‘I can’t get it right’ – Understanding a loved one with BPD

 

(originally published on counselling directory- Expert articles)

If your loved one identifies with Borderline Personality Disorder, he or she probably experiences reality differently than you do. It is helpful to gain some insights into how their world operates, thus make some sense of their behaviours.

BPD is characterised by symptoms such as a fear of abandonment, mood instability, unmanageable anger, rocky relationships, an uncertain sense of self, a pervading sense of emptiness, suicidal behaviour, urges to self-harm, stress-induced paranoia, or even episodes of dissociation (the feeling of leaving your body or ‘zoning out’, as though you’re living in a dream or a movie). Despite its often-misunderstood title, Borderline personality Disorder (BPD) is essentially a label describing a range of persistent problems that affect various aspects of a person’s life.

If you are living with someone with BPD, you may be feeling hurt or frustrated as your loved one seems to: constantly make untrue accusation, are angry at you all the time, or blame you for things that are not your fault.  Being or living with someone with BPD can be a painful and exhausting journey. Sometimes, it is hard to see or remember that their behaviours are not directed towards you but stem from their internal struggles. Here are a few descriptions of psychological phenomena that a person with BPD commonly experience:

-       Feelings are ‘too real’

Some psychologists call this ‘psychic equivalence’. People with BPD may forget that their feelings, thoughts, beliefs and wishes are simply part of their mental activities. To them, their fear, anxiety, feelings of disgust, the thought that someone dislikes them… are all as real as reality. In other words, for a person with BPD, the feeling of shame and self- badness can be experienced with such level of intensity that it creates suicidal urges.

-       Out of sight, out of mind

In psychology terminology, this is known as lack of object constancy. Some people with BPD have problems with holding onto a consistent mind image when it comes to relating to other. They struggle to have a sense of continuity and consistency about people in their lives.

A person with BPD may experience terrible anxiety when people leave. There is a desperate need to hold onto the physical connection or to seek reassurance of others’ love, because a person with BPD may struggle to hold onto the concept of self without the help of others.

You may feel that you need to constantly remind them of the fact that you love and care for them. When you don’t, they may interpret this as you not caring for them anymore. This is because without you constantly reminding them, they have a hard time holding a sense of ‘loving presence’ in their mind. On the surface, this can come across as ‘clingy’, or extremely anxious behaviours in relationships.

-       Extreme sensitivity and rage

Because of the lack of object constancy, you may find that your action is often being read as if there were no prior context, and that your intention is being defined solely by how you last interacted with them. You may feel that whatever you say seem to trigger an intense rage, or that you are constantly being misinterpreted for what you say. This can also come across as a heightened sensitivity towards criticism.

However, it is important to not blame every conflict or misunderstanding on BPD. With or without BPD, we sometimes have reactions that seem ‘irrational’.

People with BPD can be very intuitive. In fact, they may pick up your feelings or intention before you are aware of them. Acknowledging how you may have contributed to the conflict can defuse the rage and may be the most constructive response.

Finally, try to remember that your loved ones’ behaviours are often there to shield them from intense emotional pain, not to hurt or manipulate you.

If you suspect someone has BPD, it is often not helpful to directly confront his or her with the label. However you can let them know about your concerns, provide linkages to relevant resources, and let them know that effective treatments are available when they are ready to reach out for help.

In contrary to some old beliefs, BPD can be effectively treated. Evidence has accumulated to support the following treatments designed for BPD: Mentalization- based Therapy, Dialectical Behaviour Therapy, Schema Therapy. Other therapy models such as Mindfulness- based Cognitive Therapy, and Art Therapy are used to treat depression, anxiety and self esteem issues associated with BPD. Whilst Group Therapy and Psychodynamic psychotherapy may be helpful in healing attachment trauma.