Borderline Personality Disorder

This post returns to our past discussion of various character types; I concentrated on Character descriptions in multiple posts in 2014, covering many of Reich’s types. As some of you know, my method integrates the personality disorders described by James Masterson, M.D. and referenced as “disorders of the self” diagnostic categories in order to amplify Reich’s character typology. These types originate in earlier phases of development and are caused, in part, by attachment impairments before age 3. The borderline, although commonly referenced in psychiatric diagnostic manuals as a series of symptoms, has a unique developmental quagmire described by Dr. Masterson and other object-relations theorists. The borderline is defined not by symptoms, but rather by character structure and related developmental conflicts that never resolved in the psyche and therefore result in inadequate functioning across multiple parameters.

Individuals with Borderline Personality Disorder have not developed an authentic self. Rather they live in their defensive structure and façade – what Masterson called the “false self”. They sacrificed their real self for a pathological relational bargain with parents. Therefore, they manifest impairments in their ability to activate toward goals and personal creativity, and their capacity for responsibility is impaired. They have serious intimacy problems, separation stress, depression and anxiety.

Individuals with Borderline Personality Disorder create volatility in their relationships as well as in the therapeutic relationship, as they ‘act-out’ frequently and dramatically. The description ‘acting-out’ means rather than think about, feel and explore their problems and emotions, and discuss them with friends, family, or their therapist; they instead, initiate behaviors that display their unmediated emotions, impulses and reactivity. Frantic, angry, sometimes violent displays of emotion, suicidal gestures, impulsive decision-making and/or substance abuse are examples of acting-out behaviors. These feelings and behaviors are not understood and contained. Instead, destructive actions toward self and others are repetitively played-out.

The borderline individual does not establish a mature identity and rather lives without what is termed, a reality ego. Her life can revolve around fantasy hopes and dreams rather than be based on realistic assessments that create realistic behaviors and activations. She is notably immature, and seeks pleasure and avoids reality.

This type is prone to dependency relationships all their life and live in a regressed mode counting on others to finance them and take care of them in a myriad of ways. The borderline can feel entitled to get from others, denying their own weaknesses, absence of independence and self-sufficiency. Their entitlement can lead to outbursts of rage when it is thwarted. They have difficulty taking responsibility and organizing their life so they can go forward with plans and tasks. Rather they often count on others to handle their life for them. With young adults, this is often described as failure to launch. A bright student goes away to college only to panic, get depressed and struggle to stay or leave and come home. Or the young adult does not find his way after graduating high school and stays at home with parents without creating and following up with a game plan geared towards independence.

Borderline relationships are fraught with upheaval. Borderlines mobilize the defenses of clinging and then distancing, and the less functional types distance more than cling to express their displeasure at not being gratified. They express their immature regressive tendencies by seeking solace from others. If they are not satisfied with the gratification received, they can viciously blame the other as mean, wrong and a bad person.

This type is waylaid in the rapprochement phase of separation-individuation. This phase, in healthy development, describes the young child who can engage and play on his own, having completed the fusion phase of infancy, and is beginning to feel his separateness. He ventures forward at the playground with confidence, returning to the parent or viewing the parent as a way to feel a sense of security for a brief period. This shuttling back and forth from activity to parent and back to activity is a normal process in this phase of development as the parent both encourages his independence yet remains a secure, stable object that provides the child with consistent refueling. That process enables the child to develop confidence and feel secure with stable, loving parents while, at the same time, venturing forward on his own. The child continues his path to independence knowing his parents do not need to cling or distance from him as he seeks autonomy. The parents understand who their child is and support his uniqueness always.

Borderlines do not ever fully separate, as they are too anxious and have chronic fears of abandonment. The abandonment trauma originates with parents who were either disengaged too early, demanding premature self-sufficiency due to their personal preoccupation outside of parenting, or were dissociated, troubled and anxious themselves and did not supply the child with the fuel she needed. Or the parents suffocated and engulfed the child, due to their own anxiety or neediness and did not support the child’s autonomy. In these ways, the child was abandoned; not loved in a way that contributed to her developing health and maturity. Rather she was a pawn in her parents’ pathological life.

Then, as adults, borderlines will continue an immature life that lacks autonomy and self-sufficiency, often depending on relationships in the same way they acted with parental figures. Underneath their dependent, gratified contentment is emptiness and fear of abandonment. It is this abandonment fear and panic that can produce the desperate acting-out actions. Their moods are unstable and they can have raging angry tantrums with violence, screaming and loss of control. They are triggered by feelings of fear and loneliness when they or a mate tries to separate and pursue self-activation. Those events set off depression as borderlines fear being alone and abandoned unless they are clinging to the object and regressing. They have chronic separation anxiety and fear of abandonment loss.

The borderline often comes from a family where regression is encouraged and individuation is not. Many borderline mothers produce borderline children and the fathers can be distancing Narcissistic types. The mother may collude with unhealthy dependency, as the mother needs the child to remain close and take care of her. The mom may manipulate the child to keep them in an emotionally and physically caretaking position. In fact, the child receives support for giving up her autonomous functioning. The child and adolescent learn that if they stay close to mom, give her what she needs, and hold back disagreement with mom’s ideas and directions, then they can feel secure and ‘loved’. If the daughter thinks about venturing out, she is not prepared. Independent pursuits seem threatening and challenging, plus mom may likely distance and express disapproval if her daughter does try to go out on her own. Separating violates the unconscious bargain between mom and daughter and the consequences are dire, resulting in a life-long failure to mature. These two approaches of the mother – 1) rewarding regression and 2) withholding good feelings and punishing when the child or young adult wants to differentiate – are internalized. The borderline adult is left with this intra-psychic conflict inside: rewards and good feelings when she is regressed, and feelings of badness when she tries to grow up and be responsible. The borderline then has deep self-loathing, can feel ugly, inadequate and worthless.

These internalized good and bad parts are projected onto others. Seeing others as good or bad is a borderline process. There are no gray areas; they may feel good about you if you give them what they feel entitled to. And they can turn on a dime and hate you, think you have betrayed them, have been unfair and see you as their enemy. They lack reasonableness to moderate their black and white thinking. Instead they reinforce it by talking to others, getting validation for their irrational feelings, and then acting out their hatred. The black and white disparaging views exist within their psyche in a painful way and they can disparage themselves ruthlessly or project those splits on to others.

This good and bad dichotomy plays out in the therapist’s office. The client may try to entice the therapist to gratify her dependency needs and the therapist may feel compelled to collude with her regression. If the therapist does not gratify, but rather confronts the lack of responsibility, for example, then the client may feel abandoned and compensate with rage, seeing the therapist as ‘mean’ and not supportive. Therapists unconsciously collude by giving too much advice, not expecting the client to act responsibly in all situations, and tolerating acting-out behaviors. The therapist may fear the client will judge him harshly and leave him if he confronts.

A borderline can dissociate and lose connection with her self and reality. This loss of self happens more often with this type than other types as she can be overwhelmed with anxiety and lose contact. Therefore it is critical that substance abuse not be tolerated. The dissociative defense needs to be addressed in session when the client drifts off into contactlessness. Clients need to learn about their chronic, ambivalent dependency that leads to raging tantrums with those with which she is in relationship. Therapists need to learn that any and all maladaptive defenses in the treatment room need to be confronted. The initial containment works as clients became aware of how they distract themselves from feelings of emptiness and loss by creating dramatic interactions to fill the void.

This client will pull for gratification so they feel taken care of and avoid the looming abandonment depression. When the therapist does not comply with that expectation, the client can see the therapist as unkind, withholding and negative. The borderline sees himself in his split as inadequate and worthless and the therapist as the horrible mother or father who is rejecting and abandoning him. He will rail against you until the split begins to repair and he can see himself and you without distortion. Then the client faces into their deep abandonment depression without acting-out to avoid it, and the deep grief from the loss of self can resolve. Acting-out stops, reality is faced, depression is worked through, the split resolves and the client moves forward in a whole, authentic wayAs the borderline heals and becomes whole without good and bad parts, she has capacity for health. She can create healthy relationships and attach. She has a good quantity of energy to apply to activated plans and go forward with maturity and confidence in her various pursuits. As she is capable of feeling, she brings an emotional depth to her life.