A Matter of Personality

From borderline to narcissism

Responding to “Borderline” Provocations Part V

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 V of this series, I recommend countermeasures for times when they ask you to solve their impossible problems. Read More

thanks!

I have to say, Thank you X 5, for this very helpful series. I am looking forward to the rest. I have stumbled onto some of your guidelines through trial and error, but having the context spelled out clearly is a big relief.

I was diagnosed BPD in the

I was diagnosed BPD in the late 1980s. I have to say I am astonished at the ways people, including professionals, have misinterpreted it. I never wanted anyone to feel upset at not being able to help me. I just wanted the truth. Though so many said I was hard to read, it was the exact opposite; I meant just what I said, and other people were too complex and taken with their sophisticated ideas that they refused to hear me.

I laughed out loud at this

"I was absolutely, incontrovertibly, and in all ways helpless to solve her conundrum. I'm supposed to be upset about that? Hits me right in the God, you know."

So funny! I'm really enjoying this series, but the sarcasm and humor in this post was wonderful.

You are making negative assumptions in this statement.

Lets look at what this person was saying and what they were actually asking for when they came to you for assistance:

"I've missed so much work that if I am out sick any more, I'll be fired," she told me. "But I'm so depressed I can't do the job, and my boss says if I screw up again, I'll be fired!" she quickly added. "What should I do?"

Your feeling that she was intentionally putting you in a hopeless situation and trying to make you feel guilty for that is wrong and your response did not help her to break down the situation so that she could find enough peace to make the right decision was informed by your assumption that she was trying to make you feel bad.

Yes she was probably going to lose her job, she was aware of that. Her concern as far as I read it was that she was between a rock and a hard place and couldn't see her way clear to peace of mind. Your response simply amplified that situation and infuriated her, understandably. You were saying "You're going to lose your job anyway so what do you expect me to say?" even if you didn't say that in so many words.

What you should have done was take out your presumptions from the situation about her trying to make you feel bad and see that what she was asking for was not for you to come up with some miraculous solutions to the situation but to help her gain the peace of mind so she could accept the situation and make the right decisions for her own health.

Unfortunately this would probably have involved helping her to accept that she clearly wasn't well enough to be in work at the moment and that her immediate need was for her to take her state of mind seriously rather than keep piling pressure on and making herself even more unwell.

To hear this from a professional that was taking her concerns seriously would have helped her see the sense in this suggestion and find a way to not be trapped in this position anymore.

So many people with BPD force themselves to work when they are not well enough to do so. Your belief that she way playing games and trying to make you feel bad instead of actually asking you for help to see what she needed to do is just one example of how your poor insight into BPD patients motivations and genuine desperation for assistance affects your work. I suspect there are many more.

Time and again you write from a very skewed and anachronistic view of BPD. Because you are clinging to your version of treatment you are not up to date with recent research into the condition and treatments which enable full recovery that do not fall back on these stigmatised interpretations of the disorder.

Go back to school, you are not qualified to treat BPD in the modern age. The day of the dinosaur is over and very soon you will be out of a job unless you get with the programme and get over your prejudices.

negative assumptions

Anonymous,

I never said anything to her that implied in any way she was playing games. All I did, in fact, was empathise with the bind she was in, and she hung up on me. She knew very well that there was nothing I could do or say that would help her with the immediate bind.

If I started lecturing her about disability options, which she was more than smart enough to know about already, then I would not only be telling her what a sick person she was, but that she was too stupid to have thought of that herself.

In fact, since she hung up on me, I would not have had a chance to explore any such options with her even if I indeed thought that would be helpful.

There are a lot distortions and lies in a much of the recent "research" about the condition, such as the recent rantings of the editor of Current Psychiatry that BPD is a brain disease based on MRI findings which automatically but falsely equate any differences with abnormalities.

See: http://www.davidmallenmd.blogspot.com/2010/03/neural-plasticity.html and http://www.davidmallenmd.blogspot.com/2013/02/neural-plasticity-and-erro...

I don't know whether or not you believe that BPD is in fact a brain disease. It's not. Nobody wants to look at family dynamics any more, but it's not because they are not the most central problem in personality disorders. They are.

I agree. I see that she felt

I agree. I see that she felt very helpless, not trying to make somebody else helpless, but looking for help. Assumption that she wants to make somebody else to feel helpless is sick, it shows distrust and suspicion of person thinking this way. And as we all know this kind of reactions (distrust, suspicion) are based on fears, so I propose therapy for this man.

I had a boss who was more sympathetic in helping me understand this situation than you.

I made a very similar comment to the one this desperate individual made to you. My boss sat me down and we chatted about how I really wasn't well enough to be working and that I clearly needed time out work on my issues without being at work. She helped me to understand that I really didn't have any other options but validated me for the important work I had done for the company. She even pointed me in the right direction to get ssi payments.

While I did lose my wages and thereby my ability to pay for treatment any longer, not having to work and being made to feel that claiming benefits for my illness was a viable option was all the support I needed. You could have done that but you didn't because you were too busy worrying about how you felt instead of listening to what this patient was actually saying.

So you are basically confirming that you are so arrogant that you reject current research

Try listening to this lecture by Jon Gundersson who unlike you is respected in the field unlike you and your faulty "systems" approach. There were things you could say as I have just pointed out.

http://youtu.be/E_kFNWXVF1Y

You'll note here that Jon Gundersson is fully aware of family dynamics in the development of BPD and how those dynamics are often complicated by the child's hypersensitivity. He does not resort like you to dredging up overthrown stigmatising perceptions of the disorder.

I pity your poor patients who only find out after they've paid you for treatment just how judgemental and manipulative you are in your dealings with them.

basic confirmation

Hi anonymous,

I notice that you did not address the points I raised, but instead resorted to name calling and making presumptuous statement about what I know/don't know about and what I do/don't do with my patients.

John Gunderson would be the first to admit that you cannot tell the difference between cause and effect or pathophysiology verse normal physiology in the brain just by looking at an fMRI scan. For that you would need prospective studies in which infants are followed for years, serial fMRI's are done, and the family is watched with TV cameras 24 hours per day. If you know of any studies like that, please forward the references.

I'm hardly the only academic who's pointed this out, so if doing so makes me arrogant, then I plead guilty.

The clip you posted, btw, is Gunderson talking to a parent support group called NEA-BPD, which is one of two along with another called TARA. Both of these groups cater to parents who tend to be hyper-involved with their kids. The abusive parents do not join.

Both of these support groups downplay the selective bias in their group compositions. Both downplay the high incidence of child abuse and neglect in the families that produce children with BPD in order to cater to this audience, despite the fact that one of the founders of NEA-BPD told me in private that she herself had in fact been severly abused growing up.

And you are correct that overt abuse and neglect is not present in all of such families - but other forms of dysfunction are.

Unfortunately, many researchers have begun to cater to the support groups, and even invite them to research meetings. That is doing them no favors, and is a source of a major lack of objectivity in the field.

You're not a fan of research are you?

Is their any research you respect and accept? Knowledge of the condtion itself is in the process of making great leaps forward since more and more people with the condition, like myself, have now fully recovered from its thrall.

The voice that was missing from all debates surrounding the condition for so long can now be heard. The result is not as yet that we are free from harsh judgement from people like yourself simply for having BPD, or indeed ever having suffered from it, but its getting there.

This is an exciting new dawn in the world of BPD, not because of arrogant, self publicising egotists like yourselves who reject research, and refuse to conform to treatments that are proving to work. If you don't believe in research and scientific evidence then maybe just take a moment to consider that your method is not popular, not proven to be effective amongst the demographic you are professing to serve, the people who have BPD - we talk you know. We are an interactive international community.

I'm sure you have your own self preserving reasons for believing that you are being conspiratorially sidelined by organisations who have vested interests in promoting their own treatment programmes over yours. However, there is one form of endorsement where you have repeatedly failed to provide results - with people who suffer from the condition recommending your programme.

People with BPD are desperate for treatment and we communicate on line to find out how worthwhile the treatments are and how accessible they are. Yours is inaccessible and not highly recommended. It is precisely because you cling to this belief that people with BPD are trying to make people feel bad that your method doesn't work.

And while you're asking why I didn't answer your questions its because they weren't relevant to what I was saying and you yourself failed to engage with what that actually was, preferring to segway down this reductio absurdum dead end instead.

Because the girl who was asking you what to do about work came to you for advice you rejected my advice by saying "she should know if she was disabled or not", and this is your problem - she has BPD so you don't care. Either it is precisely because she has BPD that you didn't care or you are generally a person who lacks empathy as your consitant sarcastic approach to describing people who are in intense emotional pain indicates.

People ask catch 22 questions like this all the time in life and they seek counsel from their friends about what is best to do. So why on earth wouldn't a person who is in treatment come to ask such a question from an actual therapist? Thats why we ask you people these questions because you are supposed to be trained in sophisticated methods to help us see the wood from the trees. When that person has BPD you jump to the conclusion that they are trying to make you feel bad and say utterly unhelpful things like "well it sounds like your going to lose your job either way" and then you come on here bragging about it like anything that falls from your lips is manna from heaven.

And as for this "John Gunderson would be the first to admit that you cannot tell the difference between cause and effect or pathophysiology verse normal physiology in the brain just by looking at an fMRI scan." What has this got to do with anything? Of course no-one is saying that BPD is caused by birth abnormalities alone and that is not what I was saying either and yet you've latched onto some territory where you feel you have safe ground instead of taking on board the actual critism which was regarding you and your rotten attitude towards people with BPD.

You questioning the reliability of fMRI scans in assessing BPD as far as I am concerned is just another case of you throwing much in the face of any scientific breakthrough in your desperate hope that progress will be halted so that your faulty treatment programme and your livelihood connected to it can continue to be promoted. Respectable clinicians providing effective treatment programmes do not waste their time publicising themselves in incorrigible rags like Psychology Today. And the speed with which your responses come to people comments suggests you really don't have much else going on in your professional life that requires your attention. Bye bye dino x

fan of research

A bit more reasoned but still presuming facts not in evidence, with incorrect paraphrasing of what I described to you, and with gratuitious insults (the use of which may [or may not] possibly illustrate exactly what I've been writing about).

So are you saying that you have interviewed a random selection of several of the patients I've treated to find out how they did? How about Schema Therapy, which is very similar to what I do? That has efficacy studies that are as good as anything else out there.

I'm glad, despite what you might want to believe, that you benefitted from whatever treatment you received and that you have recovered. But my pointing out that research claims are exaggerated is not the same thing as "rejecting" research, as I am sure you know.

As far as "proven" treatments, show me one study that shows that, after any of these treatments you refer to, a clinically significant proportion of patients correctly diagnosed with moderate to severe BPD have fairly harmonious romantic and family relationships and fairly well-adjusted children (if they have any) five years after treatment - so we can discuss how I'm wrong. I look forward to seeing all of these studies that I've apparently missed.

I have time to answer because I'm partly retired and I enjoy doing it. Is that somehow indicative of the validity of my ideas?

Accessibility? Maybe you are not aware of this, but a HUGE percentage of patients with the disorder are being misdiagnosed as having "bipolar II" and are being plied with potentially toxic and often unnecessary medication. This is a VERY accessible treatment. And many such patients claim to be happy customers despite the fact that their lives continue to be train wrecks. So I don't think that popularity necessarily correlates with quality. Do you?

Incorrigle rag? Then why are you reading it?

I agree with Dr Allen that

I agree with Dr Allen that BPD is likely not rooted in brain anomalies. The "whats cause and whats effect" question for those colourful images on a computer screen remains unanswered. Dr Allen's contribution to the discussion concerning the pathogenesis of this condition is an extremely important one. We are not robots who walk through life as slaves of our genes. Our environment shapes who we are. But people, of course, prefer simple answers and quick solutions. So the idea that one day there will be a pill for this is understandably an appealing one.

From my own experience I can tell you that the "head I win, tail you lose" constellation when communicating with my wife (who has been diagnosed with BPD by her psychiatrist) is a pretty common one. So how Dr Allen communicated with this female patient makes sense to me.

Anonymous, you on the other hand seem quite offended by Dr Allens professional opinion and may still have some anger issues to work through, may I suggest?

Semi retired and out of touch

I'm glad to hear you are approaching retirement as are many of the people who are still hurling unkind insults and assessments of people in intense pain. When you see someone grieving and they are unstable and suffering in existential hell you don't thinkg "that person is just trying to make me feel bad because they feel bad". No, you recognise and respect that the person is in turmoil and you need to cut them some slack. BPD in essence is a lot like experiencing grief and yet when we exhibit our pain we get treated by people like yourself as if it is part of some subconcious game to control and harm other people.

Like I said, understanding of BPD is increasing now that people with the condition are now longer considered to be disruptive asshats who intentionally harm others because they are twisted. The more we are validated in our actual experiences of the condition the more apparent it is becoming that BPD is not a personality disorder at all but a condition that is caused by an inability to reign in painful emotions such as those experienced by people who are living through grief.

You are out of touch and you frequently insult people with BPD saying we are trying to make other people feel bad when this is not the case. We agonise daily over making other people feel bad and often the stress of this causes us to overthink and analyse our interactions with others. You don't believe people with BPD ever fully recover? They can and do but they will not be able to do that by following your programme and advice because you don't believe or offer that possibility.

I have personally experienced before my diagnosis the appropriate care for my distressed condition when I attended a crisis centre. People knew the right things to say to help me through and keep me alive because they understood they were dealing with someone in intense emotional pain. Post diagnosis I had another melt down and went to the same crisis centre and was dealt with with the kind of unnecessarily self preserving defensiveness that you prescribe to people dealing with those with BPD. My motivations were questioned and I was stonewalled when what I needed was compassion and care.

You just don't get it and you never will and this back and forth with someone who isn't listening is frustrating. You keep changing the goal posts of the discussion instead of keeping it to the actual criticism which is, i reiterate once again, your rotten attitude towards people with BPD, your insulting misinterpretation of our motives and lived experience.

And lastly I gave up reading Psychology Today a long time ago because it is as out of touch with the current understanding of BPD in the real world as you and consistantly gives copy space to people who cause harm to vulnerable people with the condition. I have spoken to so many caring family members of those with BPD who have harmed themselves and worse after reading awful articles in this magazine. I have complained time and again as others have but hey, why would anyone take me seriously. I'm only trying to make other people feel bad because I have BPD and I'm probably just overdramatising anyhow to get attention.

I come to the comments section to offer an alternative view to the appalling presentations on these pages so that people with BPD feel some hope that not everyone feels as you do. Harming themselves because they feel so pained by these presentations isn't the only answer and they can know that just because one professional sees them through distorted lenses that doesn't mean that all do. Why would anyone with BPD go into therapy if they thought that every professional felt as you do?

Out of touch

Hi Anonymous,

Thanks for clarifying. I think I see where you're coming from.

I can see how you might interpret what I write as indicating that I'm just like the therapists and psychiatrists - and there are indeed many of them - who view pts with BPD as the second coming of the plague and as playing "some subconcious game to control and harm other people" and as "disruptive asshats who intentionally harm others because they are twisted." In fact, they are also seen by many therapists as functioning at the level of a two year old, manipulative, and distorting reality.

There's probably nothing I can say to convince you that my attitude is about as far removed from that as is possible, and that I don't believe ANY of that BS, but I'll try anyway:

As I described in several other posts, I view the condition as altruistically (not selfishly)designed to HELP others in the family, and as a self sacrifice which is far more self-destructive than it is other-destructive, although it sometimes does damage others as an unfortunate side effect.

I cut patients with BPD far more slack than most therapists, and I indeed see them as in tremendous and very understandable pain and emotional turmoil. They have trouble reigning in their emotions only because they are being continuously traumatized by people who should care about them.

I even try to find the hidden altruism in their parents and other family members. Sometimes they even get angry at me for trying to help them be empathic with parents who have indeed been abusive to them, and who continue to invalidate them.

I have been saying the same the thing the whole way through

It has taken numerous comments from me to get you to listen and it has been intensely frustrating. Yes I know that you have a unique approach and in your time you probably were the best bet for people with BPD as opposed to the chronic abuse they experienced in other mental health settings. But that does not change the fact that you are clinging onto an antiquated view and it is one you frequently give voice to on this blog.

If you insult people with BPD by misrepresenting and misinterpretting our behaviour because you are too precious about your own perspective regardless of how many times I and others protest to you about this, I will continue to be pained by your words and respond to them to prevent others from being so.

The main stumbling block for you I fear is that you do not understand that there are natural inclinations within those of us diagnosed with BPD that cause us to develop the condition. Yes abuse and neglect are contributing factors as they were with my development of the condition. But this is not all that there is to BPDs genesis within an individual.

While you may challenge the research and the evidence provided that does not concern me. My conviction of this fact comes through my own experiences and through my communication with others who have BPD. We are not just damaged individuals playing out roles in a dysfunctional family dynamic and seeking to forge that dynamic with others that we encounter. There is a shared way of being and a heightened sensivity that is fundamental to our beings and, unfortunately, at odds with a world that is based on raw competition and consumerism.

There is a really profound quality at the heart of people who develop BPD which has no voice in your assessments of our existence. It is a profound heart which is anathema to many of your projections about our motives and behaviours.

saying the same thing

It's fine if you think that people with BPD are fundamentally different from everyone else. I repectfully disagree. The heightened sensitivity of which you speak, while it may have a genetic component just like any human behavior, is IMO a necessary adaptation to a chaotic kin environment

And as far as the motives I talk about being my projections? My ideas are actually based on what my patients routinely admit to me, as well as to the psychiatry residents and psychology interns I've supervised, after we dissect their family experiences and their genograms in an empathic way. And most of these patients have never read my rather counter-intuititive ideas re kin selection and self sacrifice, so they have no way of knowing what I might expect to hear. Believe it or don't!

In touch

Found these articles today, found them to be most helpfull. BPD is very difficult to understand if you have it or love someone who has it. For many years my now adult daughter has struggled with this and so have we as parents. She has recently reconnected after nearly two years of limited and sporadic contact. Your advice for communicating has worked for us at times and we've been able to laugh at each others fumbling attempts to understand each other. So much I've read in the past few years are parents are to blame. All children aren't born with the same personality, and God forbid we don't know the exact and proper way to communicate with them. No matter how much you love your kids and do your best to raise them, when they need help and are troubled, the quickest way to go is the blame game. The posts and blogs on the internet show a lot of hurting people and people only too quick to blame others.

Please Keep Them Coming

I am so thankful for these posts. Please keep them coming.

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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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