What Is Borderline
Personality Disorder?
by Alexander Shaumyan
"I end up asking myself... Why
me? Why me? I only truly loved her and cared for her. There
is nothing in the world humanly possibly that I would not have done for
her. I cherished her so much. She made me happy, She made me feel
important and complete, she filled the missing pieces of my heart. Was
I just attracted toward her? Was I just having a mere physical
attraction towards her? NO.. She was as beautiful as beautiful can be,
and she was as low and horrible as she could be also. When she showered
me with love there was nothing more beautiful than that. When she hated
me there was nothing more painful than that."
"And they sure move on, move on to what? I don't know... Nobody knows.
Everything in their lives is all of a sudden alright, new friends, new
parties, new romance, and everything is better than it was with you.
Nothing once mattered when she was with you. What is it supposed to
mean anymore? Anything?"
--Jae,
http://www.borderlinepersonality.ca/whyme.htm
Did you ever love someone who appeared sweet as an angel at one moment
only to change into a raging monster at the next? Did this person see
you as all good or all bad, with nothing in between? Did you feel
manipulated and lied to? Did this person rush into a relationship based
on a fantasy of some perfect love? Were you accused and blamed for
things that you haven't done? Did you feel as if you were walking on
eggshells, trying your best not to trigger an angry outburst from your
partner? Do you know someone with borderline personality disorder? Did
you ever love someone with BPD? Here's an excerpt from the book The Siren's Dance by Anthony
Walker, a memoir by a psychiatrist who had a tumultuous year-and-a-half
marriage to a woman with BPD:
"I know that you love me because you still make love to me
even after we have a fight." She was right. Her sorrow and
embarrassment at her outbursts were real, and her attempts to control
her anger so earnest that I knew she was trying for me, for herself,
and for us. I had to remind myself that I had known that she was
intense to the extreme in her experience of life, and that her struggle
was my struggle. We would share anger, but we would also share love.
No one could ever love Michelle enough. Not her family, not her
friends, and certainly not the men (and women) she so easily attracted,
like moths to a flame. But when a final-year med student falls for her
while she's recovering from a suicide attempt over her latest breakup,
they both may be in for more than they bargained for. Hoping to help
cure her of her debilitating fears and explosive rage, Anthony marries
Michelle in a secret ceremony that alienates him from his family, and
ultimately from himself. Initially mesmerized by her seductive smile,
her surprising sensuality, and the why behind her wildly unpredictable
behavior, the author comes to realize that he will have to sacrifice
his career--and more--in order to be with her. This achingly honest and
true account of Anthony and Michelle's whirlwind year-and-a-half
together provides a window into the emotionally intense world of
someone suffering from borderline personality disorder, a condition
seen in an estimated 2 percent of the general population and 10 percent
of mental health outpatients. It also offers the perspective of those
most affected--the sufferer's loved ones, whom despite all the upheaval
are still compelled to care. So concludes the account.
--from The Siren's Dance
Borderline personality disorder can be a living hell for everyone
involved. I had a very painful relationship with a woman in 2003 and I
couldn't make sense of what was going on with her at the time. She was in
her late 20's and has been going through many relationships with
different guys and had a 12 year old daughter and a 5 year old son --
both kids by different men. She had her daughter when she was 15. As I
learn more about BPD, I recognize that impulsiveness is one its
characteristic features. This woman was very impulsive and was ready to
have sex or get married to someone, who she just got to know for a very
short time. And her emotions were fluctuating from one moment to the
next, triggering an outburst at some minor thing. She could be very
sweet and seductive at one moment and then turn into someone cruel and
vindictive -- a complete 180 degree change from an angel to a monster.
If I ignored her, she'd say I didn't love her enough and if I showered
her with gifts, she'd accuse me of smothering her. She lived in another
state and I went to visit her for a week, and her moods would change
from appearing very happy at one moment to crying the next. She also
had paranoid delusions about people trying to hurt her. I didn't know
what to do. I tried to be patient und understanding. I went back to
Connecticut, hoping we could continue seeing each other. And then I
started learning about her bisexuality and her sleeping around. She
would always lie to protect herself and I couldn't tell at one point
what was truth and what was fiction anymore. She would also accuse me
of things that I hadn't done. And the more I tried to understand her,
the more I saw that she had no real sense of self -- she was like a
chameleon, being different things to different people. I learned from
her that she was belittled and humiliated by her mother and molested by
her stepfather. That could well explain her lack of a real self.
Anyway, she ended up cutting all contact with me and marrying another
guy, who is nine years younger than her. It was a nightmare that led to
my depression and hospitalization for two weeks. I finally understand
that it's not my fault. Borderline personality disorder is destructive
for everyone involved. I studied psychology in college and I'm now
beginning to appreciate some of the insights that I gained. BPD is very
real, and I think people can recover from it if they recognize the
problem. It was only after a lot soul-searching, therapy and studying
that I began to understand her behavior. Here's an excerpt from Borderline Personality Disorder Demystified by Dr. Robert Friedel, et al.:
Over six million Americans suffer from borderline personality disorder
(BPD), a chronic, disabling psychiatric condition that causes extreme
instability in their emotional lives, behavior, and self-image and
severely impacts their family and friends. But despite the devastation
it can cause, borderline personality disorder remains largely
overlooked by the medical community, misunderstood by the public, and
many people continue to go misdiagnosed or untreated. In Borderline Personality Disorder Demystified, Dr. Robert Friedel, a leading expert on the disorder and a
pioneer in its treatment, turns his vast personal experience into a
useful and supportive guide for everyone living with and seeking to
understand this condition. Friedel sheds light on all the intricacies
of borderline personality disorder, such as the course it takes, the
difficulties in diagnosing it, and the types of treatment available,
and offers effective advice on the best ways to cope with it. Filled
with wisdom and encouragement, Borderline Personality Disorder Demystified is essential reading for everyone diagnosed with BPD, those
who think they might have the illness, and friends and family who love
and support them.
--from Borderline Personality Disorder Demystified
So what exactly is borderline personality disorder? There is a lot of
online information about it and a lot of excellent books on the
subject. BPD Central is an excellent web site for
people who care about someone with borderline personality disorder.
Here are the basics of BPD, provided by
BPD
Central.
What is BPD?
Indicators
Additional traits
Types of BPD
Assumptions held by BPD sufferers
Myths and Realities
Common "games" between BPs and Non-BPs
What is Borderline Personality Disorder (BPD)?
A borderline writes:
"Being a borderline feels like eternal hell. Nothing less.
Pain, anger, confusion, hurt, never knowing how I'm gonna feel from one
minute to the next. Hurting because I hurt those who I love. Feeling
misunderstood. Analyzing everything. Nothing gives me pleasure. Once in
a great while I will get "too happy" and then anxious because of that.
Then I self-medicate with alcohol. Then I physically hurt myself. Then
I feel guilty because of that. Shame. Wanting to die but not being able
to kill myself because I'd feel too much guilt for those I'd hurt, and
then feeling angry about that so I cut myself or O.D. to make all the
feelings go away. Stress!"
Therapists use a book called "Diagnostic and Statistical Manual" (DSM)
to make mental health diagnoses. They've outlined nine traits that
borderlines seem to have in common; the presence of five or more of
them may indicate BPD.
However, please note the following:
Everyone has all these traits to a certain
extent.
Especially teenagers. These traits must be long-standing (lasting
years) and persistent. And they must be intense.
Be very careful about diagnosing yourself or others. In fact, don't do
it. Top researchers guide patients through several days of testing
before they make a diagnosis. Don't make your own diagnosis on the
basis of a WWW site or a book!
Many people who have BPD also have other concerns, such as depression,
eating disorders, substance abuse — even multiple personality disorder
or attention deficit disorder. It can be difficult to isolate what is
BPD and what might be something else. Again, you need to talk to a
qualified professional.
DSM-IV Definition of BPD
-
A pervasive pattern of instability of interpersonal relationships,
self-image, and affects, and marked impulsivity beginning by early
adulthood and present in a variety of contexts, as indicated by five
(or more) of the following:
-
Frantic efforts to avoid real or imagined abandonment. Note: Do not
include suicidal or self-mutilating behavior covered in (5).
-
A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation. This is called "splitting."
Following is a definition of splitting from the book I Hate You, Don't Leave Me
by Jerry Kreisman, M.D. From page 10:
The world of a BP, like that of a child, is split into
heroes
and villains. A child emotionally, the BP cannot tolerate human
inconsistencies and ambiguities; he cannot reconcile another is good and
bad qualities into a constant coherent understanding of another person.
At any particular moment, one is either Good or EVIL. There is no
in-between; no gray area....people are idolized one day; totally
devalued and dismissed the next.
Normal people are ambivalent and can experience two
contradictory states atone time; BPs shift back and forth, entirely
unaware of one feeling state while in the other.
When the idealized person finally disappoints (as we all
do,
sooner or later) the borderline must drastically restructure his
one-dimensional conceptionalization. Either the idol is banished to the
dungeon, or the borderline banishes himself in other to preserve the
all-good image of the other person.
Splitting is intended to shield the BP from a barrage of
contradictory feelings and images and from the anxiety of trying to
reconcile those images. But splitting often achieves the opposite
effect. The frays in the BP's personality become rips, and the sense of
his own identity and the identity of others shifts even more
dramatically and frequently.
-
Identity disturbance: markedly and persistently unstable self-image
or sense of self.
-
Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, sex, substance abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in
(5).
-
Recurrent suicidal behavior, gestures, or threats, or
self-mutilating behavior.
-
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).
-
Chronic feelings of emptiness.
-
Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical
fights).
-
Transient, stress-related paranoid ideation or severe dissociative
symptoms.
Dissociation is the state in which, on some level or another, one
becomes somewhat removed from "reality," whether this be daydreaming,
performing actions without being fully connected to their performance
("running on automatic"), or other, more disconnected actions. It is
the opposite of "association" and involves the lack of association,
usually of one's identity, with the rest of the world.
There is no "pure" BPD; it coexists with other illnesses. These are the
most common. BPD may coexist with:
-
Post traumatic stress disorder
-
Mood disorders
-
Panic/anxiety disorders
-
Substance abuse (54% of BPs also have a problem with substance
abuse)
-
Gender identity disorder
-
Attention deficit disorder
-
Eating disorders
-
Multiple personality disorder
-
Obsessive-compulsive disorder
Statistics about BPD
BPs comprise:
-
2% of the general population
-
10% of all mental health
outpatients
-
20% of psychiatric inpatients
-
75% of those diagnosed are women
-
75% have been physically or
sexually
abused
Indicators of BPD
Is someone you care about causing you a great deal of pain?
Do you find yourself concealing what you think or feel because you're
afraid of the other person's reaction or because it just doesn't seem
worth the horrible fight or hurt feelings that will follow?
Do you feel that anything you say or do will be twisted and used
against you? Are you blamed and criticized for everything wrong in the
relationship-even when it makes no logical sense?
Are you the focus of intense, violent, and irrational rages,
alternating with periods when the other person acts perfectly normal
and loving? Does no one believe you when you explain that this is going
on?
Do you feel manipulated, controlled, or even lied to sometimes? Do you
feel like you're the victim of emotional blackmail?
Do you feel like the person you care about sees you as either all good
or all bad, with nothing in between? Is there sometimes no rational
reason for the switch?
Are you afraid to ask for things in the relationship because you will
be told that you're too demanding or that there is something wrong with
you? Are you told that your needs are not important?
Is the person always denigrating or denying your point of view? Do you
feel that their expectations of you are constantly changing, so you can
never do anything right?
Are you accused of doing things you never did and saying things you
never said? Do you feel misunderstood a great deal of the time, and
when you try to explain do you find that the other person doesn't
believe you?
Are you constantly being put down? When you try to leave the
relationship does the other person try to prevent you from leaving in a
variety of ways (anything from declarations of love and promises to
change to implicit or explicit threats)?
Do you have a hard time planning anything (social engagements, etc.)
because of the other person's moodiness, impulsiveness, or
unpredictability? Do you make excuses for their behavior or try to
convince yourself that everything is okay?
Right now, are you thinking, "I had no idea that anyone else was going
through this?"
Thoughts that may indicate BPD
Does this person:
-
Alternate between seeing people as
either flawless or evil? Have difficulty remembering the good things
about a person they're casting in the role of villain?
-
Find it impossible to recall anything
negative about this person when they become the hero?
-
Alternate between seeing others as completely for them or against them?
-
Alternate between seeing situations as either disastrous or ideal?
-
Alternate between seeing themselves as either worthless or flawless?
-
Have a hard time recalling someone's love for them when they're not around?
-
Believe that others are either completely right or totally wrong?
-
Change their opinions depending upon who they're with?
-
Alternate between idealizing people and devaluing them?
-
Remember situations very differently than other people, or find themselves unable to recall them at
all?
-
Believe that others are responsible for their actions--or take too much responsibility for the actions of others?
-
Seem unwilling to admit to a
mistake--or feel that everything that they do is a mistake?
-
Base their beliefs on feelings rather than facts?
-
Not realize the effects of theirbehavior on others?
Feelings that may indicate BPD
Does this person:
-
Feel abandoned at the slightest provocation?
-
Have extreme moodiness that cycles very quickly (in minutes or hours)?
-
Have difficulty managing their emotions?
-
Feel emotions so intensely that it's difficult to put others' needs--even those of their own children-ahead of their own?
-
Feel distrustful and suspicious a great deal of the time?
-
Feel anxious or irritable a great deal of the time?
-
Feel empty or like they have no self a great deal of the time?
-
Feel ignored when they are not the focus of attention?
-
Express anger inappropriately or have difficulty expressing anger at all?
-
Feel that they never can get enough love, affection, or attention?
-
Frequently feel spacey, unreal, or out of it?
Behaviors that may indicate BPD
Does this person:
-
Have trouble observing others' personal limits?
-
Have trouble defining their own personal limits?
-
Act impulsively in ways that are potentially self-damaging, such as spending too much, engaging in dangerous sex, fighting, gambling, abusing drugs or alcohol, reckless
driving, shoplifting, or disordered eating?
-
Mutilate themselves-for example,
purposely cutting or burning their skin?
-
Threaten to kill themselves--or make actual suicide attempts?
-
Rush into relationships based on idealized fantasies of what they would like the other person or the
relationship to be?
-
Change their expectations in such a
way that the other person feels they can never do anything right?
-
Have frightening, unpredictable rages that make no logical sense--or have trouble expressing anger at all?
-
Physically abuse others, such as slapping, kicking, and scratching them?
-
Needlessly create crises or live a chaotic lifestyle?
-
Act inconsistently or unpredictably?
-
Alternately want to be close to others, then distance themselves?
(Examples include picking fights when things are going well or
alternately ending relationships and then trying to get back together.)
-
Cut people out of their life over issues that seem trivial or overblown?
-
Act competent and controlled in some
situations but extremely out of control in others?
-
Verbally abuse others, criticizing and blaming them to the point where it feels brutal?
-
Act verbally abusive toward people they know very well, while putting on a charming front for others? Can they switch from one mode to the other in seconds?
-
Act in what seems like extreme or controlling ways to get their own needs met?
-
Do or say something inappropriate to
focus the attention on them when they feel ignored?
-
Accuse others of doing things they did not do, having feelings they do not feel, or believing things they do not believe?
Additional Traits Common to People with BPD
People with BPD may have other attributes that are not part of the DSM
definition but that researchers believe are common to the disorder.
Many of these may be related to sexual or physical abuse if the BP has
experienced abuse earlier in life.
Pervasive Shame: The all-pervasive sense that I am flawed and defective
as a human being. It is no longer an emotion that signals our limits;
it is a state of being, a core identity. Toxic shame gives you a sense
of worthlessness, the feeling of being isolated, empty, and alone in a
complete sense. Non-BPs share this characteristic.
Undefined Boundaries
People with BPD have difficulty with personal limits-both their own and
those of others. Non-BPs share this characteristic.
Control Issues
Borderlines may need to feel in control of other people because they
feel so out of control with themselves. In addition, they may be trying
to make their own world more predictable and manageable. People with
BPD may unconsciously try to control others by putting them in no-win
situations, creating chaos that no one else can figure out, or accusing
others of trying to control them. Conversely, some people with BPD may
cope with feeling out of control by giving up their own power; for
example, they may choose a lifestyle where all choices are made for
them, such as the military or a cult, or they may align themselves with
abusive people who try to control them through fear. Non-BPs
share this characteristic.
Lack of Object Constancy
When we're lonely, most of us can soothe ourselves by remembering the
love that others have for us. This is very comforting even if these
people are far away-sometimes, even if they're no longer living. This
ability is known as object constancy. Some people with BPD, however,
find it difficult to evoke an image of a loved one to soothe them when
they feel upset or anxious. If that person is not physically present,
they don't exist on an emotional level. The BP may call you frequently
just to make sure you're still there and still care about them. (One
non-BP told us that every time her boyfriend called her at work,
he introduced himself using both his first and last name.)
Interpersonal Sensitivity
Many individuals have noticed that some people with BPD have an amazing
ability to read people and uncover their triggers and vulnerabilities.
One clinician jokingly called people with BPD psychic.
Situational Competence
Some people with BPD are competent and in control in some situations.
For example, many perform very well at work and are high achievers.
Many are very intelligent, creative, and artistic. This can be
very confusing for family members who don't understand why the person
can act so assuredly in one situation and fall apart in another.
Narcissistic Demands
Some people with BPD frequently bring the focus of attention back
to themselves. They may react to most things based solely on how
it affects them.
Types of BPD
High Functioning, Low Functioning
People with BPD vary a great deal in their functionality: that is, in
their ability to live a normal lifestyle, work inside or outside the
home, cope with everyday problems, interact with others, and so on.
Some people with BPD are so incapacitated by their illness that they
are unable to work. They may spend a great deal of time in the hospital
because of self-mutilation, severe eating disorders, substance abuse,
or suicide attempts. BPD makes it very hard for them to form
relationships, so they may have a weak support system. They may be so
incapable of dealing with money that they have no cash for food or a
place to live.
People who are close to low-functioning borderlines often find
themselves living from crisis to crisis. They often feel manipulated by
self-mutilation and suicide attempts. However, because the borderline
is obviously ill, non-BPs usually receive understanding and support
from family and friends.
High-functioning borderlines act perfectly normal most of the
time. Successful, outgoing, and well-liked, they may show their
other side only to people they know very well. Although these
borderlines may feel the same way inside as their less-functional
counterparts, they have covered it up very well-so well, in fact, that
they may be strangers unto themselves.
Non-borderlines involved with this type of BP need to have their
perceptions and feelings confirmed. Friends and family members who
don't know the borderline as well may not believe stories of rage and
verbal abuse. Many non-BPs told us that even their therapists refused
to believe them when they described the BP's out-of-control
behavior.
Of course, there's a lot of room in between high-functioning (sometimes
referred to as the "borderline" borderline) and low- functioning
BPs. Stressful life events are most likely to trigger
dysfunctional coping mechanisms.
Acting In, Acting Out
Most borderline behavior is about one thing: trying to cope with
internal anguish. However, people with BPD may do this in different
ways. In our experience, the behavior of people with BPD tends to fall
into two general categories: "acting out" and "acting in." These are
not official, empirically researched categories. Rather, they are a
convenient, real-world way of looking at differences.
Acting-out behaviors are attempts to alleviate pain by dumping it onto
someone else-for example, by raging, blaming, criticizing, making
accusations, becoming physically violent, and engaging in verbal abuse.
Acting-out behaviors cause direct anguish for friends, family members,
and partners. For example, one borderline woman, Kiesha, became very
angry when she felt that her husband was ignoring her at an office
Christmas party. So she went up to him, threw her drink in his face,
and stalked out.
Acting-in behaviors mostly hurt the person with BPD, although non-BPs
are also affected. Someone with BPD who mostly acts in may feel
extremely guilty over imagined transgressions. They may mutilate
themselves, try to hold in their anger, and blame themselves for
problems that are not their fault. Suicide is also a possibility.
Some BPs seem to mainly act in. Some mainly act out. And some both act
in and act out. Take Kiesha, for example; after she embarrassed her
husband at the Christmas party, she felt very guilty. She walked home
from the party, a distance of several miles. When she arrived home, she
grabbed several ornaments from the tree and crushed them with her
hands, causing a great deal of bleeding.
Assumptions held by BPD sufferers
When you're interacting with someone with BPD, it's crucial to
understand that their unconscious assumptions may be very different
from yours.
Their assumptions may include:
-
I must be loved by all the important
people in my life at all times or else I am worthless. I must be
completely competent in all ways to be a worthwhile person.
-
Some people are good and everything
about them is perfect. Other people are thoroughly bad and should be
severely blamed and punished for it.
-
My feelings are always caused by
external events. I have no control over my emotions or the things I do
in reaction to them.
-
Nobody cares about me as much as I
care about them, so I always lose everyone I care about-despite the
desperate things I try to do to stop them from leaving me.
-
If someone treats me badly, then I become bad.
-
When I am alone, I become nobody and nothing.
-
I will be happy only when I can find
an all-giving, perfect person to love me and take care of me no matter
what. But if someone close to this loves me, then something must be
wrong with them.
-
I can't stand the frustration that I feel when I need something from someone and I can't get it. I've got to do something to make it go away.
Keep in mind that these do not reflect the thinking of every person
with BPD. You must judge what is pertinent in your individual
circumstances.
Myths and Realities about BPD
Myth 1: People with BPD never get better.
Reality: Many people with BPD report success with proper
treatment.
It is true that ingrained personality traits are not easy for people
to change. But BPD behavior that has been learned can be
unlearned. And many symptoms of BPD that are biological or chemical in
nature can be treated effectively with medication.
Why is it, then, that this myth persists n spite of the fact
that researchers have demonstrated effective treatments? The
problem is the stigma of BPD and the lack of awareness. The research on
effective BPD treatment is so new that many seasoned clinicians weren't
exposed to it during their training. In addition, clinicians are
bombarded with contradictory research on BPD treatment, which may leave
them confused about which treatment approaches are most effective.
Since many mental health professionals find working with borderline
patients arduous and exhausting, promising new studies often go
unnoticed by clinicians who don't specialize in BPD. It becomes a
vicious circle: clinicians don't read studies that could help them work
with borderline patients because they believe that borderline patients
are always going to be difficult to work with.
Another problem is that many insurance plans won't cover BPD
treatment-again, because of the myth that treatment rarely works. This
acts as a barrier for clinicians to learn about state-of-the-art BPD
treatments. Clinicians then rely on outdated information, misleading
statements, and false information about BPD they've heard from their
associates.
Myth 2: BPD is a "wastebasket definition."
Clinicians
give patients this diagnosis when they can't figure out what's wrong
with them.
Reality: BPD should be diagnosed only when patients meet
the
specific clinical criteria.
Janice Cauwels (1992) wrote: BPD is still a wastebasket diagnosis, a
label slapped on patients by therapists trying to pretend that their
illness is understood. It is also used to rationalize treatment
mistakes or failures, to avoid prescribing drugs or other medical
treatments, to defend against sexual issues that may have arisen in
therapy, to express hatred of patients, and to justify behavior
resulting from such emotional reactions.
In other words, some clinicians use the word "borderline" like some
schoolyard bullies use the word "cooties." But the fact that BPD is
used as a wastebasket definition doesn't make it a wastebasket
definition, any more than calling grapefruit a fat burner makes
it a fat burner. A patient should be diagnosed as borderline only if
they meet the clinical criteria and only after a clinician has worked
with the patient over time to verify that the BPD symptoms are
persistent, extreme, and long standing.
Myth 3: Women have BPD; men have Antisocial
Personality
Disorder.
Reality: Although BPD is diagnosed in women much more
frequently, men have it as well.
According to the DSM-IV, about 75 percent of those diagnosed with BPD
are women and that most people diagnosed with Anti-social Personality
Disorder (APD) are men. But although the personality disorders have
some external similarities (i.e., difficulties with relationships,
tendencies to blame others), their internal states are strikingly
different. Borderlines feel shame, guilt, emotional distress, and
emptiness; people with APD generally do not.
So why are more women diagnosed with BPD than men? No one knows, but
several theories have arisen.
Theories of why BPD happens more often in women
-
Sexual abuse, which is common in
childhood histories of borderline patients, happens more often to women
than men.
-
Women experience more inconsistent and
invalidating messages in this society.
-
Women are more vulnerable to BPD
because they are socialized to be more dependent on others and more
sensitive to rejection.
-
Clinicians are biased. Studies have
shown that mental health professionals tend to diagnose BPD more often
in women than men, even when patient profiles are identical except for
the gender of the patient.
-
Men seek psychiatric help less often.
-
Men are more likely to be treated only
for their alcoholism or substance abuse; their borderline symptoms go
unnoticed because BPD is assumed to be a woman's disorder.
-
Female borderlines are in the mental
health system; male borderlines are in jail.
Myth 4: There is no such thing as BPD.
Reality: More than three hundred research studies and
three
thousand clinical papers provide ample evidence that BPD is a valid,
diagnosable psychiatric illness.
Clinicians may claim that BPD doesn't exist for several reasons. They
may not have kept up-to-date with the research and are
misinformed. They may believe that BPD is not a separate disorder, but
part of another illness such as Bipolar Disorder or Post-Traumatic
Stress Disorder. They may simply reject the idea of labeling anyone as
"borderline" because they think it is too stigmatizing, or they may
find nearly all psychiatric diagnoses limiting and misleading.
Common "games" between BPs and Non-BPs
Feelings Create Facts
In general, emotionally healthy people base their feelings on facts. If
your dad came home drunk every night (fact) you might feel worried or
concerned (feeling). If your boss complimented you on a big project
(fact) you would feel proud and happy (feeling).
People with BPD, however, may do the opposite. When their feelings
don't fit the facts, they may unconsciously revise the facts to fit
their feelings. This may be one reason why their perception of events
is so different from yours.
Splitting: (I Hate You -- Don't Leave Me)
People with BPD may have a hard time seeing gray areas. To them, people
and situations are all black or white, wonderful or evil. This process
of splitting serves as another defense mechanism. Peter, who has BPD,
explains: "Dividing the world into good or evil makes it easier
to understand. When I feel evil, that explains why I am the way I am.
When you are evil, that explains why I think bad things about you."
Tag, You're It : A Game of Projection
Some people with BPD who act out may use a more complicated type of
defense mechanism --we've named it "Tag, You're It"-- to relieve their
anxiety, pain, and feelings of shame. It's more complex because it
combines shame, splitting, denial, and projection.
People with BPD usually lack a clear sense of who they are, and feel
empty and inherently defective. Others seem to run away from
them, which is lonely and excruciatingly painful. So borderlines cope
by trying to "tag" or "put" these feelings onto someone else. This is
called projection.
Projection is denying one's own unpleasant traits, behaviors, or
feelings by attributing them (often in an accusing way) to someone
else. In our interview with Elyce M. Benham, M.S., she explained that
projection is like gazing at yourself in a hand-held mirror. When you
think you look ugly, you turn the mirror around. Voila! Now the homely
face in the mirror belongs to somebody else.
Sometimes the projection is an exaggeration of something that has a
basis in reality. For example, the borderline may accuse you of
"hating" them when you just feel irritated. Sometimes the projection
may come entirely from their imagination: for example, they accuse you
of flirting with a salesclerk when you were just asking for directions
to the shoe department.
The BP's unconscious hope is that by projecting this unpleasant stuff
onto another person-by tagging someone else and making them "it"
like a game of Tag -- the person with BPD will feel better about
themselves. And they do feel better, for a little while. But the pain
comes back. So the game is played again and again.
Projection also has another purpose: your loved one unconsciously fears
that if you find out they're not perfect, you will abandon them. Like
in the Wizard of Oz, they live in constant terror that you'll
discover the person behind the curtain. Projecting the negative traits
and feelings onto you is a way to keep the curtain closed and redirect
your attention on the perfect image they've tried to create for
themselves.
How can people with BPD deny that they are projecting when it is so
obvious to everyone else? The answer is that shame and splitting may
combine with projection and denial to make the "Tag, You're It" defense
mechanism a more powerful way of denying ownership of unpleasant
thoughts and feelings.
Some adults who enter into relationships with borderlines feel
brainwashed by the BP's accusations and criticisms. Says Benham: "The
techniques of brainwashing are simple: isolate the victim, expose them
to inconsistent messages, mix with sleep deprivation, add some form of
abuse, get the person to doubt what they know and feel, keep them on
their toes, wear them down, and stir well."
Everything Is Your Fault
Continual blame and criticism is another defense mechanism that some
people with BPD who act out use as a survival tool. The criticism may
be based on a real issue that the person with BPD has exaggerated, or
it may be a pure fantasy on the borderline's part.
Family members we interviewed have been raged at and castigated for
such things as carrying a grocery bag the wrong way, having bed sheets
that weighed too heavily on the BP's toes, and reading a book the BP
demanded they read.
One exasperated non-BP said that if by some chance he didn't make
an unforgivable error one day, his wife would probably rage at him
for being too perfect.
If you object to the criticism or try to defend yourself, your loved
one may accuse you of being defensive, too sensitive, or unable to
accept constructive criticism. Since their very survival seems to
be at stake, they may defend themselves with the ferociousness of a
mother bear protecting her cubs. When the crisis has passed and the
person with BPD seems to have won, they may act surprised that you're
still upset.
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