Susanna Kaysen and Borderline Personality Disorder

In the book Girl, Interrupted, the young female character Susanna Kaysen offers as herself meets the criteria for Borderline Personality Disorder (BPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders 4th Ed, although meets the relatively less crippling conditions of the disorder. Kaysen fits into basic age-range of the disorder as proposed in the DSM-IV, having BPD characteristics present by “early adulthood.” To be diagnosed with BPD, Kaysen must meet five of the nine decisive factors listed in the DSM-IV. Clues from her autobiographical account can be used to verify or dismiss each criterion.

Kaysen suffers from an identity disturbance as detailed in the DSM-IV. Her “unstable self-image” often oscillated between perceiving herself as having a mental disturbance and her not having one. During her short time as a professional typist, she found herself as the “one person who had trouble with the rules. Everyone else accepted them.” Yet, her strong beliefs against the rules contrasted with the social message that she was disruptive. She described her mental processes as a conversation between two interpreters, a conversation that is often contradictory. Even after leaving the hospital as a supposedly recovered patient, Kaysen questioned whether she had been perhaps purposely “flirting with madness” the way she flirted with others in her life. This instability of her understanding of herself supports Kayson meeting third criterion for BPD.

Kaysen also suffered from “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.” Her persistent thoughts of suicide resulted in a serious attempt. The mental unrest that led to Kaysen’s attempted suicide manifested itself as self-mutilating behavior once she began in-patient treatment. “I spent hours in my butterfly chair banging my wrist.” She admitted this was self-mutilating behavior and discussed other behavior of this type, such as face scratching. This sort of activity accounts for the fifth criterion for BPD.

The DSM-IV calls for an “affective instability due to a marked reactivity of mood,” such as “intense episodic dysphoria, irritability, or anxiety usually lasting a few hours.” Kaysen often became irritated by customary stimulation of everyday life. For example, while visiting the ice cream parlor, and other places, she would become fixated and internally aggravated by the shape and contrast of the checkerboard tiles. “The contrast got under my skin. I always felt itchy at the ice cream parlor.” Kaysen also discussed an overexcited state of mind that she called “velocity.” She often reverted to this frenzied thought process when confronted with seemingly ordinary situations. This pattern of reactivity suggests Kaysen meets the sixth criterion for BPD.

Another criterion for BPD, as put forth in the DSM-IV, is “chronic feelings of emptiness.” Kaysen thought of her personality as broken, a notion associated with feelings of emptiness. “I imagined my character as a plate or shirt that had been manufactured incorrectly and was therefore useless.” In fact, Kaysen claimed her feelings were beyond emptiness: “Emptiness and boredom: what an understatement. What I felt was complete desolation. Desolation, despair, and depression.” These self-reported qualities strongly suggest Kaysen meets the seventh criterion for BPD.

Finally, Kaysen endured “transient, stress-related paranoid ideation or severe dissociative symptoms,” which the DSM-IV suggests as properties of the borderline personality. While debating to commit suicide in the period before her admittance, Kaysen explained, “Anything I thought or did was immediately drawn into the debate. Made a stupid remark—why not kill myself?” This sort of idea creation in the face of stress is typical of BPD. “Paranoid ideation” came to Kaysen not only as unhealthy thought formation, but also as ideas of reference. She believed the Vermeer painting in the museum had a special message just for her. “She was warning me of something—she had looked up from her work to warn me.” Still, her dissociative symptoms surpassed her paranoid ideation. Kaysen suffered from the dissociative mindset of depersonalization. She often dissociated her thoughts from her body and saw herself from an outside perspective, where she became to herself an object to be prodded and examined. In one such episode, her self-concept degraded into an understanding of herself as first a monkey, and then just ordinary matter. She became restlessly unsure as to her own material composition and whether or not she was in fact a human. “I started to get worried. Where were my bones? I put my hand in my mouth and bit it, to see if I crunched down on something hard… I was getting really nervous. Oh God, I thought, there aren’t any bones in there, nothing’s in there.” These exceedingly paranoid internalizations demonstrate Kayson meets the ninth criterion for BPD.

Ultimately, Kaysen meets the criteria for BPD because she qualifies for five of the disorder’s criteria. An example of a criterion her character as portrayed in Girl, Interrupted does not meet includes the first criterion, “frantic efforts to avoid real or imagined abandonment.” Kaysen often expressed wishes to be alone. After abandoning her husband, she avowed, “I wanted to be going on alone to my future.” Kaysen repeatedly articulated discomfort with being monitored in the hospital, a schedule of social affirmation others with BPD might find comforting. She also does not seem to meet the criterion that calls for “inappropriate, intense anger.” Perhaps the author left out accounts of her own displays of temper or instigation of physical fights. Still, her character meets the criteria for BPD, albeit a less aggressive and more internalized form of the disorder.