•extremely intense response to Jimmy which may be indicative of criterion # 8, inappropriate intense anger…
•relatively short tenure with the publishing house, which may, upon investigation, be indicative any number of reasons that are related to this disorder, including:
recurrent job losses due to a pattern of undermining oneself at the moment a goal is about to be realized, perhaps due to criterion # 9, paranoid thinking (Kapuchinski, 2007, p. 124).
highly unpredictable behavior which often results in only a rare achievement of the level of an individual’s ability (Kaplan and Sadock, 1991, p.534).
poor stress tolerance which might cause one to impulsively walk away from a job; cause frequent changes in career and training plans; or create workplace dangers due to unpleasant interactions or violence (Fischler and Booth, 1999. pp.124-125).
This may also be attributed to criterion # 2, a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. As a result of this splitting, shifts of allegiance from one person or group to another are frequent (Kapuchinski, 2007, pp. 124-125; and Kaplan and Sadock, 1991, p.534).1`
•interest in a man who is (a) married and (b) has not really expressed an interest in her which may be indicative of criterion # 4, impulsivity…
Once again, these are just clues that may be part, not all, of the diagnostic criteria. In and of themselves, these behaviors do not necessarily meet the criteria for the diagnosis of BPD as stated in the following DSM-IV-TR (APA, 2000, pp.27-35) multiaxial diagnostic system for categorizing mental disorders which guides clinical practice, research and education:
Axis I
Clinical Disorders
Other Conditions That May Be Focus of Clinical Attention
Axis II
Personality Disorders
Mental Retardation
Axis III
General Medical Conditions
Axis IV
Psychosocial and Environmental Problems
Axis V
Global Assessment of Functioning (GAF)
Axis I disorders include, but are not limited to, Schizophrenia and Other Psychotic Disorders, Mood Disorder, Anxiety Disorders and Substance-Related Disorders.
Axis II disorders include Mental Retardation and Personality Disorders which are grouped into three clusters, i.e., Cluster A (odd and eccentric) Paranoid, Schizoid, Schizotypal; Cluster B (dramatic, emotional or erratic) Antisocial, Borderline, Histrionic, Narcissistic;
and Cluster C (anxious and fearful) Avoidant, Dependent, and Obsessive-Compulsive.
Axis III is for reporting current general medical conditions that are potentially relevant to the understanding or management of the individual’s mental disorder.
Axis IV includes problems with one’s primary support group, social environment, educational, occupation, housing, economic issues, access to health care services, interaction with the legal system/crime, and other psychosocial and environmental problems such as exposure to disasters and difficulty with caregivers and social agencies.
Axis V is a rating determined by the GAF Scale that considers psychological, social, and occupational functioning and symptom severity on a hypothetical continuum of mental health-illness from 0 (inadequate information), 1(persistent danger of severely hurting self or others) through 100 (superior functioning in a wide range of activities, life’s problem’s never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms).
The DSM-IV-TR criteria for BPD, (APA, 2000, p. 710) an Axis II diagnosis, is, “a pervasive pattern of instability of interpersonal relationships , self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by five (or more),” of nine criteria that will be discussed in depth throughout this study guide. Any of the criteria may be present with other disorders. For that reason, at least five must be present to meet the diagnostic criteria for BPD. Similarly, many people, at one time or other, may experience any of the nine criteria, thus, the symptoms must be pervasive, not just in response to one relationship or one event (Warner, 2004, PP.8-9).
Scene 3: Are You Discreet?
This scene, similar to the previous scene, provides more clues that Alex may fit the diagnostic criteria for BPD rather than actually providing specific evidence to make such a diagnosis. She acts on the opportunity to seduce Dan and, in and of itself, her action and reasoning seem sound, i.e., Dan’s wife is out of town for the week-end, Alex is attracted to Dan, both are adults and both agree to be discreet.
The clues appearing in this scene are:
•a pattern of undermining oneself at the moment a goal is about to be realized. This is exemplified by Alex’s response to Dan when he lets her know that he is willing to be a “naughty boy” with her and the decision as to whether to go ahead and act on it will be up to her. After successfully seducing him, she cuts him down by telling him she has not yet made up her mind as to whether she wants to go forward.
•seducing a man that she barely knows and who is not available for a relationship with her may be indicative of criterion # 4, impulsivity…
People with BPD cannot tolerate being alone. Thus, they “prefer a frantic search for companionship, no matter how unsatisfactory, to sitting by themselves. To assuage loneliness, if only for brief periods, they accept a stranger as a friend or are promiscuous.” (Kaplan and Sadock, 1991, p.534).
Scene 4: One Night Stand
Given the opportunistic circumstances stated in the previous scene, Dan and Alex have a sexual evening and, then, an enjoyable night out dancing together. Dan implies that the liaison has reached its end after he escorts Alex to the building where she lives and, at the entrance, inquires about where he can find a cab. Alex nonverbally lets him know that she is not of the same mind as she gently pulls him into the building, then, more aggressively, into the elevator where she locks the elevator door and sexually seduces Dan. When Dan’s is depleted of energy he unlocks the elevator and walks Alex to her apartment door. Dan’s nonverbal communication suggests that he, once again, intends to go his own way. Alex blocks the communication with a sexual gesture and a quick movement into her apartment, nonverbally suggesting that Dan follow, which he does and he spends the night.
This scene begins to provide a piece of evidence for the diagnosis for Borderline Personality Disorder as well as a new clue:
•The piece of evidence is the impulsivity Alex demonstrates by the act of having sex with a man she barely knows. This meets a part of criterion # 4 (APA, 2000, p. 710) which states, “impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse,
