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September 25 - October 15, 2023
more Americans (3 to 6 percent of the population) exhibit primary symptoms of BPD, and many studies suggest this figure is an underestimation.1,2 Approximately 10 percent of psychiatric outpatients and 20 percent of inpatients, and between 15 and 25 percent of all patients seeking psychiatric care, are diagnosed with the disorder. It is one of the most common of all of the personality disorders.3,4
Some studies have uncovered BPD in almost 50 percent of all patients admitted to a facility for an eating disorder.16 Other studies have found that over 50 percent of substance abusers also fulfill criteria for BPD.
Keeping one’s distance or leaving her alone—even for brief periods—recalls the sense of abandonment she felt as a child. In either case, the borderline individual reacts intensely.
To compensate, he caroms back and forth from clinging dependency to angry manipulation, from gushes of gratitude to fits of irrational anger. He fears abandonment, so he clings; he fears engulfment, so he pushes away. He craves intimacy and is terrified of it at the same time. He winds up repelling those with whom he most wants to connect.
Michelle bristles under his controlling yoke yet becomes frightened when she sees his weaknesses. The dissatisfactions lead to more provocation and more conflict.
boredom as “the desire for desires”;
In both stages, the child’s behavior is based less on independently determined internal needs than on reacting to the significant people in the immediate environment.
Behavior then becomes a quest to discover identity rather than to reinforce an established one.
The borderline adolescent’s failure to maintain object constancy results in later problems with sustaining consistent, trusting relationships, establishing a core sense of identity, and tolerating anxiety and frustration.
Each culture probably needs its own scapegoats as expressions of society’s ills. Just as the hysterics of Freud’s day exemplified the sexual repression of that era, the borderline, whose identity is split into many pieces, represents the fracturing of stable units in our society.2
A healthy civilization can accept the uncomfortable ambiguities.
Attempts to eradicate or ignore uncertainty tend only to encourage a borderline society, ripped apart by polarizations.
If you suffered from neglect in childhood, it may cause you to go from one person to another, hoping that someone will supply whatever is missing.
Anyone who offers admiration and respect has appeal to them—and because their need for affection is so great, their ability to discriminate is severely impaired.
Narcissistic parents perceive their children as extensions of themselves or as objects/possessions, rather than as separate human beings.
but numerous relocations are often also accompanied by a feeling of rootlessness.
Tough Love groups for parents of teenagers, for example, may insist that an adolescent drug abuser either be hospitalized or be barred from the home. This type of approach emphasizes the Truth element of the SET-UP triangle but may ignore the Support and Empathy segments.
The split view of the borderline self includes a special entitled part and an angry unworthy part that masochistically deserves punishment, although he may not be consciously aware of one side or the other.
Annette’s need to remain a victim, Harry said, shielded her from assuming any responsibility for what happened in her life. She could feel justified in cursing society rather than bravely investigating her own role in continuing to be used by others. By wrapping herself in a veil of righteous anger, Annette was avoiding any kind of frightening self-examination or confrontation that might induce change, and thereby was perpetuating her impotency and helplessness. This left her incapable of making changes “for her sake.”
If “the Truth will set you free,” then Support and Empathy must accompany it to ensure it will be heard.
Pat lacked object constancy (see chapter 2 and Appendix B). Friendships and love relationships had to be constantly tested because she never felt secure with any human contact. Her need for reassurance was insatiable. She had been through countless other relationships in which she first appeared ingenuous and in need of caretaking and then tested them with outrageous demands. The relationships all ended with precisely the abandonment she feared; then she would repeat the process in her next romance.
the BPD identity is fabricated from insecurity, fear, and dread. This chameleon aspect of BPD reveals her remarkable sensitivity toward others, deriving an impression of what she feels the other person wants her to be.
“the only time I feel in control. It’s when I manipulate others instead of others always controlling me.”
Perseverance is necessary to effect change over the long haul. For many with BPD, having a consistent unflappable figure in their lives, whether it be a neighbor, a friend, or a therapist, may be one of the most important requirements for healing. Such a figure may contribute little except for consistency and acceptance (in the face of frequent provocations), yet furnish the borderline loved one with a model of constancy in her otherwise chaotic world.
Indeed, some of the hallmarks of borderline behavior are the sudden, unpredictable, and “out of nowhere” eruptions of anger, extreme suspiciousness, or suicidal depression from someone who has appeared so normal.
Her bulimia, drinking, and anxieties occupied all her energy, distracting her from addressing the conflicts with her parents.
For such children, the world abounds with inconsistencies and invalidation. When the child requires structure, he receives contradictions; when he needs firmness, he gets ambivalence. Thus, the future borderline adult is deprived of the opportunity to develop a consistent core identity.
This analysis of ninety-seven different studies determined that individuals with BPD experienced childhood adversity at almost fourteen times the rate reported by nonclinical controls.
He may see abuse as a kind of love and repeat the abuse with his own children. As an adult, he remains locked in the child’s confusing world, in which love and hate commingle, only good and bad exist with no in-between, and only inconsistency is consistent.
At every turn, however, Stephanie tried to sabotage the relationship by testing his loyalty and questioning his commitment, convinced that no one whom she valued could value her.
The teenager’s easy distractibility and oblivious daydreaming are analogous to borderline dissociative experiences and difficulties with committing to a goal and following through.
serial tumultuous relationships,
“I don’t really know who I am” is a common BPD mantra. Developing a reliable, consistent sense of identity is a challenge for someone with BPD. She often feels she is “faking it” when interacting with others—she can be a chameleon, a Democrat among Democrats, a Republican among Republicans, and so on.
Indeed, self-defeating behaviors may emanate precisely because his life is settling down, and he feels uncomfortable in a crisis-free state.
“She needs support and caring,” I replied. “She needs to be re-parented. She needs to learn trust.”
“I thought you were different,” she said. “I thought you were special. I thought you really cared.” The problem was, I thought so, too.
She could see that no matter how hard she tried to run away from her feelings, she could not escape being herself.
It wasn’t much longer before all of us—Julie, the staff, and I—began working together. I stopped trying so hard to be likable, wise, and unerring; it was more important to be consistent and reliable—to be there.
The borderline patient is often very perceptive about others, including the therapist. This sensitivity often provokes the therapist’s own unresolved feelings.
In a group he can more easily control the constant struggle between emotional closeness and distance; unlike individual therapy, in which the spotlight is always on him, he can attract or avoid attention in a group. Confrontations
The borderline person’s demanding nature, egocentrism, isolating withdrawal, abrasiveness, or social deviance can all be more effectively challenged by group peers. In addition, he may accept more readily the group’s expressions of hope, caring, and altruism.
which afforded her the opportunity to develop mastery over these frightening experiences and to place them in proper perspective.
“You always spoke of unconditional acceptance,” said one borderline patient to her therapist, “and somewhere in the recent past I finally began to feel it. It’s wonderful. . . . You gave me a safe place to unravel—to unfold. I was lost somewhere inside my mind. You gave me enough acceptance and freedom to finally let my true self out.”
True life is lived when tiny changes occur. —Leo Tolstoy
Borderline fear of change involves a basic distrust of his “brakes.” In healthier people, these psychological brakes allow a gradual descent from the pinnacle of a mood or behavior to a gentle stop in the “gray zone” of the incline.
She utilized SET-UP techniques to try to better understand these family members and to maintain protective boundaries for herself, which could shield her from being pulled into further conflicts. She began to accept them for who they were, love them as best she could, and go on with her own life. She recognized the need for new friends and new activities in her life. Elizabeth called this “going home.”
