses. They often react uncontrollably with anger instead of experiencing fear, affection, or other emotions.

Individuals with borderline relational disorder may lead a disordered lifestyle, engage in dependencies, have unsafe sex, binge-eating, exhibit risky behaviors, control and manipulate others, and display inconsistency in their actions and attitudes towards loved ones. They often engage into substance-use, gambling, and reckless driving. In terms of finances, they may make impulsive and irrational purchases, experiencing shopping sprees.

In extreme cases, hallucinations, suicidal ideation, and self-mutilation can take place. The suicide rate reaches 8-10%, although suicidal tendencies are often used as a means to seek attention. It is more common among young-adults, but impulsivity, extreme emotions, and the intensity of relationship manifestations and their instability can persist lifelong.

Dysphoria (a sense of dissatisfaction) is a common experience, and research demonstrates that deviations in a specific gene can provoke certain disruptions in brain function, leading to impaired dopamine production (a neurotransmitter associated with pleasure).

Most often, individuals with borderline disorder do not recognize that they have problems, while it is the people close to them who suffer. It is a disorder that manifests in the realm of interpersonal relationships.

From Gestalt theory perspective, it is characterized by a problem at the precontact and can occur on two levels: body (id) or cognition – in thoughts or ideas (personality).

On the body level, a person may have a poor sense of their body, often picking up and assimilating the experiences of others within their own body.

On the cognitive level of thoughts and ideas, the disorder may be reflected in the narrative (through language, words, expressions). Giovanni Salonia provides an example from the work of Isadore From: when a client with borderline disorder said that the moon is made of cheese, From (the therapist) responded that both the moon and cheese are yellow in color.

Therefore, it is important for the therapist to validate their experience rather than deny or argue against it.

When working with clients with borderline relational disorder, there are certain things to avoid in therapy:

– Avoid intensifying emotions.

– Refrain from providing interpretations that may make them feel that you are imposing mistrust in their own experiences.

– Avoid delving excessively into the past in search of meaning behind the disorder.

– Don’t focus too much on insight-seeking, as they need clarity rather than awareness (they are aware).

– Avoid verbalizing their emotional content in a way that sounds limiting or defining their experiences.

– Do not engage in arguments or conflicts over who is right.

– Do not insist on regular therapy sessions, but rather allow them to have autonomy in regulating their own appointments.

It’s important to create a safe and validating environment where their experiences are respected, and to work collaboratively with them to address their needs and promote their autonomy.

It is beneficial to:

– Initially focus more on the background rather than the figure to establish trust and a sense of being understood, minimizing misunderstandings.

– Be friendly and approachable without being overly warm. Excessive warmth can startle individuals with borderline disorder, making them feel confused and distant in order to understand their own desires. The difference from narcissistic disorder is that a borderline client will distance themselves to understand their own desires (due to the characteristic of confusion), while narcissistic clients will distance themselves to protect their feelings from being humiliated.

– Help them to validate their own experience, acknowledging that their emotions are real and acceptable, while also teaching them to control impulses and accept and experience negative affect without resorting to destructive behavior.

– Assist in identifying disappointments and idealizations.

– Work in a dialectical manner, recognizing that life is not solely black and white, but rather consists of various shades of gray.

These approaches help create a therapeutic environment that validates their experiences, encourages emotional regulation, and promotes a nuanced understanding of their thoughts and emotions.

It is important to note that in the DSM-5, this disorder is called Borderline Personality Disorder, while in Gestalt therapy, we refer to it as Borderline Relational Disorder. This distinction is made because we focus on the function of relationships, as one of the causes of the disorder (in addition to genetic and biological factors) is considered to be the neglecting treatment by others in childhood, including the denial of certain experiences of the child (which leads to confusion and ambiguity in their own experiences).

It was previously believed that 75% of individuals with the disorder were women, but recent research has challenged this ratio, demonstrating that women simply seek help from specialists more often, resulting in a higher diagnosis rate.