Stable instability – Borderline Personality Disorder (BPD)

Personality disorder as an expression is often used in our daily life mainly in pejorative sense but actually they are difficult to be diagnosed even for professionals. One of the well-known personality disorder is the Borderline but in common knowledge sometimes it has a different meaning. How does Borderline Personality Disorder work? Facts. What are the most typical symptoms and what is known about its development?

First we need to make clear what Borderline Personality Disorder means and we can find that in the DSM (Diagnostic and Statistical Manual of Mental Disorders). Personality Disorder is when the person’s internal experiences and behaviour form a pattern which is very different from the cultural expectations. Its negative effects appear in emotional well-being, relationships and on the area of impulse control. The same characteristic in almost every personality disorder is that the person doesn’t feel ill just perceive that the problem is in the surroundings, like partner, boss, parents, other people etc. Because there is a problem, well the deviation from social norms cause adaption problems and make the person and the environment suffer.

index

Once it’s black, once it’s white

The expressions of a person with BPD are immoderate and unpredictable. Emotional control is a problem and that’s why sometimes they are nice and attractive and other times impulsive, arbitrary and can be aggressive. Often appears self-destructive behaviour or attempted suicide. The typical symptom is the splitting, which appears in the person’s view on self, in the judgement of environment and people around and in the own change of mood. What does it mean in daily life? Splitting is a primitive defense mechanism. Both harmful and helpful impulses are split off and unintegrated, frequently projected onto someone else. The defended individual segregates experiences into all-good and all-bad categories, with no room for ambiguity and ambivalence. There is no mixture of positive and negative characteristics to them. Someone – including him/her – is God or the Devil to him/her. Often person with BPD gets into self-contradiction in change of mood which can be seen uninteresting or clear denial by the person. In relationship just two category is used as a judgement, perfectly good or perfectly bad but also these categories can be shifted often relating to one person. If the person with BPD sees someone nice and kind for the moment, she/he can idealize this person but also on the same easy way she/he can undervalue if has got a small critic or negative feedback. The own view of self also shifts time by time, day by day or hour by hour, and it goes a great way to the feeling of chronic emptiness. Has a relationship emotionally intense but very unstable. A person with BPD experiences continuous internal anxiety, tense for instance strong fear of abandonment which often can be expressed  in a desperate, intens and impulsive form. Often we can see easily developed offendedness, using physical or mental abuse (emotional blackmail, threat etc.) which are desperate efforts to minimize or refuse own emotional intensity, conflict, responsibility in a situation.

More symptoms:

– Emotional lability, extreme and intensive change of mood: the mood may change in seconds, without any identified reason, like being very happy but in the next moment very lethargic. The basic mood often is depression, irritability and anxiety which can remain from minutes till days.

– Unstable and intense relationships: shifting between idealization or undervaluing someone. The background of this attitude the fear of abandonment and the missing object permanence, which means she/he is not able to see the other person as a complex totality (can be just good or bad and not able to deal with contradictory behaviour).

– Impulsive, self-destructive behaviour: at least in two areas – for instance over-indulgence in alcohol or other psychedelic drugs, irresponsible extravagance, dangerous driving, impulsive sexual attitude etc.

– Repeated threatening of suicide, attempted suicide and self-abuse: maladaptive efforts releasing a desperate internal tense, refusing food, bingeing, over-indulgence of alcohol or drugs. There can be several reasons in the background: self-punishment, call for help, expressing and releasing intense mental pain, manipulating the environment, reducing anger, fear, and sadness.

– Disproportionate intense, inadequate anger: often can have uncontrolled anger bursts where the intensity of the anger is not proportional to the cause. The intensified fear of abandonment and disappointment is in the background.

– Identity disorder, long-lasting self-image disorder, defective self-perception capacity: uncertainty relating to the own self, who she/he is, what she/he wants, where her/his place in this world. It covers mainly all of the aspects of the person’s life. Often can have difficulties with decision making. Often feels worthless and not being able to be loved. Not able to accept his/her real characteristics as permanent, continuously depends on confirmations and feedbacks from others, values him or herself comparing to others. That’s where the effort of perfection comes from which also causes several failures after a while and because of this often changes partners or/and jobs.

– Desperate effort to avoid presumed or real abandonment: person with BPD needs relationships mainly to feel existence. The fact of existence may get questioned when she/he is alone because there is no feedback from the environment what to compare himself/herself. To avoid being alone and feel abandoned again, does everything, sometimes extremely, to keep the partner. She/he gets into a grave emotional crises after the partner left. The self-destructive behaviour become stronger. This is often the reason why people with BPD stay in abusive relationships.

– Chronic feeling of emptiness and boredom: intensive and often comes with physical symptoms. To ease that, often used maladaptive attempts, like self-destructive behaviour modes and unsuccessful relationships.

– Temporary paranoid thoughts and grave dissociative symptoms by stress: if the person is getting into an emotionally unbearable situation, can happen experiencing dissociative psychotic episode, so withdrawing from the reality. Experiencing this situation as depersonalization and also can appear with hallucinations, illusions.

Notice that these symptoms can be different individually. Not a requirement at a person with BPD to have all these symptoms and in intensive form.

How does it develop?

The reason as usually is complex like our personality and still under research. Several element can play an important part in development. Like, genetic background, childhood experiences, family patterns or early traumatization forms (physical, emotional, verbal or sexual abuse). However often there is a deficit condition behind. Haven’t expressed unsatisfied needs which by phrasing already can help.

The symptoms of personality disorders actually are the extreme expressions of normal personality traits. Mentally stable and healthy people also can show extreme personality traits but just temporarily, like experiencing a trauma or being under strong pressure. Before starting diagnose someone, must be highlighted that those extreme expressions of personality traits exist in long time period in BPD and must be diagnosed and treated by a clinical psychologist or psychiatrist.

In this and also in other personality disorders is very important to get professional help. Psychotherapy can improve the quality of daily life as well. Around 2% of the population has BPD and it shows a rising tendency but most of them don’t know about it, never have been diagnosed or treated. People with personality disorder usually don’t feel ill, they believe their problem is in the environment or in the people around. BPD can cause several difficult emotions to the person and puts a very heavy “weight” onto the people’s shoulder around, they suffer as well.

What can we do if someone in our family or environment suffers from BPD?

Communication: the internal and external communication of people with BPD is very confused. In conflicts usually they decline to accept responsibility and their partners don’t set up proper borders towards them. “No further than this!” Not setting up borders after a while cause a feeling of avoiding honest communication, feelings like sense of guilt and shame. The dominant feelings of people with BPD (anger, helplessness) get shifted on to the partner. If any small critic, defense or setting up borders appears, that would cause immediately a fear of abandonment in people with BPD so they try even harder to shift the responsibility upon the other. “The aim of the people with BPD is to get back the control and the own position, also leaving the dangerous conflicting area without feeling guilty.” (Rösel) They use like, fleeing, offending, rake over previous injuries, disparagement, causing consciousness of guilt, physical abuse and threatening etc. The partner is not able to get out a conflict without losing dignity. Non-violent model of communication can help, it requires just a bit of practice and patience.

Non-violent model of communication

It has four steps:

  1. Observation – notification of facts about the current situation without value judgement and generalization.
  2. Emotions – Identifying and expressing current emotions caused by situation without using value judgement and without attaching those emotions to the partner like cause and effect.
  3. Needs – Identifying and expressing needs.
  4. Ask – Phrasing a positive, real but also refusable ask.

SET (support, empathy, truth) is a technique made for people who live with somebody who has BPD. The aim of the SET is stability, consistency and beaming security, helping to identify fears and reacting honestly and acceptably to them. In this way they can get connected to the person with BPD and the critical situation also can be eased. The key of this technique is to to give support by showing care and worries. But also showing sympathy on the way to perceive their emotions properly, identifying them and reflecting back. Like, “I see how desperate you are……” “It’s very hard for you now because….”But also make them understand that she/he is the only one who is responsible for her/his own life and must take this responsibility. This must be expressed without causing consciousness of guilt or threat. Support him/her to express next concrete steps according to the current problem.

Picture: http://www.resiliencetreatment.com

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