Eminem and Borderline Personality Disorder

Everyday, millions of people dream about being a celebrity. The ideas of endless money, fame, parties and attention are some of the few reasons why the lifestyles of the rich and famous are so appealing. From the outside, their lives appear to be flawless, almost unreal. They have people for everything whether it be planning their schedules, driving their cars or styling their everyday looks; it seems so easy. So why is it that so many of these people, whose lives are made look so easy, seem to have the most psychological issues? The answer is simple; not everything is as it seems.

What we do not take into account is the minimal amount of privacy these famous people have. Fame brings high expectations, responsibility, stress and getting every aspect of your life getting magnified on a daily basis. Because of this, it is no wonder some celebrities end up with psychological disorders; more specifically, personality disorders.

A personality disorder is defined as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, is stable over time and leads to distress and impairment.

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The DSM-V divides personality disorders into three clusters. Cluster A, which is "odd or eccentric", Cluster B, which is "dramatic, emotional, or erratic" and Cluster C, which is "anxious or fearful." Each cluster contains a number of different personality disorders with specified characteristics and diagnostic features. This paper focuses on Borderline Personality Disorder of Cluster B and how this disorder's symptoms and etiology are present in world-renowned rapper, songwriter, actor and producer, Eminem, as well as a possible effective treatment plan.

SYMPTOMOLOGY

Borderline personality disorder (BPD) is "a pervasive pattern of unstable personal relationships, self-image, affect and impulsivity (Beidel, Bulik and Stanley 2013)." According to the Mayo Clinic, persons with BPD have feelings of "emptiness, emotional instability, periods of extreme impulsivity, risky behavior and awareness of destructive behavior, including self-injury, but sometimes feeling unable to change it." With those symptoms, it is very clear that people with BPD have a high suicide and self harm risk rate. Individuals with BPD also struggle with social relationships. They go from loving someone then dramatically shifting to hatred over a small issue or slight misunderstanding. Another key symptom is having an insecure sense of self. Their self-image and self-identity often change rapidly (Mayo Clinic, 2014). The term "borderline" refers to being on the border between neurosis and psychosis (Beidel, Bulik and Stanley 2013).

Those who know people with BPD sometimes describe their friendship as an "emotional rollercoaster" (Mayo Clinic, 2014), and that it is very difficult to maintain the friendship. High stress environments or environments of unfamiliarity may trigger symptoms to occur. At the core of borderline personality disorder is an extreme fear of abandonment. Due to a severe insecurity with themselves, people with BPD become severely attached to someone they are in a relationship with because they are scared to be left alone by that person. The fear becomes so consuming that they often begin to push the other person away so that they will not be left. Naturally this leads to the other person eventually leaving which validates the fear of abandonment causing the vicious cycle to start up all over again (Dejdar, 2006). Since BPD has a lot to do with personal thoughts and feelings, it is hard to pinpoint the exact etiology of it.

ETIOLOGY OF BORDERLINE PERSONALITY DISORDER

Over the past decade research on personality disorders has increased more and more. As with other disorders, it is unknown what exactly causes a personality disorder. Environmental, genetic and brain abnormalities all seem to play a role in the cause of borderline personality disorder. Multiple studies have found that childhood experiences are the most important factor in persons with borderline personality disorder. Childhood abuse, neglect and separation are the most common triggers among BPD patients with 87% having suffered some type of trauma related events. Of the 87%, 40-71% have been sexually abused and 25-71% have been physically abused (Winston, 2000). As with many other disorders, the earlier the abuse/trauma happens the more detrimental effect it has on the person's health overall and may create permanent neuroanatomical changes.

Another theory suggests that people with BPD have a problem in the limbic system of their brain, particularly the parts that control rage, fear, emotion and impulsivity: the amygdala and hippocampus. With the help of PET and fMRI scans, it has been found that the hippocampus and amygdala may be as much as 16% smaller in people with borderline personality disorder (Beidel, Bulik and Stanley 2013).

Some studies with twins have suggested that personality disorders are genetic and can be inherited. Those with some sort of familial mental illness are at a higher risk than those who have no family mental illness history. Scientists are currently "studying genes that help regulate emotions and impulse control for possible links to the disorder (Mayo Clinic, 2014)." Unfortunately, BPD is often under diagnosed or misdiagnosed. According to the National Institute of Mental Health, "about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness."

RISK FACTORS IN BORDERLINE PERSONALITY DISORDER

Borderline personality disorder is about five times more common among first-degree biological relatives of those with a mental disorder than in the general population (DSM-V). BPD usually begins in late adolescents to early adulthood and is diagnosed more often in young adult women rather than men. Around 1.6% of people are diagnosed with BPD each year in the United States (National Institute of Mental Health, 2104) and according to the DSM-V, women are 75% more likely to be diagnosed than men. As stated earlier, BPD is based on personal feelings and thoughts so it is very hard to get a good statistic to represent the number of annual cases each year. BPD is highly comorbid with bulimia and substance abuse.

DIAGNOSIS OF EMINEM WITH BORDERLINE PERSONALITY DISORDER

Marshall Bruce Mathers III, more famously known as Eminem, is arguably the most influential and successful rapper of all time. In addition to rap music he has also been involved in songwriting, acting and producing. His raps consist of stories about his life, the places he has been and many people he has had relationships with. Most of his songs are incredibly violent and nasty with him frequently using curse words and talking about people he hates, such as his ex-wife as well as Lindsay Lohan, in very explicit ways. Through his rap lyrics, relationships with other people and actions, it is very clear that Eminem is not only a successful rapper but he is also suffering from borderline personality disorder.

EMINEM'S RISK FACTORS AND EARLY LIFE

Eminem was born on October 17, 1972 to his 15 year old mother and a father who left when he was just six months old. He and his mother moved around from place to place for the first 11 years of his life, never staying in the same place for more than a year, and almost always living with family members. Essentially they were homeless. Growing up, Eminem would send letters to his Dad trying to contact him but every time the letters came back as "return to sender." At a young age, Eminem was already experiencing signs of abandonment by his father which is the prominent characteristic in borderline personality disorder.

At the age of 12, he and his mother settled in a predominately black, lower class neighborhood in Detroit (Eminembase.com). His classmates described Eminem as a loner who was often bullied by other students, which was due to his lack of self-identity and sense of self. Eminem also got into a lot of physical altercations with kids in his neighborhood, with one instance leaving him with a severe head injury. Getting into fights shows that he is impulsive and reckless with his health, as well as inability to control his anger or channel it differently.

Eminem's life growing up was anything but easy. His mother was diagnosed with Munchausen syndrome, which is a mental disorder where the affected person sees illness in those who are not (IBDb.com). This further proves that Eminem has borderline personality disorder because genetically, due to his mother's illness, he was five times more likely to have a disorder. His mother would abuse Eminem by inflicting physical and psychological stress to give him the appearance that he was sick when he truly was not (Eminembase.com). Childhood abuse is another key attribute in causing BPD.

EVIDENCE OF SYMPTOMOLOGY

Evidence of borderline personality disorder in Eminem is unmistakably clear in his music, how he acts while in the public eye, and his drug addiction problems.

MUSIC

Eminem has a number of songs that talk about his childhood abandonment, his mother's mental disorder and unstable relationships, most of which demonstrate his inappropriate, intense anger. In his hit song "Cleaning Out My Closet," he references his mother's abuse by saying "Victim of Munchausen's syndrome. My whole life I was made to believe I was sick when I wasn't." This shows that his mother's illness really affected him as a child growing up and further proves the abuse contributed to him developing BPD at an early age.

Likewise, the hit song "Love the Way You Lie" is about an abusive relationship between a man and woman that features lyrics like "Wait! Where you going? I'm leaving you! No you ain't, come back" which is very similar to his relationship with his on-again off-again ex-wife Kim. These lyrics show his fear of abandonment at an adult level with his significant other (Kim). The lyrics continue to say "just gonna stand there and hear me cry. But that's alright because I love the way you lie," which shows his intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (DSM-V). "Love the Way You Lie" is Eminem's best selling song and received five Grammy Nominations.

In the song "When I'm Gone" he exhibits suicidal behavior with the lyrics "I turn around, find a gun on the ground, cock it. Put it to my brain, scream 'Die Shady!' and pop it." This is one example from lyrics when Eminem talks about killing himself. Recurrent suicidal thoughts are another criterion for borderline personality disorder. Eminem has a plethora of songs talking about abuse, anger, fighting, suicide, neglect and unstable relationships making it clear he meets the diagnostic criteria for BPD.

RELATIONSHIPS WITH OTHERS IN THE PUBLIC EYE

Eminem is notorious for getting into feuds with other celebrities over small altercations. To name a few, he has gotten into fights with Christina Aguilera, Michael Jackson, Ja Rule, Nick Cannon, and most notably, Mariah Carey. Eminem claims that he and Mariah had a sexual relationship and has referenced her in a negative, derogatory way in some of his songs. Mariah denies the whole thing and says nothing every happened. She wrote the song "Obsessed" about her relationship, or lack there of, with Eminem.

In response, Eminem came out with the song "The Warning" which is a 3 minute 24 second song solely about ripping Mariah apart featuring such lines as "Enough dirt on you to murder you. This is what the f*** I do, Mariah it ever occur to you that I still have pictures?" This is an example of how Eminem has a difficult time controlling his anger, another sign that he has BPD. There is still no confirmation that the relationship was true or false but if it happened to be all made up by Eminem, this would show signs that he has severe dissociative thoughts, the last symptom criteria of borderline personality disorder.

DRUG PROBLEMS AND LEGAL ISSUES

Since the public fights with Mariah Carey, Eminem has been more focused on himself. He has had a long-time drug addiction to prescription drugs including Vicodin and A m bien. In December of 2007, he overdosed on Methadone and was two hours away from dying (Eminembase.com). Having a bad substance abuse problem can be attributed to impulsivity in a self-damaging way of borderline personality disorder. Since his near death overdose, Eminem had a small stint in rehab, which he left early because he missed Christmas with his kids, another sign of irresponsible impulsivity. He relapsed less than a month later. By April of 2008, he was completely sober with the help of attending church meeting and daily phone calls from his mentor, Elton John.

FURTHER EXPLANATION OF BORDERLINE PERSONALITY DISORDER

Borderline personality disorder is persistent, pervasive and pathological. After analyzing different aspects of Eminem's life such as his childhood, music, personal relationships, professional relationships and drug addiction it is very clear that he is suffering from BPD. His abusive, neglectful childhood, fear of abandonment, unstable relationships, dangerous impulsivity, uncontrollable anger, and mentions of suicide make Eminem an inarguable real-life example of someone with borderline personality disorder.

TREATMENT STRATEGY

To treat borderline personality disorder, a form of cognitive-behavior therapy should be used called dialectical behavior therapy (DBT). DBT focuses on the "intersection of biological and environmental causes (Beidel, Bulik and Stanley, 2013). Furthermore, DBT suggests that the fundamental biological problem occurs within emotion regulation and may arise from genetics, traumatic events or a combination of the two. DBT is a type of therapy that emphasizes discussion and negotiation between the therapist and patient.

Together they develop a "hierarchy of treatment goals, giving priority to eliminating self-harm behaviors (Beidel, Bulik and Stanley, 2013)." BDT teaches patients skills in the following five areas: mindfulness, interpersonal skills and conflict management, emotional regulation, distress tolerance, and self-management (Beidel, Bulik and Stanley, 2013) This is the best treatment approach for people with borderline personality disorder because it has proven to provide better results and is more cost effective than cognitive behavior therapy.

Medications such as antidepressants and mood stabilizers also help with the treatment of borderline personality disorder. The drugs help stabilize mood shifts, impulsivity and aggression. Currently, there is not much data on the helpfulness of drugs but there is no evidence that they are causing more harm than good. With borderline personality disorder, it is important to keep in mind that remission rates are very high and this type of treatment seems to be working rather successfully away. After six years, 68.6% of patients met criteria for remission (Beidel, Bulik and Stanley, 2013).

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