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"Life is like a ship in a stormy sea without a keel," says New York psychiatrist Frank Yeomans.
If interacting with a borderline is confounding, the condition is highly disruptive to borderlines themselves.
And borderlines often become hostile to their helpers.
But the availability of dialectical behavior therapy, an emerging understanding of the roots of the disorder, and a disentangling of the behaviors that characterize it have all begun to brighten the outlook for borderline patients.
"One day I'll be wearing Lilly Pulitzer and pearls and playing the role of a perfect Southern belle; the next I'll be dyeing my hair black, wearing tie-dye and hemp necklaces, smoking pot and listening to The Grateful Dead," writes borderline sufferer Jennifer O'Brien.
"Each time he traveled, I would become a complete and total mess—ending up in the emergency room dehydrated and having not eaten." The fear of abandonment commonly drives borderlines to seek confirmation that they truly matter.
Borderlines are quick to assume others are excluding them—and quick to react to that perceived rejection.
"Say you're having dinner with a borderline person and someone else comes into the room, and you start a conversation with that other person," Gunderson offers.
In practice, it could mean interrupting a boyfriend during an important work meeting or showing up at his doorstep in pajamas in the middle of the night.
"I feel I'm going to die if I can't contact the person," says "Kim," a 32-year-old mother from the Northeast who was diagnosed as borderline several years ago.
Emotional dysregulation and impulsivity are at the disorder's core.