Men and women with borderline personality disorder (BPD) can’t seem to stop arguing. They’re often labeled “drama queens” or “abusive,” and they often wreak havoc in situations where others are coping smoothly with the normal disagreements and disappointments that arise from time to time for all of us.
Marsha Linehan, the creator of dialectical behavior therapy (DBT), the treatment approach most often recommended for people with BPD, bases her understanding of the disorder on the belief that people with BPD “feel mental episodes of anger, emptiness, and anxiety more intensely than most people do.” This intensity of emotional pain was the subject of the first in a series of articles I’ve begun to publish about the inner experience of people with BPD.
This is the second in the series. Like the first, this one chronicles my conversation with H.O., a very insightful clinician who herself was diagnosed with BPD. Like many BPD patients, she was determined to find ways to heal.
Previous articles in Physical Therapy have discussed BPD from the perspective of people who have had to deal with an individual with difficult BPD behaviors, such as adult children of mothers with BPD. In contrast, this current series of posts illustrates the painful inner experience of someone with BPD themselves.
Many thanks to Dr. H. O. for sharing her thoughts with us.
To Dr. Heitler,
I wrote to you after reading three of your Psychology Today posts: “Evil Genes? An Unconventional View of Borderline Personality Disorder,” “From Sweet Little Girl to Borderline Personality,” and “You Can End Your Borderline Personality Pattern.”
I must say that I disagree with a basic premise, especially in the first post, which refers to “manipulative” or even “sadistic” behaviors in BPD patients. The choice of the term “manipulative” suggests a kind of Machiavellian planning and cunning to achieve goals that are not immediately apparent.
I think Dr. Linehan was closest to the truth in explaining the so-called “manipulative” behaviors in BPD patients when she declared that they were blatant, clumsy, and ineffective efforts to meet the needs of BPD.
The purpose of these behaviors is very clear to all involved, thus removing any element of manipulation.
I strongly recommend avoiding the term “manipulation” about any clumsy efforts by BPD patients to achieve anything, because these efforts are not that at all. At best, these behaviors (e.g., threatening suicide in the event of abandonment by a loved one) are rather pathetic efforts, as the BPD patient begs and humiliates himself in an inevitably unsuccessful attempt to avoid abandonment.
In my humble opinion, the use of the term “sadistic” is a misinterpretation of the motivations behind the “bad” behaviors of BPD, which only serves to further stigmatize them.
In my work with severely under-functioning BPD patients, I have commonly seen these girls as victims of sadistic and inhumane abuse as children. However, they never intentionally hurt or harmed anyone for pure evil pleasure. The arguments and even the physical acts of violence did not involve any gratification from inflicting pain, whatsoever. These ideas were simply outlets for frustration and anger at not meeting the needs and demands of BPD patients again.
The source of these common misconceptions about the intentions and motivations of BPD patients lies in a fundamental misunderstanding. Please believe me, BPD makes it impossible to function in the world as it is, where most people are completely indifferent and uncaring while others try hard but rarely succeed in meeting the needs of BPD patients. This is because these needs are so overwhelming!
A person with BPD, when symptomatic, can only function in a world where everyone loves them like their mother, unconditionally and patiently. Of course, such a world will never exist, and so BPD patients with their enormous unmet needs for love and affection will forever be frustrated and angry, resorting to behaviors that are misunderstood as “manipulation.”
The strength of the average person in daily functioning in an indifferent or sometimes hostile world comes from their healthy ego. A BPD patient does not have a healthy ego to base their survival on. A person with borderline personality disorder can only survive on a constant flow of love and affection, and if that love and affection dry up, the person with borderline personality disorder’s world collapses. Hence the frantic efforts to avoid abandonment—because people with borderline personality disorder are well aware that they cannot function without that flow.
The use of terms like “bad,” “sadistic,” and “manipulative” to describe how the “normal” world views and judges the desperate attempts of people with borderline personality disorder to have their needs met is a sad testament to the fact that the world is, in fact, often hostile to these patients.
The only way to understand these patients is to assume that their needs for affection, support, understanding, and human warmth are far greater than can reasonably be met in the world as it is. For this reason, these needs will inevitably go unmet, leaving the person with borderline personality disorder feeling frustrated, angry, and hostile.
As “bad” as these patients are, their situation is much worse. I would argue that borderline personality disorder, in terms of quality of life, falls into the same category as deadly cancer. The irony of course is that while everyone has compassion for cancer patients, few, if any, have any real compassion for patients with borderline personality disorder because these patients, due to their complete lack of social skills and their use of behaviors that are at best inappropriate and at worst “sadistic,” are absolute masters at antagonizing everyone around them.
This is the vicious circle of borderline personality disorder — while these patients’ need for human compassion is infinitely greater than that of the average person, their failure to meet this need results in less, if any, compassion.
I appreciate your interest in the perspective of a patient with borderline personality disorder.
Best regards,
