This article is published in the book:

"Psych 101 -
What you didn't learn in nursing school."


by Kathi Stringer
Paperback: 320 pages
ISBN-13: 978-0615193137
Order
   

Borderline Personality Disorder,
Stress and Mood Swings

Written by Kathi Stringer

Question

My friend is facing a lot of stress in his own life and has become even more moody and sometimes quite distant. Then he suddenly latches on again for reassurance. Is this typical behavior? The dark mood seems to be engulfing as the stress on him increases. He lashes out in anger and then regrets are expressed within a day or 2....

Answer

The degree of apparent moodiness sometimes correlates with two operands, stress and the degree of poorly integrated internal objects. The more primitive and unintegrated the personality structure, the more confusing the behavior appears since it oscillates at times rapidly. The primary defense is splitting or primitive dissociation and becomes more pervasive as emotions rise leading to intense regression.

When triggered, TIME for most individuals with borderline personality disorder becomes narrowed or pressured. The focal point is acute giving rise to a sense that immediate action is necessary to ward off overwhelming anxieties. Since each internal object is associated with its own affect and lacks a global cohesiveness, then mood seems to change as rapidly as the individual with borderline personality disorder focuses on different external objects with analogous qualities. [1] Kernbreg stated, “Primitive transferences are rapidly mobilized, highly distorted, fragmented, and ephemeral. They reflect the patient’s lack of a stable sense of self or significant others.”

For example, under stress, repressed object representations (love or hate from the past) are reactivated and resurrected from the there-and-then with their accompanying affects (emotions) into the here-and-now. The old objects that are resurrected with the old emotions that go with them are ‘transferred’ onto another person. In reality, the old objects and affects are a distortion (belonging to a past event) but they are amplified in the transference. One may think, “I have awoken the monster within.” Which sounds about right because without stress, it is far easier to manage what is real, with what is not real (the past). Under stress, the fragile system goes on the blink and everything gets lumped together, old material with new material. Since unintegrated objects have binding affects, the individual with borderline personality disorder experiences the situation as dynamically intense in the present as they had in the past because stress lowers the threshold of ego strength.

If it seems extremely confusing to the observer, imagine the confusion due to the inability to integrate thoughts into the secondary process of the executive ego in the borderline individual.

One of the primary goals of psychodynamic psychotherapy is to integrate the compartmentalized objects from a primitive fixation that is insufficiently integrated (part-objects) into a more advanced and continuous global object relations. Work moves to establish an observing ego so that one hand knows what the other hand is doing (thinking).

Why: Splitting, primitive dissociation, projecting part objects and representations, primitive transferences, and STRESS.

Solution: Development of an observing ego and integration of fragmented self into a more global object representation. Stress management.

Reference:

1. (1989) Psychodynamic Psychotherapy of the Borderline Patients / Kernberg, Selzer, Koenigsberg, Carr and Appelbaum.
[Book Link]