Twisters and Roller
Living With Borderline Personality Disorder Part
- Debra L. Kaplan,
MA, LAC, LISAC
Not too long ago, a client who I was treating for prescription drug abuse, looked at me and said, “It’s my desperate need to silence my feelings that drives me to want to use.” She went on to describe what it felt like to live in her skin. “It’s as if the people in my life are at the controls of this rollercoaster called my life and I’m trapped and I can’t get off. I like or hate the ride based on how I feel about them at that moment; in my mind you’re either with me or against me. But I can’t fire them from the controls!”
Unbeknownst to this woman she was verbalizing what was part of her underlying issue—Borderline Personality Disorder. For the uninitiated Borderline Personality Disorder, or BPD, is classified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a psychological disorder characterized by two or more of the following criteria: frantic efforts to avoid real or imagined abandonment; a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation; identity disturbance: markedly and persistently unstable self-image or sense of self; impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, spending, sex, reckless driving, binge eating); recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days); chronic feelings of emptiness; inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) and transient, stress-related paranoid ideation or severe dissociative symptoms.
Those who are familiar with BPD know all too well the chaos and havoc brought to bear upon a relationship. In my experience working with addictions complicated by the constellation of borderline behaviors, I have often likened the displays of impulsive rage to that of a cluster bomb. From one furious mass come multiple smaller sub munitions. In a fashion not too dissimilar to a cluster bomb’s defensive and offensive use in war, the rageful, emotional explosions neutralize any threat of real or imagined relational rejection, abandonment or disapproval by a loved one.
While this metaphor might resonate as downright ludicrous it is not far from the truths of those that struggle with BPD and those that relate to a loved one’s emotional dysregulation ready to blow at the slightest internal or external provocation. I believe this metaphor plays directly to the core issue. Those who struggle with BPD live an endless rollercoaster of defensive and offensive measures summoned to thwart the slightest hint of shame and pain brought on by rejection or abandonment be it real or imagined.
Loved ones that are idealized one day are devalued and rejected the next and relegated to the role of enemy all perhaps because an act of parting was taken as an act of betrayal. Some who struggle with BPD have co-occurring mood disorders that might exacerbate internal stressors to the point of experiencing brief psychotic episodes. The name of BPD was originally intended to delineate the line between psychosis and neurosis although that is no longer the case—yet the title has remained.
Individuals with BPD often verbalize feeling wronged, misunderstood, and empty which provokes the internal mood to reach “broil”. And as is often the case in an individual with BPD, the trigger be it internal or external prompts attempts to self medicate overwhelming emotions with alcohol and chemical dependence, self injurious behavior notably, intentional acts of self-mutilation (cutting, burning, wrist slashing) and even suicide attempts.
The proposed causal factors behind BPD are varied and have been debated but are linked and not limited to childhood trauma (e.g. physical or sexual abuse), familial and social relationships, and neurochemical imbalances in the brain. As varied as the proposed factors for the disorder are the proposed treatment modalities that include a range of psychosocial and pharmacological interventions.
Psychosocial interventions include talk therapy and it is arguably the most vital component to successfully treat the constellation of BPD behaviors. At the heart of therapy, regardless of the modality, is the relationship between clinician and client. Identified are several therapeutic target goals for enduring success:
· Identifying ones emotions and learning skills for distress tolerance;
· Identifying and establishing boundaries in order to create safe relationships in one’s life;
· Establishing and validating an individual’s core sense of self;
· Modeling a collaborative and trusting relationship between client and therapist.
Historically speaking, the prognosis for individuals with BPD has been poor. But despite what has been written it is the current belief that a consistently trusting therapeutic relationship can and does become the healthy foundation from which a client experiences enduring and positive change. Much is still unknown about the disorder but continued advances in genetic and neurobiological research have helped lead to new psychopharmacological interventions and posited treatment modalities.
The bottom line is this…It is important to remember that you and you alone are at the controls of your own life and your own recovery. The motivation to change has to come from within. The job is yours and yours alone. The help and resources are there for the taking but nobody else can do it for you. You have to know that you are worth it!
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ABOUT THE AUTHOR:Debra L. Kaplan, MA, LAC, LISAC, is a licensed therapist in Tucson, Arizona. She integrates authentic power and spirituality into her work and teachings for the healing of Posttraumatic Stress and co-occurring addictions. You can email Debra at Deb886@comcast.net