Lighthearted confab #1: How to diagnose Borderline PD from the face and voice*

I’ve written a few pieces on the nature of personality disorder,** presenting some ideas grounded in Masterson’s theory that traces its formation to a neurotic mother-infant separation-individual phase (age one to three). The personality disordered individual has remained unformed, a child. This would be fairly apparent in the childish or “emotionally primary” Borderline, Dependent or Histrionic, but even more decisively though less visibly in the Narcissist or psychopath. Consider our “man-baby” president, Trump. Has there ever been, in all present generations’ experience, a more obliviously immature incongruity of sick child’s painful feeling and irrationality with the gossamer veneer of adult character? Logic would then take us one more step to see perinatal abortion in the murderous psychopath. This is someone whose heart burned out in birth and infancy. Everything after that became self-medication of pain and therefore a life of agenda and manipulation in the social realm. Clearly this person could never grow.

The Borderline’s face and voice typically exude out-of-place youth. We can’t diagnose based on those signs, but once we’ve determined that the woman cannot parent competently, deals with stress by, essentially, holding her breath ’til she turns blue, feels abandonment extremes, has a rice paper-thin sense of identity, we re-look at the goofy, childlike twisty or coy or vicious mouth, hear the strangely unpleasant lilting voice, and know. There will sometimes be the same phenomenon Lowen noted in the Narcissist: His face is years younger than his chronological age, as narcissism has caused the burdens of life to waft over him.***

Personality disorders can be difficult to diagnose, in part

because defense and immaturity exist on a continuum. We know adolescents and adults who are egotistical but not Narcissistic; immature, impulsive men or women who are not Borderline; subservient, domestic violence victims who are not snugly Depen­dent; someone capable of transient cruelty who doesn’t qualify for Antisocial Personality.**

I think it is acceptable, then, to listen to the voice, observe the face, and get a good first clue. From the ground of that prejudice, we’d then check ourselves brutally for a long time, trying to disprove that impression at every turn until little could deny it.

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* Disclaimer: This is nonsense, though with a smidgen of reality.

** https://pessimisticshrink.blogspot.com/2014/01/normal-0-false-false-false-en-us-x-none.html, https://pessimisticshrink.blogspot.com/2019/01/definition-personality-disorder.html, https://pessimisticshrink.blogspot.com/2014/09/in-house-3-youthfulness-and-personality.html.

*** “Though the story of Dorian Gray is fiction, the idea that a person can present a physical appearance that belies the inner state of his being is valid. I have been struck by how many narcissistic individuals look much younger than they are. They have even features and smooth complexions, which do not show any lines of worry or trouble. These people do not allow life to touch them – specifically, they don’t allow the inner events of living to reach the surface of their minds or the surface of their bodies. This constitutes a denial of feeling.” Narcissism, Denial of the True Self. Alexander Lowen, M.D., Simon & Schuster, 1985, p. 38.