"Borderline' Is Code for 'Difficult' " is the title of an article by Bruce Bower in Science News. The article reports on a major challenge faced by women, and men as well, who suffer from borderline personality disorder and the relationship struggles that syndrome tends to bring.
The article quotes Sandra Sulzer of the University of North Carolina at Chapel Hill who conducted extensive interviews with psychologists and psychiatrists. Her research clarified that the diagnosis of borderline, for all too many therapists, connotes needy, manipulative people — drama queens who do not need or benefit from treatment.
"Clinicians," Sulzer said, "frequently view borderline personality disorder symptoms as signs of badness, not sickness..."
The attitude toward borderline personality disorder that equates borderline with difficult merits challenging. This blog post is the first in a series of posts that aim to offer an alternative, more empathic, view.
The seeds of this post were planted by a reader who wrote an email to me complaining of what she had interpreted in my earlier blogposts on this syndrome as a pejorative attitude toward folks with BPD. H.O.'s apparently knowledgable perspective piqued my interest.
So I wrote back. And H.O. responded further.
The resulting informative dialogue about borderline personality disorder has influenced me greatly. I am pleased therefore to be able, having received H.O.'s permission, to share our dialogue with Psychology Today readers.
Letter to Dr. Heitler:
Dear Dr. Heitler,
People with BPD don't want to be treated like royalty. They just want to be loved, an emotion which many never experienced. There is strong biological vulnerability and often horrific abuse which results in this devastating condition. For BPD sufferers, dysphoria, or mental pain, is their baseline mood, which can feel unbearable. Their lives are hellish.
As a physician who has worked with borderline personality disorder patients herself, and a BPD sufferer personally, I really appreciate your interest.
As a borderline personality disorder sufferer myself, I want you to know that we are not manipulative. We are desperate.
We don't know how to live with others, how to have friends and get our needs met the normal way. We simply are ignorant in this respect.
If you read Freud's classic works, he points out that intense feelings bring about "abaissement de niveau mentale" which means it clouds judgment to the point of insanity. Our uncontrollable and horrible emotions deprive us of the ability to think and control our behaviour. Our behaviours are not meant to harm, at least not mine. Rather they are an expression of desperation.
We do not manipulate by cutting ourselves. We cut because the pain of being borderline is so intense and so unbearable that the little kick of endogenous endorphins in reaction to acute physical pain is the only thing that brings relief from this horrific mental pain. How bad would you have to feel to want to kill yourself? We feel like it most of the time.
Please understand. Having a borderline personality disorder means suffering which I can only compare to terminal cancer.
If you saw a cancer patient howling with pain you would have compassion. The world does not have compassion toward us, even though we howl with pain because our effort to escape unbearable pain causes behaviours which antagonize people.
Please believe me, if our pain went away, we would not do any of the 'bad' things that the world finds inappropriate or harmful. We commit suicide because our pain is sometimes simply impossible to bear.
Please believe me, the depression and dysphoria of BPD is the most horrible feeling. Sometimes I prefer I had cancer instead. At least then, the whole world would not blame me for desperate efforts to blunt the pain brought about by my biological vulnerability and abuse I suffered as a child.
Pain is the core and the essence of borderline personality disorder.
BPD behaviours are nothing but inefficient ways to escape the pain. It is a vicious circle because these behaviours bring even more pain.
Pain distorts reality and results in what traditionally was called "borderline" psychosis. Our perception of reality is so distorted by intense emotion that we do not think straight. Only after recovery do we realize how we were wrong and how our perceptions were distorted by the illness.
When symptomatic, a Borderline is in living hell, surrounded by perceived universal hostility.
I wish you all the best in your efforts to help alleviate this horrible condition and damage it brings both to the sufferers and those who have to deal with them.
Response from Dr. Heitler:
Thank you so much H.O. for this description of your experience as someone who suffers from Borderline Personality Disorder. What you describe fits very much with newer theories that BPD is at core a function of amygdala hyper-reactivity.
The amygdala is the part of the brain that tells us when there is a danger ahead. A hyper-reactive amygdala sees danger where there is none and reads small dangers as catastrophic.
These overly intense emotional reactions cause the thinking parts of the brain to turn off and the ability to take in new non-confirmatory information to drop down to near zero, both of which add to the difficulties of self-soothing.
More on this disorder and potentially helpful treatments to follow...
Dr. Heitler's articles on this blog on the subject of borderline personality disorder include: