A Matter of Personality

From borderline to narcissism

Responding to “Borderline” Provocations—Part I

Reacting to someone with borderline personality disorder is a challenge

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If you are an adult in a relationship with another adult, either through blood or through a romantic liaison, who fits the description of a patient diagnosed with borderline personality disorder (BPD), then you already know that you have your hands full. 

Of course, as readers of the comments of this blog know, addressing anything about this disorder raises a lot of emotions among everybody involved, with blaming, attacks, and counterattacks coming from every direction.

Similarly, a New York Times blog post about BPD way back in 2009 drew over 530 rather contentious comments, and is still drawing the occasional comment (http://well.blogs.nytimes.com/2009/06/16/understanding-borderline-personality-disorder/?apage=1#comments) from people who are dealing with BPD relatives and other people who themselves have the disorder. 

This is all very understandable, but very counterproductive. Blaming and attacking leads to anger and defensiveness, which is the antidote to efforts at productive problem solving. As I recently said in a comment here, “The relevant questions: what are the repetitive family behavior patterns in a given family, what function do they serve, and how do we put a stop to them?” We need to do less attacking and more listening to each other.

This next series of posts is for the intimates of other people who have BPD, not for those with the disorder themselves. For those who do have the disorder, the suggestions I am making for others are also meant, in the long run, to help you. If you are not engaging in some of the provocative behaviors I describe, good for you. Please do not feel personally attacked because other people with the same disorder do these things. I am dealing with prototypes here, and there are always lots of exceptions to every rule.

However, if my descriptions of borderline provocations make you feel defensive, this might mean that you should look at yourself a little more objectively.

Also, if you are in a relationship with a person with BPD, YOU are also part of the problem no matter how well intended you are. Family members are all beans in the same dysfunctional family soup.

What about non-family members?  Well, if you have stayed in a romantic relationship with a provocative person with BPD, you need to ask yourself why you are attracted to a difficult person in the first place. Please don't give me the usual crap like, "I didn't know what (he or she) was like that at first, but now I'm involved and I can't get out.  (He or she) was so charming at the beginning of the relationship!" 

Puh-leeeze!  You are like the wife who insists her husband is not having an affair while she looks for the stain remover to get the lipstick off her husband's shirt collar. Sorry, but most people run at the first sign of major trouble in a relationship. It is always unsubtle, and one does not often have to wait very long before one first sees it.

Well, you might object, the person threatens suicide if I tell them I'm going to leave them! So, let me get this straight. You're planning to sacrifice your whole life because someone might stab themselves in the heart in front of you and then quickly hand the knife to you before they die so your fingerprints are all over it?  If you feel so responsible for other people that you respond to this kind of threat by caving in to it, please, get some therapy.

If you are someone who has parents with BPD, the strategy of divorcing your family, while better than remaining in a toxic relationship with them, creates problems.  First of all, it's kind of lonely to have no family. You will be faced with a cavernous hole in your life. 

Second, you came from them. If they are monsters, what does that make you? You undoubtedly share at least some of their toxic behaviors whether you like to admit to it or not, because one cannot grow up in a toxic household without adapting to it in ways that are both problematic themselves and very hard to stop later on in other social contexts. 

Especially with your own children. Attachment studies clearly show that the best predictor of one's relationship with one's children is...one's relationship with one's parents or other primary caretakers. Some people from abusive households wisely decide not to have children for fear that they, too, might become abusive. But is that what you really want to do?

Besides, you cannot completely divorce yourself from your family, because you carry them around with you in your head. Literally. Forever. We in the biz call these mental representations schemas.

I have been repeatedly attacked for saying the following on my blog, but I am going to repeat it again:

Your choices are not just limited to these two:

1) To either to continue to be mistreated, or

2) to cut off all contact with your family.

A third choice is to change the nature of your relationship with your parents so that you are not being mistreated but are still in contact with them. Impossible, you say? I disagree. While you do not have the power to "fix" your parents, you do have the power to fix your relationship with them. If you change your approach to them in a consistent manner, that will force them to change their approach to you. 

However, there is a big problem that you will face in doing this: since you have been in a relationship with them your whole life, they have developed a whole repertoire of behaviors, include recruiting other family members, to give you the powerful message, "You're wrong.  Go back to responding the way you used to."  If one strategy does not work, no worry. There are plenty more where that came from. Scary to be sure, but not insurmountable if  you can enlist a therapist who knows something about the family dynamics in people with BPD.

Therapists like myself who work primarily with patients with BPD, regardless of their "school" of psychotherapy or their theoretical ideas about the causes and cures for the condition, all have independently developed some ways of getting BPD patients to be more cooperative with them. (That is, cooperative just with the therapist. Unfortunately, not with anyone else). We seem to have all come up with these little tricks of the trade independently, yet they are all very similar, as I described in a paper called, "Techniques for Reducing Therapy-Interfering Behavior in Patients with Borderline Personality Disorders: Similarities in Four Diverse Treatment Paradigms" (Journal of Psychotherapy Practice and Research 1997; 6:25-35). 

Marsha Linehan of DBT fame, Otto Kernberg of psychoanalysis fame, Lorna Smith Benjamin of interpersonal therapy fame, and myself (with my not-at-all famous treatment paradigm called Unified Therapy) all do pretty much the same things at the beginning of treatment. (We then start to diverge considerably). These strategies are survival skills for us. Therapists used to come up to me all the time and ask me how I could stand to work with several patients with BPD at the same time, but it really is not a big problem if you know the "tricks." I had to devise them a long time ago because I built up a private practice by taking referrals of these patients whom no one else wanted to treat.

As I mentioned, it is much harder to use these strategies for someone who is already enmeshed with a relative with BPD than it is for a therapist who has just met a patient with BPD.  One reason is the aforementioned repertoire of behaviors they have designed over many years specifically with you (the enmeshee) in mind. They know all of your weaknesses and exactly how to take advantage of them.  Second, as a therapist, I do not have to deal directly with a bunch of interfering relatives like the enmeshee does.


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The third reason has to do with something behaviorists call a variable intermittent reinforcement schedule. This schedule is why slot machines in casinos are so successful. You never know when the damn thing is going to pay off, and it pays off just often enough, so you keep pulling the lever until you lose your shirt.

I should mention that, as parenting columnist John Rosemond is fond of saying, people are not lab rats that blindly respond to rewards and punishments. However, if a person has a goal, and their behavior helps them to reach it, reinforcement schedules kick into play. It is not the person being "rewarded," but the behavior. It is anything but rewarding to have people hate you.

The goals of the most troublesome of the behavior exhibited by people with BPD, for reasons I discussed here and here, is to cause in their targets one of three reactions. The first two of these invariably lead to the third. The three reactions they shoot for in their targets are a sense of anxious helplessness, a sense of anxious guilt, and overt hostility.

Again, I must emphasize that they behave this way not out of selfish reasons, but covertly altruistic ones. They get nothing but misery out of acting this way.

The great big secret, in fact, is that folks with BPD are highly ambivalent about getting these reactions. They will try like heck to get them—and believe me, they are real professionals at it—but they secretly wish to fail. (How do I know this? Experience. But I cannot prove it - because there is literally no way to set up an "empirical" experiment that would fill the bill -so readers can call this highly speculative if they wish).

If the persons with BPD succeed at getting one of three reactions, they will continue to draw for it. Pull out all the stops in order to get them, in fact. If they fail at getting the reactions, however, they will suddenly become more conciliatory. However, because of the variable reinforcement schedule, if they only occasionally succeed in getting one of the reactions with a person with whom they have already been interacting for a long time, they will keep trying much longer. 

Therefore, if you already have a history with them, and they have a track record of making you react in any or all of the three ways, their behavior will get much worse before it gets better.  If you cannot keep your cool and you occasionally react the wrong way, it becomes even harder to get the people with BPD to change their behavior toward you than if you react the wrong way all the time!

In later posts in this series, I will share with readers the therapist's tricks for avoiding "rewarding" the bad behavior of persons with BPD, but most people who are already enmeshed with a BPD family member will find it nearly impossible to employ them successfully without the help of a therapist who understands the family dynamics of those who suffer with the BPD traits, and who can prepare them for their intimate's formidable defenses. I will start in the next post with what not to do.

David M. Allen, M.D., is a Professor of Psychiatry at the University of Tennessee and author of the book How Dysfunctional Families Spur Mental Disorders.

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