Symptoms of Borderline Personality Disorder (BPD): A Conversation with a Therapist

The phrase "I have Borderline personality disorder" legitimizes any destructive or immature behavior and therapists themselves often unwittingly fall into the ear and need to "save" such people. I will try to explain why this is happening and describe BPD as a character with own unique traits, but not as a dangerous pathology which are often exaggerated in social surrounding. Let's take a look at the features of BPD as well as the myths and realities of this personality type.

The main reason for the formation of BPD is a painful, traumatic childhood experience. And I'm not talking about a conventionally "cold" mother or a withdrawn father. Trauma is an any form of abuse (sexual, physical, emotional) and/or a situation in which a child has been abandoned in difficult conditions and loneliness. In response to experiences that are unbearable for a child's psyche a certain psychophysiological adaptation occurs which is absolutely normal for unnatural and abnormal conditions. Borderline personality disorder is largely about post-traumatic stress, not about psychiatric disorders in any way.

Let's discuss the main criteria for BPD.

What does this mean? When a psychotherapist asks a client to describe their character the client with BPD often closes up and speaks in a fragmentary and superficial way using words like "I'm evil" or "I'm kind", but can't provide detailed description of themselves. Intelligence is not the issue here as the inability to characterize oneself has more to do with the brain's response to ongoing trauma. In these situations the child's brain blocks acute emotional reactions in order to protect itself so these emotions don’t exist any more. Next to the emotional zone there is also a zone of self-awareness that is captured and suppressed leading to the loss of a sense of self. No fear - no self. This physiological explanation helps to understand why some people struggle to describe themselves.

There is a second aspect which is psychological. The child perceives his own personality as the cause of the adult's attitude. Violence creates an unconscious fantasy about why the parent is abusing them which leads to extreme self-hatred. Sadly, but his aggression becomes a frozen self-image and is experienced as "I am so disgusting that I should not exist." As a result no positive characteristics can be seen in the child's own image. He sees himself as a "devil" who deserves horrible attitude.

Some of my clients asked for therapy with the request "I can't feel myself". For them the lack of identity was an extremely difficult problem in personal and social functioning. It is completely useless to give tasks on self-description, suggest self observations. Only working through unconscious aggression towards oneself helps the client to move towards some kind of self-perception.

Many therapists are scared to upset clients with BPD, so they avoid confronting people's feelings of worthlessness and focus more on their emotional weaknesses. In fact self-hatred is a natural response to abuse that child have experienced in order to survive. «Ugly me» means «good mother» as this mechanism helps to stay with a parent both psycically and psychologically. This suggests that there are underlying forces for stability within an individual.

After a couple of years of therapy the client may find the strength to say: «I'm a complex person". These words would sound with pain, but it would be a sign of a growing ability to grieve and accept themselves. Freezing the perception of trauma can also create an unrealistic view of the reality as if life were a dream or a demo-version that soon would be replaced by something real. On one hand memories of past events constantly loom in front of the person's eyes, but on the other hand their psyche is unable to fully process these memories, so life feels like it is happening in two parallel universes. This is also a symptom of post-traumatic stress disorder (PTSD). Therapy helps to start real life by helping work through trauma and PTSD.

In a friendship or romantic relationship a person with BPD is constantly checking the reliability of the connection. The partner's fatigue, temporary unwillingness to communicate, separation or even sleep can cause severe anxiety and a desire to attack or escape. The main reason for these emotions is not just feeling worthless, but an unconscious need to attach to a "saver" figure. In response to unbearable reality a child create fantasies about a person who can alleviate his suffering and provide healing from painful experiences. This idealized figure would be incredibly affectionate and caring, without any negative traits and would act as a parent with clear boundaries, providing adult and nurturing care. This «saver» would embody all the qualities a child needs in one person.

Another important component of the fear of being abandonment is self-loathing for the childhood experience. People with BPD jokingly talk about their past with violence protecting themselves from the shame of feeling helpless with a Hollywood-style smile. It really takes a lot of hard work to overcome that shame and realize the level of harm caused by those who had to protect and care.

As a result a person with BPD is unable to take emotional care of himself, so entering into relationships he unconsciously drops this hated child to a "rescuer". Therefore when there is a separation, whether physical or emotional, from a supportive figure, people with borderline disorder suddenly find themselves feeling alone, helpless and experiencing severe anxiety. Traumatic childhood experiences also led to the inability to perceive the fact that emotions are finite. Each experience feels like lasting forever.

Speaking of «rescue». These are people who unconsciously divide their personality into "good" and "bad" parts rejecting anything that doesn't fit their idea of an ideal person. Their childhood was spent in emotional emptiness and lack of personal communication with their parents what formed the feeling that they don’t exist and that they are quite bad as real individuals (that’s why parent don’t notice them). Therefore they unconsciously strive to be comfortable in order to receive approval from others. It is important for them to be needed. They intuitively feel what kind of personality to create so that another person feels comfortable. And people with BPD since childhood dream about an ideal and comfortable person that would the best parent ever! The other thing is that to maintain the image of an ideal person they need a "bad partner" who will be needy for care and support. People with borderline personality disorder often find themselves connected to these «rescues» and this connection can further reinforce their tendency towards the fantasy of their own unworthiness. They stay with an «ideal» partner who accepts and supports a lonely «disgusting» child.

Same connection can be quite dangerous in therapy. The therapist may believe that the client is unable to be independent and may become lost in endless complaints and suffering. This is dead end. In fact working through the fantasy of salvation can help to accept the past and the reality of violence which can’t be changed. This allows for a fuller emotional care for yourself, self-reliance during difficult times and simply develops the ability to not lose yourself in a relationship.

These swings are based on a primitive (meaning simple) mechanisms of adaptation to life situations in childhood. In families of people with BPD cruel periods were followed by calm moments. The child didn’t have stable relationships with parents who could be perceived as both good and bad, as normal. Instead he experienced either hatred or indifference from his parents, indifference was interpreted as ideal connection. Therefore in adulthood these people have a very splitted perception of others. Their partner's flaws, mistakes and shortcomings instantly cause feelings of disaster and betrayal while at other times the other person is idealized to the maximum possible extent. This trait can be treated in therapy through the interaction between the client and the therapist. The therapist due to his ability to withstand strong emotions helps the client gradually stabilize his perception of self and therapist as people with both flaws and advantages. With time the client develop an ability for realistic perception which also helps in building healthy and stable relationships.

If a person experiences sadness on a Saturday evening or anger in a quarrel he tries to "get rid" of these emotions through instant action instead of simply accepting the emotional state as normal. This happens due to several factors. Firstly, lack of parents in childhood who could empathize and stabilize emotional experiences of a child. Instead adults were cruel and humiliating. Additionally in response to traumatic experiences a child develops a protective perception of their own painful emotions as signs of weakness and lack of worth. During therapy if a client is asked about the meaning of sadness or anger the first thing they may feel is that these emotions indicate a lack of self-worth. It’s a shame to feel grief or sadness. The emotional behavior of a person with BPD is more about a fear of experiencing fear than an actual experience of difficult situations.

However this doesn't mean that these people can't analyze and control their actions. In the back of their minds they always have a fully functioning observing ego. The truth is that childhood traumas create a fantasy that the world still owes and the injured individual feels like a victim destined to suffer forever. As a result everyone around is expected to be obligated. With a more subtle analysis it becomes clear that behind the outward appearance of helplessness lies a more aggressive expectation that everything should be allowed and others have to understand and forgive. Therefore in addition to work on emotions it's important to help a client to realize his demand from world (or people around) to repair his damaged childhood which is unfortunately has happened and can't be changed in this reality. It is necessary to be responsible for own life by for oneself.

This feature creates the impression that people with BPD are inadequate or extremely unhappy. However suicidal thoughts and actions have several reasons that reveal quite optimistic possibilities. The unwillingness to live is the sign of a strong hunger for changes. When a child experiences suffering he develops a hope for a different world without unbearable pain. This fantasy accompanies throughout his whole life, but during periods when feelings of loneliness or anger escalate the door to another world opens and this can provoke an impulsive suicide. Which is actually a rejection of the current situation and strong wish for better reality. When a client expresses suicidal thoughts or intentions at the beginning of therapy I never attempt to dissuade him. It's important for a person to maintain hope and control over his life, so any attempts to convince could be perceived as misunderstanding which would confirm the fact that nobody accepts client's feelings. When discussing suicide people are more likely to express feelings of abandonment rather than a genuine desire to commit suicide.

Parasuicide can also be related to this problem specifically autodestructive behavior such as self-cutting and self-burning. This is a way to pass through negative emotions, particularly feelings of guilt after negative events in their lives (more frequently breakups). Parasuicide is an extension of aggression towards oneself, especially during times when person with BPD feels abandoned, unwanted or goes through a separation. Cuts and burns allow to punish themselves in some way while also help to cope with feeling of emptiness. After injuries the brain releases endorphins which lead to a brief feeling of euphoria. However negative thoughts, fantasies and the tendency to focus on self-hatred are also ways that people can inflict wounds upon themselves. Clients with BPD often get a sense of relief when talking negatively about themselves.

I have already mentioned emotional swings, but let me elaborate on them in the context of testing boundaries and difficulty in perceiving emotions. Affective outbursts are also linked to a disrupted natural "fight or flight" mechanism which in a psychologically healthy state allows us to react to danger. A child in a violent situation can't fight back against an adult and protect himself mentally or physically. As a result he freezes up (in psychology this is called dissociation - emotional disconnection from reality). Adults with BPD react weakly to emotional danger at the moment, for example, when a loved one offends or humiliates them. During therapy a person who has experienced this freezing in childhood gradually remembers how he used to freeze up during moments of violence. However in calm periods people with BPD need to release their anxiety and anger, that's why they frequently find reasons for aggression and arguments.

This sense of loneliness is different from when there is nobody to talk to and it can be quite scary, like being completely abandoned in the universe as a single person. It feels like a scene from the movie "Vanilla Sky" when Tom Cruise found himself in Times Square, totally alone. When this happens people experience strong panic and act impulsively, running from home to the bar in search of random connections or just inviting themselves over to friends' houses. The presence of others, even just the fact of communicating, somehow mirrors a person's existence, confirming that he is alive. However once the conversation ends the sense of abandonment returns. This often happens on weekends or holidays, when people are away from work.

But there is no such emotion as "abandonment". The feeling of emptiness is associated with an unconscious fantasy of own worthlessness and plenty of aggression towards oneself. In a state of loneliness a person feels sense of meaningless and instead of self-support intuitively reinforce this negative experience, making it even more painful. In psychotherapy the feeling of emptiness is resolved by working through the feeling of being useless to anyone. As the work progresses the client begins to feel the presence of friends, some good relatives in his life, he develops the ability to accept love.

Tony, the main character in the TV series "The Sopranos", was assumed to have BPD. However it's important to note that cruel and antisocial behaviors are typical for individuals with malignant narcissism.People with BPD often have short tempers, especially when they feel misunderstood or rejected, but their outbursts of anger aren't intended to harm.

As I wrote above people with BPD tend to choose partners with a rescuer complex who subconsciously need a "bad partner" and covertly undermine their unstable chosen ones to show their worst traits. For example, a man will covertly provoke his borderline girlfriend into hysteria and then through silence during her fit of rage he will enjoy his own triumph in comparison with the inappropriate behavior of his "crazy" woman. With time this definitely will become a reason for analyzing her inadequacy.

By the way during aggressive outbursts a person with BPD may attack a partner with fists, but he won't aim for painful spots. He will scream and knock as if seeking help and trying to get attention. These actions are of course destructive, I just want to emphasize the lack of intention to hurt. There may be intense emotional outbursts and intense feelings that take over a person for a while, but they are not meant to be hurtful.

The inability to overcome the effect of trauma also leads to the experience of permanent depression, which is denied by the psyche of person with borderline disorder. That’s why people smile remembering violence episodes. Suppressed depression leads to outbursts of rage as it happens with war veterans. Only working with PTSD helps to stabilize the emotional sphere and to withstand fits of rage.

A relationship with a borderline personality is presented in literature as something unhealthy. I think these descriptions also show the need to invalidate people with BPD. As a psychotherapist I will say that the main interpersonal conflict of a borderline personality is the situation of "want to stay and want to leave" without an option to male a choice. How does it manifest itself?

On the one hand a person needs extremely strong connection with a partner. Some of my clients shared fantasies about desire to get under the skin of their partner, literally becoming them or becoming an embryo inside them. Just the "me-you" relationship is not enough; it requires an endless and sexless "us". Attachment helps plug an emotional hole. But this connection can be suffocating and the next step is to break free from the symbiosis and regain a sense of independence. That's what people use to say when they are in a close, symbiotic relationship: «I want my freedom back». But freedom can be a source of emptiness and loneliness and attempts to escape from these feelings often lead to an even deeper connection. This internal conflict creates a chaotic pattern of behavior from idealized honeymoons to destructive conflicts. Emotional instability and anxiety about attachment can be tools for understanding this deep unconscious pattern. Only facing out this conflict may give people with BPD sense of stability and peace.

Most importantly borderline personality disorder is not a barrier to a fulfilling social life. It's simply a character that has traits which noticeably disrupt well-being and adaptability, but doesn't make an ordinary life impossible. This is absolutely adequate character that appeared as adaptation to abnormal life conditions.