The Essential Family Guide to Borderline Personality Disorder Read online

  People with anorexia starve themselves to dangerous levels. Some experts see it as an alternative type of self-harm and another way to capture control. A BP says, “When people said I was so thin that something must be wrong with me, it pushed me to lose even more weight. This was mine, something that only a few can accomplish. It was my control.”

  Those with bulimia binge then rid themselves of the food by vomiting, taking enemas, exercising obsessively, or abusing laxatives. The long-term effects can include stomach rupture, tooth loss, and even death.

  Narcissistic Personality Disorder

  In a popular television cartoon series, a young girl gives her father a lovingly crafted drawing for Father’s Day. Dad says “thank you,” but his daughter starts complaining when he makes it obvious that he prefers his son’s present: a “real” gift from a store. To mollify her, he puts her picture on the refrigerator. But it’s too heavy and slips off, quickly becoming a water-soaked glob of paper. As the daughter runs off, crying, the puzzled father asks his wife how it is possible that his daughter can be unhappy when she knows that this is his very special day.

  It may be a cartoon, but it’s not an exaggeration of the way people with narcissistic personality disorder (NPD) behave. Based on the experience of Welcome to Oz members, especially partners and adult children, it’s quite common for higher-functioning invisible BPs to have NPD or NPD traits, especially the men. In fact, roughly 75 percent of the women partners on WTO have husbands or boyfriends with traits of both BPD and NPD.

  While BPs depend on close relationships with others to meet their insatiable need for love, narcissists (NPs) don’t need real relationships as much as they need a supply of unceasing adulation, special treatment, and confirmation of their superiority. A hallmark of the disorder is that they don’t have empathy for other people; that is, they can’t put themselves in another person’s place. To the person with NPD, other people are objects whose function is to meet their needs.

  People with NPD may come off as quite charming and confident, even arrogant. They may overestimate their abilities and inflate their accomplishments while devaluing accomplishments of others. But don’t let that fool you. When it comes to their inner experience, both BPs and NPs have much in common.

  According to www.mentalhelp.net, underneath the NP’s image of grandiosity is an insecure person with very low self-esteem and underlying feelings of emptiness and worthlessness. The arrogant image is a way to protect others from finding out that the NP has weaknesses and imperfections.19

  “Narcissistic individuals are actually needier than most people,” says Beverly Engel in her book The Jekyll and Hyde Syndrome.20 “To admit that a relationship is important to them forces them to face feelings of deficiency. This, in turn, creates intolerable emptiness, jealousy, and rage. If anyone crosses them or challenges them in any way, there will be hell to pay for whoever forces them to face themselves or face reality.”21

  Bipolar Disorder

  Because both people with BPD and those with bipolar disorder experience dramatic mood swings, the disorders are often mistaken for one another. The situation gets even more confusing when someone has both disorders.

  Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.22

  A cycle is the period of time it takes for a person to go through one episode of mania and one of depression. The frequency and duration of these cycles vary from person to person, from once every five years to once every three months. People with a subtype of bipolar, rapid-cycling bipolar, may cycle more quickly, but much less quickly than people with BPD.

  According to Dr. Friedel, director of the BPD program at Virginia Commonwealth University, there are two main differences between BPD and bipolar disorder:

  1. People with BPD cycle much more quickly, often several times a day.

  2. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment.23

  Marsha M. Linehan, professor of psychology at the University of Washington, says that while people with bipolar disorder swing between all-encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, “You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down.”24

  Histrionic Personality Disorder

  Adult children frequently describe their BP mother as having traits of histrionic personality disorder (HPD). These traits include striking self-centeredness or seductiveness, over-the-top emotional displays, and a need for attention that’s so excessive it’s beyond borderline. Those with HPD may charm people and use their appearance to draw attention to themselves; they’re often the life of the party—until they can’t get something they want.

  Chapter 3

  Making Sense of Your Relationship

  People leave me. Everyone does. I know it and you know it. Why? Because the only people I hurt are the people I love. It’s as if I’m driven to give them a reason to leave, even though being abandoned scares me more than anything.

  • Mary Ann, a woman with BPD •

  When non-BPs join the Welcome to Oz Family Community, they immediately discover that their story is not unique. It’s not just that their loved ones with BPD act alike—that is to be expected if they all meet basically the same diagnostic criteria. What astounds new members is the similarity of the dynamics—the psychological interplay—within the BP/non-BP relationship. For example, phrases heard again and again include

  • “I keep telling my BP I don’t hate her. I love her. But she refuses to believe me.”

  • “My borderline husband is one of the smartest people I’ve ever met. But when it comes to him understanding my feelings, he doesn’t have a clue.”

  • “If I want to spend any time by myself, she thinks I’m rejecting her and starts to cry.”

  • “My husband works in an emergency room and can keep calm under pressure. But when someone makes him mad, he yells and lashes out at me and says he just can’t help it.”

  • “She keeps saying, ‘You never loved me, not really,’ and when I assure her that I do, she just shakes her head and refuses to believe me.”

  • “My borderline mother always turns things around so she’s the victim and I’m the nasty, unreasonable person who’s hurting her.”

  This chapter will explain the BP/non-BP relationship: the dysfunctional interaction patterns that keep people walking on eggshells and feeling stuck. Please read this chapter carefully. The terms and concepts discussed here are fundamental to understanding the interpersonal conflicts going on between you and your family member and will appear many times in other chapters.

  Most Borderline Behavior Isn’t Deliberate

  Without education about BPD, family members take their BP family member’s behavior personally—especially if the BP is of the higher-functioning invisible type. This leads to much unnecessary suffering, because BPD behavior isn’t willful. Think of it this way: Why would anyone choose to be in situations that make them angry, unhappy, or otherwise in distress?

  Look at your BP’s face the next time you’re having a conflict. Does she look cheerful and satisfied with the way things are going? Does his jealously, anger, criticism, and general crazy-making actions seem to make him happy? Quite the contrary—after all, one out of ten BPs commit suicide. You can’t get much more miserable than that.

  The following empathy exercise will give you a glimpse into what’s really behind borderline behavior.

  See the World through BPD-Colored Glasses

  This empathy exercise will take two months to complete. You will need to buy a thick blank journal or lined notebook. IMPORTANT: Begin this exercise only after you have
read it in its entirety.

  Week one: Sit down with your notebook and recall every time you ever felt publicly humiliated or ashamed, starting with grade school. For now, hold off on recording incidents having anything to do with your family.

  Week two: Go over your life, from as early as you can remember. Think about times when each member of your family did or said something that caused you a great deal of pain. Then conjure up all those feelings you had at that time. Next, do the same thing for all your love relationships.

  Week three: Take note of the times you felt enraged at someone. Did you ever feel like throwing something at the wall—or even at the person—during a major free-for-all?

  Week four: Repeat as before, focusing on the following issues: Did you ever feel as though you wanted to die—really die? Are there any areas of your life you can’t control, like eating or drinking too much? Make a list of all the things you hate about yourself.

  Week five: Think of all the times you’ve hurt others. Did you ever break a promise to a child or give an unfair punishment?

  Week six: Go through your notebook. In each instance, no matter how absurd it seems, find someone or something else to blame for each incidence, as a higher-functioning invisible BP might do. Chant to yourself, “It wasn’t my fault. It was her fault (his fault).” Feel the relief that acts as a blessed sunburn balm that takes away the pain on your emotional skin.

  Go back through each week casting blame and criticism. For example, for the previous week, blame the other person for making you hurt him. Do the same type of thing for week two. When you’re done, reward yourself to compensate for having had to deal with such crazy people.

  Week seven: Now do what some lower-functioning conventional BPs do: blame yourself for every painful incident. If your parent forgot your birthday, believe it was because you did something bad or were so worthless that you didn’t deserve to have your birthday remembered.

  Week eight: Now it’s time for the most complex assignment yet: spend a few hours with your notebook and put all your notes equally at the top of your mind—even the ones that contradict each other, such as blame yourself and blame everyone else (in fact, especially those). You may find that you can think of little else, making it hard to function. Feel free to cry liberally.

  Interpreting the Exercise

  Now that you’re prepared to run out and buy your blank journal, don’t. Hopefully, just reading the exercise has given you insight into what it is like to have BPD. Imagine living with this emotional turmoil 24/7 and put yourself in the following situations. How would you react?

  • You’re at work, and your boss criticizes something about your job performance.

  • Your daughter says she hates you.

  • You miss the bus, and it’s raining.

  • You interview for a job, and they pick somebody else.

  • Someone you’re interested in says he or she “just wants to be friends.”

  Just facing the daily challenges of life and maintaining self-esteem and good humor can be difficult for anyone, let alone someone with BPD. Individuals with BPD often feel—for the lack of a better word—wounded. When they believe they’ve been deliberately hurt, part of their pain is from wondering why someone who is supposed to love them would want to hurt them.

  When you swoop in to rescue them—for example, with the intense “love-at-first-sight” Romeo and Juliet type of heroic and undying love, they see a chance (unconsciously so) to escape from their horrifying mental prison. No wonder they fall in love so far so fast and cling to it with all they have.

  BPD Features That Challenge Relationships

  BPD is characterized by the following four features, all of which make relationships difficult:

  1. Childlike characteristics and defense mechanisms: Non-BPs say that having a discussion with a borderline adult can be reminiscent of arguing with a small child. That’s because in a developmental sense, they are arguing with a small child.

  2. Low emotional intelligence: There’s more than one way to be smart. In addition to the kind of intelligence you can measure on an IQ test, there’s emotional intelligence. Emotional intelligence is about monitoring emotions—both your own and those of the people around you—and then using this knowledge to guide your thinking and actions.

  3. Rejection sensitivity: In addition to fearing abandonment, people with BPD are overly sensitive to rejection. They anxiously await it, see it when it isn’t there, and overreact to it whether it’s there or not. This is why small slights—or perceived small slights—can cause major messes.

  4. Impulsive aggression: Impulsive aggression is what ensues when the other shoe drops, when the eggshells break, and the emotional roller coaster takes a 180-degree turn. The aggression can be turned inward (self-injury, suicide) or turned outward (raging, verbal abuse, domestic violence).

  Childlike Characteristics

  People with BPD may seem as mature as any other adult in social or professional situations. But if you could do a Star Trek Vulcan mind-meld, you’d know that on the inside they feel as vulnerable, scared, and needy as a small child left alone by his parents for the first time.

  Modes or Feeling States

  Jeffrey Young, PhD, the founder of schema therapy (pages 91–92), believes that people with BPD can fall into four different childhood modes: the abandoned or abused child, the angry and impulsive child, the punitive parent, and the detached protector.

  The Abandoned or Abused Child: The abandoned child feels lonely, sad, misunderstood, unsupported, defective, deprived, overwhelmed, needy, frightened, anxious, victimized, unlovable, weak, excluded, and pessimistic.

  The abandoned child is easy to spot in lower-functioning conventional BPs. It’s that quality exuded by Marilyn Monroe and Princess Diana Spencer—both people who were said to have suffered from BPD.

  The Angry and Impulsive Child: The angry child is infuriated, frustrated, and impatient because core emotional and physical needs aren’t being met.These children are self-absorbed and out of control, acting on their desires to get their own way.

  The Punitive Parent: The punitive parent punishes the child for expressing needs and feelings and for making mistakes. As a result, the BP is full of self-hatred, self-criticism, and self-denial and may self-mutilate.

  The Detached Protector: BPs protect themselves emotionally by cutting off their needs and feelings and by detaching from others. The result is emptiness and boredom, which lead to substance abuse, bingeing, and self-mutilation.1

  Primitive Defense Mechanisms

  Defense mechanisms are psychological strategies that protect us from being consciously aware of thoughts or feelings that could make us feel bad, especially about ourselves. A common one is rationalization, where we make up good reasons for a course of action we wish to take. (“I might as well eat this last piece of cake so I can put the plate in the dishwasher.”)

  We begin using defense mechanisms as children, when our methods are fairly primitive. Primitive defense mechanisms include splitting, dissociation, denial, and acting out.

  As we grow older and become more sophisticated about social situations, most of us move from these “primitive” defense mechanisms to more mature and complex ones, like rationalization. People with BPD, however, keep using primitive defense mechanisms even in adulthood. That’s why interacting with a BP can be reminiscent of dealing with a child.2

  Low Emotional Intelligence

  Emotional intelligence (EI) is a measure of qualities such as self-awareness, personal motivation, empathy, and the ability to love and be loved by friends, partners, and family members.

  The concept of emotional intelligence helps explain why people with BPD can have multiple doctorates and be Mensa members in good standing, yet be unable to sense what other people are feeling. EI theories weren’t developed with BPD in mind. Nonetheless, it sure looks as if the social scientists who theorized about EI and those who formulated the concept of BPD must at least have been connected
by two tin cans and some string.

  The best seller Emotional Intelligence: Why It Can Matter More Than IQ revolutionized the way we think about why some people live happy, successful lives and some don’t. In the book, the author, Daniel Goleman, explains that EI falls into five domains:

  1. Knowing one’s emotions

  2. Managing emotions

  3. Motivating oneself

  4. Recognizing emotions in others

  5. Handling relationships3

  BPD seems to diminish a person’s skills in all five domains.

  Knowing One’s Emotions

  Some people with BPD are self-aware and can articulate their emotions, but others have trouble. For one thing, their emotions can shift so radically and so quickly that it can be tough for anyone to keep up—even them. Second, some BPs have a tough time separating their own emotions from the emotions of others. Knowing what you feel is essential to knowing who you are. BPs who become enmeshed with others suffer from identity issues.

  Managing Emotions

  “Emotional dysregulation,” as clinicians call it, is a hallmark of BPD and needs no further explanation.

  Motivating Oneself/Impulsivity

  A portion of motivation has to do with the ability to control impulsive actions, especially those driven by intense emotions.

  “There is perhaps no psychological skill more fundamental than resisting impulse,” Goleman writes. “It is the root of all emotional self control, since emotions, by their very nature, lead to one or another impulse to act.” An experiment designed to test children’s ability to resist temptation at age four found that the four-year-olds who were able to delay gratification were, as adolescents, more socially competent, personally effective, and better equipped to handle frustration.4

  Recognizing Emotions in Others

  As we just discussed, some BPs have trouble identifying their own emotions, let alone anyone else’s. BPs can misread cues: For example, they will see somebody who’s angry and they’ll think the anger is directed at them, even when it isn’t. Then they will assign too much significance to it, as if the anger means that the person is going to abandon or hurt them.