Trauma, unresolved: The paradox of Borderline Personality Disorder (BPD)
Why does it seem that people with BPD don't "want" to get better?
The term “borderline” was coined to describe a condition that is characterized by both acute distortions of reality (i.e., psychosis) and acute anxiety (i.e., neurosis). The diagnostic criteria in mental health have always been poorly defined, predicated on self-reported subjective symptoms, and subject to overlapping diagnostic criteria. In my review of Brain Energy by Dr. Chris Palmer, I credited Dr. Palmer with a scathing critique of the DSM-V that should make an reader skeptical of diagnostic labels — especially Borderline Personality Disorder (BPD).
The problem with all psychiatric diagnoses is that they do little to describe the origins of the disorder or suggest reliable remedies. Palmer, like an increasing number of trained psychiatrists, psychologists, and mental health professionals, seem to have little use for the DSM-V and its ambiguous diagnostic labels. For example, Pete Walker writes:
I once heard renowned traumatologist John Briere quip that if complex post-traumatic stress disorder (CPTSD) were ever given its due, the DSM used by all mental health professionals would shrink from its dictionary-like size to a thin pamphlet.
- Pete Walker, Complex PTSD (2013, p8)
In other words, it’s only helpful to use the term BPD as a shorthand for patterns of behavior that could also fit other psychiatric diagnoses. In fact, borderline syndrome has been called a “disguised presentation hiding underlying PTSD” (Herman, Trauma & Recovery 1992).
The label doesn’t matter, although the distortions and anxieties that the label is meant to encompass do. Nevertheless, the BPD term entered the mainstream of American cultural consciousness sometime before 2008, when Congress declared the month of May 2008 as “borderline awareness week.” Despite the fact that “borderline” itself is an adjective that suggests uncertainty in a clinician’s mind relative to diagnostic criteria, a constellation of characteristics have become associated with people diagnosed as BPD (pwBPD), including:
… their desperate need to attach to others as transitional objects ; their unstable, often distorted sense of self and others; their reliance on splitting; and their abandonment fears.
- Gunderson (2009)
pwBPD are at high risk of suicide.
Rachel Reiland (Get Me Outta Here 2002) wrote an autobiographical account of living with and recovering from BPD that includes graphic descriptions of aberrant, seemingly self-destructive behaviors. Consistent throughout her description of her own episodes is the overwhelming urge to run— i.e., to flee unbearable emotions— that is typical of pwBPD. To others, especially those in close relationships with pwBPD, this urge is inexplicable. Nonetheless, to the extent that suicide is the ultimate commitment to pain avoidance, pwBPD may fantasize about or attempt suicide as if it represents to them an escape from what they perceive as unsolvable problems.
Regardless of whether an official diagnosis is meaningful, maintaining long-term relationship is an extraordinary challenge for people who experience mental disturbances typical of BPD. Most pwBPD, whether diagnosed or not, are aware that there are problems in their close relationships and sometimes they are self-aware enough to recognize their own contributions to those problems. For example, outbursts of anger towards loved ones is typical of pwBPD. In the throes of a tantrum, the pwBPD may be convinced of the righteousness of their outrage, and fail to recognize the damage they’re doing to an important relationship. For example, they may imagine their partner has secret and malicious motives, project those imagined motives onto their partners, and attribute the cause of the problems exclusively to partner actions.
Because the origins of BPD are in childhood abuse, neglect, abandonment, and exploitation by those who exercise power over them (e.g., parents, teachers, coaches) it is reasonable to expect that pwBPD have an extraordinary anger bottled up inside them. The problem is that when they were children, that anger was suppressed as a matter of survival. Directing it towards their abusers would have no doubt resulted in punishment and further abuse.
As adults, that unresolved anger in the pwBPD is either directed at the ones who loved them — i.e., the people who are “safe” to express anger towards — or inwards towards themselves. During an emotional flashback, attributing the cause of their anger to their partner’s behavior will feel true and justified to a pwBPD, because anger is an appropriate response to the abuse, exploitation, and neglect they experienced (or inherited the experience of) as a child — even though the attribution is misplaced in the present relationship.
Only later, when they’ve calmed down and reality sets in might they realize the mistake of expressing that anger towards the wrong person. In those moments, they can feel overwhelming shame and worthlessness that causes them to direct the anger inwards. They may withdraw from relationships altogether, have suicidal thoughts, escapist fantasies, and rationalize that the people who love them might somehow be better off without them.
Those thoughts are catastrophic and the consequences can be devastating.
Sometimes, the pwBPD will enter an abusive relationship (e.g., with a narcissist) and their partner’s poor behavior will confirm the pwBPD’s world view that the real cause of all the problems in the relationship lie with the partner, thereby masking their own contributions to the relationship problems. This may feel comfortable to the pwBPD, because it is probably familiar to them from childhood. In that case, they are free to express the anger that was denied them as children, and anger is preferable to sadness. However, it is not a healing relationship. It is more likely to reinforce, rather than resolve, the complex PTSD that is at the origin of these dysfunctional patterns.
Thus, being in a relationship with a pwBPD can be frustrating—even exasperating.
What most people fail to understand about pwBPD
The biggest misconception I’ve seen about BPD is the idea that you can “game” BPD with classic operant conditioning.
For a lot of people, rewarding more of what you want and punishing or withholding rewards for behavior that you don’t want will change behaviors. Most people will respond to incentives.
My experience with pwBPD is that they do not respond to incentives, punishments, or rewards in the ways that you expect them to. At first, this seems irrational to the point of being crazy, until you think about it more and see how it makes sense when you consider that there is no greater punishment than their own anxiety, and no greater reward than temporary freedom from that anxiety. No other external reward or punishment compares with the ferocity of the emotions experienced in their inner world.
To most people, it seems like pwBPD don’t want to get better.
However, BPD presents a paradox. As a child experiencing chronic, complex relational trauma, the disordered thinking, detachment from reality, and hyper-vigilant anxiety characteristic of BPD are all adaptations that keep the child alive under conditions of abuse, exploitation, neglect and betrayal. When the child enters the adult world, these unconscious adaptations that protected their psychological safety are now maladaptive to their new adult conditions. Although the pwBPD is no longer trapped in the childhood world of complex trauma and lies, the mental models and behaviors they learned in childhood come with them into adulthood.
The paradox is that the relational trauma of BPD can only be resolved in a relationship, and everything true that they’re going to hear in a loving relationship (whether that is with a therapist or favorite person) will sound like the lies and gaslighting they received from their abusers when they were young.
For example, when the therapist asks, “Is that true?” to attempt to equip the pwBPD with cognitive reframing skills, it will sound to the pwBPD like the same abusive gaslighting lies they were subjected to as children.
It’s not, but the typical pwBPD will experience emotional flashbacks that trigger maladaptive behaviors. When they’re self-aware, they will realize that their judgment (i.e., grip on reality) is not to be trusted. But their experience of betrayal by people who were “supposed” to love them means they don’t know who to trust.
It’s not that they don’t want to get better. It’s more accurate to say that getting better requires two things:
1. Skills they don’t have, and
2. A level of vulnerability & trust in a loving relationship that feels to them like an existential threat (for good reason).
And those are just the prerequisites.
Resolving the trauma at the origins of BPD
My experience has been that the association between BPD and abuse trauma is very strong. Reportedly, more than 70% of cases of BPD are associated with past trauma (Herman, Trauma & Recovery 1992). However, it has since been revealed that trauma can also be inherited in the epigenome, such that a pwBPD might not have experienced abuse/trauma themselves, but is instead carrying the epigenomic response to trauma experienced by an ancestor.
In this case, the pwBPD faces an especially difficult task of resolving trauma they never experienced and likely do not understand.
What a pwBPD needs is a resolution of the trauma that drives them to the borderline. Because that trauma is very likely relational, its resolution will likely only be found in a relationship. That could be a relationship with a therapist, a Lover, or someone else, but the relationship itself will not resolve the trauma or heal the wound. The relationship can only create the conditions under which the pwBPD is able to heal themselves.
The difficulty is that pwBPD are not equipped with the skills or temperament necessary for healthy, loving relationships, because pwBPD have often experienced (or inherited the experience in their epigenome) childhood abuse, exploitation, and/or abandonment & neglect in a relationship with an authority figure or caregiver (e.g., parent) who was expected to love them.
The childhood experience of betrayal by those whom they were biologically hard-wired to depend upon for caring causes the adult pwBPD to respond to intimacy with hyper-vigilance for threats. IOW, the more caring the relationship they experience in adulthood, the more vulnerable the pwBPD is to risk of reliving the childhood trauma of betrayal.
The “solution” to betrayal as children was to guard against intimacy and dependence. This can sometimes present as a pathological need in the adult pwBPD for independence and autonomy, such as an avoidant attachment style. However, it fails to resolve the pwBPD existential fear of abandonment.
As a consequence, pwBPD can feel desperately lonely while at the same time engaging in behaviors that push caring people away.
pwBPD are positioned in a perpetual relationship double-bind: they can neither live without caring relationships, nor do they have the relational and emotional management skills necessary to maintain them.
It is essential for pwBPD to seek resolution of their relational trauma in the context of a loving relationship. It is likely that relationship will be with a professional therapist with expertise in BPD, given that most romantic partners are unprepared and ill-equipped.
The best chance for recovery from BPD is in a therapeutic relationship with a skilled professional. The problem is that few professionals are able to meet the extraordinary challenge of treating BPD. The obstacles are legion, and when therapists get together they will often commiserate about the difficulties of enlisting the cooperation of pwBPD in their own recovery.
Some pwBPD will seek attachment to their children to mitigate their overriding Fear Of Abandonment. Because an infant is dependent upon its parent(s), it cannot leave. It cannot betray. It cannot abandon.
That fact may provide some relief and sense of purpose to a parent with BPD.
As the child matures, it becomes more independent. Healthy maturation in the child may pose an increasing Abandonment threat to the parent, and cause a parent with BPD to foster other mechanisms of attachment (e.g., learned helplessness) that bind the child to the BPD parent.
When the child has epigenetically inherited Fear of Abandonment from the parent w/BPD, the formation of co-dependent attachment bonds might seem like it assuages that fear in both the parent and the child. In these cases, the two may become more inseparable (rather than more independent) as the child matures.
In such cases, there is little room for co-parenting, so one of the challenges may be that a parent with BPD splits the child from the co-parent. This postpones resolution of BPD in both the parent and the child.
What can you do when you are in a close committed relationship with a pwBPD?
Because the pwBPD is experiencing an alternative reality that is generated internally during emotional flashbacks, it can be particularly vexing to be confronted with accusations or descriptions of that alternative reality that are demonstrably untrue. However, in those moments, you might have better luck listening to what the pwBPD feels, rather than what they say. The content of any specific accusation may not be as important as the emotion the pwBPD he is hoping you will feel with or recognize in them.
Try responding to the emotion, rather than the accusation.
You can start with sentence stems like “It sounds like…” or “It seems like…” and finish with
“… honesty is very important to you,” or
“… you’re scared,” or
“ … it’s important to you that I never …”
After that, you might remind the pwBPD of why you are in the relationship, as in “I’m here because I want an exclusive, committed, loving relationship with you,” or “I’m here because I want to make a life together with you.”
Kris Voss has a term called “tactical empathy” and he goes into detail in his Masterclass derived from his book Never Split the Difference (2016). These sentence stems are his suggestions. You also might benefit from some of the conversational scripts in When I Say No, I Feel Guilty (Smith 1975).
What can pwBPD do to improve their coping skills?
BPD can be a learned, adaptive response to betrayal, abandonment, abuse, neglect, and trauma in relationships with the people from whom we were biologically wired to expect love, caring, and support. That trauma can come at a very young age (even infancy) when the brain is highly plastic and the experience is not consolidated in conscious memory.
Under conditions of such trauma at the hands of our parents, teachers, authority figures, or others to whom we have no choice but to be vulnerable, detaching from those relationships (i.e., “pushing away”) is a healthy, self-protective, resilient response. However, it becomes maladaptive later in life because it interferes with formation of close, loving, interdependent relationships.
All close relationships require vulnerability. Yet, as soon as the pwBPD senses that vulnerability, the self-protective instinct to push away from it is triggered. That instinct is not the result of some rational, or cognitive, process. It is the result of unconscious conditioning, or epigenetic programming. Thus, when later reflecting on their own actions, the pwBPD might experience regret at the consequences, shame themselves for sabotaging a promising relationship and ask “Why do I keep doing this?”
Here’s a technique used by some people who have already acknowledged that they experience unwanted, automatic emotional flashbacks in their close relationships. During those flashbacks, they experience at present the same feelings that were associated with their past trauma, but they attribute the feelings to the new relationship, rather than the traumatic relationship.
It is important to acknowledge these feelings, because something is triggering the flashback. It is also important to acknowledge that these feelings are not a reliable arbiter of reality.
When feeling the impulse to push that close person away, a pwBPD can instead take a sheet of paper and draw a vertical line down the middle to create two columns and make two lists.
In the left-hand column, they can write a description of “How is this person with whom I am in a close relationship just like all the other people in my life who have hurt me?”
This column will be filled with attributes that typically trigger emotional flashbacks. Not all of responses will be negative, either. Some of the experiences of this person might be very positive, and yet still remind of those who have hurt the pwBPD in the past.
In the right-hand column, they can write a description of “How is this person different from all the other people in my life who have hurt me?”
In the throes of an emotional flashback, the right-hand column will be much more difficult to complete than the left-hand column. Yet, this exercise may be what allows the pwBPD to make a conscious choice about how they will behave towards the person whom they value and have become close, rather than splitting them black. In this column, they might rediscover many of the things that they value about that person.
For example, perhaps in the left-hand column they’ve written “This person lied to me, just like my Father did.” In the right-hand column perhaps they’ve written, “This person offered me a sincere apology, which my Father has never done.”
Everyone they become close to in adulthood is different in some way from the people who hurt them in the past. Acknowledging the similarities that may trigger could also empower description of the differences on which the psyche of the pwBPD has pinned its hopes for this relationship.
What about the anger?
pwBPD typically have a lot to be angry about. Failing to express that anger is a shortcut to depression, or self harm.
The problem is that pwBPD often misdirect their anger towards the people it is “safe” to express anger towards. In other words, the people who are the most kind and most loving towards the pwBPD may be the most frequent targets of angry outbursts (which is very frustrating).
For example, imagine a pwBPD who was never, as a child, permitted to express anger towards their parents. That person will grow up with a helluvalot of bottled up, unexpressed anger — but it will never be directed at the parents who punished them for expressing it. Instead, it will typically be directed towards a Lover or a Best Friend who didn’t cause it, is not responsible for it, and doesn’t deserve it.
This expression of anger can result in several consequences:
Create some temporary relief from negative emotions in the pwBPD, such as interrupting feelings of anxiety & helplessness,
Damage to the love relationship, which sometimes will help protect the pwBPD from the vulnerability they felt as children,
Activate the pwBPD’s Inner Critic, and create feelings of shame and self-loathing
As someone who loves a pwBPD, it is possible to ameliorate these negative consequences by reframing (for yourself) what it means when you are receiving that anger.
First, know that the person pwBPD has a lot to be angry about, and has historically had no constructive outlets for their anger. The fact that they’re expressing anger towards you means they’re working on some deep psychological issue of which they may not be aware.
Second, you did not cause their anger and its not your fault. You are a prop in the pwBPD’s unscripted attempt to figure out how to resolve some past trauma from a position of control.
Third, you are under no obligation to serve their agenda by playing some role in the drama of their trauma. You may set a boundary, such as “That’s not how you speak to me,” or “This isn’t a loving conversation. This is you having a tantrum, and that’s not what we’re trying to do here.” This is usually a high conflict moment. Setting boundaries under circumstances like that takes many repetitions, may cause the end of the relationship, and works better when you have your own loving support network.
Fourth, should you chose to remain a part of the pwBPD’s process of practicing anger expression, you might say something like “Thank you for sharing your anger.” That last line, “Thank you for sharing your anger with me,” is probably something the pwBPD has never heard before. They may ask you “What?” or request that you repeat yourself. They may want to know why you say such a crazy thing, when they’re trying to pick a fight, shift blame, or defend themselves. In that moment, you might try saying:
“Because you have a lot to be angry about, and I know you have trouble expressing it. I can see how it all gets bottled up inside you until it explodes when it just has to come out.
“I don’t like it. I don’t enjoy being the object of your anger expression. I think it’s misplaced, because I’m not the one you really need to be so angry with.
“But I get it.
“Anger is a normal, healthy response to a violation of boundaries. I know when you allow yourself to be angry, it’s a step towards the healing I want for you.
“So, thank you for sharing it with me.”
I’m not recommending you take this approach, because it essentially positions you in a therapeutic role for the pwBPD. That might not be a responsibility you feel qualified to take on, or even want.
There can be no relationship with a pwBPD with unresolved relational trauma without their commitment to heal, and your commitment to some role in their therapy.
That’s a helluvalot to take on.
I don't think I had full BPD, but my issues leaned in that direction (Fearful-Avoidant/Disorganized Attachment). My emotional dysregulation and reactivity and emotional flashbacks were completely resolved by (a) going into the pain of every trigger and letting the trauma release/resolve, which felt like hell but worked amazingly well (b) intense self-validation, which resolved the inner instability which was caused by invalidation trauma (gaslighting). I also did a fair amount of parts work to resolve inner conflicts. No relationship necessary--in fact I only really started healing when I gave up my relationship healing fantasies and decided to address my pain myself. Relationships just distract by keeping the focus external rather than internal which is necessary to heal. I think that's also why DBT works. It's not relational, it's based on emotional self-tending skills. That's what heals disorganized attachment trauma, not other people. You need a grounding in your own sense of self before other people will be anything but further destabilizing. And that sense of self arises naturally after resolving the trauma that made selfhood impossible to establish. As far as why people don't "want" to heal, it's because then they can't be rescued. To hang onto the hope of rescue, one must still need it by being broken. Also, staying broken makes you living proof that you were hurt. That is stabilizing when nobody validated the abuse. So it's a tragic form of self-validation.
Man this is good. Thanks for these thoughts and comments. Seems like these are good tips for anyone in any relationship since all us humans tend to unfairly dump emotions on those that don’t deserve it at times