Wednesday 6 August 2014

Borderline personality disorder: Cause and Therapy

Borderline personality disorder (BPD) is an environmentally aquired disorder. It’s nurture, not nature, that causes it. BPD is the worst manifestation of post traumatic stress syndrome: Borderliners have received less love during childhood than the absolute minimum required to avoid serious, permanent brain damage.
Borderliners are people with unhealed third degree burns to their emotional system. This means that a borderliner is in a constant state of emotional suffering of varying intensity. This suffering is so great and the societal and personal consequences of their peculiar character are so severe, that about one in ten borderliners eventually commits suicide. The emotional pain suffered by a borderliner is such that they may be willing to exchange their predicament with a terminal cancer patient, as long as they would be emotionally “whole”. In essence, the self-aware borderliner can’t imagine a greater pain. Sadly, the borderliner, even when given genuine affection, usually feels uncomfortable with it or experiences it as insincere.

BPD improves with age

Borderliners’ wide spectrum of problems can’t be blamed on bad genes, narcissism or carelessness. They often don’t finish an education, hold a job or stay in a relationship – and there is nothing they can do about it. The borderliner’s psyche is that of an emotionally shell-shocked person. If you were to throw a firecracker at the heels of a person with a war trauma, he’ll take cover, initially, while you’d better beat a hasty retreat or experience his fury. No matter how often you tell a person with BPD to “just forget about the past, chill out and start enjoying life” – this won’t work.  A borderliner’s efforts to ignore the problem, apply himself and be like a normal person remain fruitless, because the borderliner is not just in a “state of mind”. We can make the analogy that it is more a hardware problem than a software problem. As a child, the emotional processing part of the borderliners’ brain did not develop properly. Some parts were undeveloped and certain coping- and defence mechanisms became overdeveloped. It is impossible to fully rewire those neuronal pathways, but things can in fact be done to slowly revert some of the damage. And borderliners mellow with age as well.
BPD is extremely difficult to treat because the aberrant neural pathways were formed in early childhood and reinforced for years afterward, in the child’s most sensitive formative period. These abnormalities are real and visible in brain scans – both of brain stucture and activity. We can’t really speak of abnormalities for they likely are sanity- and even life-preserving coping mechanisms that have proven beneficial to the borderliner as the target of abuse. To the pre-borderline child, the environment appears chronically life-threatening and there is no help available (on the contrary) from the family. These survival mechanisms cope with the abuse either actively (agressive-defensive behavior) or passively (social withdrawal and emotional coping strategies such as the creation of a fantasy world in which the borderliner is a loved and respected hero). In the borderliner, some important emotional neuronal pathways have never formed, such as feeling comfortable when  given affection, and the ability to express their own desire for closeness. Whereas schizoids and psychopaths are usually content with their personality disorders and in fact consider “normals” to be impaired by their emotions or concience, borderliners are constantly aware of their “strangeness”. They are unhappy misfits. They are hypersensitive, badly control their emotions and may have feelings of inferiority. And if you’d ask a borderliner: “What makes you happy”, they’d likely say: “Nothing, really”. Most borderliners don’t have the ability to be truly happy, not even for a short while.
Essentially, BPD is what happens to a person when you spend years mentally and physically torturing them from early childhood. The torture consists at least in withholding all physical and verbal expressions of love, and often it there is the active component of telling the child that he is hated and worthless. Broken promises, emotional neglect and verbal abuse. Often, threats are made of various types, such as to harm or kill the child or expel it from the house. Borderliners often were regularly beaten or even sexually abused and generally have been treated without a modicum of emotional support or even a basic respect for them as a human being with feelings.  The most irrepairable damage, the most vicious torture of all is the near-total absence of parental closeness. Instead  there is rude verbal and physical rejection of the infant, resulting in the absence of any kind of bonding. This leaves severe, permanent scars and is perhaps the main cause of BPD. A classic example of the background and behavior of a person with BPD is here. Many ignorant comments by armchair psychologists, blaming the victim, assuming it’s all a trivially solved attitude problem of a selfish and lazy narcissist, instead of severe brain damage caused by years of extreme child abuse.
Ironically, the overwhelming underlying cause for such a childhood is personality disorders in their parents. An example would be a passive father who for some reason (drug addiction, illness, disability) doesn’t participate in the childrearing an overbearing, highly controlling mother with Aspergers syndrome.  Some parents treat the child as an annoying object they are stuck with, a frustrating entity with unfortunately a mind of its own. This sometimes rebellious, attention-craving little person should be turned into an obedient drone who follows strict schedules and procedures, robbing it of everything that makes it a person. Privacy is denied. Myriads of rules and restrictions are imposed and punishments inflicted at the slightest infraction. Any form of affection is withheld. Physical contact is taboo, except when it can’t be avoided, and then it is done with coarse indifference or annoyed hostility. Emotional closeness is zero. The child will feel under permanent threat and constant surveillance. It comes to realize it has no rights, only duties. It is denied its basic humanity. There is no refuge. No alternative ways of receiving or expressing affection are available. The infant grows up a feral child concerning matters to do with love. To ward off insanity, coping mechanisms develop. The borderliner withdraws in solitary hobbies and lying becomes second nature, such as not to provoke anger in people with power over him. Petty theft such as shoplifting occurs as a surrogate for “receiving something nice”. The child retracts into fantasy world of its own making in which it is the center of positive attention, admired and respected by all. Terrible nightmares are common, such as dreams in which the child is chased and killed by a parent.

Borderliners need love and want to give it, too

Borderliners are misunderstood. Some call them “emotional vampires”, a bottomless pit for love, a one-way street, unable to reciprocate on affection, using people for temporary relief and discarding them as used bubble gum. The borderline person comes across that way due to a total lack of love throughout their entire childhood. It should not come as a surprise that borderliners have one gigantic need: The need to feel loved. No person has a greater need for genuine affection than the borderliner. A borderliner needs love like a person with scurvy needs vitamin C. And they desperately want to give themselves to those they feel affection for – but they often have great difficulty doing so. Borderliners are so emotionally insecure that it is easy to hurt them. And because they have never experienced the safety of the knowledge of being loved, they’ll “split” you one way or the other: They will immediately and often permanently reclassify you from “friendly” to “hostile”, and a small perceived slight can terminate a relationship before it had a chance to come to fruition.
This oversensitive black-and-white thinking may make borderliners look “needy”, but that would be oversimplification.  Their sense of belonging in the relationship need regular reinforcement in the form of tenderly expressed physical affection and a genuine interest in, and respect of their persona. If that condition is fulfilled, they can become loyal partners, even when things aren’t always perfect in the relationship. Borderliners do very badly with people who make careless hurtful remarks or who are unable to regularly express affection. A borderliner’s fragile sense of acceptance easily becomes a feeling of being a tolerated burden. He will never again want to be an undesirable element and thus will crudely cancel a relationship in which he is hurt once too often.

Self-treating Borderline Personality Disorder

There are ways in which the borderliner can undo a little of the damage inflicted to him. The best thing a borderliner can do to partially heal himself is to be around people who give him the feeling of being loved and accepted. The more a borderliner experiences affection, the more often he is treated kindly, the more self esteem and confidence is built up. The fragile self is slowly bolstered and it becomes possible to see people as more colorful entities than merely black and white, good or bad, loving or indifferent.
Such a therapy is very hard to attain. I know someone – a classical case of Borderline Personality – who was seriously contemplating suicide. During a long phone conversation I suggested him to go on a long holiday instead. He ended up quitting his job, selling most of his belongings and embarking on a long journey of working his way around the world. Originally an office worker, he held various more glamorous jobs such as windsurfing instructor and he had many flings and short relationships. This way, he learnt that he could be a desirable, respected, loved person. He was significantly “deprogrammed” after years of living that way. His partners initially suffered the consequences of dealing with an emotional invalid, but his travels eventually boosted his self confidence and made relatively stable love relationships possible for him. The likelihood of accelerated improvement is increased when the borderliner understands what it is that ails him. But the severest of cases can sometimes be referred to as “damaged goods” and their emotional scars heal slowly.

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