Borderline Personality Disorder: "I Hate You, Don't Leave Me!"
A professor of mine at the end of her career argued borderline personality disorder the most challenging diagnosis for her to treat throughout her career as a therapist. Being an “old-school” psychoanalyst, our professor underlined when she was still studying back in the 60s, they would divide the universe of mental illness in two worlds, between the neurosis and the psychosis; and in between there were all those patients who are confronted with a borderline personality disorder.
Neurosis suffers from chronic distress, with anxiety, major depressions, phobias, obsessions and lots of others issues, but neither delusions nor hallucinations, which, on the contrary, are the main traits of psychosis.
Borderline is defined by typically unstable relationships, emotions and identity and are to be found between these 2 worlds, while sometimes in severe cases also suffering of psychosis. Apart from being chronicly emotionally disregulated, people with BPD have a lot of challenges to overcome.
People affected with BPD have a very rough life, suffer A LOT and even if they behave disruptively against themselves or others, they often are victims of abuse and have deep wounds. If treated supported and helped these humans can get better, there is HOPE!
People affected by BPD, show symptoms in the 4 typical spheres or aspects:
1) The affective aspect, including loneliness, emptiness, inappropriate and intense anger and quick mood swings.
2) The social aspect, referring to these patients’ intense and promiscuous relationships and their tendency to be at once manipulative, as well as dependent, idealizing, and fearful of abandonment (I hate you but do not go!).
3) The cognitive aspect, featuring perceptual disturbances, as dissociation and paranoia when stressed.
4) The behavioral aspect, relating risky, impulsive behaviors, self-injury and threats of self-harm.
These influence their relationships, and life in general, lead to unemployment and other mental health issues, like anxiety or substance use.
Arguing with them will make you go crazy!
They will deny what they have just said, and strongly and constantly projecting feelings and affirmations of their own... Onto you, reversing feelings and words, always refusing the responsibility of their mistakes and charging on your behavior, therefore confusing all your reasoning.
Their manipulation is powerful and even professionals might happen to confuse, at a certain point, their mixed ambivalent, suddenly varying feelings and rough reactions with an aching soul acting out, who they certainly are.
Our relationship with the borderline must be based on: PRESENCE, TRUST (built up on wobbling legs!), and above all, COMMITMENT, PATIENCE and unbreakable motivation to help while being SAFE ourselves.
It can be difficult to maintain relationships with individuals who have BPD, when facing bad episodes of self-harming and self-cutting, or hospital visits. Friendship means being forced to their rules and rhythms!
Most of my experiences I’ve earned in the psychiatric units of my hometown hospital, where lots of people are alone and go back on a monthly basis, after having been treated multiple times and checked out; in addition to this, I’ve been working in private clinics treating alcohol and drug abuse and in a center specialized for eating-disorders in adolescents.
My first week at the hospital actually made me think of quitting, as I was doubting treatment would help and felt powerless. Apart from diagnosing and giving them the right meds to make their life livable, we faced very desperate people returning to the hospital not only because of their multiple issues, but also due to the families and blocks they would go back to after discharge. Expressed emotivity is an issue in those families, actually worsening some symptoms due to the kind of relationship, ill habits and interactions in the family and neighborhoods.
We can give them meds, but nothing apart from a very well reflected programmed of psychotherapy, self-aid and psychoeducation in protected environments makes their life valuable. This is a very big concern of mine, which also has to do with prevention. How am I supposed to help people who are stuck in families I simply cannot reach and effectively support?!
From our studies some borderline traits have impairments in the brain systems affecting self-regulation and emotions, leading to emotional and behavioral dysregulation, identity issues, cognitive impairments, and interpersonal difficulties. At university we learnt the role of neurotransmitters in the development of impulsive-aggression and affective instability, which also might be out of childhood neglect and abuse.
A myth on BPD is, it is typically diagnosed only in women, while men suffer also but tend not to seek treatment and to be more prone to drug abuse and aggressive behaviors.
This has been confirmed in the practical experience. 80% of women we were treating at the hospital had been raped by a relative, friend or teacher. Colleagues of mine taking care of women houses and anti-violence units are constantly dealing with women suffering from PTSD and the consequences of abuse many years after those events happened, and among those many also suffer from BPD.
BPD is a severe condition which might be an “adaptation” - meaning spontaneous response! - as a result of many types of chronic severe stress, traumas, and aversive parental care style, influencing behavior and physiological outcomes in offspring: Their families are often affected by addiction, live in crimes, and are defined as “multiple-problematic”.
I often wonder who’s the victim: humans have been “made” so as they have been treated horribly, or they are horribly treated as they were affected by such a condition in the first place?
In facial recognition studies, people with BPD are more likely to perceive negative and untrustworthy emotions. Oxytocin (OXT) is believed to regulate social cognition through the front limbic system: the unavailability of OXT receptors in these humans may be responsible for the low treatment response to it. It is also involved in regulating the hypothalamic-pituitary-adrenal axis, helping to habituate the fear circuitry and responding to previously emotionally relevant impulses.
OXT could be useful in decreasing hypersensitivity while enhancing psychosocial interventions among struggling parents.
A BPD diagnosis might be very tricky, and it always is the cherry on top of many years of sufferance, unstable lives, with relatives and friends of the patients experiencing lots of difficulties, offenses, disguises, accidents and manipulation wars. They are used to react ill and aggressively, out of fear, rage and self-hate.
Diagnosis and treatment are very useful as they may save life, clarify and provide with the right support, both the patients, and their significant others.
Denying such a condition is dangerous!
If you’ve experienced something like this in yourself, friends and family, please contact your trusted physician, counselor, psychologist or social worker!
Thanks to treatments and recovery programs, the majority of people affected find relief and achieve long-term remission.
I’m writing for all of you, for the loved ones you beat up and let suffer, for me who suffered with you and them.
We can see light on the horizon!
***Written by Marialisa for Meridian Counseling.
Marialisa decided to become a psychologist after her teaching and mentoring experiences. Inspired by the stories of her patients, she’s dedicated to psycho-education and emergencies care, especially with her “Plumeria Project”.
You can find her on IG: @Miracolosa.Mente