My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.
Following are the notes of a simulated first therapy session with Do, a female, 26 years old, diagnosed with borderline personality disorder.
Do is an attractive young woman, but seems to be unable to maintain a stable sense of self-worth and self-esteem. Her confidence in her ability to hold on to men is at a low ebb, having just parted ways with the love of her life.
In the last year alone, she confesses to having had six serious relationships. Why didn’t all these relationships end, inquires the psychotherapist.
Irreconcilable differences, the answers. Commencement of each affair was a dream come true, and the men were all-in-one Prince Charming.
But then she invariably found herself in the stormy throes of violent fights over seeming trifles. She tried to hang on there, but the more she invested in the relationship, the more distant and vicious her partners became. Finally, they abandoned her, claiming that they are being suffocated by her clinging, and drama queen untucks.
Is she truly a drama queen, asks the therapist?
She shrugs, and then becomes visibly irritated, her speech slurred, and her posture almost violent as she bends forward.
No one f’s with me. I stand my ground. Get my meaning?
She admits that she physically assaulted three of her six lost paramours. She hurled things at them, and amidst uncontrollable rage attacks and temper tantrums, even threatened to kill them.
What made her so angry? She can’t remember now, but it must have been something really big because by nature, she is very calm and composed.
As she recounts these said excludes, Do, patient, alternates between boastful swagger and self-chestizing, biting criticism of her own traits and conduct, and boastful statements.
Her affect swings wildly in the confines of a single therapy session between exuberant and fantastic optimism and unbridled gloom.
One minute, she can conquer the world. She’s fearless, and she’s free at last. The next instant, she hyperventilates with unsuppressed anxiety, bordering on a panic attack.
One minute, she says, it’s their loss. I would have made the perfect wife had they known how to treat me right.
The next split second, she says, I am not getting younger, you know. Who would want me when I’m 40 and penniless?
Dan, the patient, likes to live dangerously on the edge. She does drugs occasionally, it’s not a habit, it’s just for recreation.
She assures the therapist. She’s a shopaholic and often finds herself mired in this.
She went through three personal bankruptcies in her short life and blames the credit card companies for doling out their wares like so many pushers.
She also binges on food, especially when she’s stressed or depressed, which seems to occur quite often.
She’s so unhinged because she’s having intrusive thoughts about killing herself.
Her suicidal ideation often manifests in minor acts of self-injury and self-mutilation, and she shows me a pair of pale, patched wrists more scratched than slashed actually.
Prior to such self-destructive acts, she sometimes hears derisive and contemptuous voices, but she knows that they are not real, just reactions to the stress of being the target for persecution and vilification by her former mates.
Dan, 26 years old, a borderline personality disorder patient.
