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Three Different Personality Disorders

Question:

I’m 18 years old going on 19. My childhood from about 14 on was spent getting kicked out of schools, or if I was in school basically being in and out of in-school suspension. There was a point where I threatened my school, and specific students and it seemed that the parents of the other students were going to charge me with something. Of course I went to the school shrink I plead a victim story so instead of going to a trial I was kicked out of the school and then sent to a behavioral center. During the behavioral center I lied my way to just get out which I successfully did after a week. They claimed I had bipolar disorder, and I saw several psychologists/psychiatrist afterward but convinced my parents I didn’t need it. Over the next few years I went through a lot of relationships, leaving a lot of people hurt. Stopped talking to my family and I was wondering whether something truly was wrong with me…so six months ago I admitted myself back into a behavior center. They said I had three personality disorders which are: Antisocial, narcissistic and borderline. I left shortly after knowing these, not really having any follow-up treatment and very discouraged by that. Up till that moment, I’ve hit my boyfriend, threatened and wanted to kill him having restraint on me. Destroyed his car, tore up his apartment, cut myself, and trying everyday to calm my anger which seems to be uncontrollable after certain points. I live in a state where there isn’t much help for well, anything regarding personality disorders. My former psychologist was basically telling me that there wasn’t much help for me, so I stopped seeing her. I’m at a lost…some days I don’t ever want changing, and other times I realize I need as much help as I could get. I’m not sure exactly what to do

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Answer:

Your ambivalent posture is where you’re at, but it isn’t going to help you. Getting help for the types of problems you describe here isn’t easy. It is generally difficult to find good helpers you can relate to; difficult to do the work they prescribe and expensive to pay for it all. It takes a fair amount of motivation to get through it. If you are only half-hearted about wanting to do this work, it doesn’t seem likely to me that you’ll do it. At least not right now at this ambivalent time. But people change as time goes by and they get new experiences under their belts. If you don’t want help enough now, maybe you will want it enough in the future.

What sort of help are we talking about? Well, there is no way to know whether the diagnoses you mention are accurate for you, but if we consider them collectively, we can say that the people diagnosing you are remarking on your energy, self-focus, and capacity for drama and emotional theatrics. You report anger problems, self-mutilation and difficulty managing interpersonal relationships. You don’t say at all why you are so angry, but it is likely that your childhood was not a bed of roses. You also talk about lying and manipulating people (which is why people are describing you in Antisocial terms rather than just Borderline terms). I suspect you’re ambivalent in more than one way. You aren’t sure if you want help or not, and also you aren’t sure if you care about other people or not. Maybe a better way to characterize it (that fits better with the borderline diagnosis) would be to say that you want relationships with other people but find most of them to be terribly disappointing, and you don’t (want to) care what happens to the people who disappoint you.

Sometimes ambivalence about therapy comes from a sort of pride people take in their outlandish and harmful activities. They may think to themselves, "though I feel out of control, I can make myself feel powerful and I can teach other people a lesson, if I act out my fury and anger feelings. I don’t like myself when I simply feel vulnerable, but I like myself a lot better when I act out in an angry manner". Anger frequently starts out as a feeling of hurt and (because it hurts so much to feel that hurt) it gets converted into anger. It’s easier to hate someone else than to hate myself. It feels more powerful and in control to be angry than it does to be vulnerable. You may feel that you can’t afford to give up your angry feelings because if you do, you’ll revert to being someone who is vulnerable. Also, so far, you’ve gotten away with being angry. You’ve avoided jail time and a criminal record, for instance. For now, anyway. It may take some time before consequences occur and anger ceases to be less expensive than simply feeling your painful vulnerable feelings.

Anyway, this sort of pride in being angry and powerful is going to get in your way of finding the things that most people want from life like a healthy mutually caring relationship. The price of the anger defense is going to be that it keeps you separate from other people and therefore lonely as hell deep inside. It is true that if you give up the anger, you’ll feel more vulnerable, but in that act of opening up you’ll also become more human and other people will be able to relate to you better, and you’ll have a better chance of being happy. And it doesn’t have to be the case that you never get angry; you can learn how to be assertive, rather than aggressive, for instance. It will likely take some maturation on your part before what I’m trying to communicate here makes sense, so in the short term, just hear that finding alternative ways to manage your anger feelings is in everyone’s best interest, including your own.

What sort of therapy you might seek out and in what order depends on what you can tolerate. The best therapy currently available for the more severe spectrum of borderline individuals is Dialectical Behavior Therapy or DBT. DBT therapists spend a lot of time helping patients to learn how to get their emotions under control, primarily through the use of various mindfulness techniques. As it becomes easier to tolerate painful situations without acting out, the therapy becomes more cognitive behavioral in orientation and helps to teach patients how to do accurate reality testing, how to put things into rational perspective, and how to find alternative, non-self-harming means of coping with stress.

As out of control anger is one of your presenting problems, it might make sense for you to look into a course of Anger Management therapy, if you can tolerate it (if not – start with DBT). In a typical anger management therapy (there is not one standardized type), patients are taught how to recognize anger feelings so as to be better able to control them. Cognitive therapy reality testing techniques are frequently taught to help people re-evaluate their beliefs about what justifies an angry response, and consequences of angry actions are discussed so as to put the impulse to act out in angry ways into a rational perspective.

There is hope for you, but you will have to find the motivation to seek out the appropriate kinds of help in order to maximize your chances for a happier life.

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Comments
  • Brittney

    As much as I struggle everyday trying to decide whether I should seek help or embrace the way I am I do recognize that I'm only getting worse, half of my family disowned me and I continue to job-hop because of my anger. Nothing will get better for me the way I continue on, maturity has to be a part of it because they said it slows down when I hit about 35-40. Yes I have had a rocky childhood I've been abused in everyway from 11-14 but the thing is I felt nothing, I have no feeling to really what happened I was never angry or sad by it.

    I'll look into what you said, I've never heard of it but I've had anger management problems and it seemed to only frustrate me and anger me more. I really haven't received better advice from anyone and I think you pretty much said what needed to be said I'm just glad that I'm not some terrible monster always going to be this way and that there is hope.

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