ShrinkWrapped

Making sense of our unreal world.

The Borderline Personality: A Clinical Example

Alternately idealizing and devaluing leads to failure for Borderlines.

In Borderline Personality Disorder: Early Development I described how the young child must integrate multiple images (self and object representations) into a coherent, unitary, relatively consistent and stable sense of himself and the important people (objects) in his life. The person who suffers from Borderline Personality disorder has a greater than usual vulnerability to a regressive (re)splitting of his objects and himself when under stress. A clinical example follows:

Ms. S was an attractive, very bright young woman who entered into an intensive Psychotherapy to deal with issues related to her chronic insecurity and unhappiness and her tendency to get involved with unsuitable and disappointing men. Early on a pattern became apparent. She tended to heavily idealize new men she met, as long as they met certain threshold criteria (particularly in terms of their looks, intelligence, and job prospects.) For the first month or two of dating, the new relationship would be all I heard about in her sessions. Nothing else mattered in her life and all efforts to engage her in reflection about the man in question (about whom she often offered very early signs that all was not as rosy as she believed) were met with an angry accusation that I didn't want her to be happy. In fact, she would continue, this man was the answer to all her problems and I didn't want it to work out because if it did, she wouldn't need my help anymore and I wouldn't get her money!

[I might add that she was paying a very low fee at the time, and she knew, from previous therapy and from friends, that she was paying a very low fee.]

She would fantasize about marriage and their future together for several sessions and then, without any apparent warning, he would disappear from her sessions. Upon my inquiry, she would mention that she had stopped seeing him because he was a loser.

Her ability to explore what had happened was very limited for quite a while but eventually we were able to understand what typically happened.

After several iterations, the pattern repeated: my patient met the "perfect man."

He was extremely talented and very good looking; he was quite well known in his field. In addition, he was as excited by her as she was by him. She blandly mentioned that, though he (and she) were both in their 30s, he still lived with his mother. Further, until he met her (so he told her) he had only dated women younger than 21.

Either of these facts, on their own, would be sufficient to at least raise questions about whether this man had the requisite emotional health and maturity for a long term relationship. Furthermore, because I was quite aware of her tendency to use important others as "self objects" (ie, as means for stabilizing a positive sense of herself; see below) I had some reason to expect he had a similar level of self-pathology. In such cases, as soon as the important other disappoints, they lose their value as an external buttress for the damaged person's self-esteem. Such people, which includes but is not limited to Narcissistic and Borderline characters, tend to "split" objects into all-good and all-bad. When an all-good object fails them, the person's rage at the disappointment and sense of shame causes the object to shift to become all-bad. Usually the relationship ends at that point. (This is one of the difficulties in conducting therapy with such people; disappointments are inevitable in every human interaction and maintaining the therapy in the face of such reactions is a difficult technical problem.)

[A self-object is an idealized object which a person uses as a "perfect" mirror. The dynamic is as follows: if a "perfect" person loves me, then by reflection off of their image, I must be perfect, too. This is one way that Narcissists and Borderlines attempt to stabilize their sense of themselves and protect themselves from feeling defective and damaged.]

For the purposes of this discussion, the salient aspect is that once the inevitable disappointment occurred, a transformation in my patient's emotional life took place that was a marvel to witness. Not only was he a terrible disappointment and a loser but he had always been a terrible disappointment and a loser. She insisted she had always known that he was inappropriate ("how could someone who still lives with his mother at 35 be much of a man") but had chosen to overlook his shortcomings, knowing it wouldn't last, because she had enjoyed dating him, and psychologically needed him to be her perfect lover.

It is important to recognize that not only did the ex-boyfriend become, in the present and the past, a different person, but she experienced herself as a different person as well. She had been deeply in love, ready to make the move into marriage and family; an entire new aspect of her life was about to unfold. Her future husband was flawless and so was she. In fact, he needed to be imagined as perfect in order for her to feel that she was perfect. When he failed her (by dating an 18 year old while they were supposedly in love) the disappointment meant that if he remained perfect, she would have to accept that she was deeply flawed; otherwise why would he reject her? Her rage would not tolerate such an outcome (which would have led to a serious depression) so she devalued him; he became worthless and she maintained her protective sense of herself as without flaws. In order to protect herself from knowing of her obviously flawed choice, she had to change her memory to "remember" that he had always been a poor choice.

It took many years of work before she was able to tolerate recognizing her own imperfections and she had to negotiate significant depression and rage to arrive at some comfort with a more accurate picture of herself, flaws and all.

In the next installment I plan on discussing some of the various treatment options at our disposal for helping people with Borderline Personality Disorder.

 

[A slightly different version of this, with some additional material, was originally posted at ShrinkWrapped in April, 2007 as Retrospective Falsification.]

 

Perry R. Branson, M.D., is a psychiatrist in New York.

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