It can be a confusing experience to be in any kind of relationship (personal or therapeutic) with a person who has borderline personality disorder (BPD). At first, the relationship can seem deep and connecting. People with BPD can be extremely empathetic and perceptive, and they share authentically and generously about themselves. Over time, however, certain patterns emerge as murky and sticky, where they have high expectations of others and resent when others don’t give them what they think they want.
To reduce a person with BPD down to being manipulative and hard to be around overlooks the deep pain and grief around unmet needs from the past that influence their meaning making.
Borderline Personality Disorder (BPD) is listed in the DSM-V under a category of personality disorders known as cluster B. Cluster B personality disorders are disorders that include characteristics of having a dramatic presentation, emotional dysregulation, and relationship difficulties. To meet the criteria of a cluster B diagnosis, these characteristics must be present in various contexts and not limited to one specific situation or relationship.
BPD is considered one of the main cluster B disorders, and it is characterized by the following symptoms:
- Fear of abandonment
- Unstable relationships
- Unstable identity
- Impulsive behavior
- Self-harm, such as cutting or threaten suicide
- Extreme mood swings
- Chronic emptiness and loneliness
- Reactivity and extreme anger
- Paranoia and psychosis
- Dissociation
While the DSM-V does not distinguish different subtypes of BPD, many people get confused in their understanding of BPD because there are can be 4 distinct presentations:
- Impulsive: Impulsive borderline is a subtype characterized by impulsivity, self-harm, and difficulty controlling emotions. They are highly reactive, blaming others for their inner turmoil and then imploding on themselves.
- Discouraged: Discouraged borderline is a subtype that is depressed and withdrawn, with a sense of hopelessness and feelings of inadequacy. They loop in thoughts of never getting their needs met, and they regret the way they treated people because in hindsight they can see the way they pushed people away.
- Petulant: Petulant borderline is a subtype prone to tantrums, outbursts of anger, and manipulative behaviors. There is a quality of defiance or opposition towards others, with a sense of feeling misunderstood.
- Self-destructive: Self-destructive borderline is a subtype that engages in risky behaviors, such as substance abuse, promiscuity, or suicidal ideation
To reduce someone with BPD down to being a manipulative person is to ignore the depth of humanity that lives beneath their patterns. Look a little deeper and you will find a person who is grieving deeply from unmet needs and abandonment in their upbringing. Anger at their caregivers is misplaced onto their current environment, and they feel trapped between their anger and loneliness. Looking to others as the solution and cause of their pain has them unsure of how to find a solution to their suffering.
It is common for a client with BPD to be resistant to working internally to heal their attachment system. Because their mind is convinced others are the cause and the solution, they want someone else to give them what they need. Similarly, because they are so lonely in their patterns, they feel pathetic when they are the ones needed to give them the needs they so want from others.
As a clinician, it can be challenging when the client wants us to be that reparative person for them, especially when they are resisting giving it to themselves. Staying seated in ourselves and seeing our client clearly, we can support them in moving deeper into whatever is present for them. If resistance is the predominant expression, invite them to welcome and validate resistance. If loneliness then emerges as the predominant expression, invite them to welcome and validate loneliness. If dissociation occurs, invite them to notice that they’ve left and honor this strategy as wise.
Affirming their humanity over and over again, the client eventually arrives at a place of more spaciousness and regulation. From a transpersonal, gestalt lens, any imbalance in a person’s symptom is viewed as an adaptive strategy that originated as an attempt to create balance in a system that was not designed for the individual’s well-being. Continuing to use these patterns when the original circumstances are no longer present is where they turn into maladaptive qualities.
It is common for people with BPD to come from a neglectful and shaming household, where their safety came from disowning their needs. A wise way to adapt to this environment was to believe it was their fault they didn’t get the connection they longed for. However, continuing with this pattern is harmful to themselves and their loved ones.
When a client has the opportunity to be seen for the wholeness of who they are, they can discover deeper and more profound places within themselves. There is a sacred and beautiful opportunity to support clients in returning home to their True Self, where they have the capacity to hold themselves in their experience and meet life from their more Awake, resourced Self.
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References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596