Three borderline personality traits in the DSM-IV definition have to do with what I will call "pain management techniques."
- Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself. Adolescents are especially creative when it comes to self-harm. Please note that not all people with BPD self-injure or are suicidal. In fact, real suicidal urges are uncommon among high functioning "invisible" BPs.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, or reckless driving. Low-functioning "conventional" people with BPD are more like to have an eating disorder.
- Inappropriate anger, recurrent physical fights. Physical abuse is not uncommon.
Following is one recovered borderline woman's experience with several of these:
I was so promiscuous in my 20's that I basically sterilized myself because of all the sexually transmitted diseases I got doing while sleeping with men from bars after drinking. I think I was searching for love and thought that having sex in the beginning would allow the men to not stress and get to know me and stay with me. Never worked that way. Guess I watched too many Hollywood romances.
I struggled in my 30's with eating disorders, especially anorexic thinking and athletic anorexia (over-exercising). I binge drank until the suicide of a close relative when I was 24. I did it again, though, when I turned 40 and freaked out about not having a mate, a good job, or even friends I could count on.
As for suicidal behavior, in my 20's I was very careless about safety and did things regardless of their consequences. I would go out by myself late at night, go through "bad areas" with no concern (luckily nothing happened), and go out with strange men. I didn't think that I'd live to see 30--that either I would kill myself directly or get myself into a situation where I'd be killed one way or another.
I first wanted to kill myself at age 14. I don't remember know why; just remember telling a friend I had felt that way. In my early 20's one time I had a suicide plan and began shopping around for a gun. But luckily my mood changed, so I didn't want to die. I got to a point in recovery where I made a promise not to kill myself, even if I still thought about it. I've promised not to do it while my parents are still alive. I couldn't do that to them.
However, I still struggle with reckless driving. I am in rage-road incidents fairly frequently (I live in a tourist town, so there are lots of opportunities). Driving recklessly feels good--it's a rush and the danger adds to that. For example, once a semi truck was tailgating me on the interstate even though I was speeding I was trying to get around the person on my right.
However, when I saw the truck was so close that I couldn't even see his headlights in my rearview, I got pissed and slowed way down, so he was stuck. Eventually I got over, but by that time, he had radioed some of his fellow truckers so that when the lanes merged, I got boxed in by one of them and ran off the road. Luckily I was able to maintain control and get back on the road.
Here is another borderline woman's experience with self-harm. This shows how addictive it can be:
I don't even know for sure why the thoughts began; maybe it was tension with the impending return to work. At first it would just be a fleeting, passing notion. A brief voice in my head that said things like 'relief, blade, sharp, cut, blood.' The words would be followed by a desire for relief, punishment, release, escape...
Ideas started to form. What to use? When to do it? How to hide it? Just opening the knife drawer in the kitchen would make me smile. Yet at the same time, anger at myself was building for these thoughts... unfortunately though this anger inflames the urges, the idea of cutting became a form of punishment for thinking of cutting--how twisted is this?
I know I can't cut in obvious, visible places without being caught. I'm not an attention seeking cutter; I hide what I do. Then a 'real' trigger happens; something provokes my BPD. Frustrated and badly needing release, I spill out my thoughts in words not to be published--too private, too intense, too personal to share, even though sharing will ease the burden.
I cry, wishing I could die, wishing the pain would stop, needing to hurt myself to be able to 'feel' because even though I am clearly 'feeling' a hell of a lot, I don't actually believe I am 'feeling.' Emotions are a haze; what is 'feeling' anyway?
I cry myself to sleep while my fiancee holds me still. For today at least we've beaten the desire. But tomorrow is another day. I don't know if the thoughts will be there or if we have done enough to keep them at bay for a while. So long as I can be strong enough to share, hopefully it will be enough to stop the urges from winning... time will tell.
These behaviors greatly impact family members. Of course they are very concerned and worried; parents especially feel some kind of responsibility for what is happening whether or not they had anything to do with it. Luckily, personality disorder organization have developed programs to help parents and guide them through these terrifying times.
- His Impulsivity in is not spending money. When he is frightened, he refuses to pay for things that he had committed to buy, he will leave family members in a lurch by going back suddenly on expectations that he was planning to pay for some certain thing. He will suddenly set up accounts, for example, for family cell phones, then abruptly decide he doesn't like the cell phone company and changes to a different cell phone company, disrupting the whole family's cell phone arrangements.
- When we split up, I paid off her credit card bill, which was over $8,000. I just got a letter this week saying that she owes her attorney over $17,000 and will be switching representation.
- We had sex on our first date, and later in a public park in the daytime.In addition to the tryst she had while we were engaged, she had a two-year long affair with a married man.
My wife has threatened suicide many, many times in our 22-year marriage. In 2010, I told her if she threatened suicide I would call the deputies, which would have been a first. She threatened again; I called the deputies. They counseled her, and she agreed if she got too worked up she would go to a room and calm down. A couple of hours later her verbal/emotional abuse was too much for me, and I isolated myself behind a locked door. She tried to get me to come out. Finally she seemed calm; I came out. She hinted she'd taken something. Admitted fairly quickly it was some drugs she'd squirreled away from a non-completed medication trial. I drove her to the hospital 30 miles away at midnight on a cold January night, back country icy roads, 80 plus mph, as she kept a constant monologue that it was my fault she did what she'd done.
People with NPD and BPD use alcohol and other drugs at astounding rates to kill the pain. Of people with a diagnosis of NPD, during their lifetimes, 64.2% also have a substance abuse disorder (73.5% men; 50.5% women) and 51.1% have alcohol abuse or dependence. The latest statistics about BPD say that during their lifetime 50.7% of borderlines will cope with substance abuse.
Part of the reason that narcissists are so susceptible to substance abuse is the belief that they are unique and special. The thought is that while other people might get addicted, they have a unique ability to use substances without becoming dependent on them. They are in charge of the drug taking, not the reverse.
Certain drugs temporary inflate the vulnerable narcissist's False Self and prevent cracks from forming in the barrier that hold shame, depression, and low self-esteem at bay. Defense mechanisms such as splitting, fantasy and grandiosity, and controlling behavior make it even easier than it is for the average addict to deny their addiction.
Rokelle Lerner of Object of my Affection Is in My Reflection says that the prognosis for narcissistic addicts is poor. She writes (p 143):
In treatment, a narcissistic addict/alcoholic will consider himself above the rules and proceed to break them without remorse. The narcissistic/addict will be intolerant and abusive to those who disagree with him and point out his character 'defects.' Group members and even counselors may resign themselves to this behavior to avoid his wrath.
Yet this same individual can be affable, cooperative, and completely disarming to win you over and get narcissistic supply. Masters of manipulation, they will steer any group process in their direction and even leave the most competent clinician baffled as to what occurred.
Sadly, interrupting the denial dynamic of a narcissist addict is like breaking into Fort Knox. A narcissist may complete the process and not have absorbed anything. Part of the reason is that the qualities of both addiction and narcissism make it possible for him or her to turn in a convincing, magnificent performance....They can use the recovery vernacular, lie about their progress, claim to be using drugs to conduct firsthand research for the benefit of humanity, and generally manipulate counselors into believing they're sincerely interested in what's being said.
Should the narcissist relapse (very often a part of recovery), she will feel ashamed about admitting her fallibility, need for emotional sustenance, and impotence. Subsequently, she is likely to avoid treatment altogether and convince herself that now, having succeeded once in getting rid of her addiction, she is self-sufficient and omniscient.
What about Alcoholics Anonymous? According Lerner and the Center for Substance Abuse Treatment, 12-step groups can be helpful for NPs with a substance abuse problem. With time and support of others in the program, it can help them break through the denial.
However, for other NPs the lure of attention and admiration is too strong. They will grab all the narcissistic supply they can get through the program. They have a stage for discussing their illness in view of a few dozen people, and then befriend those who show them the most admiration. If they've been with the program for awhile, they can take on the superior role of sponsor. If people see through their act, they can find another meeting.
Before personality disordered people can be treating for the underlying disorder, they first need to seek medical attention and overcome addictions, eating disorders, and other medical problems. These are deeply ingrained coping techniques. Without them, borderline individuals, in particular, are left out in the cold without any way to cope with the pain. If these techniques are life threatening, you may want to do all you can do to get them into treatment. But expect that this will not be an easy road for you to travel. On the other hand, verifiable disorders that commonly require treatment may make it easier for the BP or NP to seek help. It's very individual.