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Journal of Personality Disorders, 6(3), 226-240, 1992 © 1992 The Guilford Press


Lee C. Park, MD, John B. Imboden, MD, Thomas J. Park, PhD, Stewart H. Hulse, PhD, and H. Thomas Unger, MD

(Click Here to view a poetic and pictoral metaphor for Borderline Personality Disorder)

From the Johns Hopkins University, Baltimore, MD (Dr. L. Park, Associate Professor of Psychiatry; Dr. Imboden, Associate Professor of Psychiatry and Psychiatrist-in-Chief, Sinai Hospital of Baltimore; Dr. Hulse, Professor and Chairman, Department of Psychology; Dr. Unger, Instructor in Psychiatry) and the University of Texas (Dr. T. Park, Research Fellow, Department of Zoology). An earlier version of this paper was presented at the Department of Psychology, University of Texas, Austin, March 9, 1990. We thank Carol Hicks, Mary W. Park, and Stephanie S. Reynolds for critical assistance in library and data base searches, and for editorial review; and Dr. Lee Willerman and two anonymous reviewers for their pertinent advice. We wish to express profound gratitude to the patients who contributed to this study (18 of whom also reviewed the completed manuscript) and who hope their experiences will help others. Address correspondence to Dr. Lee Crandall Park, 1205 York Road, Suite 35, Lutherville, MD 21093.

This clinical study of 23 borderline outpatients and 38 outpatients with other personality disorders provides evidence that individuals who become borderline frequently have a special talent or gift, namely a potential to be unusually perceptive about the feelings of others. We postulate that this talent is derived from an innate characteristic rather than simply arising from early environmental influences. We also present evidence that chronic, severe, pervasive psychological abuse, or "mind abuse," is the most frequent and significant form of caretaker abuse (vs. sexual or physical) in the childhood histories of this disorder. Our data support the hypothesis that the interaction of a child's gifted characteristics with this abuse creates a tragic drama that is etiological for BPD in a substantial number of cases. We propose that the abuse markedly perverts not only use of the perceptual talents (e.g., powerfully compelling projective identification) but overall psychological development. We discuss how these issues are relevant to the conduct of effective therapy.

Almost all clinicians who have significant experience with borderline patients are impressed at times with their exceptional ability to sense psychological characteristics of significant others in their lives, including therapists. This ability tends to be coupled with the manipulative induction of feelings like those the patients themselves experience, that is, projective identification (Kernberg, 1975; Ogden, 1982). Patients may also employ this talent in engendering strong rescue and attachment responses, as well as disagreements, quarrels, or "splits" among those who are involved in their lives, for example, between members of the family or clinic staffs, especially inpatient staffs (Adier. 1985; Gunderson, 1989; Gutheil, 1989).

It is our hypothesis that the significance of this talent goes far beyond these particular symptomatic manifestations of the disorder. We assert that there is an inborn talent and need to discern the feelings and motivations of others, and, to emphasize its positive value as well as its innateness, we choose to refer to this characteristic as a gift. Much as one would refer to the mathematically gifted person or the musically gifted person, we believe many borderline patients have a cognitive giftedness in the area of self- and other-perceptiveness called "personal intelligence" (Gardner, 1983, 1985). This talent has remained unrecognized both because it occurs in very perturbed individuals for whom it is generally unavailable in a conscious fashion, and because it is embedded in the service of self-protection, neediness, control, and rage.

Under favorable circumstances an infant born with this gift would not, of course, grow up to have borderline personality disorder (BPD). We assume that such persons, given other healthy attributes and an appropriately nurturing environment, would grow up to become particularly successful in their relationships and careers. But what of the infant whose primary caretaker has defective capacity to be empathically attuned to others, even resents or is threatened by an unusually perceptive child and responds by psychologically abusing the child?

We are proposing the etiological hypothesis that BPD frequently results from the interaction of two factors (Gunderson & Zanarini, 1989), one of them biogenetic, the giftedness; and the other a disturbed parental involvement factor, severe, chronic verbal/psychological abuse by caretakers during infancy and childhood. The psychological abuse may differ in many ways from child to child, but it always includes chronic resistance to or assault on the healthy development of a child's perceptions and sense of an autonomous self. This abuse is so threatening and damaging that any intuitive talents become almost totally directed to pathological patterns of relating that are the basis for the characteristic, perhaps pathognomonic (Zanarini, Gunderson, Frankenburg, & Chauncey, 1990) interpersonal powers of these patients. Attachment theory (Bowlby, 1988) can explain the clinical manifestations of BPD as resulting from the interaction of these two factors, without assuming other biogenetic factors such as inborn abnormal personality traits or defects (Soloff & Millward, 1983). However, since there may be a number of combinations of innate and environmental factors that facilitate development of BPD, studies of borderline individuals in various populations are required to determine the validity and clinical significance of any etiological hypothesis (Millon, 1987; Stone, 1990a).

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