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Being with someone with borderline personality disorder is an emotional swing: it’s hard to predict what the next day will be or what will happen. Therapist Magdalena Paszko from the Mazovian Psychotherapy Center explains that it is not bad will; such people simply cannot do otherwise.
- Borderline personality disorder is characterized, inter alia, by constant changes in emotional state
- People suffering from them are impulsive, they also manifest behaviors that are harmful to themselves, e.g. excessive spending of money, risky sex, abuse of psychoactive substances or alcohol, bouts of gluttony, repeated suicide threats
- Magdalena Paszko: – I sometimes hear such stories in my office: «We are driving a car, we are arguing. My partner says: Stop, I get off, and when I don’t, she opens the door while driving and tries to get out »
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In Polish, the following words are used to describe this disorder: borderline personality. It is characterized by constant changes in the emotional state. As with other personality disorders, it is not a disease but a permanent pattern of malfunction that causes suffering. Its coexistence with other mental disorders or diseases, such as depression, bipolar disorder or sexual dysfunction is often observed.
Panic fear of rejection
As Magdalena Paszko says, one of the hallmarks of people with borderline disorder is producing an idealized image of other people. When, after some time, it turns out that it is not entirely true, they perceive the same people as those who reject, control, betray or abandon.
This is because in building the relationship of a person suffering from borderline disorder, at some point there is a fear of closeness, accompanied by a very strong internal level of tension. Fearing that they will be abandoned, they unknowingly provoke the breakup, get angry, explode, and when the other person begins to withdraw, they try to keep her with them, because they do not want to lead to this abandonment.
Often there is emotional blackmail, violent behavior and the lack of control of these emotions. It happens that close relationships of a person with bordeline are unstable, characterized by violence, emotional swings. It is difficult to predict what the next day will be and what will happen. Lacking a pattern of keeping boundaries, they often cross those boundaries – not because they want to, but simply can’t otherwise
– explains Magdalena Paszko from the Mazowieckie Center for Psychotherapy.
At the same time, people with these personality disorders are convinced that they cannot cope on their own, and therefore have to rely on someone else. No wonder abandonment is treated as the worst thing that can happen. At the same time, these people are very strict on themselves, they believe that they deserve punishment. It all causes a very strong level of inner suffering.
– Such a person arranges his beliefs according to someone with whom he is in a relationship, which means that he or she crosses their borders in order to maintain this relationship, and on the other hand, they do not have internal consent to it – therefore, in a situation of some tension, they often react with anger. There is a lot of drama in this protest, a willingness to take revenge on those who potentially signal rejection. Once, during a crisis intervention, I encountered a situation in which you were diagnosed with narcissistic personality and your was diagnosed with borderline personality. There were very brutal scenes of violence there. When he signaled that she wanted to leave, she would take a knife from the kitchen, went to the bathroom, put her foot in the tub and aimed at the femoral artery, asking her partner if she was definitely determined to leave. This is, of course, a very extreme example, but such situations sometimes occur – says the therapist.
This type of behavior is the result of suffering associated with the childhood pattern of rejection, emotional neglect. As Agata Szulc and Piotr Gałecki point out in the textbook “Psychiatry”, personality is constructed from birth to adulthood on the foundation of inborn traits and predispositions. Hence, the first bonds we establish after birth are so important. If at this time we are deprived of a sense of security, belonging, but at the same time of autonomy, we may pay a high price in adulthood.
A person deprived of a sense of security in childhood builds new relationships based on trial and error. Sometimes it works, but it is often accompanied by the conviction that a miracle happened, divine providence or simply life decided so.
In the event of a failure, a person with a malformed borderline personality combines this with an inner conviction: “I’m good for nothing.”
- Read also: Wróblewska: I have borderline personality disorder. What is this?
Self-destruction as a way to deal with anxiety
People with bordeline disorders are impulsive, and often manifest behaviors that are harmful to themselves: excessive spending of money, risky sex, abuse of psychoactive substances or alcohol, bouts of gluttony, repeated suicide threats. Some people relieve tension through self-harm or self-destructive behavior, such as holding their breath for a long time. Sometimes the stress response is breakthrough paranoia or severe dissociative symptoms.
Magdalena Paszko points out that recently attention has been paid to the coexistence of borderline personality disorder and narcissistic personality disorder, the so-called high sensitivity. It means hypersensitivity to emotional stimuli, lability, reactivity, intensity of feeling emotions. Such people have strong biological conditions.
Another hypothesis is that psychological temperament and emotional instability can be understood as a personality continuum ranging from borderline to bipolar disorder.
– Serotonin deficiency and an excess of norepinephrine, which are responsible for the transmission of impulses in our nervous system, lead to the fact that we have an advantage of activation processes over inhibition processes. In practice, this means internal readiness to attack. Very often, there is also a hypersensitivity to criticism, which is perceived as an attack, which leads to an over-reaction – explains the specialist.
From this point of view, the greatest risk of autoimmunity is found in people who have serotonergic abnormalities, meaning that it happens not only at the cognitive level, but deeper at the level of brain processes.
The rest of the text below the video.
The role of anger
Anger outbursts are a key coping mechanism in people with borderline disorder. Reactions very violent, completely inadequate to the situation that caused it, as unpredictable as it is terrifying, especially for those who are the addressees of this anger.
– I sometimes hear such stories in my office: «We are driving the car, we are arguing. My partner says: Stop, I get off, and when I don’t, she opens the door while driving and tries to get off », or: “There is an argument and she leaves the house. He does not take the phone, so there is no contact with her, no one knows where she is. I’m losing my mind wondering where she has gone, if she has done something to herself and she comes back after a few hours and as if nothing ever announces that she was at the cinema to recover and that she has already passed – says the therapist.
He explains that such behavior is the activation of childhood schemas that refer to the nullification of violence, to the lack of limits. Sometimes, even as an adult, someone may still be internally angry and scared by the behavior of, for example, an abusive or alcohol-abusing parent. He still feels such a strong fear that he is unable to set limits for this parent and allows him to continue to exceed them.
– This is a kind of violence that such an adult child still feels internally and reflects in the relationship he is currently in – explains the psychologist.
He adds that anger can also cause some minor difficulties – they are based on a whole arsenal of fear, disappointment and anxiety about abandonment.
– I often hear from such patients: “I do not know how and where to set limits, I agree to something, and then I realize that I did not want it to happen at all”. And because there was no consent from that person, there is anger in the reaction. Then I advise them to learn to listen to their body, because it most often lets you know when these boundaries are exceeded and catching this reaction will help you learn to say “no” – says Magdalena Paszko.
The anger of a person with CBD can be, and often is, a cry for help. The effect, however, is that it repels the closest people in this way.
The psychologist points to the aspect of human suffering, which on the one hand has a great need for closeness, and on the other, due to the mechanisms of idealization and devaluation and the fear of being hurt, it becomes impossible to satisfy.
Can a person with borderline be helped?
Help is possible though it is difficult to count on without the intervention and help of a psychotherapist.
– We try to help the patient to function better in a world that, under the influence of the therapy, will be experienced as less mysterious, less harmful, allowing to enjoy more life. This process, however, requires realizing, first of all, how unproductive the behaviors with which a person comes to the office are, i.e. anger, emotional swing, impulsiveness and many others – lists the psychologist.
- From reality to illusion. How to help a mentally ill person?
It is worth starting work with a patient with a bordeline personality disorder by determining what the basis of it is: avoiding-dependent (characterized by high internal anxiety, low self-esteem, hypersensitivity to criticism), narcissistic (manifested by an unstable mood, high relationship dynamics, impulsiveness, irritability, overwhelming need for care and feelings), anti-social (associated with disregarding rules, exaggerating self-esteem, extreme way of showing jealousy and anger, reckless action) or paranoid (characterized by a lack of trust in other people, their intentions and intentions, excessive sensitivity to failure and rejection, a tendency to survive for a long time).
– Such a distinction is helpful in therapy, as it allows you to adjust the methods of work to the personality and the problems it is struggling with. We do not have a standard set of methods that we use against one disorder or another, therefore each therapeutic process is preceded by an interview, searching for nuances, in order to choose the most effective method of work – explains the psychologist.
The most important part of therapy is the relationship between the therapist and the patient – one that will create a basis for trust, emotional closeness, and teach you to feel safe. If the rules are followed in the office and the patient begins to function within this framework, then after some time he learns to trust and feel safe.
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– It is important for the therapist to become a mirror in which the patient is viewed. If extreme emotions arise in the therapeutic process, our task is to show this person: it is this emotion that makes your life difficult, and it is you who came to me with it, not the other way around. Learning to function in these emotions and showing him that this is not a threat, but an experience worth drawing from, will allow him to understand the principles of interpersonal relations, the psychologist believes.
Learning to set boundaries is a longer process, because it requires understanding that they are not something bad, but on the contrary: they are needed, because they build a sense of security not only in relationships with others, but also a sense of personal security.
Criteria for recognizing borderline personality
Borderline personality disorder is defined as a behavioral pattern dominated by instability in interpersonal relationships, in self-assessment and in emotional terms, and with clearly marked explosiveness. According to the DSM-5 classification making such a diagnosis is appropriate when at least five of the following characteristics are present:
- making desperate efforts to prevent real or imaginary abandonment;
- unstable but intense interpersonal relationships (extreme idealizing or devaluing);
- identity disorders – fixed and clearly distorted, distorted or unstable image of oneself or self-esteem;
- impulsivity in at least two areas that pose a potential threat to oneself (sex life, spending money, the use of psychoactive substances, risky driving, binge eating);
- recurrent suicide behavior, suicide attempts or threats, self-harm;
- emotional instability caused by excessive mood reactivity;
- chronic feeling of emptiness;
- strong anger inadequate to the situation or lack of control over outbursts of anger;
- Transient, stress-related paranoid thoughts or marked dissociative symptoms.
Author: Monika Wysocka, Zdrowie.pap.pl.
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