Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
1. "Jan 17th 2009 E. Mail from anonymous person:
I have BPD and I do shut down contacts, well, quite often actually. It happens when I don’t meet that person anymore. I get tired of speaking only on a phone or sending emails. I just don’t care anymore. Somehow it seems like I need to see a person in front of my eyes to be assured that she/he is real."
2. Fictional examples based on psychotherapy experiences:
A. This forty year old woman was referred to me for psychotherapy with a diagnosis of BPD. She came for psychoanalytic psychotherapy twice per week. After the second session each week she became extremely anxious and depressed because she experienced me as having disappeared from her life. As a result, she felt abandoned and alone in the world until the start of the next week when sessions resumed.
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B. A new patient with BPD seemed to have made a good start at her psychotherapy. All of her symptoms of depression and anger cleared away and she felt wonderful. I became her hero, a man who was brilliant and capable of solving all problems. One day, I yawned during the session. She became fiercely angry at me. She experienced my yawn as my anger at and rejection of her. I quickly fell from my lofty heights of being a talented therapist to being a charlatan who was callous, cold and devoid of human compassion.
The E.Mail above, as well as the fictional case vignettes describe part of the experience of those with a Borderline Personality Disorder.
These are people who do not have a clear sense of who they are, what they look like, and how they are seen by others. Moods are stormy, shifting, unstable as the person becomes easily offended and either angry or rageful even though others may think there is not reason for it. When things are at their worst, these people can quickly become suicidal, cutting themselves or making very real and dangerous suicide attempts. In rare instances, they can become assaultive.
The fact that this is a personality disorder means that behaviors and reactions are patterned and repetitive over many years dating back to childhood. In many ways, the experience of loss and disappointment in me when the weekend came or when I yawned represented the same losses experienced at the hands of parents when they were children.
Various studies show that adults with this disorder were either sexually abused on an ongoing basis during childhood or were severely neglected. The confusion felt during adulthood reflects the confusion, storminess and lack of safety they felt during their formative years. Parents behaved in ways that were inappropriate, intrusive, harsh, punitive and both neglectful and abusive.
In point of fact, studies show that many, if not most, people with BPD were severely abused as children, both sexually and physically.
People with BPD tend to be very concrete and "black and white" in their thinking. My yawn was experienced as an attack on and rejection of the patient. It never occurred to her to ask if I was ill. In fact, I was ill, fighting a nasty virus that kept me up most of the night. The point here is not that I felt misunderstood, but that, she, the patient, had no room in her thinking for other possibilities than that I was rejecting of her.
In the same way, that same patient, in her anger and disappointment, experienced me as falling from hero worship to worthless charlatan, all because of a yawn. Again, the point that is being made her is not to blame the patient but to illustrate the painful way she experienced life.
Perhaps one of the most difficult problems that BPD afflicted people have is that they do succeed in alienating and embittering family, friends and loved ones. It is very true that they bring about the realization of their worst fears: rejection and abandonment. Then, they are able to say, in psychotherapy, "see, I told you so."
Treatment for BPD is long and difficult. One of the most successful treatment strategies used today is DBT or Dialectical Behavior Therapy. Basically, DBT is a form of Cognitive Behavior Therapy during which the patient learns to identify the ways in which their thoughts are unrealistic and unfounded, then learning to replace them with reality based and accurate ways of thinking. Included in this is the use of meditation and visualization to help the patient learn how to reduce and control their stormy and shifting emotions.
If you know someone with BPD and find it hard to deal with them please try to remember that it is even harder for them to cope with their own selves.
Your thoughts and comments are welcome.
Allan N. Schwartz, PhD.
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