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The Window and the Wound: Dysphoria and Anger in Borderline Disorders

Abstract

In the clinical case described (Carla) it is easy to recognize many of the elements which, according to the current psychiatric nosography, constitute the borderline personality disorder (DSM 5). In accordance with a descriptively and categorically oriented psychiatry, this diagnosis tells us something about Carla’s disorder but nothing about Carla as a person, about her lived experiences and her way of dealing with (or taking a stand toward) those symptoms. What happens inside Carla’s world, a world that in order to be seen needs to be observed through her own eyes and words? If a description in the first person is to be made accessible, one has first to pay attention to all of Carla’s statements and focus on what she feels and expresses through her words, her behavior, and her ways of relating to the others (with particular attention to the therapeutic relationship). In order to recover its specific meaning, each of the symptoms described by clinical psychiatry must be rethought and repositioned on the basis of Carla as a person, with her history and her experiences. Only from this point a therapeutic plan can be developed. In order to clarify the elements from which one such plan can be developed, I will follow the same path followed by Carla during our sessions and focus on these three aspects: (1) the anger; (2) the feeling of emptiness, loneliness, inconsistency, and inauthenticity; and (3) the self-harming behaviors.

Keywords

  • Borderline personality disorder
  • Dysphoria
  • Self-harm
  • Psychopathological organizers

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References

  • Berner, P., Musalek, M., & Walter, H. (1987). Psychopathological concepts of dysphoria. Psychopathology, 20(93), 100.

    Google Scholar 

  • Chiesa, M., Drahorad, C., & Longo, S. (2000). Early termination of treatment in personality disorder treated in a psychotherapy hospital. British Journal of Psychiatry, 177, 107–111.

    CAS  CrossRef  PubMed  Google Scholar 

  • Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the Self. London: Other Press.

    Google Scholar 

  • Gabbard, G. (1999). An overview of countertransference: theory and technique. In G. Gabbard (Ed.), Countertransference issues in psychiatric treatment. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Gabriel, E. (1987). Dysphoric mood in paranoid psychoses. Psychopathology, 20, 101–106.

    CAS  CrossRef  PubMed  Google Scholar 

  • Jaspers, K. (1913). Allgemeine Psychopathologie. Berlin: Springer. English edition: Jaspers, K. (1997). General Psychopathology. Volumes 1 & 2 (trans: Hoenig, J., Hamilton, M. W.). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Kernberg, O. F. (1992). Aggression in personality disorders and perversion. New Haven: Yale University Press.

    Google Scholar 

  • Kernberg, O. F. (1994). Aggression, trauma and hatred in the treatment of borderline patients. The Psychiatric Clinics of North America, 17, 701–714.

    CAS  PubMed  Google Scholar 

  • Kettlewell, C. (1999). Skin game: A cutter’s memoir. New York: St. Martin’s Press.

    Google Scholar 

  • Kimura, B. (1992). Écrits de psychopathologie phénoménologique. Paris: Presses Universitaires de France.

    Google Scholar 

  • Leibenluft, E., Gardner, D. L., & Cowdry, R. W. (1987). The inner experience of the borderline self-mutilator. Journal of Personality Disorders, 1, 317–324.

    CrossRef  Google Scholar 

  • Lemma, A. (2005). Under the skin. A psychoanalytic study of body modification. London: Routledge.

    Google Scholar 

  • Lolli, F. (2012). L’epoca dell’inconshow. Milano: Mimesis.

    Google Scholar 

  • McDonald, M., Pietsch, T., & Wilson, T. (2010). Ontological insecurity: A guiding framework for borderline personality disorder. Journal of Phenomenological Psychology, 41, 85–105.

    CrossRef  Google Scholar 

  • McWilliams, N. (2014). La patologia borderline come livello di organizzazione della personalità. In M. Fontana & S. Zito (Eds.), La patologia borderline in psicoanalisi. Modelli per l’intervento. Milano: Franco Angeli.

    Google Scholar 

  • Meares, R., Gerull, F., Stevenson, J., & Korner, A. (2011). Is self-disturbance the core of borderline personality disorder? An outcome study of borderline personality factors. Australian and New Zealand Journal of Psychiatry, 45, 214–222.

    CrossRef  PubMed  Google Scholar 

  • Pazzagli, A., & Rossi Monti, M. (2000). Dysphoria and aloneness in borderline personality disorder. Psychopathology, 33, 220–226.

    CAS  CrossRef  PubMed  Google Scholar 

  • Pestalozzi, J. (2003). The symbolic and concrete: Psychotic adolescents in psychoanalytic psychotherapy. International Journal of Psychoanalysis, 84, 733–753.

    CrossRef  PubMed  Google Scholar 

  • Potter, N. (2003). Commodity/body/sign: Borderline personality disorder and the signification of self-injurious behavior. Philosophy, Psychiatry and Psychology, 10, 1–16.

    CrossRef  Google Scholar 

  • Rossi Monti, M. (2012). Borderline: Il dramma della disforia. In M. Rossi Monti (Ed.), Psicopatologia del presente. Crisi della nosografia e nuove forme della clinica. Milano: Franco Angeli.

    Google Scholar 

  • Rossi Monti, M., & D’Agostino, A. (2009). Autolesionismo. Roma: Carocci.

    Google Scholar 

  • Rossi Monti, M., & Stanghellini, G. (1996). Psychopathology: An edgeless razor? Comprehensive Psychiatry, 37, 196–204.

    CrossRef  Google Scholar 

  • Ruggiero, I. (2012). The unreachable object? Difficulties and paradoxes in the analytical relationship with borderline patients. International Journal of Psychoanalysis, 93, 585–606.

    CrossRef  PubMed  Google Scholar 

  • Stanghellini, G. (2000). Dysphoria, vulnerability and identity. Psychopathology, 33, 198–220.

    CAS  CrossRef  PubMed  Google Scholar 

  • Stanghellini, G. (2014). De-stigmatising manipulation: an exercise in second-order empathic understanding. South African Journal of Psychiatry, 20, 11–14.

    CrossRef  Google Scholar 

  • Stanghellini, G., & Rosfort, R. (2013). Borderline depression: A desperate vitality. Journal of Consciousness Studies, 20, 153–177.

    Google Scholar 

  • Straker, G. (2006). Signing with a scar: Understanding self-harm. Psychoanalytic Dialogues, 16, 93–112.

    Google Scholar 

  • Wilkinson-Ryan, T., & Westen, D. (2000). Identity disturbance in borderline personality disorder: An empirical investigation. American Journal of Psychiatry, 157, 528–541.

    CAS  CrossRef  PubMed  Google Scholar 

  • Winnicott, D. W. (1969). The use of an object and relating through identifications. In: Playing and Reality. London: Tavistock.

    Google Scholar 

  • Zanarini, M. (2008). Reasons for change in borderline personality disorder (and other axis II disorders). Psychiatry Clinics of North America, 31, 505–515.

    CrossRef  Google Scholar 

  • Zanarini, M., Frankenburg, F. R., DeLuca, C. J., Hennen, J., Khera, G. S., & Gunderson, J. (1998). The pain of being borderline: dysphoric states specific to borderline personality disorder. Harvard Review of Psychiatry, 6, 201–207.

    CAS  CrossRef  PubMed  Google Scholar 

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Monti, M.R. (2016). The Window and the Wound: Dysphoria and Anger in Borderline Disorders. In: Stanghellini, G., Aragona, M. (eds) An Experiential Approach to Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-29945-7_3

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  • DOI: https://doi.org/10.1007/978-3-319-29945-7_3

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