The traditional world of psychology and psychiatry is based on diagnosing people. Certain clusters of behaviors and characteristics have been labeled abnormal or indicative or a disorder, condition, or mental illness. If you are reading this blog, I’m guessing you were diagnosed with Borderline Personality Disorder (BPD) or think you or someone you know might have it. Here are some of the classic characteristics associated with BPD:
*Intense fear of rejection or abandonment
*Unstable, abusive, and volatile relationships
*Having a distorted self-image that constantly influences their moods and decisions
*Engaging in impulsive and/or risky behaviors like quitting jobs, spending sprees, gambling, or unsafe sex
*Thinking of suicide or attempting suicide when under stress
*Experiencing intense anger, usually followed by expressions of guilt and shame
*Self-harm behaviors like cutting and substance abuse
*Periods of disassociation, lasting from a few minutes to a few hours
If you do a little Googling about BPD, you will find that it points to a combination of genetic factors and early childhood experiences as the cause. It also says that people with this personality disorder were often abused and neglected.
Warning: I’m about to make a bold, controversial statement.
I don’t believe in Borderline Personality Disorder. I don’t think it exists.
Please keep reading and hear me out!
My view of Borderline Personality Disorder (BPD) as a diagnosis has changed over the course of my clinical experience. In general, I’m not a big fan of using a diagnostic label to describe what is wrong with someone, or to call a cluster of symptoms a mental illness. I know that may sound a little odd considering I’m a clinical Social Worker and therefore have the ability to give a person a mental health diagnosis. Personality disorder diagnoses don’t just describe a mental health condition, they brand a person as having something permanently wrong with them. One’s personality is thought to be something set in stone after age 6 and without fluctuations. I think it sends a message that there’s no hope for change if we label someone with a disorder of their personality. If you’ve read my blog about Internal Family Systems (IFS), you might have a better understanding of my alternative view of what we consider personality disorders. If you haven’t already read the blog, I encourage you to do so now. The basic idea of this framework is that each of us has a multifaceted personality rather than just one singular personality. We are all made of various aspects or “parts” of ourselves that play out in different situations and in different relationships. Take a minute to think about yourself and how you might describe parts of yourself. Sometimes you might be playful or silly while other times you could be analytical or serious. Sometimes you might be more sensitive, reactive or angry. There may be an aspect of yourself that enjoys having a social life, yet sometimes you might be socially anxious. You can also have mixed feelings about something, all at the same time. How would all of this be possible if we each had just one singular thing called a personality? In this model, we all also have a True Self, Divine Self, Authentic Self, or some other similar term. It is the True Self that is the essence of a person and that is the thing that is unchangeable. Within the Internal Family Systems paradigm, we ALL have parts and we ALL have a True Self, and the idea of a singular personality doesn’t apply whatsoever.
In my efforts to explain why I don’t believe that Borderline Personality Disorder exists, I need to take a detour here and talk about Complex Trauma. It will all make sense, I promise. Just keep reading! Understanding what Complex Trauma really is and how it profoundly affects people is vital to my argument that BPD isn’t a real phenomenon. I have many years of post graduate experience and training in helping clients heal Complex Trauma. When I use the term “Complex Trauma,” I’m not referring to an isolated event like a physical assault or bad car accident which may lead to Post Traumatic Stress Disorder (PTSD) symptoms that are specific to that event. Rather, I’m talking about ongoing abuse and neglect throughout childhood and adolescence. Complex Trauma is much more damaging and leads to Complex Post Traumatic Stress Disorder (also known as C-PTSD) which takes a long time to effectively address in therapy. I’ve worked with many adult clients with C-PTSD and they all grew up in families in which they weren’t safe physically or emotionally.
Here’s a summary of how clients with Complex Trauma often describe their childhood in my clinical experience. They might not have all of the following in common but they often have a bunch: They grew up being abused and neglected on a daily basis. This includes physical, sexual and/or emotional components. Their parents didn’t comfort them when they were upset, and often punished them for expressing emotions such as sadness, anger or frustration. Parents were often addicted to substances or unable to parent effectively due to untreated mental health conditions themselves. There was also a lot of parental arguing and/or violence witnessed regularly which created a scary environment for a child as you can imagine. Parents weren’t reliable; they promised things and then didn’t follow through. They belittled and berated their children and made them question their own perceptions of what was happening. Those who were sexually abused by one parent and tried to tell the other parent what was happening weren’t believed or taken seriously, thus adding another layer to the trauma that they were enduring. Sexual or physical abuse was normalized and treated as something they were just expected to endure.
The drive to survive is universal to all living creatures and children need their parents in order to survive. Parents are the access point for food, clothing and shelter which we all know are our basic needs. We need our parents for years and years, physically and financially. So to get those basic needs met, we have to maintain a connection to our parents and we will do whatever it takes to do so even if our parents are abusive and neglectful. A child living in a hellish nightmare needs a strategy that will create the illusion that their parents are loving and protective. And the strategy is to buy in to the idea that the child deserves to be treated this way. Instead of thinking “My parents are abusive and neglectful”, they think “I’m bad and deserved to be punished or ignored.” This flipped narrative frees up the parents to be seen as justified and right in their mistreatment of the child. If a child were to see the reality that their parents were abusive and neglectful, that would mean the child didn’t have anyone to protect them and this would be terrifying. How can we expect a child to attach to a monster? The answer is to believe that YOU are the monster. And this isn’t difficult if your parents tell you that’s what you are.
Children who grow up with this type of unpredictable and chaotic childhood experience end up with anxiety and depression, self-hatred to the point of having frequent suicidal thoughts and engaging in self-harm behaviors, fear of abandonment and rejection, lack of ability to regulate their emotions, and a deep mistrust of others. This all fits and makes sense, right? I mean, who wouldn’t end up with these kinds of issues given their history? The cornerstone of Complex Trauma comes from lack of safe relationship between a child and their parent(s). Parents are supposed to protect and nurture their children. Complex Post Traumatic Stress Disorder is created when the opposite happens. Abuse and neglect occur within the context of relationship. A child’s relationship with their parents becomes the template for relationship with others, like friends and especially intimate partners. If the template is “If I get close, I get hurt”, then it makes sense that relationships in general feel risky, unpredictable and scary. People who have this relationship template often instigate arguments with others because it feels safer be the one to push someone away rather than risk being abandoned or rejected. Eventually, though, the biological urge to connect kicks in (remember we are hard-wired in our DNA to attach to others in order to survive), so that translates into reaching back out to the person they picked the argument with in order to maintain that attachment. The reaching back out might involve pretending like nothing happened, apologizing and promising not to repeat the behavior, or overcompensating with people-pleasing behavior. This pattern of “push-pull” repeats over and over and unfortunately, many of the people on the receiving end of the pattern eventually get worn out and exhausted by the relationship and decide to end it. When this happens, it reinforces the fear of abandonment and rejection and this relationship template of “If I get close then I get hurt” becomes stronger and more imprinted.
Some of the toughest people to connect with are folks who fit the description of BPD since they are mistrusting of others and rightfully so. The cluster of symptoms we call BPD are all the natural consequences of trauma. Abuse and neglect, both physical and emotional, create a domino effect that can last a lifetime unfortunately. In my clinical experience, clients who have been labeled as having BPD have had the most trauma and attachment rupture when it comes to interpersonal relationships with their parents. So instead of using the label of Borderline Personality Disorder, I would simply call that person a trauma survivor which is a much more accurate descriptor. What this means for therapy is that it takes years and years of having a secure attachment with a patient therapist who is willing to navigate the “push-pull” relationship of having a client who is a trauma survivor. Research strongly indicates that the number one factor in having a successful therapy outcome is the quality of the therapeutic relationship between the client and the therapist. Not the education or experience of the therapist. Not a specific technique or modality. The therapeutic connection. This makes sense when you look through the lens of attachment and relationship template. Clients who were harmed in significant relationships need to have a reparative healing experience within relationship. When the therapist understands the reverberating effects of trauma and fractured attachment on interpersonal dynamics then he or she can effectively provide a safe holding environment for the client which is what is needed for healing to happen. It can take many years for clients to really trust that I’m a safe person and am not going to repeat their parents’s behaviors that they learned to expect in childhood. I believe that people are more than their experiences, and they are definitely more than their diagnoses. People can learn and grow at any age if they are at least a little willing to push themselves out of their comfort zone. People can learn healthy ways to self-soothe and regulate their emotions. They can work toward having compassion for themselves rather than self-blame and shame. They can learn effective communication skills and how to recognize red flags in relationships. They can learn what a healthy relationship looks and feels like by being in relationship with a good therapist. And as for our “parts”, we all have at least one part that hasn’t given up hope of connection, and definitely wants connection even if we’ve had negative experiences. The reason I know this to be true is that if it wasn’t, therapists would be out of a job really quickly! Therapists are sought out when people are struggling to the point of needing to ask for help. It’s in our DNA to seek connection. It’s what makes us human, regardless of our negative relationship experiences.