Borderline Personality Disorder in the Pandemic Situation in Indonesia

1.1. Study 1

Interaction among individuals that have enough affection becomes a great input and guide to the individuals in problem-solving. However, too much affection in it will result in dependence. This is often referred to as borderline personality disorder [1]. According to Wong [2], borderline personality disorder (BPD) is a personality that can be found in people from all cultures. The causes of individuals experiencing BPD in an area/country need to be known for prevention because individuals with BPD can do risky things.

Since the Coronavirus disease (COVID-19) became a pandemic, WHO instructed the public, including people in Indonesia, always to wash their hands, wear masks properly and keep physical distance from others. This makes people unable to do many activities. The instruction can minimize the transmission of the COVID-19 virus, but it impacts the psychological condition of the individual, such as post-traumatic stress symptoms, confusion, and anger. Stress is also due to the long quarantine duration, fear of infection, frustration, boredom, inadequate supplies and information, and financial loss. Therefore, Brooks, et al. [3] suggest that if quarantine is deemed necessary, officers should quarantine individuals no longer than it needs.

Individuals with borderline personality disorder (BPD) feel more stressed than others during the pandemic because in the DSM-5 del Barrio [4] stated that individuals with BPD often experience a fear of being alone and often feel empty. Even though the pandemic is almost over, individuals with BPD still feel the effects of the pandemic. The researcher gained this data from several clients who said that the pandemic conditions still impacted them. Therefore, they always need the presence of others to accompany them. If these needs are unmet, they can engage in risky behavior to attempt suicide to get attention. In his research, Preti, et al. [5] conclude that people with Cluster B personalities (including BPD) exhibit stress-related reactions and impulsive and risky behavior during this pandemic. Individuals with BPD will have difficulty regulating emotions, fear of abandonment and rejection. This condition is painful for individuals with BPD.

Several researchers have concluded that the factors causing BPD consist of neurobiology [6, 7] childhood trauma [8-10], attachment [11-13], coping [14, 15] and social support [16, 17]. Childhood trauma is a child’s perception of parenting that involves parent’s antipathy, emotional neglect, physical and psychological violence, sexual abuse and witnessing other violence committed by close people [10]. Riggs [18] explored a cold, and inconsistent parenting can cause childhood trauma. Furthermore, adult attachment also plays a role in BPD. Hasan & Zeifman [19] referred to attachment to human behavior from babies to adulthood. One could measure the attachment by observing several aspect, such as being safe, intimacy, protection, stress upon farewell and sexual relationship. Attachment theory provides a broad yet parsimonious explanatory framework for understanding the development, maintenance, and treatment of personality pathology [20].

Coping also gives effects on BPD. According to Greenglas, Shwarzer, & Jakubiec [21] no coping is negative when taken with the right measure. In proactive coping, individuals have the initiatives in solving their problems, obstacles will become opportunities, start thinking of steps to take before doing something. They can learn from their own experiences when they solve problems in the past.

These studies were conducted in the West, and the results differed from the research conducted by Wibhowo, et al. [22] The study concluded that childhood trauma, social support, and adult attachment did not directly contribute to BPD. Other factors become mediators, namely proactive coping. This shows that there is a gap between the studies. Therefore, it is necessary to re-examine the factors causing BPD as knowing the causative factors of BPD is very important for prevention.

This research consists of two stages, as follows:

1. Mapping the factors causing BPD

2. Knowing the proactive coping used by participants

To prove the role of the factors causing BPD, it is necessary to investigate individuals aged 18-30 years. The reason for choosing this age is that BPD can be diagnosed starting at 18 years. In addition, this age range is included in emerging adulthood, when individuals face challenges toward maturity [23, 24]. If the individual can go through it without a personality disorder in the emerging adult period, then the individual will be happier. Individuals aged 18-30 years are active internet users, so knowing the factors that cause BPD at that age can be done onsite or online.

The hypotheses in study 1 are:

1. There is a direct effect of CA on BPD

2. There is a direct role of the SS towards BPD

3. There is a role for CA and SS via PC against BPD

The hypothesis in study 1 can be illustrated as shown in Fig. (1).

1.2. Study 2

Coping is the individual's way of reacting when they are facing problems. Grebot, Paty, & Girarddephanix [25] conclude that there are similarities between defense mechanisms and coping. Repression in the defense mechanism is the same as an escape in coping. Denial (defense mechanism) is the same as minimizing problems by not being constructive (coping). The difference between defense mechanisms and coping is in the process of their occurrence. The defense mechanism is done accidentally, while coping is done intentionally.

A study conducted by Zajenkowska, et al. [26] concluded that many people with BPD do not believe in the existence of Covid-19 and use maladaptive coping. The use of maladaptive coping will exacerbate the disorders experienced by individuals. Therefore, the purpose of this study is to find out the coping that is often used by individuals with BPD, so that appropriate therapy can be carried out.

2.1. Study 1

In this study, the data were taken by using four measuring instruments in the form of a scale, which is valid and reliable [10].

The following are the four scales used.

1. Borderline Personality Disorder Scale (BPD-scale). This scale was created by researchers in Indonesian, based on the BPD criteria in the DSM-5, to know the individual's BPD level (alpha coefficient = 0.811). The examples of items on the BPD scale are “I feel empty”, “My mood easily changes from very sad to very happy in just hours”, “I have tried to suicide several times”.

2. Childhood Adversity Scale. Examples of items on this scale include “parents grabbed my hair,” “parents neglected my education.”

3. Social support scale. This scale contains items such as 'I am involved in activities organized by friends,' it is easy for me to get the information I need.”

4. Proactive coping scale. This scale contains items that reveal individual ways of dealing with problems. Examples of things are “I take advice from professionals about my problems, 'I am used to planning before doing something.

Participants and Procedure

Participants in the study were individuals aged 18-30 years, obtained by the snowball technique. The scale is shared online (google form). The number of participants is 180 people. The results, show 25% (14% male and 11 female) of 180 participants had high BPD scores.

2.2. Study 2

After the data had been collected (Study 1), participants with a BPD score above 75 were selected (above average value). Participants were contacted via email and asked for their willingness to be interviewed. Six participants were willing to be interviewed through google meet.

This study used semi-structured interviews. To find out the participants' coping methods, interviews were conducted with participants who scored above 75 on the Borderline Personality Disorder Scale. 25 people scored above 75, but six people with the highest score were interviewed (two male, four female). The interview guide is based on the Defense Style Questionnaire/DSQ-40 [24] and the Proactive Coping Scale [22] The proactive Coping Scale has good reliability (coefficient Alpha 0.798). Interviews were conducted via google meet. Some of the questions in the interview were; “What is the most difficult problem you have ever experienced?”, “How did you overcome it?”, “How did you overcome the problem, especially during this pandemic?”.

3.1. Study 1

To test the hypothesis, analysis was performed with SEM. The model on threshold personality factors can be accepted because the goodness of the fit criteria has met the cut-off value (Fig. 2).

For more detail, the relationship of each variable can be seen in Table 1.

Based on these data, it can be seen that childhood adversity does not have a direct role in proactive coping and does not play a direct role in BPD. Social support plays a role in proactive coping but does not play a role in BPD, while proactive coping plays a role in BPD.

3.2. Study 2

The results show that 9.02% of participants aged 18-40 years were included in the BPD category. Meanwhile, Table 2 shows participants of the interview conducted in Indonesia when the condition was still physically distancing.

Based on the results of the interview, it can be seen that participants aged 30 years above (Lc and Nn) want to get married but always have an on-and-off relationship with their partner. Participant Fr was married but complained that he did not divorce to keep his commitments. He felt empty in his marriage. Furthermore, participants aged 20 (Al and Er) have not thought about having a serious relationship. Currently, they are confused about their future because they feel they have not found a field that matches their interests and talents. Lb (22) is currently in a dating relationship. LB feels that his relationship worries him because he always wants to be close to his partner. If his partner is far away, he demands that his partner always call him. This condition made him uncomfortable, but he did not know how to deal with it. From all participants, it can be concluded that they want an adult attachment, but especially during this pandemic, it is difficult to achieve it. Table 3 is a summary of the results of the interviews with participants.

Based on the results of the interview, it can be seen that the participants do not use proactive coping but use defence mechanisms, such as repression, regression, and denial. According to participants, they tend to be more depressed, so they don't use proactive coping as usual

Besides, all participants said they were also depressed during this pandemic because they could not meet face-to-face with their friends. One of the criteria for people with BPD is that they are afraid of being ignored, soduring this pandemic, they felt neglected by their friends. To overcome this, they (participants Lc and Nn) suppressed their feelings of loneliness until they wanted to commit suicide to be noticed by others. Participants Al, Er, Fd and Lb suppressed their feelings of loneliness by trying to contact their friends via social media, but they were not satisfied because they could not find a solution to their problem. They thought that because they could only meet online, their friends could only provide limited solutions, such as directly providing solutions without listening carefully to their complaints.

Study 1

This research concludes that childhood adversity, social support, and proactive coping play a role in borderline personality disorder. However, not all factors play a direct role in BPD. The better the PC (proactive coping) owned, the fewer BPD criteria individuals have.

Study 2

Participants with BPD have changed their coping strategies before and during the pandemic. Before the pandemic, participants used proactive coping but during the pandemic, participants used defense mechanisms.