Importancia de la GpP en la gestión pública

The Diagnostic and Statistical Manual for Mental Disorders (APA, 2013, p. 658), describes borderline personality disorder as: “…a pervasive pattern of instability of interpersonal

35

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 the following:”

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

3. Identity disturbance: An unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).

5. Recurrent suicidal tendencies or self-mutilating behaviour.

6. Emotional instability due to marked fluctuations of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). Chronic feelings of emptiness may also occur.

7. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).

8. Transient, stress-related paranoid ideation or severe dissociative symptoms. Borderline personality disorder was first ‘identified’ in the 1930s when clinicians encountered troubling groups of patients who did not fit into the usual categorisation of psychoses or neuroses (Bateman & Krawitz, 2013). “The term ‘borderline’ referred to the belief at the time that this group of people were on the ‘border’ between ‘neurotic’ and ‘psychotic’ (Bateman et al., 2013, p. 2). After the 1950s, borderline personality disorder was used to describe patients who were neither neurotic nor psychotic but rather ‘problematic’ (Gunderson, 2010). It was only during the 1980s that borderline personality disorder was considered to have sufficient validity as a personality disorder to be included into the DSM manual of psychiatry (Widiger, 2012).

36

Borderline individuals show high levels of impaired social functioning and experience negative emotions (e.g. episodes of impulsive aggression, self-injury and drug and alcohol abuse) if they are in a relationship in which they perceive that their emotional needs are unrequited. They are extremely sensitive to feelings of rejection, criticism, isolation and perceived failure. The moment borderline individuals sense that they do not get what they need from a relationship they can become angry and frustrated (Hines, 2008). According to the DSM-5, when borderline individuals feel cared for and supported in a relationship signs of depressive features (e.g. loneliness and emptiness) will diminish. As soon as this caring relationship is under threat and there is a fear of losing the relationship the partner is devalued and demonised. The fear of abandonment and loneliness will cause the borderline individual to experience intense anger and rage (Hines, 2008). The borderline individual is said to be ‘splitting’ objects into two categories namely the good side of a person that they find acceptable and the bad side which they find ‘painful’. There is no middle ground for these individuals; according to them a person is either all good or all bad (Hales, Yudofsky & Roberts, 2014).

Borderline personality traits are often associated with functional impairments of which uncontrolled aggression is one of the most commonly seen (Latalova & Prasko, 2010; Leichsenring, Leibing, Kruse, New & Leweke, 2011). When individuals with borderline personality disorder engage in aggressive behaviour it is normally directed towards an intimate partner (Newhill, Eack & Mulvey, 2009; Sansone R., & Sansone L., 2012).

“Individuals with borderline traits may have deficits in self-regulation that make them more likely to behave aggressively, and their violence may in turn spark more aggressive responses by their partner” (Maneta, Cohen, Schulz & Waldinger, 2013, p. 240). The findings of two studies (Holtzworth-Munroe, 2000; Costa et al., 2008) revealed that men who abused their partners commonly evidenced borderline personality features.

37

The borderline individual experiences rapidly changing emotions (e.g. from happiness to sadness and anger to despair) which make them unpredictable and unstable (Widiger, 2012). These individuals show signs of extreme instability which normally lead to impulsive and self-destructive behaviour (e.g. self-harm such as cutting or burning themselves, suicide, substance abuse, and eating disorders) (Hales et al., 2014). More or less 10% of people diagnosed with borderline personality disorder commit suicide before the age of 40 (Black, Blum, Pfohl & Hale, 2004; Oldham 2006).

Little is known about borderline personality disorder and intimate partner violence due to biases in the conceptualisation of borderline personality disorder as a female disorder (Newhill et al., 2009). Individuals with borderline personality disorder are not only at a higher risk of getting hurt but also hurting of others (Drapeau & Perry, 2009). Zanarini, Frankenburg, Reich, Hennen & Silk (2005) found that women with borderline personality disorder are at a higher risk for experiencing domestic violence.

In an international study conducted with 67 university sites from around the world it was confirmed that borderline personality was linked with intimate partner aggression in both men and women (Hines, 2008). The results of the study indicated that borderline personality predicts physical, psychological, and sexual intimate partner aggression in nonclinical

samples (Hines, 2008). Borderline personality features which includes self-harming behaviour, fear of abandonment, anger, jealousy, impulsivity, and emotional volatility are risk factors that predict intimate partner aggression (Hines, 2008). I believe that the findings of the study conducted by Hines can be compared to South Africa because the study took place across 67 worldwide universities. This means that a greater variety of the population had been tested for the link between borderline personality features and intimate partner aggression.

38

Individuals that have been diagnosed with borderline personality disorder often report a history of major family problems, domestic violence in the family of origin as well as violent punishment and abuse during childhood (Kendall et al., 2009).