Borderline Bodies: Affect Regulation Therapy for Personality Disorders

A bold look at the body as a source of contention for those who suffer from personality disorders.

This work connects interpersonal neurobiology, attachment theory, and psychoanalytic theory with cognitive and neuroscientific work on implicit memory, trauma theory, and dissociation to propose an integrated method for treating severe borderline and narcissistic disorders, with the prime aim of resolving the affect dysregulation that affects the various realms of bodily discomfort and existential pain.

Each chapter presents a particular case and illustrates the methods for working with the specific problems that arise: from bulimia to self-cutting to sexual identity diffusion to suicidality. Treatment is illustrated from the initial level of careful diagnosis to the first stages of the interaction to the further steps and development of the interpersonal work of the dyad patient-therapist, including powerful enactments.

In accessible language that references psychodynamic and relational psychoanalytic theory, the book proposes a revision of the etiopathogenesis of personality disorders, starting from the traumatic interpersonal exchanges (early relational trauma, maltreatment, deprivation, and abuse).

The book breaks new ground on several levels. For the first time the body is accorded full attention in the treatment: developmentally and epigenetically situation as it is "in-between" the self and the other (at first, the caregiver, then in other circumstances of upbringing and traumatic personal relationships). The body is viewed as the main vehicle of this dysfunctional development, so that both the body and the subject are at once the "victim"―the recipient of the dysregulation resulting in impulsivity, destructiveness, self-harm, or eating disorders―and the internalized persecutor, i.e. the abuser of one's own body that sometimes also becomes the aggressor of others.

Profoundly humane and scientifically sound, this book is a must-read for professionals, clients, and families involved in the difficult task of relieving the symptoms and reorganizing the personalities of subjects living in "borderline bodies."