I’ve written previously about the differences between borderline personality disorder and post traumatic stress disorder of abandonment but here I’d like to explain why distinguishing the two seems important to me. It has to do with the stigma attached to the diagnosis of “borderline.”
The two diagnostic categories (BPD and PTSD of Abandonment) have an important feature in common –hyper-reactivity to abandonment triggers. But folks can show a pattern of intense overreaction to abandonment without exhibiting other key features of BPD. In my effort to free abandonment trauma victims from the “borderline” diagnosis, I want to avoid maligning people struggling with the symptoms of BPD.
In the first place, the terms “post traumatic stress disorder” and “borderline personality disorder” are at most conceptual entities – part of the analytic equipment of the diagnostician, not part of the data. In other words, these terms offer descriptors that approximate the symptoms exhibited by a number of people whose behaviors share enough in common to warrant creating conceptual stereotypes for them. But since people are individuals, each unique, they can only “resemble” the stereotypes on a continuum, and not be them. That is why I use quotation marks around terms like “borderline.” Both BPD and PTSD fall under the category of “emotional dysregulation.”
Spectrum of emotional dysregulation
You can have people who experienced abandonment trauma in childhood and/or adulthood and who go on post-traumatically to display intense emotional reactions to any perceived threat of abandonment. (1) On the other hand, you can have people with similar abandonment histories and posttraumatic reactions but who struggle with the additional problems attendant to a diagnosis of BPD, one of which is a tendency to “rewrite history” in the service of the ego in an attempt to justify one’s extreme (socially aggressive, alienating, or combative) behaviors. If people can blame others, they can perceive themselves as less crazy, less damaged, less hopeless. Their tendency to reverse blame (something we all do, but perhaps we’re speaking about a matter of degree) appears to be involuntary in many cases – something that their “unconscious defense mechanisms” (or some internal neuropsychological mechanism) accomplishes automatically.
Once people struggling with this feature have twisted things around and created a new narrative, they are no longer able to participate in consensually validated reality which would otherwise allow them to resolve perceptions of reality that clash with the other person’s. The borderline tendency to become rigidly entrenched in a distorted reality makes it difficult for them to learn from their interpersonal mistakes and deepens their chasms with others, including those others who have sought to help them.
Here’s how it might work: In their reality-distortion, people seem to forget the role they may actually have played in a particular fracas. Janet, for instance, an attractive, successful woman in her late fifties, exhibited a genuine memory blackout, having “erased” how she had lashed out at friends from her yoga class. She wasn’t able to recall that she had, in fact, initiated this particular conflict by angrily accusing them of excluding her from something, which had not been the case. Afterward she replaced the blank spaces in her memory about “what went down” with a vision of herself of having acted like Florence Nightingale, and felt innocent of any provocation, and unduly, unjustly victimized.
Janet appeared to believe her reality distortion wholeheartedly – namely, that she had been actually excluded and that she had “merely asked an innocent question.” When the others attempted to point out an “alternative reality” and said they felt “unjustly attacked and hurt by her accusations,” Janet further accused them of “taking each other’s sides,” “twisting things,” “making up stories,” and “ganging up” to further exclude her. Her angry projections and overwrought emotional displays toward them created a vicious cycle severe enough to create some real exclusion. (2)
The feature of entrenched reality distortion accounts in part for the stigma attached to BPD. Whereas sympathy is extended to those labeled with schizophrenia, bi-polar disorder, alcoholism, bulimia, post traumatic stress disorder, and even encopresis, there is marked aversion toward “borderlines.” People with this diagnosis can usually suss out this aversion (with their hypersensitive social antennae), which exacerbates their sense of social exclusion and isolation (abandonment). So the stigma is clearly “not part of the solution.”
Whereas “schizophrenics” may go off in a corner and talk to themselves, “borderlines” are able to engage socially. They can be very high functioning, hold important positions in society, but when a social interaction heats up (becomes intimate, perhaps), it can heighten their vulnerability and supercharge their emotional needs, including their need to have the other person take their side, believe their story, and apologize for a list of perceived wrongs from the past. They crave being emotionally validated and unconditionally loved and accepted. These needs can conflict and set up the other (lover, friend or family) to fall short, unwittingly triggering a new round of destructive emotional volatility.
People exhibiting “borderline” symptoms may wreak havoc in their relationships, but they are the ones who probably suffer most, owing to their entrenched egocentric perspective that features themselves as victims who have been maligned and abandoned, a perception that produces a never ending source of angst. They must cope alone with the overwhelmingly painful emotions of loneliness, grief, rage, longing, and despair, because their behaviors have alienated those others who might otherwise offer them support. They have bitten the hands that feed them.
Perceptions of others
Their friends and families may think that “borderlines” are manipulating and deliberately making up stories, twisting the truth, and even lying. But in fact in many (most) cases “borderlines” create their fabrications involuntarily. Their “new narratives” appear to have been constructed automatically, beyond any conscious manipulation. Once they concoct them, they tend to believe these fabrications. Their distorted version of reality becomes their new reality. They have left the field of consensually validated reality and remain at a loss to self-correct.
This is the old fashioned reason the term borderline was coined: People with reality distortion appear to straddle the borderline between psychotic (delusional) and neurotic (emotionally reactive and confused). It is also why “borderline” is considered a personality disorder: The mechanisms appear to be built into the deep structure of one’s neurological formation.
Treatment challenges and options
Can the destructive defenses be dismantled? Can “borderlines” heal from the inside out? Can they get out of their on way? Yes, but patience becomes treatment’s most important virtue. Forbearance helps too because “borderlines” can challenge the therapist with their entrenched projections, reality distortions, and lack of insight. Also psychiatric medications tend to treat the co-existing conditions and secondary symptoms that they tend to suffer from, including severe mood swings, depression, anxiety, addiction, self-destructive impulsivity (like cutting), and panic attacks, without necessarily correcting the faulty defensive structure of perception and belief.
Once insight is gained, however (a difficult task for a sorely injured ego, bravo!), “borderlines” can zoom forward by availing themselves of their other high functioning personality resources – able to repair and rebuild their lives.
One treatment of choice is Dialectical Behavior Therapy (DBT) which offers tools with which to emotionally self-regulate and negotiate one’s socially rocky landscape. The concept of “multiple realities” is a tool which helps people recognize that an “adversary” (perhaps an estranged friend) genuinely believes his or her sense of reality about what happened between them, just as they believe their own opposing reality. The multiple realities theory allows “borderlines” and others with emotional dysregulation, as well as all of us, to co-exist with someone else’s conflicting perception, agree to disagree with another’s reality, and create truces instead of burn bridges. We are all on a continuum with these issues and feel twinges of the emotions involved when we sense ourselves or our loved ones being dismissed, maligned, or excluded; they are all a part of being human.
(1) People struggling with PTSD of Abandonment cope with intrusive insecurity and anxiety that can interfere in their ability to form primary relationships; likewise with BPD.
(2) Projective identification is another feature along the continuum of emotional dysregulation http://psychology.wikia.com/wiki/Projective_identification