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Is Borderline Personality Disorder A Choice?

Question:

I’ve been diagnosed with Borderline Personality Disorder, along with depression and anxiety. I’ve accepted the diagnosis and know I have lots of things to work on. My biggest problem is that my emotions are so strong and take over at times and I can’t think clearly. It’s so automatic for my strong emotions to control me that all reasoning is completely gone.

When I talk about difficult things in therapy my therapist refers to my tears and strong emotions as a choice. I don’t see any of this as a choice and I’m confused by this. I so automatically begin to cry, feelings of abandonment, of how awful I am to be this way, and all sort sorts of negative feelings about myself take over. Because of this the words he’s saying don’t make sense to me and I feel very confused about what he’s trying to say.

I swear I’m not purposely being difficult or manipulative or trying to avoid the conversations–those darn emotions just control me. I can be okay one minute and then a certain topic just sweeps me into the sea of emotions and nothing makes sense. I sense my therapist becoming frustrated with me. He seems to view my emotions and reactions as a choice. Where is the choice in all this? I wish my emotions weren’t controlling me. I started attending a group for people diagnosed with Borderline but we’re only at the very beginning. So I am starting to work on these things but I just can’t see it as a choice. How is this a choice?

I’ve also having trouble with wanting to get better, as silly as it sounds. I’ve been this way for so long and even though it’s miserable, I have trouble with changes and am afraid of change. My therapist thinks I want to stay sick so that I have control of things and no one expects much of me. I think there’s some truth to all that. I know I should want my life to be better but I’m so afraid of losing my therapist in the process. Sometimes I feel I have to call to my therapist. The feeling builds and builds until I can’t stand it and I call him. That provides so much relief for me–and frustration for my therapist. I don’t understand why I need to call him or what I need to say, but somehow just talking to him helps me and I can go on. I don’t have an answer as to what it is I really need when I call him. It’s confusing to me. Please help. I feel so crazy and lost and confused.

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Answer:

Your question gets right to the heart of a core philosophical issue that people have struggled with for thousands of years, namely the nature of human freedom, and the debate between free will and determinism. To put it simply, some people believe that people have free will and the ability to make choices for themselves which aren’t determined in advance for them by what has happened to them in the past, while others believe that people’s future is very determined in advance by what has happened to them in the past. People who believe in free will believe as a consequence that it is possible for people to change. People who believe in determinism believe that free will is an illusion, and that change is impossible.

It’s oversimplifying things to say that people have to choose between positions of radical belief in free will and radical belief in determinism. Most people these days believe that people are both a little free and also a little determined at the same time, and it is only the relative percentage of how much freedom they think people have that separates them.

Based on your life experiences, you have developed a very deterministic world view. You believe that you do not have control over your emotions and cannot change. Your therapist, on the other hand, is in the change business, and by definition is going to be someone who believes more in the possibility of free will than in the idea that people’s futures are pre-determined. What is happening is that you two are experiencing a culture clash. He is suggesting to you that change is possible, and since that makes no sense to you right now, you’re confused. It’s like he was saying to you, "The sky is green" and you look up and see that it is blue! You’d wonder what he had been smoking, right? So – there’s nothing wrong with your confusion. This is a confusing issue!

The truth of the matter, as it so often does, can probably be found in between your own understanding and that of your therapist. Human nature is not nearly so deterministic and unchanging as you see it presently, and also not free for instant change as your therapist seems to be making it out to be.

While it may be true that you personally don’t have much control over your emotions at this stage of your evolution as a person, that doesn’t mean that it isn’t possible for you to learn how to gain better control over your emotions. Change for you is very possible, but it will need to happen gradually, and with some effort. Think about how straightening your teeth works, and you will know how straightening your emotions works too. Teeth cannot be straightened in a day. To do that would be to break your teeth! Instead, a dentist applies consistent gentle pressure to your teeth over long periods of time so as to straighten them gradually. Similarly, it is impossible for you to regulate your emotions today, but if you work at it consistently, over time you will be able to gain some control. You’ll never be open to learning how to sooth yourself, however, if you stay fixed in your present belief that self-soothing is impossible.

Your therapist is essentially correct that you are making choices that are causing you to feel particular ways. It doesn’t feel like you are choosing to feel a particular way, but that is only because you haven’t learned yet where to focus your attention so as to see the process happening. The choice process you are missing and unconscious about right now is known as cognitive appraisal, and it happens in the background of the mind every time something happens and you interpret the meaning of that event. Strongly ingrained habits of thought and interpretation cause you to focus on certain information and ignore other information, which leads you to experience particular moods. The essential skill you need to learn how to gain control over this process is called cognitive restructuring. In order to do cognitive restructuring effectively, however, you have to be able to think rationally about emotional topics. There is a precursor skill set to master before you take on cognitive restructuring, then, which helps you to learn how to sooth yourself and gain some control over your moods. The form of therapy that best teaches these skills to people like yourself is known as Dialectical Behavioral Therapy, or DBT. Stay in therapy, for therapy is where you will learn these important skills.

Both of you are correct then about your respective positions. You are correct that, presently, you can’t control your emotions once they get started, and your therapist is correct in suggesting that you can choose to control your emotions. What is problematic here is that there is a space of experience and skill between the two of you which is not being talked about. It would be better if your therapist said to you, "Eventually, with practice of these self-soothing skills that I’ll teach you, you will become able to control your emotions", and if you were to say to your therapist, "It feels like I have no control over my emotions, but that is because my emotional control skills are not built up. If I practice emotional control skills diligently, I will gradually become better at controlling my emotions". It’s not that you will ever be able to not feel something you feel. No one can do that without becoming numb inside, which is a bad outcome. Rather, success is measured by being able to feel something but not to allow it to overwhelm you completely.

As for the concern you express over ambivalence about getting better, the need you have to call your therapist and the more general concern over losing your therapist, such concerns are par for the course when you’re diagnosed with borderline personality disorder. They reflect an underlying sensitivity towards the possibility of abandonment, and a desire to remain connected to safe figures who play a role in helping you to feel calm. As you progress in your therapy and develop the ability to become more self-regulating, these urges and fears will likely relax some, perhaps becoming a problem again just before it is time to graduate out of therapy. They will never go away entirely, but that’s okay and normal. Believe it or not, many people have abandonment fears and have spent parts of their lives worried that they will be abandoned. It’s a common fear. Most people just don’t experience it as profoundly as you perhaps do. They also will tend to have developed ways to cope with the anxiety of the possibility of loss which makes it easier for them to make their way in life. As you develop your own coping skill set, you will feel more confident and your own fear will lessen in intensity.

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Comments
  • zephyr

    There is obviously much thought in your reply. But still, could you not just have told this poor person outright that no one chooses to be BPD - not even if they are not in their "right mind" - unless you like the idea of living in hell, and probably not even then?

    Do you have so little empathy for this disorder? Or were you so afraid to imply that they might not be able to change? Even people with schizophrenia may snap out of it. It's enough to point that the brain is a marvelous instrument and can self-heal with help - thinking can change one's chemistry. But talking about BPD as if it was just a problem of acquiring control over one's emotions misses the point.

    Is it so hard to understand that emotional dysregulation comes out of fear, shame, terror, despair, traumatic memories that haunt you by day and turn into nightmares that invade your sleep and wake you up at 4 AM daily for years on end. Is it so hard to understand that no one would ever want the dysphoria - the numbing depersonalization that turns into unbelievable sadness, despair, or into a moment of explosive anger followed by an eternity of remorse, self-hate, the voice that tells you're worthless and your life a sham as you drag yourself out of bed trying to pull together enough self esteem to face the world still another day - until all becomes numb again and a zombie look alike fills your shoes for you.

    Controlling one's emotions as if it was an acquired skill like writing in straight lines hardly touches the core of what has to change to make life worth living for individuals suffering from Borderline Personality Disorder. It is when the anguish subsides, when they are no longer so afraid of all the nameless terror lurking in their own shadow, that they suddenly will seem to have acquired "emotional control skills". But what really will have happened is that they will no longer be afraid and no longer be drowning in shame, and therefore their inner demons will now be powerless to push them to such extremes.

    Also, why does no one pay attention to the flip side of this disorder? When there are no "extreme emotions" in BPD, one goes for weeks, even years feeling nothing at all. Of course this is preferable to doctors and to the outside world as one is not only inoffensive, but too absent to compete with anyone for anything. It's as if they had never been born. That is also emotional dysregulation - but it's over control. Perhaps you would call it being over-skilled?

    The irony of seeing this group of people as giving in to empty dramatics enables us to ignore their pain when they do cry out and not recognizing their tragic inability to feel much of anything besides anguish, fear, shame and rage, we applaud them when they feel nothing at all - or learn to suffer in silence. Do we really care about addressing their pain or do we just want them to stop bothering us?

    Perhaps this is an emotional dysregulation disorder - perhaps it is a developmental disorder - but it is not about one's personality - this most certainly has nothing to do with "choosing to be bad" and it is not about expressing one's emotions in a social correct way - unless this "disorder" is only about our expectations and not their suffering.

    Editor's Note: It is a frequent occurrence that I, or someone else on this site (or other sites like it or a doctor/therapist somewhere) will take the time to make a thoughtful response based on their professional knowledge and experience, and be told that the response lacks empathy or caring. The constructive criticism part of this pattern is often useful (becuase no one thinks of everything), but the angry motive part is generally intended to hurt and says more about the person writing the comment's feelings and emotions than it helps the criticism process. My question to people making such hurtful comments is, "why do you assume that there is no empathy present in the response (because usually, the mere fact that the response is being offered is evidence of empathy - no one goes into mental health work without having some emotional reason for doing so)" - and more to the point, "what does the fact that you need to express yourself in this manner teach you about your experience and how you have felt yourself to have been treated?". It has to suck to walk around feeling so angry and misunderstood and uncared for...

  • zephyr

    No, I'm very sorry. I did not mean at all to suggest that you lack empathy as a person. The superb depth and thought that you gave to what you wrote moved me truly. As you've pointed out, the time you took to write what you have speaks eloquently for itself. I tend to state my ideas rather forcefully at times, but it was precisely the interest I had in what you had written that seduced me into giving my point of view.

    I remember being horrified a long time ago at the stigma of being labeled with "Borderline Personality Disorder" - but it slowly gave way to being equally indignant towards the way many people allow themselves to malign those trying to help this population. I am among the first to protest when I hear people generalizing negatively about psychiatrists/psychotherapists. Really!

    I just think that this disorder, whatever it is, is only superficially helped, or worse, actually in part fueled by certain "objective" approaches to it widespread today. Therefore it seems to me worthwhile to try to "subjectify" it. Take for example the therapies that work on changing behavior patterns that do change the outward presentation of many of those who externalize their pain. Outwardly many people no longer meet the five criteria needed for a BPD dx after a few years of this kind of therapy. But subjectively many are still in a great deal of psychic pain, many are still stuck in the past, many are still dysthymic, for many the underlying dysphoria still gnaws away at their existence, only now all is hidden. They will continue on as shadows of who they might have been.

    So what can be done? I propose we try to look at this disorder from a radically different angle, subjectively, existentially if you would, and see where this gets us. But I do not want to attack anyone. Pretty much autistic for many years of my life, I do not always choose my words as carefully as I should. My apologies.

    Actually I'm rather at peace with myself and the world, except for the insomnia. But there's medicine for that. Along with the direct experience of being surrounded by very fragile people all my life, who together ran the gamut of mental illnesses I have had much time and an innate tendency to reflect on the causes - which has driven me to find a perspective that keeps me alive and that I occasionally feel an urge to share. But caution: I am not sure of anything except that fragile does not mean bad or evil and most people - doctors included - are just doing the best they can.

    The battle for me was long - severe abuse from outside the family, keeping silent to protect my parents (still relieved that they never knew...), and neglect and indifference on the part of the very doctors who could have done something for me at the time when I was a child, led to the loss of all my pregnancies as an adult. Enemy number one for me is the past. My husband of twenty years stood by me when I finally succumbed to a severe melancholic depression I am very lucky to have him in my life.

    I am no longer young a decade ago I did finally find a great psychiatrist/psychotherapist, who could probably be called an existentialist and who certainly helped me turn my life around. Through him I discovered the writings of John Bowlby among others, which helped me profoundly. Perhaps I am also fortunate in that I have always internalized my pain and am introspective by nature - or perhaps I have suffered more than most because of this - hard to say.

    But members of my family and people I loved were certainly not so lucky. Although the world would never suspect it, I wake up every day to an infinite sadness, often in thinking of them. I find solace in searching in learning all I can to understand in my spare time, to make sense of the absurd, to turn night into day - texts such as yours help me think. In my own awkward way I couldn't resist trying to open a debate...

  • New BPD

    I could relate to the last post because while I can sit back and see the words I can also feel the emotions. Now with the new diagnosis I find myself being overly critical of everything then being critical of being critical. I hate labels yet I yearn for answers and labels that give me a sense of direction.

    I feel worse now knowing I am diagnosed with this BPD. I feel everything I say or do is now within a parameter of a DSM IV. If I laugh too much or suddenly get angry am I showing it too freely? Am I always going to be the "wrong one" because I am so inadeptly skilled to live in this world? Will my judgements of others always be hashed out as being "over the top"? What about other people's actions and reactions? I read that only 2 % of the population has BPD. Wow, I'm elite! I still do not feel better.

    I guess the one thing I read that makes the most sense to me? Is the following. Because so far? I only feel like I have been categorized once again for my differences. And noone, that I have ever come across has ever been "normal".

    "Personality Disorders involve behaviour that deviates from the norms or expectations of one's culture. HOWEVER,PEOPLE WHO DEVIATE FROM CULTURAL NORMS ARE NOT NECESSARILY DYSFUNCTIONAL, NOR ARE PEOPLE WHO CONFORM TO CULTURAL NORMS NECESSARILY HEALTHY!!"

    I think that is a great thing to live by for a BPD. We are not weird, we are human beings too.

  • Anguish

    Our "Editor" seems a bit defensive today!

    I think the previous poster made a lot of very good points, calmly and without finger-pointing. I don't see any reason why the "editor" should feel attacked--except that is the response people with BPD ALWAYS get from outsiders. (Which includes therapists, UNLESS they too have experienced BPD themselves).

    If someone dx'd bipolar, schizophrenic, major depressive, etc made the same remarks, "editor" would have had a wholly different response. He/she would have said, "No, you cannot 'control' your emotions, you need meds and therapy to help you to live with your illness, and you do indeed have a REAL, biological illness--you never chose it, and it is NOT your fault!"

    But a personality disorder? No, that's our choice, apparently, and all anyone wants to do is for us to learn enough "skills" to playact successfully--to pretend to be happy when we're not, to squash our anger, in fact to obliterate any emotions or any behaviors that make other people uncomfortable. Never mind that the same emotions/behaviors would be "excused" and explained away as part of an undeserved and unchosen illness in someone with an Axis 1 disorder.

    Unlike 75% of people with BPD, I was never the victim of parental abuse. (Unless you count years of bullying and name-calling at school, against which I was never allowed to defend myself--it wasn't 'ladylike', so I ended up with my self-esteem destroyed.)

    When I asked a psychiatrist about that--what about those of us dx'd BPD who do not have a history of abuse/neglect etc, she backtracked very quickly and said, "Well, obviously you fall into the 25% of cases whose disorder was not caused by abuse--in your case, I would say it's more likely genetic."

    Well, that made it all clear as mud!

    If it's genetic, is it still "my choice"? And how do you explain the many, many people who have suffered terrible abuse and neglect in childhood and who do not qualify for a dx of BPD??? Do you really think there's no biological/genetic difference there? If not, how do you explain it?

    As if it's not enough to live in constant pain--the worst part of all is being blamed for it.

    And then you wonder why we're so "angry"?

    How would you feel??

  • kalea

    My psychiatrist suggested that i look up more about this disorder and made it clear that it wasnt my fault, im sorry bt i dont think we WANT to feel this way, but then again im no expert, just a sufferer.

    Im only 18 and ive been to several different people to "help" me, i was even admitted in hospital, but only recently my new psychiatrist mentioned that i might not only be suffering only from severe depression (that i have had since i was 12) bt that i might have something else causing it.

    My point is that when people tell us that we choose to feel this way, we get even angrier and feel more abandoned and misunderstood. Thats how i felt when i read the reply...i dont know about the rest

  • Anonymous-1

    MY husband has BPD and for years I have been living with his disease. He has uncontrollable anger outburts and has been emotionally abusing me and my young son for years. I am accustomed to his refusal to blame his emotional outbursts on everything except of himself. It is a fact that he can not deal with any critism - however positive - and the comments by the BPDs on the site therefore is no surprise.

    I have chosen to stay in the relationship and try to walk the road of healing with him. It is a difficult road and very lonely. I have started studying psycology this year, as an effort to also help my son - who is now even worse than his father. If I leave him - he will move into another relationship - with the same effect. So at this stage I am still prepared to stick it out because I love him.

    I would like to say the following to someone who has been diagnosed with BPD. Your diagnosis is a gift. Be prepared to face the pain and start to change. Stop complaining about what happened to you years ago - it happened. Period. There is nothing anyone can do about that now. You do have a choice to change - do also look into energy healing modalities like EFT and Body Talk which can deal with the flow or blocking of energy due to the trauma you have suffered. Talking about problems could worsen the symptoms intially and I have found that alternatively therapies give more relief - exercise, natural anti - depressants, body talk, EFT techiniques, aligning oneself with positive attractor patterns like love, forgiveness instead of blaming, unforgiveness etc and really but really appreciating your partner. Usually BPDs replace their abusers with their partners in their heads in trying to relive and make sense of the experience and are normally of the opinion that they are being abused - again. Understand that your therapist and partner is not the enemy!!!!!!!! This is a typical symptom. If you are not prepared to face the diagnosis and work on it - and keep on blaming those who actually try to help you - you have to learn then by the abandonment of those prepared to help you - sooner or later. Loneliness can be a good teacher. And so is accepting responsibility. Do not rest until you have find the answers - this is a journey of self discovery for you - and finding peace and keeping your helpers near your heart is worth it.

  • Lisa

    I Find myself un characteristically compelled to comment on this post after reading the comment (currently at top) by the wife of a borderline husband. If anyond needs to get over themself, it's the codependent enabler who is learning psychology in order to help her son, and shame his father, who she never mentioned was actually diagnosed or in treatment, at the cost of herself (see: martyr) rather than getting the help she needs inorded to understand she not only contributes to these behaviors she describes as bpd, but also depends upon and likewise perpetuates. Without them, she couldn't be the judge mental ring leader with her whistle, telling everyome what she thinks is wrong with them mother Theresa never once judged anyone, except maybe the abusive and unaccountable.

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