“Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
I am human, I have emotions like all humans and at times I could reflect many of the diagnoses in the DSM manual for the behavior I exhibit to deal with my emotions – we ALL could. I currently do not identify with a mental illness, though I know plenty of people who do. Long before I started working in this field I felt a calling to try to help, protect and educate others for the mentally ill who could not do it on their own. This post is for people who want to better understand their friend, colleague or family member who have a borderline diagnosis.
Borderline personality disorder is diagnosed twice as often as schizophrenia and bipolar disorders combined, effecting six to ten million Americans. From experience, I know mental hospitals would prefer to treat a true diagnosis of schizophrenia or bipolar over an individual with BPD. The reason is – medication is the form of treatment for schizophrenia and bipolar. Once the correct cocktail of prescriptions is discovered, symptoms subside and a discharge is planned. Personality disorders cannot be medicated away, medication can only reduce symptoms associated like depression or anxiety, what is left is a continued thought disturbances. What’s more, the stressors which likely caused an individual with borderline to have a mental breakdown are still problems which will be present during and after a hospitalization (ie relationships, legal issues, financial crisis etc).
Personality disorders can arise in individuals for various reasons and no single person will have the same story or exhibit the same symptoms. Typically borderline personality disorder begins with a combination of mental and environmental factors. The mental side being a family history of mental illness, developmental problems or early severe neglect in infancy. And related to environmental problems, an individual has been subjected to invalidating environments throughout their life. In other words, past emotionally charged relationships, places and events were not properly recognized for the effect it had on an individual. Consider a child hearing “stop crying,” “you shouldn’t feel that way” or “it’s not that big of a deal.” After months or years of having emotions belittled, an individual internalizes these thoughts as their own. The conflict of feeling their emotions are wrong and not knowing how to cope effectively creates chaos in the mind of someone with BPD.
“The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR) defines borderline personality disorder… Five (or more) of the following:
-Frantic efforts to avoid real or imagined abandonment
-A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
-Identity disturbance: markedly and persistently unstable self-image or sense of self.
-Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving).
-Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
-Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
-Chronic feelings of emptiness
-Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
-Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms”
It would be really difficult for a typical person with stable mental health to imagine the suffering a person with borderline might be feeling to engage in these types of behaviors. So I will offer you a mild metaphor some might be able to relate to. The game of golf is much more a mental game than physical, and those who play understand a round can be disasterous or successful depending on this condition. A golfer who begins a round with a stroke of bad luck can easily begin judging each shot more critically. With each bad swing, missed opportunity and hazard found on the course a golfer’s frustration continues to grow. A golfer might resort to comparisons to others, feel they don’t have the proper equipment to be effective or disconnect from the others they are playing with to keep their misery to themselves. Golfers have broken clubs, cursed and yelled, thrown whole bags into ponds and even walked off the course giving up for the day.
Again this metaphor is mild compared to living with borderline personality disorder, the point is, the golfer is stuck in the emotional suffering of being defeated. Much like BPD, there is not separation from one event to the next, there is no rational thinking in an emotional state and there are actions taken one regrets when their mental game is not together. Now if the metaphor helped, imagine it’s not just a round of golf and it’s your life. Everywhere you go, everyone you encounter and everything you do can consume you with the same erratic thinking. Individuals with BPD are desperate for relief from the suffering, and from the outside we can sometimes see their actions making their situation worse. And for the individual with BPD they are doing the best they can with how they have learned to handle life.
If you know someone who is diagnosed with borderline personality disorder or who you believe exhibits some of the criteria listed above there is treatment which has proven to be successful for improving the quality of life for people with BPD and has been shown to reduce and eliminate many of the symptoms of the disorder. Dialectical Behavioral Therapy, or DBT, was created by Marsha Linehan who was quoted at the start of this post. DBT has been used effectively to treat a number of mental illnesses by teaching and practicing skills in the following sections: Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness. There is a big commitment to treatment for individuals to follow including individual and group therapy. Additionally, participants are required to record developing awareness of their thoughts, behaviors and applicable skills on a daily basis. The skills help with problem solving, coping with emotions and learning to communicate.
And if the person you know suffering from BPD is someone who is very close to you in your life you might have been deeply effected by the words or actions of the individual. You might have engaged in conflicts with this person, got wrapped up in the chaos of their world or unknowingly contributed to making the situation worse. Knowing what you know now, maybe you can approach with a greater sense of empathy for where the individual is coming from. It is also reasonable for you to set healthy limits and boundaries with the individual to maintain your own personal mental health. And in the situations when you feel blindsided by the emotional outburst of someone with BPD, don’t jump into the emotional state with them.
Not escalating to meet someone else’s anger is vitally important and can be an emotionally taxing skill to practice, yet critical for maintaining relationships with people who have BPD. In place of trying to argue your point of view, trying to fix the situation or threatening the individual. (Think of the golfer’s response to another player adding jokes or belittling the game during the bad round.) The best practice to help defuse an emotional crisis is to validate the individual’s emotional state. This simply means reflecting what they are feeling, verbally repeating what they are saying and letting them know you see them suffering. You don’t have to agree with them or even understand their point of view. Validation will not fix the situation and it won’t treat the disorder. Validation will help deescalate an emotional state and prevent a situation from getting worse.
Finally, encourage the person you know to get help. Existence doesn’t have to be painful, life can get better.
If you are living in the Kansas City area there are many community mental health providers who facilitate DBT programs.
–Lilac Center (KCMO) is specifically designed as a DBT program and can be contacted at 816-221-0305 or go to http://www.lilaccenter.org/
– Synergy Services (Parkville, MO) offers a range of theraputic services including DBT. 816-587-4100 or go to http://www.synergyservices.org/
– Johnson County Mental Health (Offices in Mission, Olathe & Shawnee KS) 913-826-4200 http://mentalhealth.jocogov.org/