Have you ever felt like you were on a rollercoaster, and you couldn’t get off, no matter how hard you tried? Waves of emotion wash over you like a tsunami, one after another. High highs and even lower lows coming from every direction at rapid speed. If this is you or somebody you know, friend, you are not alone. There is hope for stability and healing in your or your loved one’s future.
Borderline Personality Disorder (BPD) is defined by the Mayo Clinic as a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships. I have previously written a snapshot look at BPD, but I wanted this blog to be less clinical and more everyday life practicality. BPD is becoming better understood with each passing day. Clinicians who are worth their stock now reframe what used to be seen as a terminal disorder of dysfunction as a trauma response for which there is healing and hope.
I can spot a borderline at 50 paces. I don’t know how I do it, but I can, and I love this population. By the time clients with BPD seek out therapy, they have usually had some major losses. Relationships have been extremely strained or lost. They’ve been fired from their job. They are engaging in problematic or addictive behaviors, and those around them have had enough. They come into my office desperate for rescue and answers to why life just won’t seem to work out for them. So often, clients with BPD have been blamed for their behavior which has added wounding to an already extremely wounded individual. There is a lot of controversy in the therapeutic world about telling clients of their diagnosis. Some therapists would never in a million years let a client know they have possible borderline traits. Not me, I’m trotting it right out there. Clients with BPD already feel alone and out of control. DSM diagnoses are nothing more than a set of characteristics that give us a head start on how we help clients get their lives back. I look at BPD traits as a checklist that alerts me to the skills I know help with these behaviors.
I hate you, don’t leave me. Clients with borderline personality disorder or traits are desperate for connection. Like everyone, they want to feel loved, safe, and protected. However, often their behavior creates exactly the opposite outcome. The cornerstone trait of BPD is fear of abandonment, perceived or real. They are so afraid that people will leave them, they create situations where they can leave first, or the other party will become so tired of “dealing with them” that they abandon them. Now, this seems completely counterintuitive. If you are afraid of being left, why would you behave in ways that cause people to leave? That makes no sense. And that’s how we know it’s pathological. By that I mean, the behavior is outside of the control of the client. It is almost compulsive. Typically, this behavior is reserved for those that the client knows will never leave—lots of times a parent of sibling (The abuse suffered at the hands of an untreated borderline client is a blog post in and of itself). Again, this does not make sense. Why would you abuse the people that love you the most? Pathology. A textbook characteristic of BPD is lacking long-term relationships. They don’t keep friends for long periods of time or have a string of dysfunctional romantic relationships. People simply cannot stand up the constant ups and downs.
Addictive or compulsive behaviors. Many times, BPD clients will present in the office because a loved one has implored them to get help. Drinking too much, self-harming, high risk sex behaviors, and eating disorders are a few that come to mind. I talked about the tsunami of emotions those with BPD feel. The number of emotions most of us go through in a week happens within hours for these clients. They are constantly up and down and at the mercy of themselves. Self-medicating can be fairly powerful when a person is hurting so badly. All the compulsive behaviors listed above create dissociation. Dissociation is the best friend of a borderline. It’s a survival skill. Dissociation is described as a mental process of disconnecting from one's thoughts, feelings, memories, or sense of identity. Renowned trauma therapist Janina Fisher says, “Dissociation refers to a compartmentalization of experience: elements of an experience are not integrated into a unitary whole but are stored as isolated fragments…. Dissociation is a way of organizing information.” To cope with life, many clients with BPD learn early in life to dissociate in order to survive. Emotions are too overwhelming to process and the world feels too unsafe so they check out. Once clients get into therapy and start piecing apart their behavior patterns, they realize there are whole chunks of time they cannot account for—especially if during that time there was a conflict.
So how do people heal and rejoin life? There are a couple of ways I have seen clients do this. My first suggestion is always to get in with a psychiatrist. Mood stabilizers can be incredibly helpful in aiding clients to stay on even ground. There are so many new drugs on the market these days that have fewer side effects. Mood stabilizers have come a long way. Secondly, trauma therapy. In my practice, I utilize EMDR and Internal Family Systems (IFS). Viewing BPD as a trauma response to abandonment creates an environment of empathy and understanding. It takes the pressure off the client having to “get something right.” On the other side of trauma is meaning making. Through these forms of therapy, I have seen clients be able to get to know themselves better, why they operate the way they do, and arrive at a cohesive version of Self.
Like all chronic conditions, there can be relapses. Even the healthiest among us struggle from time to time. Therapy allows clients with BPD to gain the tools they need for self-regulation and how to advocate for their needs without alienating people in the process. There will always be setbacks, but with therapy a client can learn to build internal resilience. With resilience comes the ability to get back up after a fall and still believe in their inherent goodness.
I hope this has been helpful in better understanding borderline personality disorder. If you or someone you know thinks they might benefit from therapy, make sure you find a provider with a good working knowledge of BPD. This is not a client population for everyone. A bad therapist can do more harm than good.
10-4.
Caroline.