Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution

• Published in: European archives of psychiatry and clinical neuroscience Vol. 270; no. 8; pp. 941 - 945
• Main Authors: Ducasse, Déborah, Van Gordon, William, Brand-Arpon, Véronique, Courtet, Philippe, Olié, Emilie
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2020; Springer Nature B.V; Springer Verlag
• Subjects: Addictions; Borderline personality disorder; Human health and pathology; Impulsive behavior; Invited Review; Life Sciences; Medicine; Medicine & Public Health; Neurons and Cognition; Neurosciences; Ontology; Pain; Personality; Personality disorders; Psychiatrics and mental health; Psychiatry; Psychotherapy; Public health; Self-injury; Suicide; Suicides & suicide attempts; Affective disorder; Dimension; Borderline personality disorder; Ontological addiction
• ISSN: 0940-1334; 1433-8491
• DOI: 10.1007/s00406-019-01029-6

Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as “a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity”, is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.