Glossary of Terms

Acting Out: Expressing unconscious emotional conflicts or feelings, often of hostility or love, through overt behavior, thus bypassing conscious awareness and experience of feeling.

Affect: a subjectively experienced feeling state (emotion) and the observable behavior that represents it.

Aftercare: Continuing care services offered to a patient after he or she is discharged from the hospital or treatment program.

Anorexia Nervosa: An eating disorder characterized a misperception of body image. Individuals with anorexia nervosa often believe they are overweight even when they are grossly underweight and take extreme measures to lose weight, often putting themselves at serious physical risk.

Antidepressant: A medication that stimulates the mood of a depressed patient, including tricyclic antidepressants, monoamine oxidase inhibitors and serotonin-specific reuptake inhibitors (SSRI's).

Antipsychotic: A class of drugs primarily used to treat schizophrenic, paranoid, schizoaffective and other psychotic disorders, acute delirium and dementia and manic episodes. However, at low doses, these medications are often used to treat the anxiety associated with BPD.

Antisocial Personality Disorder: a mental illness that is characterized by symptoms of antisocial behavior in which there is little concern for the rights of others. Excessive drinking, fighting and irresponsibility may also occur.

Behavior Modification: The process of working to directly alter a patient's behavior patterns in order to minimize self-defeating trends and heighten productivity and self-satisfaction.

Bipolar Disorder: Previously referred to as manic depressive illness, characterized by the occurrence of mania (euphoria) alternating with bouts of depression.

Borderline Personality Disorder: A personality disorder characterized by extreme instability and impulsivity, fear of abandonment and self-injurious behavior.

Boundaries: In borderline personality disorder patients, the concept of boundaries involves a sense of respect for another person's personal space. Since BPD patients often have difficulty with this, treatment often involves setting limits to teach and underline boundaries.

Bulimia Nervosa: An eating disorder characterized by consuming large quantities of food and then purging behavior through vomiting and/or excessive physical exercise. Bulimia, as well as anorexia, are common co-occurring conditions in patients with borderline personality disorder.

Closed Setting: A characteristic of a psychiatric institution meaning that it does not permit its patients to leave unsupervised areas.

Cognitive-Behavioral Therapy: A type of psychotherapy in which the therapist teaches the patient to restructure his or her cognitive beliefs, (i.e. thought patterns) and hence, behavior.

Co-morbidity: The presence of coexisting or additional diseases with reference to an initial diagnosis. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.

Co-occurring Disorders: Disorders that commonly coincide with a certain condition. An example is bulimia as a co-occurring disorder of borderline personality disorder.

Countertransference: The therapist's emotional response to the transference (see Transference). At times, negative countertransference may cause limitations and interfere with the patient's treatment.

Cutting: A common practice among borderlines to self-injure by cutting their skin with knives or other sharp objects.

Day Treatment Program: A treatment program for psychiatric patients that is comprised of structured daily classes, therapy and activities, but where the patient returns to his/her own home at the end of the day.

Diagnostic and Statistical Manual of Mental Disorders (DSM): A publication put out by the American Psychiatric Association that classifies and defines different psychiatric diagnoses and lists the criteria for them.

Dialectical Behavioral Therapy (DBT): A form of cognitive-behavioral therapy for BPD patients that teaches them skills to reverse their negative thoughts and behaviors. It emphasizes balance between acceptance and change in helping clients with serious psychiatric symptoms, in order to relieve those symptoms and improve the quality of life.

Differential Diagnosis: The determination of which two or more diseases with similar symptoms is the one from which a patient is suffering based on an analysis of the clinical data.

Dual Diagnosis: The co-existence of two conditions. Examples are depression and substance abuse, or schizophrenia and mental retardation.

Electroconvulsive therapy (ECT): Electrically induced seizures primarily used in the treatment of severe affective disorders, depression and schizophrenia

Family therapy: A form of psychotherapy involving treatment of more than one member of the family simultaneously in the same session. For family members of BPD patients, family therapy aims to help them understand, empathize with and learn to cope with the patient's illness.

Group Therapy: A form of psychotherapy where there are multiple patients led by one or more therapists.

Impulse Control Disorders: Disorders that affect a person's judgment or ability to control strong and often harmful impulses, such as verbal or physical violence, substance abuse, eating behavior and sexual promiscuity.

Narcissistic Personality Disorder: A personality disorder characterized by excessive feelings of self-importance and entitlement, a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. These qualities are usually defenses against a deep-seeded feeling of inferiority or of being un-loveable.

Neurotic Personality: A mental disorder in which the predominant disturbance is a distressing symptom or group of symptoms that one considers unacceptable and alien to one's personality. There is no marked loss of reality testing; behavior does not actively violate gross social norms, although it may be quite disabling. The disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress. In general, neurotic personality is a level of mental disorders that is less severe than borderline personality disorder.

Neurotransmitters: Brain chemicals that communicate between nerve cells, and are thought to be largely responsible for a person's feelings, emotions, actions and behavior.

Object Relations: In the behavioral sciences, a school of thought that emphasizes the importance of mental representation of the self and of others. In this theory, an individual's perception of external reality is largely directed by the unconscious internal representation of self an others. This theory proposes that individuals with BPD respond to internal representations that do not adequately match the real people the individual is dealing with. This could explain, for example, why a BPD patient may be convinced that another person is abandoning them when that is not the case.

Obsessive-Compulsive Personality Disorder: A personality disorder characterized by recurrent and persistent thoughts, impulses, or images experienced as intrusive and distressing. Recognized as being excessive and unreasonable even though it is the product of one's mind. These thoughts, impulses, or images cannot be expunged by logic or reasoning

Paranoid Ideation: Ideation, of less than delusional proportions, involving suspiciousness or the belief that one is being harassed, persecuted, or unfairly treated. In some cases, it may be so extreme that reality can no longer be evaluated correctly, and then it becomes part of psychotic illness.

Partial Hospitalization: A level of treatment where the patient spends a certain number of hours at the facility each day and returns to their home at night. Usually for more acute patients than day hospital programs, but less acute than inpatient or residential programs.

Personality: Enduring patterns of perceiving, relating to, and thinking about the environment and oneself. Personality traits are prominent aspects of character that are exhibited in a wide range of important social and personal contexts. Only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress do they constitute a Personality Disorder.

Post-Traumatic Stress Disorder: A diagnosis based on symptoms of fear, terror, helplessness, avoidance of stimuli associated with past trauma, emotional numbing, sleep problems, irritability, hypervigilance, depression, anxiety, and poor concentration. This diagnosis is made when these symptoms follow the experience of a traumatic event.

Projection: A defense mechanism, operating unconsciously, in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others, often the treating therapist.

Psychoanalysis: The method of psychological therapy originated by Sigmund Freud in which free association, dream interpretation, and analysis of transference are used to explore repressed or unconscious impulses, anxieties, and internal conflicts, in order to free psychic energy for mature love and work.

Psychodynamic or Psychoanalytic Psychotherapy: A form of therapy centered around the interaction of various conscious and unconscious mental or emotional processes involved in the patient's interpersonal difficulties, especially as they influence personality, behavior, and attitudes. It is based on psychoanalytic concepts but can be adapted more specifically to BPD.

Psychosis: A severe mental disorder characterized by loss of contact with reality and causing deterioration of normal social functioning.

Schizoid Personality Disorder: A personality disorder marked by extreme shyness, flat affect, reclusiveness, discomfort with others, and an inability to form close relationships.

Secondary Gain: The external gain derived from any illness, such as personal attention and service, monetary gains, disability benefits, and release from unpleasant responsibilities.

Splitting: A mental mechanism in which the self or others are reviewed as all good or all bad, with failure to integrate the positive and negative qualities of self and others into cohesive images. Often the person alternately idealizes and devalues the same person. From a psychoanalytic point of view, splitting is fundamental to borderline personality disorder, and underlies the dramatic shifts in the person's experience of self and others and their difficulty in finding a stable adaptation to life.

Stepping Down: In the course of treatment, when a patient moves from a more intensive level of care (i.e. inpatient care) to a lesser one (i.e. day treatment program.)

Suicidal intent: Having the intention or behaviors suggesting that one is going to take one's own life.

Supportive Psychotherapy: A form of psychotherapy in which consistency, support from others and a hopeful attitude are used to contain and sustain the patient through crisis periods, and encourage small gains over time.

Transference: The unconscious assignment to others of feelings and attitudes that were originally associated with important figures (parents, siblings, etc.) in one's early life. The transference may or may not be a distortion of what actually occurred in early life, since it is based on early experiences as perceived by the developing mind. The psychiatrist utilizes this phenomenon as a therapeutic tool to help the patient understand emotional problems and their origins. In the patient-physician relationship, the transference may be negative (hostile) or positive (affectionate). In BPD, the transference often alternates between negative and positive.

Transference-Focused Psychotherapy (TFP): A specialized version of psychodynamic psychotherapy including an emphasis on certain aspects of psychoanalytic theory and modifications of some techniques of psychodynamic therapy in order to adequately address the special problems of borderline patients. Its roots are in the object relations model and the ensuing emphasis on transference as the key to understanding and change in the patient, since it is believed that the patient's internal world of object representations unfolds and is “lived” in the transference.