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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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