Borderline Personality Disorder
Written By: Mark Smith
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It is estimated that as many as 10% to 14% of the general population suffers from this disorder. It is two to three times more prevalent in women than it is in men. Frankly, this isn't going to be a "feel good" article. This is a very serious disorder that causes untold suffering for those individuals who have it and their family members. However, it is vitally important to correctly understand this disorder and to own the fact that you have it, if in fact, you do. Proper therapy cannot begin until an accurate diagnosis is made. The diagnostic manual or DSM IV gives nine criteria for this disorder. I will discuss each one in depth. If you think there is a chance that you might suffer from this disorder, then I encourage you to try to take in the information as non-defensively as possible.
1. Frantic efforts to avoid real or imagined abandonment. People who have BPD are very sensitive to environmental circumstances; they hate change. They have a really strong intolerance of being alone. Examples of abandonment issues here would be jealously grilling a spouse as to his whereabouts, accusing him of flirting with the waitress, getting highly reactive if he is just a few minutes late, becoming intensely jealous and competitive of a third party in the spouse's life, continuing to pine for and obsess about a relationship that is over, or having a complete emotional breakdown when a relationship is terminated. These abandonment reactions are very intense and they are extremely difficult to control. It is almost as if the person becomes instantly and temporarily intoxicated and unable to see things in a rational manner. Gaining insight into this pattern and then being able to shift into a more objective and rational stance on the spot is one of the most helpful aspects of the therapeutic process for these folks. These reactions are almost always rooted in some form of parental abandonment. The stronger the abandonment by a parent, the stronger the frantic efforts to avoid real or imagined abandonment in the relationship. Many times significant others of borderlines feel controlled and fearful of having any interaction with another person that might be seen as a threat. A long term nurturing relationship with a therapist who has strong boundaries is the best therapy for someone suffering from abandonment issues like these.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. In the early stages of their relationships, borderlines tend to place the objects of their love on a very high pedestal. They can see no wrong or imperfection in the objects of their desire. Many times the new man in the borderline's life has ridden in on a white horse to heroically rescue them from problems that they had been facing. During the initial enmeshment stage everything is intensely blissful. However, look out; when the walls of denial start to crack, it opens the floodgates to months or even years of unexpressed criticisms. Borderlines then become masters at devaluing everything about the object of their wrath/desire. The relationship becomes a love/hate relationship that is stormy and unstable. This gets played out in the therapeutic process as well. I used to feel like crawling under the coffee table due to feeling ashamed after a devaluing session with one of my more borderline borderlines even though in my head I knew that I had not done anything to deserve such criticism.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self. These identity disturbances might include confusion about life goals, values, career choices, or the type of friends that are desired. Borderlines do not have a very defined sense of who they are. They tend to attempt to derive their sense of self by sucking it from their relationships with others. That is why they are so dependent in their relationships; if the relationship ends, it feels to them that they are losing a big part of their very selves. Although they hate change, their lives seem to be in constant chaos due to the frequent changes they make in their lives in their search to find meaning and wholeness. In therapy, once a stronger sense of self is built, then relationships are no longer glued together by an unhealthy fear of abandonment.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Borderlines tend to have pretty addictive personalities. They are in pain a lot and when they are in pain, they tend to do things that medicate their pain, even if ultimately these activities add to their pain. Borderlines do tend to have affairs. They are extremely emotionally needy and when their relationship evolves into the devaluing stage, they frequently turn their attention to another, more idealized lover only, sadly, to ultimately feel abandoned by him as well.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. This might sound worse than it many times is. For many high functioning borderlines, what this amounts to is ruminating about wishing that they were never born or that they wish that they could just fall asleep and never wake up. They aren't truly suicidal. However, many lower functioning borderlines do attempt suicide, mainly as a way of either communicating anger or as an attempt to get attention. Tragically, at times these suicidal attempts are successful. Self-punishment or self-mutilation is common in lower functioning borderlines. This can take the form of an eating disorder, excessive exercise or even cutting or dying one's own hair in an unflattering manner.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). Living with a borderline is like riding a roller coaster ride; there are a lot of ups and downs. They can shift moods on a dime. They can be exhilarated one minute, then anxious, then full of rage, and then deeply saddened. This leaves their more stoic partners highly confused as they attempt to fix things. Borderlines are missing the anchor in their souls of a solid and consistent sense of themselves. They are feathers blowing in the wind.
7. Chronic feelings of emptiness. There is just a big empty hole in the borderline's soul and she attempts to fill that hole with external objects or people. This is an extremely painful condition. A sense of boredom and a general lack of fulfillment are part of this feeling. This tremendous chasm in their souls is the thing that fuels their desperate efforts to capture, control and then cling to their treasured and yet hated object of affection.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Borderlines can be pretty scary from time to time. Although they generally are extremely loyal, emotionally connected, creative, wonderful people, they certainly have their dark sides. Many times they just seem to have a dark cloud of irritation and anger hovering over their heads. In therapy, we teach them that being angry and being reactive do not have to go hand in hand. Borderlines can certainly be accused of being rather high maintenance. As they progress in their therapy, we see strengths and positive qualities remaining while the rough edges are taken off their destructive sides.
9. Transient, stress-related paranoid ideation or severe dissociative symptoms. This last one is broken down into two parts. Stress-related paranoid ideation is basically just being paranoid-questioning the motives of safe and well meaning people. During childhood, these folks learned that there was not a consistently safe place in the world for them. They were abandoned, abused, neglected, controlled, criticized, unloved and not given what they needed to grow up healthy and happy. It takes many years of effective, caring therapy for them to learn how to trust the world and see it as it is rather than projecting their trust issues onto the world. They view the world through tainted lenses. The final piece of the puzzle is the severe dissociative symptoms. This is a unique ability to stick their pain away for weeks, months and years at a time. They just sort of go bye-bye. I had one borderline explain it as "it was like waking up after 6 months from a deep sleep." This coping mechanism helps borderlines stay in very dysfunctional and painful relationships for way too long. They can be in the relationship without really being present. However, the disassociating also can be problematic as far as being able to make consistent progress in therapy. When the pain level gets too great, they many times bug out of their therapy. I have had many a door loudly slammed shut after a difficult session with a borderline. They have an ability to cut and run that seems very cold and calculated. They needed that defense mechanism during their childhoods and they end up being sort of stuck with it. It is like a breaker switch in your electrical box; when there is too much current, it trips the switch. Turning that emotional switch back on is a lot more difficult than hitting the breaker switch again. It feels like the ability to turn that emotional switch back on is almost entirely out of their control; they get back in touch with themselves and those around them whenever they are psychologically ready and not before.
Many therapists dread working with borderlines because they do tend to be pretty manipulative at times. We really like and enjoy working with borderlines and we are good at it. The therapeutic process is different with a borderline than it is with other clients; it is more intense, more connected, and it is special in the very appropriate sense of the word. It is about re-parenting that little child who lives inside that adult body. If you feel as if you might have borderline personality disorder or that your spouse, friend, or family member might have it, then do not hesitate to call us. I am not able to take on new borderline clients personally at this point because of my roles as director of Family Tree, supervisor of the staff and my roles as husband and father. However, I closely supervise all of the associates and I have trained them well when it comes to working with borderlines effectively. You will get excellent therapy here. Making a commitment to work with someone who has borderline personality disorder is a big deal. It might very well end up being a 7-10 year commitment. Group therapy is tremendously helpful and supportive for all of our clients, but especially for borderlines. They work well in the context of a caring and accountable community. Borderline Personality Disorder is treatable.
Before ending, I would like to recommend a couple of books which address the topic. The first one is called "I Hate You, Don't Leave Me" and it was written by Jerold Kreisman and Hal Straus. It is basically a small handbook about BPD. However, the book tends to describe a rather strong case of BPD so you need to know that many situations aren't quite that extreme. The other book that I want to recommend is directed more at the significant other of the borderline. It is called "Stop Walking On Eggshells; Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder" and it was written by Randi Kreger. You can find these books in just about any bookstore. Having BPD is not a fate worse than death; with time, hard work, trust, patience, genuine care, and even more time you can have many of the wonderful things in life that we all want-a stable, loving, relatively healthy relationship, a fulfilling, rewarding, self-defining career, a warm internal sense of joy in knowing who you are, and a spring in your step as you get out of bed every day.
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