Borderline Personality Disorder is a serious and misunderstood condition. Despite the fact that much has been written about it, it remains a mystery to many who encounter it.
I see BPD as a condition which results from significant childhood trauma. Although not everyone who suffers from Post-Traumatic Stress Disorder suffers from BPD, in my experience virtually everyone I've encountered with BPD also suffers from PTSD. The traumas these individuals experienced in early life have caused them to have debilitating symptoms.
BPD sufferers are terrified of abandonment, but also expect to be treated in the same way they were while growing up. As a result, they frequently provoke people to reject them in an unconscious attempt to deal with their fears: if rejection is inevitable, at least they can control when and how it happens.
These individuals often have complicated, even tormented relationships. They believe, deep down, that they must have deserved the childhood abuse or neglect and therefore have tremendous ambivalence around intimacy. They both want and fear love, convinced that it's associated with cruelty or rejection.
Because they feel like they're "bad" or "defective" they engage in a lot of self-destructive behavior; some of which is a cry to be rescued. They also can be very hurtful to others, unconsciously re-enacting the dysfunctional interactions they grew up with.
Sadly, many people with BPD are seen more as "trouble-makers" than as deeply wounded individuals. The trauma they experienced as children might be so subtle as to have gone unrecognized as the cause of their problem behaviors.
In many families, abuse and neglect take place in very subtle ways. Parents can be overly self-centered, resulting in the child feeling unimportant or unlovable; they can demand emotional care-taking, making the child feel responsible for their happiness; they can have inappropriately high expectations, leading the child to feel incompetent and inadequate or they can be overly-rigid and controlling, causing the child to feel helpless and overwhelmed.
Children raised in families in which the parents give a lot of contradictory messages (whether overtly or covertly) become angry, ambivalent and confused adults who are unsure of their own feelings and perceptions. Many of these people turn their anger inward against themselves. Some act out in rage and despair. Some, if the messages were particularly crazy-making, fall into paranoia, dissociation or even psychotic episodes.
Childhood trauma has a regressive effect on the personality and prevents people them from developing psychologically into fully-functioning adults. They function more like lost children, behaving impulsively and irrationally; going to emotional extremes and vacillating between fury and desperation.
They may be provocative, uncooperative and challenging, and yet, what they need most is to know that they are safe, loved and understood. The challenge for the therapist is to avoid playing into their expectations of rejection and instead provide these individuals with the stability, healthy boundaries and reassurance they've always needed.
(C) Marcia Sirota MD 2010
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