[Read Part 1 here] Uses for CBT For many years, CBT was used primarily to…
Borderline Personality Disorder: Enlisting a Community of Care
This article is written for people who have been diagnosed with borderline personality disorder (BPD) or who believe themselves to have many of the traits of this personality disorder, but it may be helpful to anyone who is a family member, partner, or friend of someone with BPD.
By now, you are familiar with the traits of this illness, the most predominant of which is an underlying terror at the perception of abandonment. The word here is “perception” because as many have said before, an adult cannot actually be abandoned. Insofar as each of us has the responsibility and capability to care for ourselves, the onus is on us to do so. The problem of borderline personalities is paradoxical; although they greatly fear abandonment, the behaviors driven by their illness frequently work to push people away. Emotional instability, an unstable sense of identity, outbursts of anger (and sometimes violence) especially in response to criticism, impulsive behavior, self-harm, and suicidal threats are common experiences of anyone suffering BPD. Behaviors like these create a pattern of unstable relationships and can negatively impact work life and occupational success.
Difficulty with Therapists
A sad fact and something well known in the mental health community (though perhaps not at all known to the world at large), is that many therapists dread working with this population. Some outright decline. People with BPD can be difficult to treat with conventional cognitive behavioral therapy (CBT), also called talk therapy, or with psychiatric medications. There are therapies with reported success rates—dialectical behavior therapy (DBT), for example, which was created by the now famous therapist, Marsha Linehan who recently came out as a longtime BPD sufferer herself. Even while DBT and similar behavior-based therapies might work, therapists find they have a difficult time because of two characteristic traits of BPDs: intense, early attachment and splitting. Splitting is at the root of an unstable sense of identity and a pattern of instability in relationships for BPDs. It is due to black-and-white thinking and is the habit of a borderline personality disordered person to place someone to whom they’ve become attached high on a pedestal but at the first sign of even a typical human flaw, to extremely devalue this individual—in essence, to push them right off that pedestal. As Jerold Kreisman, M.D., a psychiatrist and author wrote, “They may idealize beyond measure those whom they will soon come to revile without reason.”
Knowing and accepting that you possess this kind of black-and-white thinking as a matter of course, and that you are liable to split even your therapists is important. Again, the awareness is essential but the acceptance of yourself and your traits is key. It is only after we come to compassionately embrace who and what we are that we can begin to truly change.
Talking to Your Therapist
People with borderline personality disorder split themselves as much as they split others. One moment they feel they are the greatest thing since the invention of texting; the next, they’re certain they’re dirt. Knowing that you are likely to cycle through these unrealistic and highly mutable feelings is a good way to practice keeping yourself grounded. When you become stuck in black-and-white thinking about yourself and others, you can take a step back before the pendulum swings and smashes you with the next extreme feeling. It may also be helpful to explain your tendency to your therapist before beginning treatment, and to ask from a place of reasoned awareness for their help in keeping you centered and non-attached. [Note: Here “non-attached” is meant to be different than “unattached.” Non-attachment connotes the healthy and centered ability to let go if necessary, while unattached implies a sense of not caring.]
If your therapist is good, you will likely begin to feel strongly attached—too strongly—because you have borderline personality traits, and when you feel very strongly attached, you begin to feel vulnerable to abandonment, which causes you to desire to lash out. Becoming aware of this tendency and the reasons for it is very important to your ability to get better. Ask your therapist to help you devise self-checks and to assist you as you begin to monitor and maintain them.
Talking to Loved Ones
Vulnerability causes you to react without thinking. This is more common than many people realize and is likely an evolutionary trait initially designed to protect simply gone a bit haywire. Although it may be frightening, try talking to your loved ones—family, partners, very close friends—about your borderline traits and what you plan to do to get well. Explain to them what splitting is, for example, and that you recognize how this may have been. Explain that you do it to yourself, as well, which causes you pain and you want to get better for them and for you.
Steer clear of all subjects which might lead to criticizing, blaming, or victim-language, and keep the dialogue strictly about what you are doing to heal. Talk only when you are feeling calm and when you know your loved one is feeling level and receptive. Writing may be a good way to communicate so there is no chance that emotions will escalate without warning. Explain that you are working on your fear of abandonment and that you do not truly desire to push your loved ones away from you. Ask for their compassion and patience, and promise to give them the same. Then, do everything you’ve given your word to do. Do not be afraid of failure; there is no failure, only an opportunity to explore more deeply what it means to be human, facing the challenges particular to you.
Make a list of behaviors you see in yourself and a list of behaviors you would like to see. From this list, begin to do the work to change old, reactive behaviors into the new, creative ones.
Having a diagnosis for any mental health issue is not an excuse for behaving badly; we must always be accountable for our actions. Taking this position and maintaining it even when you feel you have slipped is what will help you get better. And people with BPD do get better all the time. Many people in the mental health field once believed there was no hope for those with BPD, but the research is proving that those with BPD show marked improvement after therapies like DBT, and that even without therapeutic interventions of any kind, people with borderline personality disorder frequently get better on their own. They can and do go on to lead healthy lives, particularly after the mid-life mark. It doesn’t have to take that long, however. If you are young, there’s work you can begin now. Enlisting the help of a good therapist and the support of the people closest to you is a sign that you are already on the path to a more stable and fulfilling future.