As in my several earlier articles on borderline personality disorder, my understandings of BPD have grown significantly from discussions with a physician whom I refer to as H.O. Dr. H.O. herself suffers from borderline personality disorder. Whereas my clinical practice mainly consists of clients from the middle and upper reaches of the economic spectrum seeking help with relationship issues, depression and anxiety, Dr. H.O. has worked professionally treating young women from the lower rungs of the economic ladder who suffer from borderline issues. In her comments below she draws our attention to the plight of these sufferers.
Our discussions, accomplished via email exchanges, focus on the tragic challenges faced by women, and men as well, with borderline disorders.
I share here, with her permission, Dr. H.O's most recent observations. She has been writing to me about the impact of borderline personality disorder on the sufferer and also on family members:
It is really heartbreaking how much hurt and unhappiness mental illness creates every day, is it not?
I have seen the illness of borderline personality from both sides–from the point of view a sufferer (myself), and from the perspective of those who live with and have been injured by them (including my husband). I see how both sides are deeply hurt—those affected directly from living the hellish realities of suffering from BPD and the non-BPDs who may feel terrified, abused, scared and who can be even criminally hurt by those with the disorder.
Overall people with borderline personality disorder are extremely unhappy people.
With their hyper-reactive amygdala and other dysfunctional brain aspects that cause super-intense emotional reactivity—often triggered initially by maltreatment from borderline personality-disordered parents—women and men with BPD live lives characterized by great challenges. In their younger years many of them have suffered abuse. As they grow into adulthood, and especially if they are on the lower rungs of the economic ladder, they may experience little opportunity, great anguish, sadness, loneliness, and a troubled adolescence. They may enter adulthood with broken educational and career pursuits, plus desperate attempts at self-medication with drugs and alcohol. Their dysfunctional hyper-reactive emotional reactivity may sabotage even their most determined positive efforts to establish lives of well-being. Overly intense emotional reactions potentially can eventually wreak destruction of virtually everything they attempt to do. BPD sufferers definitely can become victims of their illness.
Women and men with significant borderline personality disorders, and especially those who simultaneously suffer from economic limitations, can experience such extreme emotions that they commit felonies. They can stalk, abuse, terrorize, steal, destroy property, set fire to and even, extremely rarely, may hit or kill someone in a fit of rage.
At the same time, people with BPD are at risk for wreaking horrible chaos in the lives of others who surround them, chaos first and foremost of the emotional kind. Their quick eruptions of anger and quickness even to rage, often based on misinterpretations of situations, can lead them to treat others poorly, including and especially family members.
Anger induces a belief that what I want is holy and what you want is irrelevant, that is, profound narcissism. This temporary narcissism, in turn, can cause people with BPD to become blind and deaf to the suffering they induce in close-by others. Enormous personal strength, plus insight and determination, may be necessary to prevent emotional outbursts from erupting.
In sum, people who suffer from a borderline personality disorder may victimize others at the same time as they themselves are victims, tortured by their too-intense emotional reactions.
What can be done with this conundrum?
One way to make progress may be to look at BPD as what it really is—unequivocally proven by empirical research—a severe and too often life-limiting disability. It can be a disability that affects the sufferer’s quality of life, how far they will ever get in any career, and their ability to sustain close relationships. The disability can prevent them from ever getting married, and can increase the likelihood that if they do marry the union will end up with a divorce. The emotional storms caused by BPD's overly reactive emotional system decrease the likelihood that someone with the disorder will be able to raise children, and especially emotionally healthy children.
Therapists generally deal with only the top and highest functioning of the iceberg of borderline personality sufferers. With fees of upwards of $100s per hour, therapists generally see only the professionals and upper-level business folks who somehow, despite their brains having become wired problematically, have made it in life enough to be able to pay for psychological services.
In addition, BPD sufferers from higher income groups generally have enough education to buy and learn from self-help books that teach how to cope with the depression and anxiety, as well as the anger, induced by BPD.
In my work as a physician in a public health service, I have realized that these more fortunate BPD sufferers—the ones who receive intensive enough help to reduce the ravages of the illness—these men and women represent a tiny fraction of folks with a BPD diagnosis.
The silent majority are hidden in the shadow. Often in dire straits of destitution and unemployment, these sufferers either become profoundly lonely or endure repeated abusive relationships. They subsist on disability checks or end up homeless, institutionalized, or imprisoned.
Destitution, institutionalization or imprisonment are particularly likely outcomes for women with severe BPD. Men who have been diagnosed with anti-social disorder may, in fact, be showing the male version of what in women we call BPD. The typical outcome for low-income "personality disorder" men, who have similarly little to no opportunity or privilege, is imprisonment.
Less economically advantaged people with borderline personality disorders, through no fault of their own—the women and also the men—have been dealt a genuinely harsh hand in life. Who will help them?
Maybe they could have played better the poor hand they have been dealt if someone had taught them to understand their emotional disability. This is what Marsha Linehan has been trying to do. Her programs teach people with BPD first how to stop digging an even deeper hole for themselves if they want to get out of it. Strong mental health services could go a long way toward giving these sufferers a chance to enjoy more satisfying lives.
Meanwhile, on a brighter note, in spite of my abusive upbringing and my still-tyrannical emotional upheavals, I am doing well.
I have found ways to practice my medical profession in ways that enable me to have only minimal interaction with patients. With work that requires me to face only minimal interpersonal and therefore emotional demands, I have succeeded in becomingespecially a respected contributor in my field.
I feel most thankful for my exceptionally understanding husband. With his particularly active participation in raising our children, we have been able to protect our family from the ravages of my illness. My children are growing and developing amazingly robustly every day. Together my husband and I as a team are breaking the chain of generational transmission of BPD that goes way back in my family.
For my current good fortune, in addition to my husband, I profoundly thank both my own studies of BPD and the several mental health professionals who have helped me to learn to manage my emotional disability.
Yet who will help the many other women, and men with borderline personality disorders who have fewer resources to support them?