The Essential Family Guide to Borderline Personality Disorder Read online

  Mostly, though, BPs are so fearful of any distance between themselves and others—and so needy of other people’s attention—that it’s all too easy to forget that other people have their own needs. This proves to be the most problematic in BP parent/non-BP child relationships (the roles become reversed, to the detriment of the child) and romantic relationships (non-BP partners expect a more equal give-and-take).

  Handling Relationships

  Being able to manage one’s emotions is necessary to having close relationships. Emotional self-control includes the ability to be patient and moderate impulses, anger, and distress. It takes self-knowledge and the ability to see both the good and bad in others and to recognize they have needs, too. We want to be around people who make us feel good about ourselves.

  Feeling safe around someone, comfortable enough to show our vulnerabilities and sensitive spots, engenders trust. Trust is sacred. It is the currency of relationships of all kinds, from the plumber to the psychiatrist. We tend to trust people who

  • accept us for who we are

  • make us feel safe and secure

  • won’t hurt, betray, or ridicule us

  • don’t expect us to be perfect

  • are consistent and dependable

  • are truthful and fair

  • respect our boundaries

  • let us say what we really think and feel without repercussions

  Borderline personality disorder is incompatible with some of these qualities. The ultimate tragedy of this illness is that it makes those who have it crave close, safe relationships, and then robs them of the qualities they need to have such relationships.

  Rejection Sensitivity

  Part of being human is to experience rejection, from the other kids in kindergarten who won’t share their Play-Doh to not being asked to dance at the senior citizen’s ball. Rejections can be small, like those just mentioned, or large: being fired or learning your partner wants a divorce. Even trivial snubs can cause a world of hurt and send our self-esteem into a tailspin.

  Rejection sensitivity exists along a continuum, from the office boor who never notices people don’t like him to—unsurprisingly—people with BPD. Just as BPs are more fearful of abandonment than most people, they’re also more sensitive to rejection. Already depressed and suffering from low self-esteem, they expect to be rejected. Like giraffes at a watering hole in the African veld on the alert for predators, they continually scan their environment for any hint of disapproval or exclusion, seeing intentional slights in the smallest things.

  Once a rejection-sensitive person is convinced someone is rebuffing her, she’ll come up with her own reasons why this is so and then react in a hostile way without checking out the facts.

  A borderline man describes it like this:

  I have a constant edge-of-your-seat alertness for little clues that might mean someone hates me or doesn’t want me to be with them anymore. With my boyfriend, when we would be together doing something quiet like reading, every so often I would interject with a pleading and submissive, “Are you mad at me?” until it annoyed him so much he really would get angry! For me, though, the impression that he was displeased with me was so real. All it takes is silence to make me feel like I’ve been rejected, and this fills me with panic.

  Impulsive Aggression (the Border-Lion)

  Please read this section closely, as the concept of the “border-lion” (impulsive aggression) will appear multiple times in part 2 of this book.

  Impulsive aggression is widely acknowledged by Larry J. Siever, MD, professor of psychiatry at Mount Sinai School of Medicine, and others as a core feature of BPD that can be triggered by immediate threats of rejection or abandonment paired with frustration. Impulsive aggression:

  • comprises verbal hostility, physical hostility, or both, with the purpose of hurting another person or self.

  • can be turned outward (such as outbursts, rages, hitting objects, or violence toward others) or inward (such as suicide attempts or self-injury).

  • is impulsive, unplanned, and reckless (that is, the person gives no thought to the consequences of his actions).

  • is linked to several BPD traits, including rage, emotional instability, impulsivity, suicidal thoughts, and self-injury.

  • is associated with a biological “tug-of-war” between the logical and emotional aspects of the brain, in which the logical side loses. These aggressive tendencies can be inherited.5

  • is not exclusive to BPD, but a component of several impulse control disorders such as intermittent explosive disorder.

  Think of impulsive aggression as a “border-lion,” a ferocious beast that is uncaged when BPs’ emotions are so strong and overwhelming they can no longer be contained. The border-lion also protects the “abandoned or abused child” inside the BP (more about that in chapter 4).

  Whether the border-lion is turned inward or outward, it is one of the top barriers keeping BPs and those who love them from developing the close, trusting relationship each partner yearns for.

  It’s going to be tough, but try to hold fast to the notion that your family member and the border-lion are not one and the same. The border-lion comes from within your family member and can be tamed with the right treatment.

  The Five Dysfunctional Dances

  Having a borderline loved one means having that “it’s déjà vu all over again” feeling much of the time. You may feel stuck in these frustrating “dances” with no clue about what’s happening, how you got there, or how to get out.

  The “It’s Your Fault Fox-Trot”

  By blaming others, BPs try to avoid taking responsibility for their own behavior. Shame and splitting play a part, as well.

  For BPs to admit to themselves or others that anything about them is less than perfect would be admitting that they are defective. But this strategy alienates others, blurs reality, and ultimately doesn’t reduce the BP’s shame. In a long good-bye letter to her BP ex-lover, Chris, a non-BP, wrote:

  One morning after we had had a fight the night before, I realized that I had been wrong and wanted to apologize. I felt awkward and ashamed, and I said, “It’s hard for me to say I’m sorry.” This was a brutally honest statement. The reward for my honesty was you snapping at me, “How come it’s so hard for you to say you’re sorry!?”

  You were constantly irritated at me. If I complained, you would simply become nastier. Once you snapped at me for looking through some DVDs the wrong way. I asked you in a very even tone of voice, “What are you getting upset about?” For the rest of the day you sulked, gave me the silent treatment, wouldn’t talk to me, wouldn’t look at me—in fact, you simply walked away from me without responding when I tried to talk to you!6

  The “No-Win Waltz”

  You know you’re in a no-win scenario when you’re damned if you do and damned if you don’t. Chris gives us more examples:

  You were a master of double-binds. Whenever I got back home to my apartment at the end of the day, I never knew when to call you. It seemed that sometimes when I called you right away, you’d be in the middle of dinner or doing chores, and would be short and rude. But if I waited until later in the evening to call you, you would say in an accusatory manner, “You’ve been home for how long? And you didn’t call me?”

  When you were feeling depressed about something and I tried to comfort you, you pushed me away with anger and the seething silent treatment. However, if I just tried to leave you alone during these situations I again got—surprise!!—anger and the seething silent treatment!! Just what the hell was I supposed to do?7

  The “Projection Polka”

  People often try to avoid feeling bad about their own unpleasant traits, behaviors, or feelings by attributing them (often in an accusing way) to someone else. This is a common defense mechanism called projection. As with everything else, people with BPD take it to the extreme.

  Sam, a non-BP, and his BP friend Hank were good buddies. Hank was on his second marriage to a
woman, Beth. Sam knew things weren’t the best, but didn’t know why until late one night when Hank’s lips loosened.

  One of the main problem areas, it seems, had to do with their sex life. Sam listened in a companionable way because he knew Hank needed to talk, but it was definitely more graphic than he was comfortable with. Sam listened, nodded, made a few polite comments, and heaved a sigh of relief when Hank decided to go home. A few days later, Sam came home from work and found Hank and Hank’s wife, Beth, sitting at the kitchen table with his wife, Manjula. Sam says:

  Hank had some book with him about boundaries that he’d been reading. It was all underlined and highlighted like a textbook or something. He and Beth sat there and explained that Hank was going to have to set some boundaries with me because I was interfering with their marriage and was, in fact, the cause of many of their problems! What? How?

  He hung his head dramatically as he told my wife that he had already “confessed” to Beth that he had “betrayed” her by telling me their private matters. But then he twisted it all around as though I had been intrusive and had pried into their affairs and was telling him what they should and should not be doing in their marriage. It was all so backward from reality, like a mirror with everything appearing the opposite way.

  We had no contact until a few months later, when Hank called and asked if I wanted to watch Sunday football at his house. He chatted about work and such like the whole thing had never happened. I couldn’t believe it.

  The “I Hate You—Don’t Leave Minuet”

  When people get too close, people with BPs feel engulfed. In turn, they distance themselves to avoid feeling controlled. But then BPs feel neglected, even abandoned. So they try to get closer again, and the cycle repeats.

  For example, Agnes doesn’t understand her BP lover, Bernice. Since they live far apart, they only get to see each other every few months. Bernice writes Agnes beautiful love letters and tells her on the phone that she can’t wait to see her.

  But when Agnes actually comes to visit, Bernice picks fights and continually criticizes her. Finally, they have a big blowup. Bernice yells and says the relationship is over. Agnes cries and flies home, mourning.

  The next day, Bernice calls Agnes, begging her to take her back. She does. It happens again the next two times they’re together. By the third time, Agnes swears to herself that this is it—she will not take Bernice back one more time. But then she receives this letter:

  My sweet baby,

  I can’t imagine living the rest of my life without you. When I “go crazy” sometimes it’s because I know how truly madly in love I am with you and that scares me. My hands are shaking as I write this letter. I feel so vulnerable, but you need to know that you are it for me, my one, my own, my soul mate. I will keep trying to work on my issues. Please forgive me. It will never happen again. I am nothing without you.

  Me

  With tears in her eyes, Agnes calls Bernice and they both cry, swearing their undying love. They even plan Agnes’s next visit.

  A few months later, a joyful reunion ensues. Some twenty minutes after the makeup sex, Bernice starts screaming at Agnes because Agnes forgot to pick up the half-and-half Bernice takes with her coffee.

  The “Testing Tango”

  Does it ever seem like your BP’s behavior and demands of you just get more and more outrageous? Do you find yourself tolerating conduct you never thought you would—maybe even some things you wouldn’t want other people to know? If so, you’re on the dance floor doing the Testing Tango.

  No matter how many times non-BPs say it or show it, people with BPD don’t trust that others really love them and won’t abandon them. Elizabeth, a recovered BP, says, “How were they seeing things in me that I wasn’t? I really did want to be loved and accepted. I just didn’t know how to let in the love because I didn’t feel worthy of that love and acceptance.”

  Life is stressful when you know that the people you love are going to grab your heart and walk out the door, but you don’t know when it will happen. So you do what kids do—you act out a bit to see if your behavior will be tolerated. If it is, next time you take it up a notch to see if the other person will take that, too. Elizabeth says:

  I’ll never forget the first time I uttered the words, “I’m just testing you to see when you’ll leave me because everyone does. I know it’s wrong, but I just can’t help myself.” What might start out as a casual gripe about finances would eventually become a three-day rage-fest over money management. I became a screaming, ranting, raging mess.

  I knew that I couldn’t start with a full-blown BP rage. So I started softly and slowly. With each test I set forth and the person passed, I upped the ante and said, “If you loved me, you would do this or that.” People usually accepted the most outrageous and inappropriate behavior to maintain the relationship.

  You might think that once the non-BP passes the tests, their borderline family member would feel more secure. But that doesn’t happen. Instead, people with BPD begin to question the sanity and character of the other person. They think, “Why would a healthy, normal person accept this kind of abuse? There must be something wrong with him to put up with these things from me.”

  Family Dynamics

  Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system. One popular model is called the Karpman Triangle, after its founder, Stephen Karpman, MD. The Karpman Triangle happens in all families, even in relatively healthy ones (see page 210). The roles in this drama are

  • the “victim”

  • the “persecutor,” who bullies the victim

  • the “rescuer,” who swoops in and saves the victim

  In the following example of the triangle, two sisters discuss their problems involving child care arrangements. Eleanor, a single parent, has BPD.

  During disputes, the participants wear each other down, each trying to claim victimhood and to slap the other with the persecutor label. This constant tug-of-war is exhausting. The roles constantly shift. Eleanor, a single parent, has BPD.

  Two can play the game just as well. For example, let’s say that Harry wasn’t at home, and Eleanor’s pleas made Louise back down instead of setting clear limits. If Louise sighed and said, “Never mind, just call me whenever you need me,” Louise would then be acting as the rescuer. This is a frequent occurrence in families with members who have BPD. You’ll learn more about this in chapter 10, Power Tool 4: Set Limits with Love.

  The Karpman Triangle game inhibits real problem-solving. It creates confusion and distress, not solutions. No matter who “wins” each fight, both sides are miserable. This becomes a second layer of upsetness—one layer is the never-ending fights; the other is whatever the disagreement is about.

  When someone with BPD is one of the parties, this dynamic becomes more intense and dangerous. Metaphorically, the tug-of-war game is held over a river full of crocodiles and piranhas. Reread the BP-point-of-view empathy exercise and recall the general feeling of victimhood you might have felt. Additionally, the thinking, feeling, and acting impairments (especially splitting) of people with this disorder make finding a middle ground unlikely.

  The bottom line: you can’t “out-victim” your BP. Although you can’t change the way your loved one relates to you, you can choose to stop dancing altogether.

  Chapter 4

  Risk Factors of BPD

  The prevailing thought is that there is not one “cause” of BPD. Instead, there are many risk factors that create the likelihood that the disorder will develop. A risk factor is just what it sounds like: something that, when present, increases the risk that something else will happen. Risk factors can be both biological and environmental. The more risk factors that a person has for some type of physical or mental illness, the greater the chance he will develop that condition.

  As an example, consider heart disease. Imagine a man whose grandmother and uncle died of a heart attack. His parents own a ba
kery, so he grows up appreciating the buttery taste of croissants and chocolate-covered cream puffs. As an adult, he eats high-fat, high-cholesterol meals and doesn’t have time to exercise.

  Suddenly, on his sixtieth birthday, he dies of a heart attack while shoveling a heavy, wet snow. What caused his death? Was it his genetic history? The high-fat diet? The lack of exercise? The shoveling? The answer is all four factors (and perhaps others) working together.

  Now let’s extend that example as it applies to developing BPD. Let’s take four people: Julius and Nelson, two brothers, ages thirty and thirty-two, and Terri and Sherri, identical twins separated at birth and adopted by different families.

  Terri and Sherri are both biologically vulnerable to BPD. However, they grew up in different environments. Terri grew up in a high-conflict household. At ten years old, she was sexually abused by a neighbor. She develops BPD. Sherri was luckier. Her home life was stable and with no major trauma. She never develops the condition.

  Julius and Nelson grew up in a reasonably stable and pleasant environment, just like Sherri. In Julius, the mix of genes is such that, even with good parenting, he still develops BPD. His brother Nelson doesn’t, because his genetic heritage is just different enough.

  In the rest of this chapter, we’re going to look at the two kinds of risk factors that lead to the development of BPD: biology and environment. The argument about which is dominant has been going on for decades. One might as well debate about which came first: the chicken or the egg. Increasingly, research is finding that it’s not one or the other. It’s both.

  That’s not to say that the two are always equal. If many biological risk factors are present, only a few environmental aspects are needed to develop BPD. The fewer the biological factors, the more the environmental factors. Whichever dominates, the result is the same: lots of splattered eggs and a whole lot of crunched eggshells.