Today Jane E. Brody of the New York Times walked bravely into the troubled, misunderstood waters of borderline personality disorder. She quotes a PhD student, Georges Han describing BPD as “a serious psychiatric disorder involving a pervasive sense of emptiness, impulsivity, difficulty with emotions, transient stress-induced psychosis and frequent suicidal thoughts or attempts.” This is all true, however, in my experience this description captures a severe form of the disorder. It is possible to have BPD and not experience suicidality, for example.
The National Institutes of Mental Health define BPD more generally: “Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.” I like this definition better. My patients with BPD are people in deep pain, subject to emotional tsunamis they have no idea how to control. They will simultaneously push away loved ones, make them miserable and pull them in with declarations of love and devotion. The ‘I hate you, don’t leave me’ syndrome.
People with BPD are found in all social and educational strata. Housewives, college students, CEO’s, teachers, factory workers, come to my office for mood or relationship troubles. After a bit of digging a more fully formed diagnostic picture emerges. It is not an easy diagnosis to share. Insight is often blurred by the very defenses that he or she needs to keep from falling completely apart.
In graduate school my professors encouraged us to be careful when considering this diagnosis. Just because we found a patient annoying or difficult didn’t mean they had a personality disorder. Many of my colleagues state clearly they will not treat BPD or any personality disorder. Until experience proved me wrong, I was among that camp. Today I find work with people with personality disorders very rewarding thanks to Dr. Marsha Linehan.
Treatment for BPD is most effective if the therapist is knowledgeable in Cognitive Behavioral Therapy and trained in Dialectical Behavioral Therapy. Dr. Linehan developed DBT in response to frustration with CBT’s limited ability to help her borderline patients. DBT is like CBT married to eastern philosophies; a kinder, gentler CBT that “helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting.”
Here are seven links to learn more about borderline personality disorder:
An Emotional Hair Trigger, Often Misread
Borderline Personality Disorder, a brief overview
What Is Dialectical Behavioral Therapy?
More On Marsha M. Lenihan, PhD
Stop Walking On Eggshells: Taking Your Life Back When Someone You Love Has BPD
I Hate You, Don’t Leave Me: Understanding the Borderline Personality
Photo courtesy of cmbellman via Flickr
I first became familiar with this term when a volunteer board member I worked with began sending me stupifyingly inappropriate and abusive e-mails at work over a fundraising event we were both working on. Every day, I’d get another email, attacking me or my intelligence or my competence or my personality – and then, out of the blue, sometimes glowingly, fawningly affectionate. He’d order me to do a task (like send his photo to the media along with a news release) and then the next day berate me ferociously for doing precisely what he had told me to do. I was stunned and offended and confused, as I’d experienced nothing like this in my lengthy PR career. Hard not to take these crazy-making interactions personally!
One day, I was at my desk, reeling from yet another attack e-mail when one of our staff physicians walked into my office to say ‘Hello’. I said to her: “Get a load of this!” and showed her the E-mail Of The Day.
She immediately said “I’ll be right back!” and disappeared back into her office, only to return a minute later with copies of two medical journal articles advising docs how to treat patients with BPD. She explained to me (before demanding that I read the articles word for word IMMEDIATELY!) that she herself had some patients who were so upsetting to treat that she had to re-read these two articles just to brace herself for seeing them.
“It’s about a power imbalance”, she explained. “Most people with BPD are quite functional as long as they are in positions of power where they are totally in charge, but when they become our patients, the nature of the doctor/patient relationship is one in which the doctor is seen to have all the power, and the helpless patient has none – which is an impossible situation for somebody with BPD to manage. That patient will do anything possible to set you off-balance, to unnerve you or threaten your credibility or question your authority so that the power balance will once again be restored in his favour.”
As you say, until a situation (like a serious physical illness)threatens to make them feel as if their world is “falling completely apart”, they can often function successfully in the business world where their demandingly brutal managment style may be feared and thus tolerated.
Difficult to treat clinically, yes, but difficult to work with – DEFINITELY!
It would be very helpful for those of us who are not clinicians but unfortunately have to work with these people if you could offer some helpful strategies for just surviving in the workplace with them.
Your request gave me a lot to think about. I wrote a post on Psych Central about a year ago, Seven Rules to Surviving an Abusive Boss, (you can find the link under ‘Most Popular Posts’ in the side bar). Without identifying them as BPD I listed some ideas for coping with people in power who have those traits. You might find it useful.
Also, one of the books I recommend, Stop Walking On Eggshells, is very useful, even if the person identified with BPD is NOT someone you love. I’ve referred to it when I had to deal with a difficult (former, Thank God) business associate.
Thanks for the article idea. The subject is certainly worth another visit.
Have a happy Thanksgiving!
On one hand, he’s really angry at Buzzy, and on the other hand, he’s sorry for the life that the guy is living now; you can see it on his face.
To say, ‘I’m going to put cartoons here and music there,’ did you ever think, Maybe he doesn’t want my two cents.
When people are confused and irresponsible, they will claim to adore and love you while at the same time
doing and saying things that hurt and shame you.