On Sunday evening, March 20, “Let’s Get Real With Coach Menachem” hosted Matis Miller, LCSW, Director and Supervisor of the Center for Cognitive Behavior Therapy of New Jersey. Mr. Miller spoke about Borderline Personality Disorder.
Coach Menachem noted that this disorder affects so many people and causes so much pain. “There is hope. There are treatments, strategies, and mindsets to help us deal with these challenges.” There is also a spectrum of struggles.
Matis Miller shared that “those who are struggling with this are in far more pain than we are.” At the same time, there is a lot of pain for those in this person’s environment. Those with BPD don’t want to cause others pain. We need to be mindful that their behaviors aren’t with intention. BPD is distinct. It’s a severe illness. He detailed the criteria based on the DSM (Diagnostical and Statistical Manual of Mental Disorders). If someone has five of these criteria, then he or she fits the diagnosis.
The first criterion is fear of abandonment. It’s real or imagined, and the person is terrified. He has intense emotions. He believes that a person in his life doesn’t care about him. He will make frantic efforts to prove this. The intensity is great. Mr. Miller pointed out that no one wants to be alone or rejected. They will do anything to make sure someone will stay, including getting aggressive verbally or physically. They are so desperate for relationships, and yet they hurt those relationships.
The second criterion is unstable relationships and over-idolization. Their emotions change to sudden anger. It’s confusing to those relating to them. It’s described as a roller-coaster with swift ups and downs.
The third criterion is unclear self-image and identity disturbance. They don’t have a strong sense of self. The up and down emotions affect their self-image.
The fourth criterion is that they are impulsive and self-destructive with behaviors like addiction, shopping, road rage, etc. They try these behaviors to soothe their pain. The key here is that there are excesses in these areas. This is different from mania, which is long-lasting. BPD behavior doesn’t last long.
The fifth criterion is suicide ideation and self-harm. Others look at this as attention-seeking behavior, but it’s really a person dealing with pain. It needs to be taken seriously. We need to help the individual who is in pain. Ten percent of those with BPD do commit suicide.
The sixth criterion is extreme emotional swings. This comes from the intense pain they feel on a regular basis. Martha Linehan is the creator of Dialectical Behavioral Therapy, which is the therapy that helps with BPD. She created it for herself, as she was suffering with this condition. She speaks of a burn patient who feels pain from a tiny amount of air touching the burn. This is an analogy of the pain a person with BPD feels from the slightest seemingly innocuous things. BPD affects a person’s sense of self and his relationships.
The seventh criterion is chronic feelings of emptiness. A person with BPD is desperate to fill that emptiness and he or she looks for others to fill it.
The eighth criterion is explosive anger. The anger is often a distraction from the pain. It shifts the self-focus and focuses on fear of abandonment. They focus instead on who caused the pain. Anger is less painful than the fear of abandonment.
The ninth criterion is paranoid symptoms. The name “borderline” came about because it appeared that people with this disorder were on the borderline of psychosis. They are not psychotic, he stressed. They have chronic emotional dysregulation.
He explained that black-and-white thinking is also common with this disorder. Emotion affects cognition. “BPD is a chronic issue over many domains.”
Mr. Miller shared that there is a bright side. They are usually very sensitive, caring people with a lot of empathy for others. They are also very creative. They have an intuitive emotional sense, and they pick up emotions. All of this can be wonderful when people with BPD have the right tools to regulate themselves.
Someone asked if this is a chemical illness. Mr. Miller explained that there is a biosocial theory. Some people are born with more intense emotions and sensitivity. This can be genetic. Then the question is how the environment responds to this emotional sensitivity. If a child is punished for his emotions or is not validated, then he’ll engage in more intense behaviors. This reinforces bad behavior. If a child learns that emotions are bad, then he inhibits his emotions and develops a negative belief about himself and his feelings. Sometimes a child is a poor fit for his environment, and he starts to think that there is something wrong with him. Some 30-40 percent of those with BPD also have experienced trauma. There is a theory that the underlying needs of the child were not met, and he needed more love and attachment so he developed unhealthy ways to meet those needs.
A caller shared a question about those who are in relationship with those with BPD. Mr. Miller acknowledged that pain is beyond for those who are dealing with a person with BPD. “The person with BPD is responsible to fix his problems and to get help.” It’s also important for families of those with BPD to get help.
He then listed four options for dealing with someone with BPD. First is helping to facilitate getting the person to therapy and or to leave the relationship. Second, change how you feel about it. Change your perspective. Third is acceptance but not with change, and fourth is too stay stuck in judgment and feel miserable.
Dealing with someone with this can create a chaotic environment. It can be scary as he or she can be explosive. Change is transactional. If you can learn tools and skills to be more effective in your interactions with them, then this will help you to regulate your emotions, and this will keep things calmer. Also, it’s important to validate their feelings but not to validate the invalid. In addition, it’s important to set clear and consistent boundaries. Limits should be without anger, and you should get your own support and do self-care. He mentioned a group called Family Connections, which helps families dealing with this issue. So, accepting who they are and validating and keeping firm boundaries in the relationship are all essential. You have to find a balance of love and acceptance, while at the same time setting up consistent boundaries.
Mr. Miller shared that DBT, dialectical behavioral therapy, is the best therapy for BPD and it teaches core mindfulness. It helps the sufferer develop centeredness and to feel grounded. It also helps him to develop more self-awareness and it helps him to broaden his perspective. The idea it that two opposites can co-exist. For example, acceptance and change can happen at the same time. This means, the person will accept his emotional struggles and stop blaming himself and feeling shame and guilt, and at the same time he will work on changing. DBT builds motivation and skills to be more mindful and to be able to tolerate stress.
By Susie Garber