Borderline personality disorder (BPD) is a severe and complex personality disorder associated with instability in interpersonal relations, behavior, and emotions. Emotional dysregulation is a key contributor to BPD, involving difficulties in regulating emotions in order to support an individual’s pursuit of goals and behaving effectively in a variety of contexts.

Anger and aggression are key features associated with BPD — most often related to fears of abandonment, unstable relationships, an unstable self-image, emotional instability, and chronic feelings of emptiness. As such anger may be sudden, intense and difficult to calm down. When more intense, it is often described as “borderline rage”.

The character Alex Forrest (played by Glenn Close) offers a powerful representation of a woman suffering from borderline personality disorder in Fatal Attraction. In the pursuit of her relationship with Dan Gallagher (played by Michael Douglas) she exhibits many of the symptoms of BPD including rage, unstable self-image, fears of abandonment and violence.

The symptoms of borderline personality most often first appear during teenage years and early twenties worked with one young man early in my practice who clearly articulated the impact of “feeling empty”. On one occasion he stated, “How am I supposed to know what career I wish to pursue? I have no idea what I like. I don’t know who I am!” Another client reported getting drunk on weekends and seeking to have a physical altercation. It was as if this gave him some meaning against a blank slate presented by the weekend.

The fear of abandonment or rejection as well as sensitivity to frustration and stress can easily lead to a heightened sense of threat. The lack of a solid identity combined with feelings of emptiness leaves one with BPD vulnerable to feeling criticized, slighted or rejected, which consequently intensifies fears of being alone. The lack of a more solid self-image, coupled with a pattern of unstable interpersonal relationships combine to undermine the resilience to stress and challenging emotions.

There are a number of biosocial developmental models regarding the development of borderline personality disorder. These emphasize developing in an environment that is invalidating and having adverse childhood experiences in combination with genetically linked vulnerabilities. Specifically, these might include impulsivity and emotional instability.

Some of these theories highlight specific areas of functioning as providing an understanding of emotional triggering for individuals with BPD. Some focus on emotional regulation. Others focus on cognitive aspects, including cognitive-emotional patterns that cause those with BPD to have greater........

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