A Matter of Personality

From borderline to narcissism

Responding to “Borderline” Provocations Part IV

Being in a relationship, by blood or romance, with someone with traits of borderline personality disorder is incredibly challenging. While they may seem at times to be irrational, there is in fact a method to their madness. In Part IV of this series, I recommend a countermeasure for times when they make highly exaggerated and/or over-generalized remarks. Read More

Let's say that the person

Let's say that the person confronting the BPD sufferer is successful. What does it feel like for the BPD sufferer to be part of that success? Do they feel validated, calmed, or what? I'd agree with the idea that the goal of the confronter is to not suffer through participating in the BPD person's habitual response, but how does all this feel from the BPD sufferer's perspective?

Let's say the person

In my clinical experience, in general:

Because of the family dynamics involved (http://www.psychologytoday.com/blog/matter-personality/201109/the-family...),
the person with BPD reacts ambivalently when they are validated. It feels very good to them on one level, but it is highly threatening to them on another.

So, as I mentioned in part I, they may have a whole repertoire of behaviors designed to get the validator to revert to being an invalidator. This is so that they can continue to receive help and enabling for playing the "spoiler" role.

If the other person refuses to cooperate, there is some risk that they will cut off that relationship and look to replace it with another enabler. This is another reason that using an informed therapist for this whole process may be essential.

It feels amazing!

I disagree with the doctor on this one. I have BPD. It doesn't feel ambiguous when someone validates you, it feels amazing… like someone actually feels and gets what you are feeling.

This helps to ease the painful feeling and you are able to cope much better! The anger instantly leaves me and I am able to at least rationally evaluate the situation and look for where I may have been off too.

I will never forget the first time someone validated my feelings. It was a nun and I was telling her how no one cares. She looked at me and said "If I had been treated the way you were treated by x I'd feel like no one cares too. I don't blame you Its very upsetting and not right." For the first time in my life I felt understood and that was an extremely powerful feeling. The anger and intensity just left me.

To this day whenever I am in "arguments" and my point/feelings are validated by the opponent, I feel heard understood and the intensity of anger immediately leaves me… it is the best feeling in the world to a BPD!

But tone of voice is crucial… It has to be an honest validation..

it feels amazing

I'm not sure we entirely disagree. Being validating by their therapist is the way patients with BPD are convinced to stay with that therapist - for precisely the reasons you mention.

However, I think it's a lot more complicated that that. How else to explain why patients with BPD usually have a rather unfortunate tendency to get into relationships with people who do NOT validate them, and sometimes get quickly bored with any romantic interest who IS validating? If you don't think those are frequent occurences in this population, you are incorrect.

And then there's that honesty issue. If a parent who had been invalidating their child all of their lives suddenly said something very validating, the person suddenly being validated would have a very good reason to question the honest intent of such a parent. Some sort of a set up would be suspected - and rightly so!

Can I ask

How do your patients respond to your course of treatment? Has any of them been tested after to see if they still meet the criteria for BPD? How long does a course of treatment last and do they continue to work with you until there is a marked improvement or do they require referral on to other services after you lay the groundwork with your methods? Thanks.

Can I ask


Thanks for your questions. They're not easy to answer because there are so many variables, and I'm not going to make grandiose and exaggerated claims for treatment efficacy based on superficial criteria like most psychotherapy outcome research these days. Plus, I of course was not able to get funding for a study or even to get pilot data.

When my patients stick through the whole process (that is, successfully discuss the family dynamics with all primary attachment figures and ask for specific changes in the relationship), there is usually considerable improvement in both their degree of self-destructiveness and in their ongoing relationships. I recommend that my patients stay in therapy until the process is complete, and then I quickly terminate with them. They do not require additional services, except some may still need meds.

Unfortunately, a significant percentage of my patients do not complete the entire treatment for a variety of reasons including their unwillingness to proceed because it's stressful and frightening, insurance limitations, they move away, the length of time treatment takes, and many others.

When you go for home runs, you do strike out more.

When patients do part of the treatment, the kind of symptomatic treatment measured in studies of say, DBT, seems to be fairly significant. And I have at times kept track of my patients for several years.

Patients who cut themeselves or otherwise self injure can usually stop or cut way down with just the judicious use of the right medications alone - much quicker than with any therapy techniques studied in published therapy outcome studies.

Whether or not they continue to meet criteria for BPD may not be the best endpoint, because studies show that a lot of people with the disorder will no longer meet full criteria after a couple of years with no treatment at all! Those studies are somewhat misleading, however, because the subjects may just go from the required 5 criteria down to 4, so you can't say they've really improved all that much. And their ongoing relationships, which are rarely evaluated in psychotherapy outcome studies - or any studies for that matter - are still screwed up.

A full course of Unified Therapy usually takes in the range of 70-130 45-minute sessions, one every two weeks (2-3 years). The issues I focus on are extremely tricky.


Much appreciated

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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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