Katabasis

Nihilism is best done by professionals. — Iggy Pop

https://thepsychologist.bps.org.uk/volume-2018/february/admitting-failure-therapy

https://www.psychologytoday.com/us/blog/campus-confidential-coping-college/201604/depressed-psychologists

Chaos and Elucidation: The Borderline Kōan

Disclaimer: The following material was written for therapists to identify and manage clients with Borderline Personality Disorder (BPD) while illustrating some consequences that could occur during clinical practice. Attempting to conduct therapy with an undiagnosed Borderline mental health patient can be like walking into the Australian Outback without a compass—clinical confusion, navigational errors, and emotional dehydration are virtually guaranteed. In essence, you won’t just be lost, you’re likely to become a part of the BPD landscape. Furthermore, the following hypothetical situation in no way suggests that all patients suffering from BPD are similar regarding presentation, cognition, or behavioral responses. Therapists, like others, should avoid endorsing the “No true Borderline” fallacy. This essay is not intended as a support resource or treatment recommendation for those suffering from Borderline Personality Disorder; it represents an experiential and educational guide to inform and protect therapists from becoming professionally upended. Despite some of the behavioral depictions, occasional humor, and provocative vernacular, there is no motivation by the author to show prejudice or discriminate against this controversial, and often misunderstood, mental health population. Contempt is reserved for the disorder (the legacy of trauma) and not for the person. However, without proper diagnosis and treatment, the person and their pathology are indelibly intertwined. Similarly, compassion is reserved for the person’s suffering, but not for their destructive behavior. Having what is considered an externalizing disorder, people with BPD search for external sources of stimulation, validation, and emotional regulation. They also search for external sources of blame to avoid feelings of shame. Loved ones often describe relationships with Borderlines as “hostage situations,” but those who suffer from BPD are also held hostage by their own unresolved internal conflicts, impulses, insecurity, fear, and highly unstable emotions. Borderline Personality Disorder is a serious mental illness that negatively affects the person suffering from it, in most cases, more than it affects those who interact with them. Borderline behavior is simply a maladaptive means of survival, but therapists must learn how to recognize and survive the onslaught of such behaviors in a clinical setting. Therapists are professionally identified as caregivers, and many clients suffering from BPD obtain their sense of identity by being taken care of. This perilous juxtaposition creates the potential for a clinician’s version of Murphy’s Law. *The term Borderline (BPD) will be used for purposes of descriptive brevity, but this is not meant to imply that a human being is reducible to their disorder.

Chaos is the score upon which reality is written. — Henry Miller

Although therapists may have the necessary academic background to assess Borderline Personality Disorder (BPD) from a vignette, list of traits, anecdote, or comprehensive case study, they may not have worked with enough varieties of Borderline experience in a clinical setting to identify the full range of behavioral manifestations. For example, therapists may learn to recognize common strains of the BPD “psychovirus,” but other strains can go completely unnoticed (i.e., not recognizing a melody because it’s being played backwards). The DSM-IV and DSM-5, with their checklists of infamous Borderline traits and diagnostic features, cannot begin to capture the experiential dynamics of being in a more direct relationship with a Borderline individual (the World Health Organization’s ICD-10 defines BPD as Emotionally Unstable Personality Disorder). The complexity of this disorder sometimes goes undetected by even the most seasoned clinicians until a specific behavioral pattern over time suggests a definitive pathology. The danger of normalization and misdiagnosis is common with Borderlines because of the protean nature of this biosocial disorder and its wide array of individualized features. According to the article Subtypes of borderline personality disorder patients; a cluster-analytic approach from the journal Borderline Personality Disorder and Emotion Dysregulation, 2017: “The BPD population is notably heterogeneous from a descriptive and theoretical perspective. Two hundred fifty-six possible combinations of criteria may yield the same diagnosis. Hence, two patients with a diagnosis of BPD may have only one diagnostic criterion in common.” Correspondingly, a dimensional-based severity scale for BPD should include categories for mildly disturbed, moderately disturbed, and severely disturbed—in addition to Theodore Millon’s 4 BPD subtypes: Discouraged, Impulsive, Petulant, and Self-Destructive. Regarding functionality, some Borderlines are highly self-sufficient, whereas others can be completely dependent, yet they’re all emotionally dependent. BPD is considered to be the great masquerader of mental health disorders. As a characterological disorder, the symptoms of BPD are often camouflaged by the client’s mysterious presentation and myriad interpersonal problems, thereby making the prospects of a conclusive diagnosis even more troublesome. There’s also considerable overlap among all Cluster B disorders (narcissistic, borderline, histrionic, and antisocial). Overall, Borderline Personality Disorder should be considered on a broad psychiatric spectrum rather than relying on common caricatures, clinical stereotypes, or hyperbolized Hollywood depictions. BPD represents approximately 2% of the general population with roughly 75% of cases being diagnosed among females. A large percentage of BPDs report a history of abuse in childhood (physical, emotional, and sexual), but yet 20% claim to have no memory of such encounters (possibly repressed). But even with all of these stipulations and appraisals taken into consideration, to creatively paraphrase Richard Feynman: If you think you understand Borderline Personality Disorder, you don’t understand Borderline Personality Disorder. It’s Heisenberg’s uncertainty principle; it’s Schrodinger’s cat; it’s believing in two diametrically opposed ideas at the same time. Considering the vast catalog of mental illnesses, BPD stands out as an unpredictable ontological contradiction that never fails to generate confusion among family members, loved ones, acquaintances, and caregivers. Most tragically, it deeply confuses the person who is suffering from it.

In terms of an accessible two-tier classification system, BPD “first impressions” could be recognized as either Authoritarian or Vulnerable.

Authoritarian BPD Interpersonal disposition: Compulsively self-sufficient, domineering, mesmerizing, intrusive, anxious, dysphoric, demanding, passionate, presumptive, judgmental, perfectionistic, fearful, competitive, impatient, pessimistic, combative, easily angered, petulant, stubborn, critical, paranoid, and envious. Attachment style: Fearful/Disorganized. Intimacy style: Erotophobic. Rationale: “I have needs for stability, predictability, and approval that were not met during childhood; therefore, I must be in charge to survive.” Valence: Aggressive, flamboyant, anxious, intense, and irritable. Parenting style: Over-involved. Objective: Control of self-image, others, and their environment (overtly expressed).

Vulnerable BPD Interpersonal disposition: Dependent, charming, captivating, coercive, desperate, mercurial, seductive, playful, helpless, passionate, anxious, perfectionistic, dysphoric, duplicitous, suspicious, solipsistic, fearful, affectionate, labile, docile, hypersensitive, desultory, fantasy-prone, childlike, vindictive, and jealous. Attachment style: Anxious/Preoccupied. Intimacy style: Erotophilic. Rationale: “I have needs for safety, validation, love, and nurturing that were not met during childhood; therefore, I must be taken care of to survive.” Valence: Coy, mischievous, needy, desperate, and enigmatic. Parenting style: Under-involved. Objective: Control of self-image, others, and their environment (covertly expressed).

It should be understood that these rudimentary classifications are not mutually exclusive. For example, a Vulnerable BPD could easily switch into an authoritarian mode of expression, given the volatility of their internal barometer during stressful circumstances. However, general appearances indicate a default tendency towards either one disposition or the other, and both classifications maintain fantasies of omnipotence to offset deep feelings of insecurity. For purposes of this essay, the author will focus on clinical encounters with the Vulnerable BPD on the more severe side of the spectrum. A more descriptive archetypal rubric is supplied by Christine Ann Lawson in her popular book Understanding the Borderline Mother. 

In addition to the DSM’s notorious 9-point diagnostic criteria, here’s a 10-point list of the more “unspoken” aspects of Borderline Personality Disorder:

  1. Perfectionism. Excessive attention to details with hypervigilance.
  2. A pervasive need for control in multiple contexts. Hyper-competitive, uncompromising, jealous, anxious, defensive, and mistrusting of others (assuming malicious intent where none exists).
  3. Relying on a victim identity (learned helplessness) for obtaining sympathy, affection, and resources.
  4. Situational transmogrification. Shape-shifting according to interpersonal circumstances. Presenting and behaving differently around different people (i.e., social image versus private persona).
  5. Automatically viewing others in terms of object relations and unconsciously reenacting childhood trauma during every intimate encounter. Confusing internal objects with external objects (i.e., feelings become facts).
  6. Projective identification. Coercing intimate others to “become” an avowed or disavowed representational object without the other person realizing that it’s happening (i.e., emotionally transforming the other to establish a trauma bond that resembles the BPD’s relationship with their parents; a container for fear and frustration; a source of positive reflection and support; or an object of blame).
  7. Emotional reasoning, all-or-nothing thinking, and having personal definitions for universal language (sometimes harboring ideas of reference). Overreacting to any sudden change in plans.
  8. Seeking intimacy as a form of compensatory nurturing that provides safety, comfort, soothing, reassurance, stability, and validation.
  9. Subconsciously evaluating others for their potential as need-gratifying objects (strangers become “good” enablers or “bad” obstacles). Socially anxious, suspicious, and pathologically self-absorbed as a relational style.
  10. Compromised listening, comprehension, and communication skills due to overwhelming emotional preoccupations (inconsistent communication). Borderlines can appear and act like they understand the viewpoints of others, but they often don’t due to deficits in cognitive processing, empathy, and mentalization. Paying attention to the content of conversations becomes difficult if the subject matter deviates from their immediate interests or needs. The BPD’s attention to detail is greater than their attentiveness.

A useful image for Borderline Personality Disorder interpretation is to picture a 3-layer cake. On the surface of the cake is the BPD’s survival-based persona; a “false self” (coping self) that allows them to function in the world and feel accepted while avoiding the agony of criticism or rejection. In essence, the false self is an idealized form of identity that the BPD wants to present to others as if it were their authentic self. The middle section of the cake represents a large arsenal of primitive defense mechanisms and symptoms that generate the bulk of Borderline traits. The bottom layer of the cake symbolizes the BPD’s traumatized and psychologically arrested inner child who is buried underneath a complicated mix of ingredients that include denial, compartmentalization, and dissociation. In therapy, clinicians must become the equivalent of psychoanalytical archaeologists willing to get messy in a messy mixing bowl of toxic cake batter to unearth the Borderline’s traumatized self. Staying on the surface of the cake is what the BPD wants everyone to do, and they will fight like hell to maintain their protective exterior. But focusing on the frosting and its permutations only enables this evasive disorder to flourish with impunity. Basically, the “good side” is the BPD’s manifest image, and the “bad side” is their pathological behavior. As a result of such confusion, therapists and other providers often take an à la carte approach to symptom evaluation and treatment before getting to the center of the Borderline tootsie pop. But wait, there’s more! The therapist may assume that he or she is interacting with the BPD’s “true self,” but this is an illusion. In reality, the therapist is interacting with the BPD’s mask of normality. However, the therapist will be judged according to the Borderline’s impossible-to-please persona. In fact, the BPD’s core self is damaged, trapped, conflicted, anxious, and fearful because they never developed trust, healthy independence, or self-acceptance. In severe cases, Borderline Personality Disorder is considered a subtype of Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) with multiple self-states in perpetual conflict with one another. To make matters worse, the Borderline will believe that the therapist’s true self is either an indifferent professional or an unencumbered caregiver who has the power to magically rescue, nurture, and restore their inner child. However, all therapists endorse a “situational self” by assuming the role of a caregiver as their occupational identity. In reality, the therapist is a human being with faults, problems, vulnerabilities, stressors, and limitations just like everyone else. Last but not least, most interactions in therapy rely on neurotypical standards of reasoning and interrelating, but Borderlines have no reliable baseline for congruent communication because of their fractured identity, cognitive deficits, emotional instability, severe separation anxiety, hypersensitivity, paranoia, impulsivity, aggression, dissociative amnesia, and lack of insight. BPDs know how others are affecting their emotions, but they have no idea how they’re affecting the emotions of others. Introspection is replaced by deflection. What could possibly go wrong?

A conceptual view of BPD is noted by Robert B. Shulman: “The characteristics of the borderline personality include a marked and persistent identity disturbance, chronic feelings of emptiness and boredom, and intense unstable personal relationships. The borderline tends to have difficulty tolerating being alone, and will fear abandonment. They are highly impulsive, and may engage in self-mutilating behavior, have recurring suicidal threats, and manipulate others to meet their immediate needs. The borderline also tends toward having an intense affect; unstable mood; displays of inappropriate anger; perceptual distortions; and under great stress may depersonalize. They see the self as justified; since they feel intolerably bad, they are entitled to go by impulse instead of common sense, and feel entitled to soothe themselves. Their fictitious goal is to do whatever they want as they cannot be happy by how others do it. Their methods are protean, and include splitting, primitive idealization, projective identification, denial, and devaluation. The borderline personality is not a cooperator. Their impairments include affective instability, anxiety and panic, and engaging in self-harmful behaviors. These impairments may cause significant interference in social or occupational functioning. Because the borderline uses others to meet their needs, they can often be the ‘problematic patient’ that medical offices dread.”

Another way to think about Borderline Personality Disorder is as a unique arrangement of C-PTSD (Complex Post-Traumatic Stress Disorder) that causes the sufferer to believe that some combination of affection, validation, control, and retributive justice is the cure. However, this view is limited because it does not take into account genetics, identity disturbance, psychotic transference, autophobia, and abandonment rage that creates an impaired character structure akin to a developmental syndrome with alloplastic defenses. What emerges is a pathological, post-traumatic split-self, otherwise known as structural dissociation—multiple self-states that represent a highly unstable entity of its own (like uranium). The Borderline’s attachment issues are pervasive and owe as much to insufficient bonding during childhood as they do to trauma-induced hypervigilance. Perhaps most ironically, many individuals who become involved in a BPD relationship cycle are later diagnosed with some form of PTSD themselves due to being recipients of the Borderline’s self-justified reactivity (aka narcissistic abuse). Left to their own devices, Borderlines will not break the cycle of abuse, they will perpetuate it towards themselves and others.

The ways that Borderline Personality Disorder can present itself are sundry, but traits reliably surface whenever sufficient stressors are involved in the person’s life. The problem is that significant levels of stress may not emerge during casual therapy sessions as they would in a family context, romantic relationship, or adverse situation. In many cases, the BPD’s affable demeanor, charm, and energetic magnetism—as presented in a structured setting—can create the illusion of normalcy for extended periods of time before things begin to unravel. But, to be sure, this commonly misunderstood disorder is a far cry from the “worried well” going through a seasonal spell. BPD is a form of psychological pain that cannot be attenuated by methods of normal communication. Individuals with personality disorders do not realize that their emotions and behaviors diverge considerably from quotidian human interactions. To be inappropriately blunt, Borderline “flare-ups” act a bit like the herpes virus. There may be no visible outbreak of symptoms until the person with BPD encounters enough stress to end the latency period. In most cases, the crux of this disorder is environmentally triggered and exacerbated because the host has a skewed perceptual lens. This is why those suffering from BPD can “hide” their internal suffering when interpersonal situations are at a minimum threat level. However, it’s the stress of not getting their way that really brings out the creature features of this tumultuous disorder. *It’s important to know that not all Borderlines engage in self-mutilation or suicide attempts, but they can be self-destructive in other ways that are far less obvious (i.e., negative internal dialogue, substance use, binge eating, compulsive behaviors). As clinical misinterpretation progresses, the caregiver may end up pouring the equivalent of codependent jet fuel on the BPD’s emotional reasoning by gradually supporting their distorted views of reality, or by feeling compelled to gratify assorted requests and demands for special favors. Borderlines could be thought of as emotionally unstable individuals with maladaptive software programs—akin to a faulty GPS—when it comes to navigating interpersonal dynamics. As BPDs were often betrayed by their original caregivers, they anticipate betrayal from anyone who is supposed to care. Unfortunately, Borderlines are not responsive to most forms of traditional psychotherapy. In fact, some forms of therapy can actually make their condition worse. As a result, they must be willing to submit to specifically designed treatment programs (i.e., DBT, MBT, IFS, TFP, and schema therapy) that may require years of attendance before adequate insight is developed or meaningful change occurs. It could also be argued that this population may be better managed by clinicians who have additional training in child psychology. Borderlines don’t know how to interact in relationships, and a relationship with their therapist is just another type of relationship.

Things are not always what they seem. — Phaedrus

The challenge for clinicians is when an undiagnosed or misdiagnosed Borderline presents in multiple sessions without conspicuous traits or clear evidence of Cluster B psychopathology. Likewise, the Borderline’s clinical record is sometimes contradictory or misleading. Furthermore, the elusiveness of this disorder will often escape the radar of previous clinicians because of the client’s ability to superficially present themselves as well-mannered and ostensibly reasonable during brief interactions. BPDs can also appear cognitively copacetic and functional when engaged with specific activities that allow for structure, affirmation, control, and unambiguous results (apparent competence). If internal dysregulation (ego-dystonia) is admitted by the client, it’s often misdiagnosed as Bipolar Disorder, atypical depression, or minimized as situational anxiety. Despite a plethora of comorbid considerations, a contradictory or confusing diagnostic history might well suggest that the client is suffering from pervasive patterns of psychological disturbance that transcend Axis I considerations. However, due to time constraints and other factors involved with high-maintenance clinical work, reliance on the assessments of previous caretakers often remains unquestioned. Likewise, it’s sometimes assumed that the client has been an innocent bystander of chaotic family circumstances—surrounded by other personality disordered individuals—rather than being a card-carrying member themselves. In other words, objectivity can be lost if a confirmation bias exists in thinking that the client is an unfortunate victim of bad luck instead of being a potential culprit (this bias does not dispute victimization from abuse or neglect in childhood). Whenever such misguided conclusions become diagnostically solidified, the lost-in-translation therapist becomes a detective chasing down the wrong suspects. The clinician might be in the right neighborhood, but they’re focusing on the wrong address. In these circumstances, understanding the multi-generational and hereditary pervasiveness of Borderline Personality Disorder in families is of key importance (early diagnosis of BPD is crucial for a favorable treatment prognosis). Because of the public and mental health stigma surrounding Borderline Personality Disorder, medication management is often chosen as the sine qua non for treating symptoms rather than subjecting the client to a series of more intensive evaluations. However, psychotropic medication is only supplemental and not effective for managing the nucleus of this multi-layered disorder.

It’s the Hard Knock Life for us. — Annie

Borderlines are known for being resource and sympathy acquisition specialists—chameleons of expediency and masters of mimicry with lifestyles that are frequently in dramatic fluctuation. Their lives are in flux because their moods and emotions are in flux. Their stories can be captivating, and their charismatic powers of persuasion are often unrivaled. The BPD’s voyage of hardship (unrelenting crises) and methods of retelling are irresistible bait for any caretaker who cares too much. In fact, Borderlines are some of the most emotionally convincing interlocutors on the planet. From a BPD’s point of view, they are soldiers of misfortune struggling for survival in a hostile world filled with untrustworthy people (survival usurps self-awareness). Assessments taken at face value may have therapists believing the client’s victim identity—which can provoke a strong rescue response—thereby enabling an unwarranted and unsustainable advocacy position as the therapeutic alliance develops. After all, it’s considered rude for therapists to openly question the veracity of a self-proclaimed victim in the safe space of a treatment setting. But keep in mind, the client’s list of abusers often includes multiple offenders, in multiple contexts, to be blamed over an extended period of time. For example, BPDs can go from one personal or professional relationship to another while complaining about how they were grievously mistreated during their last encounter (aka “support surfers”). BPDs will pull at your heartstrings, but there are definitely some strings attached. In addition, the Borderline’s penchant for gossip is highly effective when collecting “flying monkeys” (aka concerned others, enablers, and negative advocates). Welcome to the triangulation trap—endorsing the innocence project with someone who may not be so innocent. However, a detailed history of the client’s former relationships will undoubtedly reveal significant contradictions while demonstrating evidence for repetition compulsion. Borderlines are notoriously involved with contentious divorces, custody battles, or complicated legal issues with partners and family members. Their history of interpersonal conflict is usually quite extensive before they step foot in a therapist’s office; however, these battles will be framed as being unfair and imposed upon the Borderline. The BPD’s ongoing search for someone who “really cares” becomes a perpetual motion machine of dependency and disappointment. Upon closer examination, Borderlines have a remarkable capacity to inadvertently exploit others while maintaining a repeated position of victimhood—perpetuating a cycle of victim and rescuer. Consequently, this position abdicates personal responsibility while justifying the Borderline’s impulsive behavior, self-aggrandizement, rage, and mistrust of others. In other words, Borderlines are playing a game of emotional tennis without a net. BPDs are crucibles of disturbance who are exceedingly proficient at persuading their sympathizers that everyone else is disturbed. But in the BPD interrogation room, accusations are often confessions in disguise. BPD paranoia is also contagious if not understood for what it is. To be sure, giving a Borderline the benefit of doubt will not benefit anyone—including themselves. Other diagnostic misinterpretations may include believing the client to be a scapegoat of other “crazy makers,” rather than investigating the client’s contributions to their own psychosocial predicaments. To make matters more convoluted, BPDs sometimes expect professional relationships to be indistinguishable from personal relationships. Therapeutic relationships, in particular, are anticipated to become more intimate if the clinician’s empathy is convincing. However, Borderlines will often interpret challenging clinical interactions to be a simulacrum of parental judgment by an authority figure with the potential for criticism and shame. Subsequently, BPDs will work hard to undermine the power differential by controlling the therapeutic process to avoid anxiety in the face of uncertainty. The process of change equals an all-too-familiar source of stress and unpredictability that subconsciously reminds them of their childhood. Furthermore, social ineptness can be seen whenever reality interferes with the BPD’s need for validation—resulting in boredom and impulsive attempts to regain recognition—or whenever intimate discussions require commensurate emotional reciprocity. Therapeutic relationships with adults are meant to be collaborations, but building a therapeutic relationship with a BPD has a much greater likelihood of becoming contentious or codependent because of their distorted perception of trust. Trust, from their perspective, is based on the acceptance and availability of the therapist to meet the unmet needs of the Borderline.

“Borderline patients seem to have the peculiar ability to inflict a specific form of ‘sweet suffering’ on their therapists. They themselves have suffered throughout their lives, and it is important to them to have their therapists suffer for them. They seem to demand that the therapist abandon the professional therapeutic role so that whoever attempts to treat them must share in their misery,” states Dr. Glen Gabbard.

Love is a battlefield. — Pat Benatar

The Borderline’s history of romantic relationships are characteristically unstable and stormy. Likewise, there is often evidence of intermittent reinforcement relationships that are intense, turbulent, and ephemeral. BPDs are looking for someone to love and someone to blame to compensate for adverse childhood experiences with primary caregivers. Borderlines want the appearance of an adult relationship with the fulfillment of a parental relationship. Consequently, the ambivalence they felt towards their parents will be projected onto their partner. This “hot and cold” relationship style is based on an extreme version of the approach-avoidance conflict (otherwise known as “I hate you, don’t leave me”).  Borderline’s can engage in paradoxical thinking that alternates within minutes, hours, or days. Confusing and contradictory in its push-and-pull nature, this self-defeating dynamic can bring fast connection, enthusiasm, and passion to relationships, but it also creates a breeding ground for disappointment and hostility. It draws people in, but it eventually pushes people away. For Borderlines, their search for love is a defense against feelings of fear, emptiness, contempt, and anger. Love becomes a clinging form of desperation beset by jealously. Frank Yeomans, a New York City psychiatrist, describes those with Borderline Personality Disorder as failed romantics. “They seek an ideal of perfect love and pursue it zealously. But as soon as the people they’re besotted with are a few minutes late, or can’t text during a busy work day, BPD sufferers go into a tailspin.” A friend or lover is either “just perfect or all hell breaks loose,” he says. “The borderline mind has not yet been able to integrate positive loving feelings with negative ones, such as frustration and anger. Since every relationship includes a whole range of emotions, you’ve got to deal with all of it to have the relationship work out.” BPDs exhibit a preoccupation with nurturing and re-parenting—under the guise of an adult romantic relationship—as the solution to their problems. However, long-term pair bonding is extremely difficult with BPDs because of their predisposition towards jealousy, irrationality, fear, self-sabotage, age regression, paranoia, and abandonment rage. More specifically, an inability to be emotionally subdued for any substantial period of time is a chronic feature in the BPD’s universe of fluctuating emotions. Borderlines crave the sensation of control, so the therapist should expect to feel dominated at some point during the therapeutic alliance. According to psychotherapist Ross Rosenberg, “Their [Borderlines] romantic relationships begin quickly, intensely, and with a great deal of excitement, euphoria, and sexual chemistry. Their volatile emotions move in one of two directions: love and adoration or hate and destruction. Because this person has had little-to-no experience with healthy relationships, the euphoric ‘perfect love’ feelings that occur in the beginning of the relationship are neither realistic nor lasting. The early euphoric love experience is transient as their psychological fragility leads them to an eventual emotional crash and burn. This black-and-white approach to their romances creates a teeter-totter effect of extreme behavior; they either shower their partner with love and kindness, or rage at them with disgust and violence. Their love/hate processing of relationships places an impossible burden on the partner. Often individuals diagnosed with BPD are preoccupied with real or imagined abandonment, which they frantically try to avoid. The perception of impending separation or rejection can lead to profound changes in the way they think about themselves and others, as well as in their emotional stability and behavior. Whether real or imagined, any reminder causes them to strike back at their romantic partner with rage and aggressive hostility. A mistaken comment, a benign disagreement, or an expression perceived as disappointing can quickly transform their loving feelings toward their ‘soulmate’ into a raging retribution against an enemy.” Borderlines are tortured souls who often torture others by association.

Perhaps most unusual is the fact that a Borderline’s preoccupation with friendship, affection, love, and romance (features of bonding that everyone appreciates) are also characteristics of this particular personality disorder—amorous-infused coping mechanisms (limerence) to attenuate anxiety, loneliness, and the fear of abandonment. Caveat emptor: Deep in the woods of Borderlandia, hate becomes a surrogate for love. Love is merely a prelude to a much darker world.

The brain is the organ of destiny. — Wilder Penfield

The neuroscience of Borderline Personality Disorder is both fascinating and unsettling. BPDs interpret their surroundings through a gallery of uncensored emotions that defy ordinary experience. Most importantly, there are significant differences in both the structure and operations of the brain with people suffering from this disorder. It is well known that the brain’s limbic system (more specifically, the amygdala) generates the bulk of human emotions, including feelings of love, sexual desire, fear, aggression, and hatred. However, these emotional states are normally regulated by the brain’s prefrontal cortex to ensure continuity of experience within the parameters of external reality. Without neurotypical filtering processes, an electrical storm of impulsive potential becomes as unpredictable as it is unmanageable. In some cases, the Borderline’s prefrontal cortex may develop lesions combined with hippocampal atrophy and anterior cingulate reduction. For BPDs, the fight or flight mode never takes a break. Excessive emotional reactivity occurs because critical faculties are not functioning properly during periods of stress. These “filters of reason” appear relatively absent or significantly diminished in BPDs, thus resulting in a unique hyperarousal of the frontolimbic network that creates unregulated feeling states. In addition, studies have shown that BPDs have an overactive hypothalamic-pituitary-adrenal area (HPA axis), which creates hypersensitivity to stress as manifested through excessive anxiety. When Borderline Personality Disorder is misdiagnosed as Bipolar Disorder, it’s crucial to understand the difference between cycles of neurochemical instability (Bipolar) and cycles of emotional instability (Borderline) arising from the influence of stressful interpersonal factors. To put it mildly, the Borderline has a brain that reacts to stress differently than the rest of us.

Because the Borderline’s feelings are not mitigated by the brain’s usual gates and checkpoints, a wide range of competing emotions are experienced with incomparable intensity. For the non-borderline, witnessing these extremes of emotion can be both captivating and terrifying. The BPD’s feelings of joy are as unrestrained as their feelings of fear, paranoia, and resentment. For example, euphoric displays of idealization and affection are compelling because such emotional intensity is abnormally exciting. On the downside, disproportionate expressions of anger and hatred will be experienced by the non-borderline as confusing and unusually disturbing. Furthermore, the BPD’s emotions during periods of extreme stress are not amenable to self-monitoring or self-reflection. In fact, these feeling states (self-states) can erratically alternate without subjective awareness or recognizing gradations of interpersonal experience. As the Borderline’s mood runs amok, an enveloping backdrop of dramatic panic becomes omnipresent—like an invading force that permeates everything. The BPD’s manifest image at any given moment is contingent on the precarious mechanisms of a reactionary mind, and this uncanny juxtaposition will surprise anyone who tries to make sense of such counterintuitive behaviors and cognition. Dysregulated minds are primarily disempathic minds, especially when reality threatens their defenses. Borderlines have affective empathy but lack cognitive empathy (understanding the perspective of others). When the rubber hits the road, the BPD’s reactivity will burn down every bridge within their radius.

*Caveat for therapists to consider: The structure of a BPD’s brain is more responsive to emotional and physical demonstrations of care (i.e., hugs, proximal reassurance, measured tone, and positive eye contact) than it is to logical conversations about the importance of behavior management, self-awareness, cognition, and self-efficacy. In such situations, the client and therapist may feel like they are talking past one another, when, in fact, they’re speaking two separate languages. These gaps in communication require that the therapist remains steadfast in order to guide the client out of a dense forest of competing thoughts and desires. 

Being a hero is about the shortest-lived profession on earth. — Will Rogers

Borderlines are like runaway trains searching for someone who will save them from emotional derailment. In their compulsive quest for control, they are literally out of control. BPDs can surreptitiously condition others to respond to their feelings of desperation through forced teaming, and conscientious therapists may feel compelled to go the extra mile—like a case manager on steroids—as a gesture of loyalty. However, this expectation places too much pressure on therapists to compensate for the BPD’s desire for unconditional support. Unfortunately, the therapist’s rescue attempts will only reinforce the client’s dependence and further vindicate their assertions of distress (Vulnerable BPDs often claim to be mistreated by those who are supporting them either financially or emotionally). In short, the therapist may feel obligated to take care of the Borderline until the caretaking fuel runs out. But a clinical death trap of Faustian proportions awaits the therapist if they become the client’s go-to person (aka “favorite person”) for emotional support. The BPD’s favorite person is based on a fabricated image (the “distorted other”) that places the therapist on a superhuman pedestal to serve the unfulfilled needs of the client. BPDs often live in a fantasy world inhabited by heroes and villains to protect themselves from painful memories of childhood trauma. As a consequence of such unrealistic constructions, the therapist will unknowingly be subjected to tests and confirmations that either prove or disprove their caretaking worth. Subsequently, the personification of a mythological trope ensues: The therapist, like many before them, becomes the BPD’s latest knight in shining armor. In this treacherous association, the BPD’s need to feel protected and nurtured matches perfectly with the therapist’s desire to feel like a compassionate and competent caregiver. Inevitably, the BPD’s performance evaluation of the therapist’s efforts may result in effusive praise followed by devastating disappointment. Because the most significant goal of Borderlines is to gain the unequivocal concern of caretakers, this disorder may very well be the most challenging condition for clinicians to work with when it comes to maintaining professional boundaries. BPD represents a strange inversion of reasoning. BPDs are assertive, and yet they’re insecure; needy, and yet suspicious; demanding, and yet implacable; helpless, and yet controlling. Therapists have a job that depends on building trust with their clients, but BPDs live in a perpetual state of mistrust. Impossible standards of care will be expected before the Borderline feels comfortable enough to trust their caregiver. However, attending to those expectations without taking sufficient precautions is the beginning of a downward spiral. In the world of BPD communication, everything is upside down and contradictory. It’s a complicated game of surreal semantics that must be carefully unpacked and analyzed. Assumptions are dangerous. The perceptions of the Borderline are frequently the polar opposite of the perceptions of the person they’re interacting with. Words like trust, relationship, friendship, love, and caring have entirely different meanings for Borderlines, and any deviation from their emotionally dysregulated dictionary can spell trouble.

Givers need to set limits because takers rarely do. — Rachel Wolchin

“Setting limits with individuals with Borderline Personality Disorder often causes them to experience frustration which may be expressed as rage. Refusing them or restricting them in any way causes them to feel slighted, or worse, rejected. These feelings leave them feeling victimized, which then justifies lashing out behavior. This may take the form of challenges to the boundary, or possibly abusive behavior towards you for setting the boundary. Individuals with BPD not only feel the sense of helplessness that others associate with feeling like a victim, they also experience the boundary as an accusation of unworthiness,” says Dr. Daniel S. Lobel.

Therapists may rationalize exceptions to treatment and loosen boundaries as a way of surrendering to the client’s increasing demands for validation, or to demonstrate solidarity within the therapeutic relationship. BPDs instinctively perceive boundaries as a form of rejection, so they will ignore these inconvenient barriers to bonding. It’s a precarious predicament, because BPDs think of themselves as being entitled to customized experiences that cater to their immediate emotional needs. Why shouldn’t they? After all, they feel emotionally empty, numb, and worthless without continuous consolation and stimulation. In addition, mental health patients who travel along the Cluster B bypass are no fans of delayed gratification. BPDs generally expect frequent contact with their caregivers and loved ones via email, phone calls, texts, and emergency visits. However, not wanting to alienate or hurt the feelings of the BPD in the short-term may result in confusion and resentment for both parties when boundaries are no longer amenable to remediation. If therapy evolves from being professional to becoming more “friendly,” it’s only a matter of time before the BPD will initiate further efforts to decimate the remaining power differential. The BPD’s urgency to have their needs prioritized can lead to multiple role endorsements by caregivers, such as becoming an apologist, negative advocate, family interventionist, avenger, personal secretary, friend, emotional support ambassador, babysitter, and emergency manager. Borderlines must dominate all of their relationships, so the therapist should expected to feel dominated at some point during the therapeutic alliance. It must be understood that BPDs will elicit strong emotional responses from their caregivers, and these responses are sometimes experienced as intensified concern (i.e., feelings of pity, outrage, endearment, or moral panic). The therapist must trust their professional instincts more than the emotionally driven impulses of the BPD, but clients in distress can be difficult to assess with neutrality. Precipitously, the dynamics of the therapist-client relationship can quickly become organized around the client’s capricious emotional states instead of being effectively analyzed and redirected by the therapist. BPDs are in the molding business as they search for others who are willing to become malleable acolytes in service of their “id without a grid.” The BPD’s basic message is: If you care for me, you will do something to make it better right now. A therapist’s protective instinct will automatically be innervated by such displays of desperation, because no caregiver wants to be seen as uncaring. It’s a Catch-22 situation. Like the parable of Thales, therapists can fall into a bottomless well of boundary violations as they attend to the client’s constellation of insurmountable needs. What was once an analytic space is now lost in space.

Psychotherapists face an unavoidable paradox. They must immerse themselves in the moment to empathize with patients and emotionally distance themselves to maintain boundaries, or offer perspectives to foster change (Bateman & Fonagy, 2006). Philosophically, therapists strive to adopt a dialectical stance in which they simultaneously accept the patient while facilitating change in the patient (Koerner, 2012). From a practical standpoint this means switching between validation and change during a session, often in the same intervention, and flexibly navigating this contradiction (Koerner, 2012). Gabbard & Wilkinson (1994) argued that therapists typically react by becoming either over-involved to “save” the patient or under-involved to emotionally distance themselves.

Controlling my environment was still a compelling need for me. I did everything I could to not be surprised by anything. Looking back, I think that my need to predict how my day was going to unfold was a direct response to the amount of chaos in my childhood. — Olga Trujillo

It’s important to be aware of the Borderline’s unrealistic expectations for validation, proximity, and reassurance. They cannot tolerate being alone (autophobia) and they cannot tolerate emotionally stressful or challenging situations. Without self-acceptance, BPDs rely on acceptance from their environment. BPDs will identify characteristics in others, such as generosity or agreeableness, to get their emotional needs met—appearing retrospectively as premeditated manipulation. Incidentally, the longer a person with BPD has gone undiagnosed and untreated, the more refined and their survival mechanisms will become. In layman’s terms, Borderlines are less interested in change than changing others to get what they need. Other people (aka need-gratifying objects) are in a position to provide services, but if those services fail to meet the BPD’s expectations, calamity will likely ensue. Therapists, by definition, are trained to be of service to those in need; however, BPDs will take advantage of every accommodation offered while cataloging these susceptibilities for future interactions. They will subjugate challenging interpersonal encounters because it makes them feel uncomfortable. For the Borderline, spatial distance may also be perceived as a sign of rejection. BPDs simultaneously seek and reject help, because accepting help that requires transformation makes them feel out of control. Notice the inherent contradiction: A helpless victim who needs to be in control. Perfectionism, a common Borderline attribute, is another manifestation of control that acts as a substitute for external validation (i.e., “when I’m perfect, then I’ll be loved”). Because Borderlines were often raised in families where survival was based on performance and conveying an image of success, they will try to prove to the world that they’re perfect. Counterintuitively, perfectionism also serves as a form of self-invalidation because these unrealistically high standards become self-imposed. It has been argued that BPD perfectionism symbolically represents a form of “emotional cutting.” In fact, many pwBPD experience various forms of somatic symptom disorders that are exacerbated by self-inflicted injuries. Inflexibility runs in tandem with perfectionism. Borderlines are perfectly content with letting the perfect be the enemy of the good. Things must go a certain way, and any sudden change in plans is anathema. The Borderline lives in fear, but control makes them feel safe. BPDs will try to obtain as much control and power as allowed in adulthood to compensate for the lack of control they experienced in childhood. Control of their image and their environment is the Borderline’s primary method for fear management. Meanwhile, they’ll dispatch a decoy of ineptitude as they demand unreasonable levels of support from anyone who gets too close. As a result of appearing victimized, the BPD’s concerns can be misinterpreted as legitimate complaints rather than pathological patterns of dependence. With Borderlines, you cannot separate personal motivation from psychopathology; it’s a distinction without a difference. Consequently, therapists who accept assertions of helplessness at face value are headed for an imminent clinical disaster. The BPD’s victim identity provides a more secure attachment to caregivers, but this attachment is unrealistic and unendurable. Subsequently, therapists will lose objectivity by allowing themselves to become emotionally invested in the BPD’s eternal quagmires. Welcome to the sunk cost fallacy for therapists.

Listed below is the Borderline’s “Tyrannical Toolkit” for obtaining recognition, emotional support, affection, resources, and allegiance from family members, friends, romantic partners, or caregivers. Commanding the will of others is the BPD’s primary goal to mitigate their insecurities, anxiety, and fear of abandonment. Weaponizing emotions is the wheelhouse of the emotionally unstable. These survival-based methods of control are strategically effective because they demand responses from the Borderline’s “target” or intended audience.

  1. Anger/hostility: Anger evokes a sense of urgency and fear in others, which may result in attempts to de-escalate the BPD through appeasement and various efforts to soothe their rage. Although it usually has the opposite effect, hostility can sometimes induce deference and accommodation. Demonstrations of disappointment, entitlement, and angry devaluation belong in this camp.
  2. Seduction/charm/flattery: BPDs sometimes use seduction as a form of currency for gaining approval, or as a defense mechanism to avoid scrutiny. BPDs may flirt and flatter until others acquiesce to their requests and desires. To acquire secure attachments, BPDs will become whatever they believe you want them to become, or they will tell you whatever they believe you want to hear about yourself (attribute mining). Either way, these approaches to “persuasion bonding” can be very effective. Furthermore, the BPD’s emotional seduction is usually as effective, or more effective, than their physical seduction. Idealization and “love bombing” fall into this category.
  3. Incentivizing: Gifts and/or financial obligations. Gifts can be used as a form of coercion under the guise of appreciation. Receiving gifts compels others to respond with gratitude while feeling obligated to reciprocate. Subsequently, others will feel valued and willing to do more for the BPD. In a similar, but much more controlling way, financial dominance implies a position of ownership to ensure that all eyes are focused on the donor.
  4. Pity: Portraying victimization to solicit support and affirmation of suffering. Appeals for sympathy can be extremely powerful, because most people do not want to be seen as indifferent to the suffering of others. Threats of self-harm and suicide can engender compassion and compliance from loved ones. Martyrdom is another method for obtaining concern and attention, whereas malingering evokes pity and allows the BPD to avoid responsibility altogether.
  5. Guilt: Shaming through guilt can make others feel negligent, cruel, inadequate, or incompetent. Apologies and offers of compensation will be made by those who succumb to blameworthiness. Criticism, blame, and disapproval causes others to feel self-conscious, or question their own experiences, thereby becoming more amenable to BPD influence. The engine of gaslighting runs like a champ in the garage of guilt. Kafka traps are inescapable accusations often used by Cluster Bs.
  6. Emotional Blackmail: An effective way to intimidate others into compliance is by posing unmerciful ultimatums. Punishment often awaits those who disappoint the BPD. The message is: “Do it or lose it!” This strategy reminds others that the BPD is always in control. Double binds, bullying, and other threats belong in this category.
  7. Entrapment: Obligation through legal ties (e.g., marital, financial, children, or professional endeavors). BPDs will work quickly to secure contractual commitments from others, but this association may result in consequential involvement with the court system whenever such unsustainable commitments sour. More importantly, high-conflict personalities (HCPs) will use the legal system as a way to obtain resources, gain attention, or to seek revenge.

When they discover the center of the universe, a lot of people will be disappointed to discover they are not it. — Bernard Bailey

Borderlines share many similarities with those suffering from attention-deficit disorders, but mostly because they believe that not enough people are paying attention to them. BPDs were not given enough validation in childhood due to parental neglect, so they’ll over-compensate for this lack of developmental stimulation in adulthood. The baryonic matter of the cosmos must revolve around the Borderline’s gravitational force, but the total mass-energy is no match for their negative energy. In fact, this is why BPDs are often described by loved ones as selfish, needy, theatrical, bossy, and impatient. BPDs are on a subconscious mission to course correct for childhood deprivation, and they expect others to be complicit with their need for recognition, reassurance, and love. Therapists often report feeling as if they have no life outside of their Borderline client—as if there’s no division between professional and personal space. Borderlines experience therapy in relation to how every interaction affects them. Of course, because they’re hypersensitive and paranoid, conflict is inevitable. Conflict is not created for purposes of effective problem solving, it’s created for purposes of keeping the spotlight on the Borderline’s emotional pain. Although many people suffering from BPD describe attention-seeking behavior as a coping mechanism, which is clinically accurate, the end result commands the attention of others in such a way that resembles premeditated manipulation. As with all parsing of BPD semantics, it’s another clinical distinction without a practical difference. Validation is an addictive drug for Cluster Bs, but the side-effects are not limited to the user. “People with BPD often derive their sense of worth from how much other people are serving them,” says psychologist Daniel S. Lobel.

Harboring enormous levels of self-doubt, Borderlines experience a sort of “prosopagnosia of the soul” (identity diffusion) and rely on others to provide a sense of self while serving as sources of stability. Otto Kernberg, a psychiatrist who pioneered a new understanding of Borderline Personality Disorder, believed that pervasive feelings of loneliness and the need to belong to something were the driving forces behind all of the other behaviors associated with BPD. For the Borderline, other people are props to help them achieve emotional stability while quenching their thirst for propinquity. Power through control over intimate others is their primary objective. Therapists learn that successful therapy requires patient engagement by developing a strong therapeutic alliance, but too much engagement with BPDs will create an avalanche of expectations. A client with BPD is less likely to pay attention to the substance of therapeutic conversations because they’re usually focusing on details related to the interaction (i.e., the therapist’s tone of voice; eye contact; the appearance of the therapist; non-verbal cues). In other words, listening comprehension is secondary to the Borderline’s need to take inventory of their surroundings. In a similar vein, the BPD’s emotional preoccupations cloud their capacity for being fully present (by definition, they exist in a dissociative state). But to be sure, the Borderline is an equal-opportunity seeker whenever emotional propitiation is on tap. Compliance with the fanciful expectations of the BPD is expected, but don’t expect them to comply to the rules and expectations of others. Over time, trying to successfully manage such interpersonal mayhem will become clinically overwhelming (this is a telltale sign that a client is hitting home runs in the Cluster B ballpark). BPDs often assume that their therapist will always be available to soothe their feelings of desolation and anxiety. The Borderline’s hypersensitivity to criticism and mistrust of others can also make therapy exceptionally challenging without triggering their inferiority/superiority complex. Borderline pathology overlaps with covert narcissism (aka “shy” narcissists), and narcissism thrives on the allegiance of others to avoid narcissistic injury. Therapists who aren’t suspecting Cluster B shenanigans will eventually be caught by surprise—like an off-duty police officer during happy hour—whenever they say or do something “wrong.”

It is the fool who thinks he cannot be fooled. — Joey Skaggs

The valence of Borderline Personality Disorder is perennial desperation, but the BPD’s ability to maintain composure often prevents or postpones diagnosis. To appear desperate suggests a need for protection, although vulnerability among BPDs is seldom revealed as a form of subterfuge. Borderlines can modify their behavior, interests, and appearance to please others because they struggle with identity disturbance. The BPD’s shape-shifting capacity to present themselves in a carefully assembled manner is a survival-based façade (aka “false self)” that increases their ability to receive social acceptance while appearing normal. Overall, BPDs are performers who painstakingly prepare for their next performance. Borderlines can be extremely captivating, energetic, provocative, seductive, and glamorous (predominant among BPDs with histrionic traits). Not being allowed to individuate or express themselves during childhood, Borderlines often work hard to become someone whom they believe others will admire. The goal is to avoid feeling flawed, invisible, empty, or damaged by portraying an ideal version of themselves. For example, BPD males often present with a hyper-masculine persona, whereas BPD females may present with a hyper-feminine persona to offset their core insecurities. Borderlines want to be noticed, accepted, and desired—despite the fact that they resent being objectified. Ironically, they become the objectifier in relationships while their partners become need-fulfilling objects (aka object-representation other). However, therapists must learn to ignore the client’s window dressing (supernormal stimuli) and pay closer attention to how the furniture is arranged inside the building. Underneath the BPD’s veneer of well-crafted pageantry lies a cauldron of festering resentment, fear, insecurity, and hostility from unprocessed frustrations. According to psychoanalyst Donald Winnicott, there are five degrees of the false self. In the worst-case scenarios (extreme pathology), the true self is completely hidden. The false self is required to become so strong that it appears to be the true self. To be sure, BPDs are much easier to recognize when their suffering results in a visible disability. At the other end of the scale, the “nearly normal cases” still retain a false self but are able to meet ordinary social expectations. However, once the Borderline’s false self begins to crack under pressure, a disproportionate display of defensive reactivity will light up the night sky. Pay attention to the fireworks rather than being blinded by the smoke.

Borderlines may incorporate emotional blackmail, angry threats, and double binds to acquire unambiguous commitment from their caregivers. Counterproductive as they often are, these behaviors are frantic efforts to preemptively avoid abandonment by asserting dominance. Borderlines crave the stability of others like a live wire requires neutral sources for proper conduction. However, the BPD’s fragmented self is a foreboding challenge for therapists who have not been trained in treating Borderlines. The monumental task of core restoration is difficult to manage without producing enmeshment. Too little engagement results in accusations of not caring, and too much engagement creates dependency. BPDs also have a preternatural antenna for spotting those who appear charitable, such as caregivers who are committed to making a difference. To reduce their anxiety, Borderlines will use flattery to create an atmosphere of friendship. As a result, the therapist’s temptation to become more accommodating allows an undiagnosed and untreated BPD to avoid being confronted in ways that might reveal their pathology. Psychotherapy stirs up a lot of emotionally painful subject matter, and BPDs will find clever ways to shut it down by using whatever defense mechanisms they have at their disposal. Having the courage (and energy) to follow the Borderline’s evasive trail of denial will inevitably lead you to their unresolved childhood wounds.

Fool me once, shame on you. Fool me twice, shame on me. Fool me three times and you’ve probably developed a characterological disorder that has been fooling everyone, including yourself.

Voices carry. — Amiee Mann

Too much self-disclosure is potentially dangerous when working with BPDs. The therapist’s efforts to relate to the client may result in revealing information that will be used against them later on. Most therapists do not have the power of prescription. What do they have? The power of conversation, encouragement, reassurance, relatedness, and emotional support. However, the very qualities that make therapists good at what they do (i.e., being attentive, compassionate, considerate, empathic, and accommodating) are the very qualities that can work against them when interacting with BPDs. Therapeutic conversations that focus on shared experiences are necessary for establishing trust with BPDs, but they could also reinforce a rescuer-victim paradigm that becomes internalized by both participants (trauma bonding). Avoiding early discussions about the limitations of therapy with a BPD only postpones the inevitability of future disappointment and abandonment rage. Talk is cheap, but the consequences of misguided communication are not. Volunteering to become a clinical marionette at the BPD’s disposal is nothing less than professional abnegation that gradually occurs as a consequence of trying to please the unpleasable (it’s common for Borderlines to think of therapy as a form of customer service). However, once the bargaining stage of self-sacrifice begins (masochistic surrender), the therapist is headed for an impossible task of perpetual mollification. For example, repeatedly soothing a cancerous outbreak with corticosteroids may temporarily reduce pain and inflammation, but it will not remove the patient’s tumor. Borderline Personality Disorder is a form of emotional cancer; in some cases, it can metastasize beyond remediation (e.g., delayed diagnosis with poor prognosis). A therapist’s compulsion to soothe the BPD may also occur if they are reminded of urgent demands imposed upon them by their own family of origin. However, BPDs identify with their suffering because excessive pain was often the only way they received attention and nurturing from a caregiver during childhood. Although BPDs may plead with others to resolve their suffering, they’re ultimately too afraid to let go of what they know best. In addition, BPDs will unconsciously use therapists to fulfill object-other roles that were denied in childhood (i.e., the emotionally available parent), or fantasies unattainable in adulthood (i.e., the ideal partner). Likewise, the therapist may capitulate for purposes of correcting former attachments gone awry in their own life, or to receive affirmations of caretaking competency. The chemistry of familiarity is a strange brew indeed.

Lookin’ for love in too many faces. — Johnny Lee

Subconscious transference by the Borderline and countertransference reactions by the therapist will undoubtedly emerge as sessions progress. Additional therapist-client intrigue can occur because of shared interests, family of origin similarities, and other forms of overidentification. Similarly, the intimate nature of therapy is magnified whenever working with Borderlines because of their intense need for nurturing and attachment (an infectious intensity). Communicating with BPDs is a bewildering lesson in psychological hermeneutics, and understanding what’s really being communicated requires a great deal of careful analysis. For example, idealization (aka “love bombing”) of the clinician is a splitting phenomenon with BPDs who become overly attached. Idealization is both a defense mechanism and a way to acquire positive mirroring. Not surprisingly, most therapists enjoy being admired for their efforts to provide emotional support, comfort, advice, and reassurance—regardless of the client’s tendentious proclamations. After all, therapists are human beings who have their own needs for validation in an otherwise thankless and emotionally grueling profession. Nonetheless, this “admiration” can have a trapdoor that includes eroticized transference (an intense, vivid, irrational erotic preoccupation with the therapist characterized by overt, seemingly ego-syntonic demands for love and sexual fulfillment that goes beyond normally expected expressions of erotic transference). This transference dynamic can intensify because the therapist is literally paid to pay attention to their client through empathic attunement and unconditional positive regard. Idealization can make a therapist feel valued, but it has no intrinsic value. If, for example, the therapist misinterprets the BPD’s idealization for genuine appreciation, a chain of events may result in the BPD’s desire to establish a corrective relationship. In such cases, the therapist may feel simultaneously drawn to the BPD’s desperate need for human connection and express malignant eroticized countertransference, especially if the therapist is not able to displace their own unconscious frustrations. Fantasies of “making up” for the client’s dismal past might happen if the therapist’s positive countertransference is not self-monitored with sufficient reality testing. As therapeutic dialogue resumes, the BPD’s need for acceptance will become increasingly problematic for therapists who are not noticing or managing countertransference reactions. Idealization transference from a BPD in therapy is an invitation for establishing an uninterrupted symbiotic connection. For the Borderline, caring is often conflated with demonstrations of intimacy. History shows that the human intellect is no match for the power of eros. It turns out that Freud was right after all.

Borderlines have a unique ability among mental health clients to uncover repressed aspects of the therapist’s self through systematic transference. Once the Kool-Aid of projective identification (to induce the other to become what is needed or disavowed) is properly ingested, the ability to maintain alterity (separation of identities) quickly evaporates. BPDs expect caregivers to meet them at their regressed level of psychological development, or else the caregiver is just another asshole like everybody else. And, to be sure, no caregiver wants to be thought of as an asshole. Therapists may become equally puerile, irrational, and impulsive as they attempt to appear more accessible, trustworthy, and convincing to the BPD via introjection (internalizing various aspects of the client’s values, feelings, and behaviors) and projective counteridentification (endorsing symbolic roles that the pwBPD avows or disavows via projective identification). Because Borderline’s are “identity thieves,” they seek to internalize the identity of their therapist while customizing this integration to fit their needs. The therapist, in essence, becomes whatever the BPD needs them to become in a transmogrifying maze of psychodrama-infused cosplay (un couple malade). For example, this equalization process can cause therapists to regress—literally losing themselves—in order to accommodate the BPD’s regression rather than maintaining a position of detached objectivity. It’s like host manipulation by parasite, replete with layers of rationalization that succumb to an emotionally charged form of subliminal programming. The therapist becomes the Borderline’s canvas, support structure, surrogate parent, and container for unbearable emotions. BPDs are hostages of their own impulsivity, but they have an incredible gift for sharing the voltage of those impulses with others. This dynamic has been described by some therapists as feeling “possessed” or invaded by their client. Once the critical sensibilities of the therapist are effectively neutralized, the Borderline ceases to become a subject of clinical observation. Likewise, the therapist may feel as if they’re under a hypnotic spell that resembles capture myopathy.

“The patient’s use of projective identification exerts subtle and powerful pressure on the analyst to fulfill the patient’s unconscious expectations that are embodied in these fantasies. Thus the impingement upon the analyst’s thinking, feelings, and actions is not an incidental side-effect of the patient’s projections, nor necessarily a manifestation of the analyst’s own conflicts and anxieties, but seems often to be an essential component in the effective use of projective identification by the patient. Therefore, a patient’s projective identification efforts are most likely to bring about some type of result if they affect the therapist. Often, if a patient feels that the therapist ignores these efforts, the patient may redouble them or may give up and try elsewhere, acting out in other relationships. The projective identification mechanism may bring the therapist in touch with core fantasies of a particular type of relationship that lives within the patient’s mental structure. The urge for the therapist is to become an active participant and act out the according feelings and behaviors,” writes Dr. M. Feldman. Similarly, the therapist may project whatever they want to believe about the client rather than scrupulously analyzing the incongruous reality of the client’s psyche. We are now reminded that the sleep of reason really does produce monsters. The psychic fusion of the client and therapist can rapidly morph into a tangled web of quid-pro-quo arrangements to quell the BPD’s urgency for devotion and to satiate their yearning for affection. Borderlines are extremely adept at attachment seeking, although they simultaneously mistrust those attachments (fear of abandonment is beset by fear of engulfment). The BPD’s libidinal intrusiveness via eroticized transference can present as disorienting for any therapist who is misinterpreting the BPD’s subconscious messaging. Borderline Personality Disorder could also be thought of as a psychosexual disorder that simultaneously craves and fears intimacy.

I’m not gonna be ignored. — Alex Forrest

Borderlines with secondary erotomania (de Clerambault’s Syndrome) can be exceptionally challenging to work with due to their extreme need for attachment; romantic ideation; obsession; aggression; invasiveness; delusions of persecution; and potential for violence. This condition, which conspicuously overlaps with BPD, was originally described by de Clerambault as having a phase of hope followed by a phase of resentment. Erotomanian is a relatively rare condition, and while the incidence is unknown, the lifetime prevalence of delusional disorder is 0.2%. Consequently, many psychiatrists do not encounter or may fail to recognize erotomania in their clinical practice. 

Erotomanic behavior may include the following:

  • obsession with someone who is considered an authority figure, celebrity, circumstantially unavailable, or of a higher social status
  • constantly sending letters, emails, or gifts to the other person
  • persistently making phone calls to the other person
  • stalking their target of obsession in person or online
  • being convinced that the other person is trying to secretly communicate through glances, gestures, or coded messages in the news, television shows, movies, or social media (aka ideas of reference)
  • paracosmic fantasy (viewing reality through a lens of complex fantasies and magical thinking unbeknownst to others) 
  • creating elaborate but false situations in which the other person is pursuing them, persecuting them, or trying to get in touch with them
  • feeling jealous due to a belief that the other person may be in contact with other “lovers” or may not be faithful
  • harassing the other person in public, sometimes to the point of being reprimanded or arrested by law enforcement
  • losing interest in activities other than talking about the other person or focusing on subject matter related to them

Classification of erotomania has always been object of debate. J. Reid Meloy formulated the hypothesis that there are two forms of erotomania: One traditional form, clinically accepted as delusional erotomania; and another “borderline” type in which there is no clear delusional disorder but rather where there is a major attachment or binding pathology colored by symptoms of continual pursuit and potential violence towards the erotomanic object. This second form of erotomania is characterized by its narcissistic, hysterical, paranoiac, and psychopathic traits. The degree of the disorder is determined by the discrepancy between the object’s emotional attachment to the erotomanic and the intensity of the erotomanic’s attachment to the object. For this type of erotomanic, relational intrusion is persistent and separation from their target is perceived as rejection and humiliation. This perception awakens rage-like feelings of abandonment that could result in chronic harassment, stalking, or death. The unexpected emergence of erotomania in a treatment setting can become extremely dangerous to the professional integrity and well-being of the therapist while developing a therapeutic alliance. Stalking is a pathology of attachment (Meloy, 1992), often driven by the force of fantasy (Person, 1995). In particular, erotomanic stalking is not amenable to reason and does not respond well to normal methods of deterrence (legal or otherwise). In the end, stalking is about power and control (emotional terrorism towards their target). Unfortunately, patients who become love obsessed with their mental health provider does occur due to the intimacy of therapeutic communication and the nature of therapeutic alliances. Clients who stalked therapists fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. According to Meloy, “Stalking motivated primarily by a personality disorder and fueled by abandonment rage will generally show a poor response to mental health interventions, especially if the subject is antisocial or worse, psychopathic. In the latter case, treatment should not be considered, since there is none, and aggressive prosecution is recommended to ensure lengthy segregation from their target. Most habitual criminals and obsessional followers are pathologically narcissistic and their intolerance of shame, defensive rage reactions, inability to grieve loss, and compensatory fantasies of entitlement and retaliation should not be forgotten. The abandonment rage fuels the subject’s pursuit, with an intent to devalue the object in real life, paradoxically restoring the subject’s narcissistic linking fantasy to the idealized object.” For the erotomanic, negative attention is better than no attention at all. It’s their psychotic melodrama, and your participation is not needed to perpetuate the obsession. Nonetheless, you’re at the mercy of an irrational, paranoid, and possessive mind. Risk assessment must precede client engagement because fixation becomes the erotomanic’s substitute for healthy human connection. If misinterpreted, the therapist may confuse the client’s attachment-driven psychopathology with the experience of establishing a unique emotional and personal connection that transcends the therapeutic framework. Delusional convictions can be as compelling to the therapist as they are to the client, especially if the beliefs are presented as minimally counterintuitive propositions. Aspects of the psychotherapeutic relationship can produce misunderstandings about the nature of the intimacy generated and about appropriate boundaries in this type of relationship. Empathy or assistance from an authority figure may be interpreted by the erotomanic as evidence of love without limits. Consequently, the therapist may feel both overwhelmed and aroused by the prospects of attending to such erotically charged inducements (i.e., falling in love with the idea of making the client feel loved). As a result, two people become infatuated with their transference-based narratives without really understanding the other person. Reality testing breaks down and the distinction between patient and therapist becomes obsolete. It’s a textbook example of folie à deux.

What the erotomanic desires, experts say, is an idealized romance that resembles a spiritual union. As noted in the book I Know You Really Love Me by Doreen Orion, M.D., “An abiding problem with managing these cases is the almost total lack of motivation for treatment. Those caught up in pathological love do not see themselves as ill, but as blessed with a romance whose only blemish is the tardiness of response in the beloved or the interference of third parties (often including the would-be therapist). The benefits of these disorders for the patient should not be forgotten, for they provide some solace for their loneliness, some support for their damaged self-esteem, and some purpose to their otherwise empty existence.” 

“The object of affection becomes an ink blot, a Rohrshach test,” says Stuart Fischoff, professor of psychology at California State University, Los Angeles. “Whatever the object of desire says, the delusional lover brings into it anything he or she wants.” In other words, it’s the erotomanic’s movie and your part is not fully revealed until the credits start rolling. Because erotomanics have an egocentric bias, they’re perpetually attributing unrelated information as personal messages from their object of attachment. No contact can be as problematic as occasional contact, because the search for signals (both positive and negative) keeps the erotomanic from feeling disconnected. In clinical training, therapists learn to put their patient’s welfare before their own, which makes it easy for them to underestimate or deny the potential for danger in certain situations. If the therapist hasn’t been burned alive by the BPD house fire, they may get chewed up in the erotomanic meat grinder.

Characteristic of erotomanics is la belle indifference, which explains
how they can profess to love their victims and yet remain so indifferent to
the pain they cause them (Zona, Palearea, & Lane, 1998). An erotomanic
almost always displays la belle indifference toward the suffering of their
victim, and the complete disruption in the victim’s life they have caused. In
this way, erotomanics are narcissistic in the true sense of the term; only the
suffering they have experienced at the hands of their capricious “lovers”
counts, because they believe, with all the unshakeable conviction of
delusional truth, that they are entitled to a relationship at any and all costs
to their victims (Orion, 1997).

You are special too, don’t lose yourself. — Ernest Hemingway

“Because of the centrality of projective identification in the experience of treating borderline patients, therapists often feel invaded and transformed into someone other than who they are. Attempting to resist this transformative process can be a formidable problem. Firm boundaries and reasonable limits will eventually reduce the patient’s infantile demands. When the therapist refuses to be the idealized, perfect parent, patients will ultimately learn that they must become their own mothers—the wish to fuse and be fed must be turned inward,” says Dr. Glen Gabbard. As Masterson (1976) noted, “Probably the single most difficult skill to acquire in psychotherapy of borderline patients is the ability to recognize and control one’s own identification with their projections.”

From an article in the Clinical Social Work Journal entitled The trainee and the borderline client: countertransference pitfalls: “Countertransference will be broadly defined as distorted thoughts, feelings, and attitudes toward the client, either consciously or unconsciously held. For the borderline client, the definition should be expanded to state that the countertransference is a response to the transference inspired behavior of the client. Borderline transference will be defined as a manifestation of the borderline psychopathology, which involves relating to the therapist as a tantalizing omnipotent, but potentially abandoning, parental stereotype. It is based on primitive object representations that are largely unavailable to the therapist. The transference contains magical expectations of infantile wish fulfillment that, if unwittingly encouraged, cause numerous problems for the therapist.” Rule of thumb: Never go full-transference gratification. The key to avoiding countertransference pitfalls is to recognize when countertransference is occurring. Enabling by accident can result in some very serious accidents.

We’re far from the shallows now. — Lady Gaga

Borderlines can pressure therapists into becoming “psychosocial saviors” if their purported tales of victimization and historical discrepancies are not thoroughly investigated. Fear and denial keep BPDs from having to do any emotional heavy lifting, so they become experts at deflection by reorganizing factual accounts to avoid personal responsibility or feelings of shame (experiential avoidance). As a result, therapists might feel responsible for doing more than they should if they’re swept away by the BPD’s anecdotes of adversity. Therapists are trained to be of service to those in need (public servitude), and Borderlines are experts at getting others to serve them. Unfortunately, much more will be expected than the therapist can provide because of the BPD’s lack of object constancy and inability to soothe themselves. In fact, the therapist could end up responding like everyone else in the BPD’s life—attending to the never-ending needs of a desperate foundling in search of a supportive audience. However, the more the therapist tries to “solve” these problems, the more difficult these problems become (the tar-baby dilemma). The therapist may unknowingly represent the most recent target in heavy rotation on the Borderline’s take-care-of-me carousel.

From the American Addiction Centers: “People with BPD have relationship issues with nearly everyone in their lives, and significant relationship issues will often develop with therapists as a result of the therapeutic process of change. The patient may first idolize the therapist and then later totally demonized them (splitting), or may attempt to manipulate different therapists against each other in order to manipulate the overall treatment. Professionals who treat people diagnosed with BPD must be aware of these potentialities and even expect them to occur. Unstable personal relationships within treatment itself as well as outside treatment contribute to the difficulty of helping these individuals adjust.” However, the limited time frame of therapy is not equipped to withstand such relentless permutations of interpersonal stratagem. As a consequence, the therapist may begin entertaining taboo fantasies of attending to the client’s psychosocial “emergencies” outside of a clinical context. Without maintaining boundaries, the therapist will no longer be able to maintain objectivity; without maintaining objectivity, the therapist will forever be trying to extinguish the BPD’s peripheral complaints instead of addressing the client’s core issues. Borderlines subconsciously manufacture their own misery, but they can make anyone who attempts to fix their problems even more miserable. Like a swiftwater first responder, the therapist will drift farther and farther down the gauntlet of BPD appeasement until the rescue raft of good intentions finally capsizes. The helping profession of psychotherapy encourages the development of a strong relationship to help the client, but it’s the professional aspect of the relationship that must be prioritized whenever working with Borderlines. In the BPD motorcade, the wheels of impulsivity are always out of brake fluid—it’s like having a hyperactive limbic system for an engine without access to a steering mechanism. If the therapist mistakenly hands over the car keys, the BPD will drive everyone off the nearest cliff with their busload of needs. Meanwhile, the therapist should prepare to be thrown under the bus whenever those “needs” are no longer being gratified. It’s the parable of the scorpion and the frog writ large.

Change begets change as much as repetition reinforces repetition. — Bill Drayton

Addressing the continuous demands of a Borderline is like experiencing The Myth of Sisyphus on methamphetamines; it’s utterly exhausting. There’s not enough coffee in the galaxy to keep up with a Borderline’s level of impulsive energy. BPDs will make six impossible demands before breakfast, but any effort to fulfill these demands will result in six more demands before lunch and dinner. The problem is that Borderlines largely identify with the drama of their problems, so any attempt at remediation threatens the BPD’s victim identity. Lacking in object permanence, there’s never enough words of reassurance or altruistic gestures to placate the BPD’s need for consolation—you might as well be sweeping a dirt road. In such circumstances, the therapist may find themselves making promises equivalent to the urgent demands of the BPD in an effort to reduce emotional reactivity; attenuate impatience; soothe anxiety; or to continue receiving encomiums as an intrepid caretaker. As this temerarious gambit commences, the pwBPD will invariably become more dependent on the therapist’s attempts to stabilize their emotional instability. Meanwhile, therapists may become “addicted” to eliciting positive changes in the BPD’s emotional state. The Borderline’s ability to reshape the therapist into becoming a more responsive caretaker provides an insurance policy for maintaining centrality. Predictably, therapists may feel professionally authenticated by gestures of lavish appreciation—willing to risk more and more for the sake of accommodating their client. Therapists who allow BPDs to take advantage of their generosity often have people-pleasing tendencies (therapy sometimes encourages dependency as a consequence of the power differential with clients who lack self-efficacy). It’s easy in these situations for therapists to feel revitalized by offering levels of emotional support and reassurance that are supposedly unavailable to their client in other contexts. After all, if positive psychology teaches us that finding a sense of meaning and engagement is curative, nothing could feel more meaningful for a caregiver than assisting a client who appears helpless and unambiguously appreciative. However, the BPD’s veneration of the therapist is always contingent on a continuation of appeasement within the therapist-client validation pyramid scheme. No matter how intoxicating validation feels during the ascending honeymoon period, the end result will invariably lead to emotional bankruptcy, disappointment, and rage. Although idealization is a potent dopamine generator, therapists should take precautions if they become the subject of excessive pedestalization. Borderlines and caretakers can become lock-and-key participants in a swamp of creeping co-dependence, but this indelicate union involves countless caveats. BPDs will use luminol to expose the bleeding hearts of anyone who is willing to be subservient to their emotional needs. Once the lifeblood of caregiving capitulation is located, Borderlines become merger-hungry hemovores of opportunism.

I went down, down, down and the flames went higher. — June Carter Cash

The therapist might regrettably believe that professional boundaries aren’t going to be effective in addressing this client’s needs. In fact, the therapist may have never encountered a client who is so oblivious to standard rules of engagement in a clinical setting (BPDs are often raised in households without any sense of boundaries). The word inappropriate is commonly used to describe BPD behavior, because Borderlines cannot relate to others in age-appropriate ways. If therapists feel intimidated by the client’s aggressive demeanor and infantile demands, a “Borderline Without Borders” situation will eventually consume the therapeutic frame. Additional fears of being perceived as uncaring or inaccessible during therapeutic interactions may cause therapists to feel guilty or inadequate. As a result, exceptions to standards of care are reluctantly made to keep their “special client” engaged (aka VIP syndrome). BPDs occupy a privileged position as mental health clients, because they often respond in treatment according to the whims of an unruly child while being granted the respect and legal rights of an adult. In some cases, therapists may feel as if they’re being negligent by upholding professional standards. Borderlines also have an aptitude for making others feel responsible for their feelings, and the gravity of this burden can turn some caregivers into deferential doormats. The BPD’s intense psychological pull has the capacity to draw therapists into their kaleidoscopic world of emotional mayhem. Furthermore, an erroneous belief may emerge that accommodation must dictate the direction of all future interactions. In other words, the rules of therapist-client engagement become secondary as the therapist is provoked by  confusion. In social circumstances, it’s advised to limit contact with those suffering from untreated personality disorders. However, therapists have no option but to engage with caution, or to initiate an appropriate referral. Subsequently, over-involved therapists may already be digging their own clinical grave sites. To be sure, Borderlines will defy boundaries without compunction while expecting therapists to suspend the reigns of professionalism when therapy is perceived to be uncomfortable or uncaring. BPDs can “play nice,” but only if you’re following their shifting rules and expectations. BPDs do not trust others because they couldn’t trust their parents and they can’t trust themselves. Most importantly, therapists must not let their objectivity become a slave to the Borderline’s subjectivity. If a boundary free zone is established, therapists should expect an escalation of efforts by the BPD to dominate the direction of all subsequent interactions. Whenever the floodgates of unconditional acceptance open up, Borderlines become Dionysian tornadoes bent on annihilating the Apollonian structures of psychotherapy. BPDs can be rewarding to work with if the therapist is trained to recognize such dynamics (aka red flags), but you must always be aware of the fine print. The only predictable variable when working with this population is unpredictability.

“This good and bad dichotomy plays out in the therapist’s office. The client may try to entice the therapist to gratify their dependency needs and the therapist may feel compelled to collude with client’s 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 them harshly and leave if they are too confrontational,” states Dr. Patricia Frisch.

Yeah, yeah, my shit’s fucked up; it has to happen to the best of us. — Warren Zevon

A veritable recipe for disaster also awaits if therapists are coping with issues of their own, such as compassion fatigue, major life transitions, marriage issues, family problems, work stress, anxiety, or depression. To be certain, there will come a time in every therapist’s career when their personal problems will match or surpass those of their clients. Improving the lives of others leaves little time to improve one’s own life, and working with a clandestine Borderline can be an insurmountable challenge if the therapist is not operating on all cylinders. Therapists must suppress their emotions due to the nature of their work, but this occupational necessity can make working with BPDs exponentially more problematic. Contrary to professional stereotypes, therapists are not emotionally impervious automatons. Therapists, by definition, are expected to be accepting, generous, patient, and supportive of their clients, but the process of therapy can be emotionally draining. Because BPDs relate to the world through a labyrinth of dysregulated emotions and unmet needs, the therapist must work even harder to manage theirs. As a reminder, the therapist’s own unresolved conflicts, family issues, relationship history, stressors, and personal problems will become magnified through transference-induced provocations whenever interacting with Borderlines. A reliable axis of balance for the therapist is required before being able to identify various degrees of imbalance in others. Likewise, losing one’s proverbial mind can sometimes occur as a byproduct of working with those who have already “lost” theirs (e.g., vicarious traumatization, compassion fatigue, and burnout). Therapists do not have all of the answers, but they’re often expected to provide a quick fix for clients who do not understand that therapy is a process. Borderline clients, in particular, have a way of pushing against the therapist’s limitations with their impatience. However, if a therapist defers to avoid conflict, therapy will become a meeting of the minds with two minds short. Burnout can also result in therapists trying to heal themselves by healing their clients. Desires to fix the client may trigger an unconscious motivation to fix the therapist’s own issues (remediation by proxy). Additional problems occur when a therapist in crisis begins to rely on comfort or support from their clients. Therapists must not allow social work to become their only social life. Elements that may cause burnout include: lack of control, unclear job expectations, dysfunctional dynamics, oppressive workplace, monotonous tasks, chaotic work environment, high workload, and work-life imbalance. Therapists need therapists too. Without proper self-care, the ability to care about the therapeutic process will eventually disintegrate. Being a repository for other people’s frustrations, unhappiness, and horror stories can make therapy a very stressful and lonely occupation.

Well-Functioning is defined as the enduring quality in the therapist’s professional functioning over time, and in the face of professional and personal stressors (Coster & Scwebel, 1997). Therapists have many factors to contend with in life and practice aside from the dynamics of working with borderline patients. The most common personal problems interfering with therapist well-functioning are emotional exhaustion and fatigue (Mahoney, 1997).

For the clinician, it may be just another day at the office; but for the Borderline, it’s about survival of the neediest. This is why ongoing supervision and consultation are essential, including a willingness by therapists to accept objective monitoring. In fast-paced clinical settings, there may be insufficient bandwidth for in-depth analysis of complicated psychiatric patients. Ongoing administration tasks and demanding clients can condition therapists to become multitasking fire extinguishers, and no client is better at building fires than a Borderline. The emotional exhaustion of caregiving is difficult enough without having to manage an emotionally unstable client. Therapists often feel frustrated by their inability to do more for their clients, and Borderline patients will further evoke a feeling of being restrained. BPDs can expose a therapist’s deepest insecurities while causing them to question themselves and their clinical competence. Without proper training for early identification and comprehensive management of BPD, therapists are potentially lost in an ocean of misapprehensions and clinical missteps. Working with a misdiagnosed Borderline is like conducting therapy in Plato’s Cave, because the client’s fractured identity will present itself as an ongoing mystery without consistency—it’s like trying to nail Jell-O to a wall. If the therapist is not cautious, the BPD’s regressive behavior will quickly capture the limelight (reason and logic are mortal enemies of the emotionally impaired). Consequently, the therapist may become a reluctant participant, or a willing accomplice, in the BPD’s quest for enmeshment. Soon thereafter, a bizarre array of rationalizations are incorporated by the therapist to maintain denial about their growing sense of fear, obligation, and guilt (FOG). Other responses may include confusion, pity, excitement, and fascination. Therapists spend their days trying to transform the lives of their clients, but Borderlines have a talent for transforming therapists. With BPDs, the Rogerian maxim should be carefully reconsidered with a strong dose of the conditional.

And you may ask yourself, am I right? Am I wrong? And you may say to yourself, ‘My God! What have I done?’ — David Bryne

Pervasive patterns of acting out conveniently thwart BPDs from exploring the origins of their neuroticism. As a result, they never learn to effectively cope with deep emotional wounds. Although dissociation and confabulation obviates emotional pain, it ultimately prevents self-reflection and results in more sensation-seeking behaviors. Borderlines, if they are anything, are invariably misunderstood by others. Similarly, they abhor personal criticism and do not appreciate humor at their expense (everything is personal). BPDs believe that other people must acknowledge their persistent feelings of emptiness and emotional suffering. It’s about their feelings, not yours. Borderlines understand the value of the squeaky wheel, but they’ve forgotten the parable of crying wolf. BPDs are not looking for solution-based therapy as much as they’re looking for reassurance, re-parenting, and collusion. Therapy with some clients is like trying to teach someone how to walk again, but a Borderline will become obsessed with the crutches. In addition, BPDs rely on others for advice that is seldom integrated in any meaningful sense (solution implementation is a problem for Borderlines due to active passivity). If the therapist is not careful, the inclination to violate boundaries to alleviate the Borderline’s unabated anxiety and desolation may occur.

“The ongoing temptation in the psychotherapy of borderline patients is to try to provide gratification for longings that cannot possibly be satisfied in a professional relationship. Indulging the patient’s wishes is a strategy bound to fail and also bound to engender regression by reinforcing infantile expectations, which will only intensify the patient’s eventual rage,” states Dr. Glen Gabbard.

Despite their age, Borderlines must be approached with adequate caution and consistent restrictions. Because of their emotional instability, immaturity, and inability to delay gratification, BPD propitiation is a mug’s game. BPDs prefer to outsource accountability for their behavior because it prevents the pain of self-reflection. The biggest mistake a therapist can make with a BPD is to interact with them as if they were rational adults with self-awareness and a reasonable sense of personal responsibility. No therapist wants to infantilize an adult client, but BPDs often require referees more than collaborators. As a defensive response, some therapists may become overly rigid or hostile (extreme negative countertransference) to compensate for the Borderline’s occasional temper tantrums. However, being too reserved or defensive could lead to accusations of being distant, cold, uncaring, or judgmental. This oleaginous tightrope is even more hazardous if the therapist is unaware that such boundary testing maneuvers are part of the BPD’s need for unambiguous acceptance. What initially felt like a once-in-a-lifetime clinical challenge could result in occupational suicide if accidentally mishandled.

But then you let me down, when I look around; baby, you just can’t be found. — Madonna

Borderlines often seek support from those with limited availability, because they anticipate abandonment in advance. But whenever their doomed attachment is disrupted, the object of love will quickly become the object of aversion. Borderlines view separation as betrayal, and perceived rejection by a caregiver will provoke abandonment rage. Without the availability of a compliant object for emotional support, the former idealization of the therapist magically evaporates as the BPD’s existential fear abandonment begins to surface. BPDs will search for malicious intent where none actually exists, and their primary mode of communicating disappointment is through reactionary rage. Without being able to control their conflicting emotions, vilification will quickly replace adoration. Sadly, the therapist has been conditioned by the warm glow of being considered an ideal caregiver. The emotionally starved and competitive Borderline wants love to be a possession, whereas the therapist has become lovesick in their pursuit of healing the client. BPD relationships alternate between gluttony and starvation; it’s all or nothing. Ironically, interacting with clients in crisis can initially feel invigorating for therapists. The rest of the world disappears as the caregiving lens focuses on rescuing the needy. However, the therapeutic lifeboat will invariably hit an iceberg of Borderline indignation before the caregiver finally comes to their senses. BPDs prefer continuous streams of validation and support instead of being challenged, and they’re remarkably proficient in achieving such ends. Any ambiguity in the BPD’s search for acceptance is terrifying, and the prospect of change is unbearable. Borderlines seek stability, reassurance, approval, safety, and unambiguous gestures of affection, but it ends up being at the expense of everyone around them. 

I am because my little dog knows me. — Gertrude Stein

I am because my little dog won’t leave me. — Borderline

According to Dr. Robert J. Gregory, “Persons with BPD have been noted to have a need for certainty and for complete understanding from others (Bateman, 1996; Shapiro, 1992). They employ a binary system of logic and attribution that excludes alternative perspectives that may create ambiguity. For example, they may tell their therapists, ‘If you really cared about me, then you would let me call more often. All you care about is your money.’ On the surface, the proposition appears logical and irrefutable. However, there is an underlying assumption that the therapist’s primary mission should be to care and nurture their patients like a mother. There is also an implied dichotomy or split in the perspective of the therapist as either totally caring and accommodative, or totally cold and callous. There is no room in such a polarized attribution system for a more ambiguous and realistic perspective of the therapist as having complex motivations, including some genuine caring for the patient, but within certain limits. What makes working with this population so difficult is the patient’s ability to provoke others into responding in a way that is consistent with the patient’s attributions and expectations. In other words, the patient expects others to behave in a certain way, and the therapist may feel compelled to behave in a way that is consistent with the patient’s expectations—an interpersonal process that has been called enactment. The confluence between the patient’s expectations of others and the actual behavior of the therapist results in reinforcing the patient’s expectations and the distorted attributions of self and other upon which those expectations are based. Therapists may have a difficult time discerning whether negative encounters with a patient resulted from the patient’s attributions and responses or from the therapist’s responses.”

Dr. Perry D. Hoffman, president and co-founder of the National Education Alliance for Borderline Personality Disorder, explained one of the defining aspects of the disorder: “It occurs in the context of relationships. Unlike other psychiatric diagnoses, if you put someone with schizophrenia on an island all by themselves, their mental illness would still be evident. If you put someone with BPD on an island, you wouldn’t necessarily see the symptoms—whatever happens, happens in the context of [interacting] with someone else.” Instead of becoming a storm chaser, it’s better for therapists to understand the nature of the storm.

I’ve waited hours for this; I’ve made myself so sick. — Robert Smith

Because Borderline Personality Disorder is essentially an attachment deficit disorder, the client’s approval-seeking behavior, neediness, and search for unconditional love is often insurmountable. However, overly attentive responses to the accumulating demands of BPDs will result in an unavoidable crash landing. The problem is that therapists have been issued the caregiving equivalent of a pilot’s license and will be held accountable for any loss in therapeutic altitude. To be sure, many support planes have disappeared while flying solo over the Borderline Triangle. However, if BPDs could rewind the flight recorder, and muster a modicum of objectivity, they would find themselves bombarding the analytic cabin space and taking over the control panel. Just as the therapist has misinterpreted their client’s tales of victimhood, the BPD will undoubtedly misinterpret the therapist’s efforts towards appeasement and feel betrayed if extraordinary caretaking promises aren’t kept. This potentially high-conflict personality can become extremely volatile if their chosen “protector” appears to have forsaken them on purpose. After all, the therapist has been providing a steady supply of validation, reassurance, and emotional support in a safe holding environment. Unprepared therapists will be marinating in a clawfoot tub of Cluster B bathwater before waking up to find themselves circling the drain. An emotional riptide in the Sea of BPD can quickly sweep therapists into shark-infested waters. If the Borderline’s sense of identity is experienced as being dependent upon a stabilizing other, the therapist has just abrogated the client’s recognition of self (it’s like denying refills on medication). The remediation of this disorder depends upon the availability and compassion others, but it’s also perpetuated by the availability and compassion of others. The therapist has unwittingly been serving as the BPD’s missing internal part, and now that part is wearing out. In the end, Borderlines will pull the rug of congeniality from underneath their caregivers whenever the support caboose goes off the rails (cessation trauma). The Borderline’s dichotomy of self will vacillate as the previously dependent victim quickly becomes the omnipotent avenger. With record-breaking speed, the former idealization of the therapist is replaced by a 180-degree devaluation phase. A critical threshold of stress has been reached and the Border-lion within has been unleashed. Uncomfortable feelings are not permissible, and the most negative and paranoid interpretation of events will be the BPD’s final interpretation. No catastrophe left behind. What was once an entirely “good” object is now a completely “bad” object (splitting), because there is no middle ground in the Borderline’s world of internalized object-representation. An overwhelming desire to feel safe again compels them to bifurcate people, messages, and situations into simple categories. BPDs consistently puts their needs at the forefront, so any sudden reduction in attention (aka narcissistic/borderline supply) will always end badly. If the therapist has formerly acquiesced to meet the needs of the Borderline, there must be an ulterior (sinister) motive. In fact, most BPDs don’t know how to interpret kindness because of the contingent “love” they experienced by their parents (i.e., rewards followed by punishment and vice versa). The Borderline’s performative paranoia is unavoidable in either direction. Unable to assimilate the complexities of interpersonal dynamics, the Borderline goes on the attack. The resulting devaluation will likely include displays of intense anger, resentment, blame, and retribution as their self-fulfilling prophecy of abandonment continues unabated. Most disturbingly, BPDs are unable to recognize the unreasonableness of their behavioral discharge before, during, or after such contentious interactions because they’re reacting in an altered-dissociative state. Shame is avoided by projection. Bad feelings are disowned by demonization of the other. What cannot be integrated must be eliminated. Destruction galvanizes the Borderline’s sense of power within chaos, and power is affirmation of their existence.

“Borderlines display a signature trait, poor observing ego, which is a dense denial of vital aspects of reality and irrationality to a degree that almost has to be seen to be believed,” says Dr. Daniel J. Zimmerman. Identity disturbance is evidenced by the BPD’s intense and tumultuous attachment to their love object. They yearn for affection, yet may eventually wish to destroy the love object, or significantly devalue the person’s life. The gratifying sensation of vengeance makes resentment feel justified as the “bad” parent is symbolically punished in a dramatic fort/da reenactment. In order to protect themselves from unbearable disappointment, the BPD will attempt to regain a sense of control over what they perceive to be an invalidating experience (impulsive BPD subtypes with high comorbidity are particularly prone towards destructive recrimination whenever enmeshment is threatened). The angry/impulsive child is experienced by the BPD’s intense rage that is rooted in childhood resentment for not receiving proper parental care. Borderlines must feel a sense of control over others, but they’re easily capable of destroying what they cannot control. The beauty of experience is reduced to a competition for supremacy.

“The spoiler child refuses to grow up, remains dependent in some way on the parent or a parent surrogate, and ruins and/or denigrates everything the parents try to do for them,” states Dr. David M. Allen. “The spoiler role is difficult to maintain, so the child needs to continually practice it with other people. The usual candidates for them to practice on are lovers, spouses, and of course therapists. No one else will continue to put up with them.” The phrase no good deed goes unpunished has come home to roost.

The end may justify the means, as long as there is something that justifies the end. — Leon Trotsky

Borderlines can ingeniously reframe events for advantageous purposes, but retrospective discrepancy identification will separate what is true from what is exaggerated or false. BPDs are poor historians, because the past is written on the pages of their emotions. Facts are replaced by feelings. The arc of chronology is contested by the Borderline’s perceptual distortions in such a way that removes fault on their behalf. Confronting and coping with feelings of shame is not going to happen on the BPD’s dysregulated watch. Part of this disorder is the person’s inability to see their obsession with control and emotional reasoning as disordered. For the Borderline, what feels right must be right! BPDs seek immediate emotional relief, even if their behavior is irrational, impulsive, and consequential. Borderlines do not see their part in causing or contributing to their own problems, because admitting such agency would require an uncomfortable awareness of unresolved emotional wounds. Likewise, BPDs believe that most of their problems in life are external, because they cannot sit with themselves long enough to accept what they’re running away from.

Therapists may ignite a codependent wildfire by soothing the Borderline’s emotional flames—transforming themselves into volunteer firefighters searching for the next batch of smoke, rather than carefully analyzing their client’s thought processes and behaviors. Doing too much for BPDs inevitably results in doing unintended harm, because Borderlines don’t know what’s best for them. Remember, BPDs are living in a state of arrested development and can overreact like an unmanageable toddler whenever confronted with challenging situations due to low frustration tolerance. BPDs see the world in terms of love and war, because there are no shades of grey on the Cluster B color wheel. Likewise, if the therapist is unaware that a Borderline is “acting out,” they may put themselves in the impossible position of becoming the client’s designated babysitter (parentification of the provider). However, re-parenting is an impossible task for caretakers. Like immature children, BPDs do not recognize the line of demarcation where their needs stop and another person’s needs begin. Assuming that Borderlines are receptive to rational compromise is another erroneous assumption. Normalizing the abnormal, however tempting, is the most precarious decision a mental health clinician can make. Professional integrity depends on recognizing the parameters necessary for self-preservation.

“Psychoanalysts view borderline personality as arising from failure by the patient’s mother to foster coherent differentiation between self and object in the first 18 months of life, leading to the development of pathologic ego defenses. The patient does not learn to tolerate negative affects associated with separation; this continues the child’s clinging into adulthood, as if others were desperately needed parts of the self. Sexuality and dependency are confused with aggression. Needs are experienced as rage. Long-term relationships disintegrate because of an inability to find optimal interpersonal distance. Because of inadequate ego mechanisms of defense, there is little ability to master painful feelings or to channel needs or aggression into creative outlets. The patient has a fragmented mental picture of the self and views others as all bad and simultaneously all potent, a chaotic mixture of shameful and grandiose images,” states Dr. James E Groves.

There’ll be someone else where you used to be; the world don’t care and yet it clings to me. — Tom Waits

By using whatever means available, the focus of all future concerns will be relocated to the Borderline’s elaborate amphitheater of victimhood, thereby disabling all possibility of self-reflection and accountability. Misfortune solicits sympathy from others, no matter how much of this misery has been internally manufactured. In a Borderline’s binary mind, you’re either for them or you’re against them. The BPD’s desperate longing to use the therapist for positive mirroring has now created an unexpected house of mirrors effect. It’s a peculiar gambit that occurs unconsciously for the Borderline: “I have successfully transformed you to serve my needs, but I will now use this transformation against you for rejecting me.” An old country song creeps into the frame: I turned the tables on you, now I’m eating your food. The script has been flipped and DARVO (deny, attack, and reverse victim and offender) is the new standard. The Karpman Drama Triangle has been played out by two participants on auto-repeat until the rescuer could no longer afford the electricity bill. Unfortunately, the very act of rescuing a Borderline reinforces their early experiences of abuse. Parental neglect becomes inevitable when the rescuer fails to match the BPD’s benchmark of idealization. Keeping up with a Borderline’s endless search for emotional satisfaction is impossible, and making customized adjustments to fulfill these unwavering desires only facilitates their regression. It’s like trying to simultaneously de-escalate and outrun a cheetah. The therapist, no matter how personally compromised, ethically unmoored, or professionally misguided, will eventually be considered part of a syndicated rejection conspiracy. Borderlines own copyrights on the phrase: It’s you, not me. What was once an ideal caregiver for the clinging child has been cast down as an untrustworthy demon who must be annihilated by the punitive parent (talionic revenge). The “omnipotent” therapist has now become the personification of everyone who has previously disappointed and abandoned the Borderline. As intensified rage propels the BPD down a seek-and-destroy warpath, the chances for conflict resolution are nil (some Borderline’s internalize their rage rather than externalize). The Borderline’s polarized thinking, projection, inappropriate anger, dissociation, paranoia, amnesia, and capacity for revisionism are the perfect building materials for constructing a gaslit firewall to make sure that accountability will always be a one-way street. Confabulation prevents mortification. Deny and project; rinse and repeat. In the Borderline’s extensive collection of defensive battle maneuvers, there is none more famous than blame-shifting. If the BPD can’t change the environment, they’ll blame the environment. Disappointment will not be tolerated, and blame-shifting quickly erases feelings of shame, guilt, and humiliation. If the therapist fails to meet such impossible standards of care, the BPD may lash out with the ferocity of a wild animal as panic and dissociative rage pushes them into the collapsed realm of F2 psychopathy. Someone unrecognizable has emerged. Who is this person? How could the paragon of love so quickly become the personification of hate? But that other person was always lurking beneath the surface. The Borderline’s unhinged reactivity serves to protect their fragile ego, but it also exposes it. Retaliatory fantasies often become a reality whenever reality comes crashing down on the Borderline. The emotionally helpless becomes an emotional terrorist. Paradoxically, BPDs often feel embarrassed and conflicted about these extreme reactions after their dissociative fury finally subsides. For some Borderlines, their psychotic dissociation is so intense that they literally black out from rage. Borderlines sabotage the things they want most in life because they believe that it’s the responsibility of others to satisfy their emotional needs and to make them feel complete as a person—a job that cannot be sustained by anyone. For Cluster Bs to consider: threatening someone to love you is probably not the best strategy for long-term relationship success. For clinicians to consider: allowing yourself to become a human punching bag will result in your own need for trauma therapy. It’s not enough for the BPD to be discouraged by unfulfilled expectations, such disappointment means that they must spread this surplus of misfortune to their object of opprobrium. It’s a heads I win, tails you lose situation. Unreasonably impatient in their wishes for emotional fulfillment, a familiar pattern is predictably repeated. For the Borderline, the mistakes and limitations of others are intentionally designed to cause them pain. After all, it’s what they’ve learned from childhood (no one cares; love is a cruel illusion; people cannot be trusted; and the world is a dangerous place). Squaring the circle of BPD determinism doesn’t make the circumference any less destructive.

I was a peripheral visionary. I could see the future, but only way off to the side. — Steven Wright

What was once believed to be legitimate desperation during a crisis is now seen as pervasive patterns of dependence (a continuation of learned helplessness). What was formerly considered to be justifiable anger derived from victimization can now be interpreted as manifestations of low distress tolerance, repetition compulsion, separation anxiety, morbid jealousy, and emotional reactivity. What appeared to be moments of confidence, assertiveness, and intellectually justified defiance can now be understood as compensatory grandiosity, aggression, and a lack of boundaries. Displays of youthful exuberance, offset by periods of terrifying tantrums, have been identified as forms of age regression and emotional instability. What was once thought to be situational anxiety is now understood to be a combination of fear, insecurity, and paranoia. Demands for validation and intimacy have been providing cover for an overwhelming fear of abandonment. An inability to recognize the needs and limitations of others is now exposed as solipsism due to inadequate mentalization. Unpredictable mood shifts and impulsivity are retrospectively linked to the client’s perceived levels of gratification or disappointment during interactions with significant others. Idealization and devaluation are explained by the client’s Manichean mindset and zero-sum approach to interpersonal relationships. People and situations are rearranged to fit the emotional reasoning of the Borderline in order to regain a sense of safety and control.

Borderlines tend to remember others based on their last encounter: The Great Moment of Disappointment. Everything that was previously done to indulge the BPD’s demands for special consideration and availability will suddenly be forgotten (emotional memory blocking), because holistic integration of interpersonal experiences do not register for this all-or-nothing competitor. The therapist has been serving as the Borderline’s stabilizing crutch, and removal of that crutch exposes a painful disability. Exposure = death of the false self. If the person suffering from BPD has a “high splash” response when triggered by fear and frustration, there will be hell to pay. To be sure, the formerly cherished caregiver will be left holding the tab for the ensuing damages. The BPD’s hypervigilant surveillance system obsessively scans for potential insults, slights, disagreements, and signs of rejection to maintain a self-fulfilling panorama of paranoia. Everything is personal, and they’ll interpret any inconvenience or change of plans as a form of calculated abandonment. The slightest mistake will be interpreted as a global catastrophe. Deflection and projection. Impulse and emotion. Passion and punishment. BPDs do not have the ego strength or maturity for compromise, and their tenuous image cannot endure mortification. Distortion campaigns, false accusations, harassment, and other acts of obsessive revenge may follow (sometimes months or years after contact has ended). There are no limits to what can happen when a BPD’s narcissistic supply is cut off. To be fair, Borderlines aren’t aware that such irrationality and destructive overreactions are primitive defense mechanisms to avoid feelings of low self-worth, shame, and abandonment that were formed during early childhood. And, to be clinically concise, the therapist has royally screwed things up because of an initial failure to see the forest for the trees. A series of clinical mistakes has resulted in a series of personal mistakes. The therapist’s professional miscalculations and deficiencies cannot be whitewashed, but one should always expect the unexpected whenever working closely with Borderlines.

“The Brutal Clock is a variation of the Brutal Test where the Borderline sets up impossible expectations of others. When others are unable to meet these unreasonable expectations, they are punished with emotional abuse, which is justified by the Borderline’s sense of being the victim because they did not get what they wanted,” states Dr. Daniel S. Lobel.

A final question remains: Are the Borderline’s cataclysmic reactions to real or imagined abandonment intentional? No, not in any normal sense (some exceptions involve high comorbidity with features of malignant narcissism, sadism, and Machiavellianism—the dark triad). Of course, various degrees of sociopathy are to be expected among all Cluster B disorders. In addition, there’s undoubtedly a segment of previously diagnosed Borderlines who rely on their diagnosis to justify selfish and destructive behavior, but their motivations would be difficult to determine with any accuracy. For the most part, BPDs are hard-wired to impulsively think and behave in ways that will allow them to get their immediate needs met. So, it could be said that Borderlines intend to get their needs met, but their thought processes are mostly subconscious and their behavior is automatic. Emotional reactivity isn’t privy to the concept of courtesy or having consideration for long-term consequences. Most Borderlines have low distress tolerance, but some BPDs have no distress tolerance. Another Borderline paradox: BPDs live in a state of distress; identify with distress; expect distress; create distress; but they cannot cope with distress. As a general rule, the survival of the Borderline will overrule the survival of anyone who gets in their way. Disproportionate reactions to perceived threats often result in destruction without compunction. You will be punished for not maintaining your role in the Cluster B’s theater of reckless self-interest. But don’t take it personally, it’s just Borderline business. However, the incalculable damage left in the wake of their rage will feel very personal. Hurricanes can destroy lives, because natural disasters do not have self-awareness, restraint, or consideration for others. To be sure, Borderlines are the heavyweight champions of emotional storm systems.

The long-awaited one has come; I ask nothing more of the sea. — Madame Butterfly

A musical analogy for therapy-client relations gone wrong with a Borderline is the ebb and flow of symphonic development. In other words, the therapist’s efforts to appease the BPD were constructed from evolving variations on a simple motif: You are worthy of being loved. Unfortunately, “proof of love” for the Borderline is contingent upon reassurance, unrealistic expectations, and commanding the will of the therapist to avoid abandonment. However, the tempo of the second movement is similar to that of the first, but subtle changes in dynamism make it more emotionally complicated than it may at first appear. The evolution of this unsustainable saga results in a rapid crescendo of dramatic fusion during the third movement towards an ecstatic final stanza. The orchestra returns to the call and response motif before a final postlude in the fourth movement—descending from the fifth to the third while the ensemble moves stepwise downward in sixths. As with therapy, it is never a single decision, but a series of misguided steps that move incrementally before resulting in a complex web of enmeshment that has to be unraveled as painstakingly as it developed. Unfortunately, the Borderline demands loyalty and insists on maintaining the emotional intensity of the third movement. If the magnitude of the emotional bond is not maintained, the performer (therapist) will be punished by the BPD who feels immense anger for the abandonment of such a quixotic attachment. The therapist, who unfortunately became a volunteer performer in the Borderline’s theatrical search for true devotion, forfeited the conductor’s role of mediating between order and chaos. As a result, the therapist has unwittingly usurped the structure of the compositional (therapeutic) framework, and the disheartened BPD has unleashed a cyclone of emotional turmoil throughout the concert hall. 

*It’s important to respect your rhythm instead of trying to keep up with the tempo of a Borderline. It’s also better for therapists to concentrate on reducing the BPD’s beats per minute rather than meeting them halfway, or becoming swept away by the impulsive “speed of need.” Keeping pace with Cluster B time is unsustainable (it’s the accelerated rhythm of hypervigilence), and the frenetic pulse will burn out even the most measured of metronomes. Borderline entrainment is a fast-moving train, and it’s best for therapists not to leave the station. 

Assumptions held by BPD sufferers (according to bpdcentral.com):

  • I must be loved by all the important people in my life at all times or else I am worthless. I must be completely competent in all ways to be a worthwhile person.
  • Some people are good and everything about them is perfect. Other people are thoroughly bad and should be severely blamed and punished for it.
  • My feelings are always caused by external events. I have no control over my emotions or the things I do in reaction to them.
  • Nobody cares about me as much as I care about them, so I always lose everyone I care about—despite the desperate things I try to do to stop them from leaving me.
  • If someone treats me badly, then I become bad.
  • When I am alone, I become nobody and nothing.
  • I will be happy only when I can find an all-giving, perfect person to love me and take care of me no matter what.
  • But if someone who is “perfect” loves me, then something must be wrong with them.
  • I can’t stand the frustration that I feel when I need something from someone and I can’t get it. I’ve got to do something to make it go away.

Absence is a house so vast that inside you will pass through its walls and hang pictures on the air. — Pablo Neruda

At the end of the abandonment rainbow, the disillusioned Borderline will be encouraged by their sympathetic allies to collect misadventure points while reclaiming victimization. However, the clinician will suffer a much greater loss because professional boundaries were not clarified before sauntering into such a formidable therapeutic landscape. The path by which any therapist deviates from protocol can be retraced, fittingly, by understanding how mysterious the realm of human psychology can be during such unorthodox encounters. Clients with characterological disorders can elicit out-of-character responses in their clinicians. All therapists have professional blind spots, biases, and personal weaknesses, but there is perhaps no client better at uncovering those blemishes than a Borderline. Many BPDs are searching for the ultimate caregiver to remove intolerable feelings of pain leftover from childhood wounds, and they will go to great lengths to make this fantasy become a reality. For historical clarity, the distinction between pervasive patterns of behavior versus circumstantial aberrations must be identified for all participants.

“We often think of boundary violations and therapist misconduct as being malevolent in nature,” Dr. Bryant Welch writes. “But with a borderline patient a therapist can get into trouble by virtue of his or her wish to help and have a therapeutic effect. Under enormous pressure to prove he or she ‘really cares,’ the therapist is either going to cross boundaries and/or ‘withhold,’ thus becoming a ‘bad object.’ The grounds are fertile for BPD rage and disappointment in either direction.” Disambiguation: Enabling by accident can result in some serious clinical accidents.

Creative rationalizations can emerge in direct proportion to the Borderline’s increasing demands for validation and reassurance. To add insult to injury, it’s embarrassing for any therapist to admit that they’ve become emotionally ensnared with a client as a result of communication errors, clinical misunderstandings, and insufficient boundaries. Like a surgeon who encounters complications in the operating room, the very act of trying to remove a person’s suffering can sometimes exacerbate it. Many therapists have too much pride in their abilities to call for backup, but backing out of Borderline Boulevard is never an easy ride. There will be damage. Replacing the parts as they break (aka fixing the symptoms) will never repair an engine that needs to be rebuilt from scratch. The German language contains a splendid word to describe this type of regret-ridden hindsight: Treppenwitz (a devastating rejoinder thought of only after leaving the bottom of the staircase). No matter how rewarding the process of problem solving may feel for caregivers, taking extraordinary risks to accommodate the client’s needs is not the same as encouraging the client to establish their own sense of emotional equanimity and independence. Becoming too involved with someone who self-sabotages in relationships is itself a form of self-sabotage.

Forgiveness is the fragrance that the violet sheds on the heel that has crushed it. — Samuel Clemens

Specialized training programs to diagnose and facilitate the effective management of BPDs should be mandatory as a preventive measure to avoid Type II errors in assessment. Respecting commonly understood boundaries among consenting adults is usually taken for granted, but it’s not always guaranteed during emotionally complicated and confusing clinical encounters. It’s up to the therapist to understand the importance of defining clear limits at the beginning of therapy while being intrepid and assertive in the face of aggressive boundary testing. Recognizing clinical shortcomings; admitting personal issues; seeking consultation; and following ethical guidelines will ensure a professional relationship for the sake of everyone’s well-being. Similarly, it’s up to the Borderline to courageously work on developing insight by understanding how a lifetime of dependency and defensive reactivity have prevented accountability and developmental growth. In cases involving ineffectual therapeutic dyads, understanding what went wrong should be given far more significance than determining the correct calculus of blame. We are all products of our genes and our environment. No matter how hard we try to escape our past, we can never fully escape our vulnerabilities. Motivated by misapprehensions and a desire to indulge the client’s desperate need for human connection, the therapist became an enabler rather than remaining a professional guide. When working with well-documented BPDs, analyzing should never yield to appeasement; confronting should never yield to catering; and challenging should never yield to capitulation. When working with an undiagnosed or misdiagnosed Borderline, good luck trekking through those enigmatic eggshells (armchair deductions writ large). Ultimately, therapists who are committed to pleasing others need to practice saying “no” whenever the client’s pressure becomes overwhelming. In other words, BPDs will not respect a therapist’s sacrifices; they will learn to expect them. Clinicians who work with Borderline patients must have an extensive knowledge of this disorder; adequate experience working with this disorder; and an actual desire to treat those suffering from this disorder. 

“Working with patients suffering from borderline personality disorder begins with an acceptance that they live in an immature psychological world, fueled by certain constitutional vulnerabilities, where they attempt to shield themselves from conflict and anxiety by splitting the world into all good and all bad. Although this produces an illusory sense of psychological safety, in fact, it renders relationships fragile and chaotic and drives away the very people who are so badly needed to stabilize the patient,” states Dr. Marcia Goin.

Now that my ladder’s gone, I must lie down where all the ladders start, in the foul rag and bone shop of the heart. — W.B. Yeats

For better or worse, the therapist will realize that being a caretaker, despite the best of intentions, cannot include the responsibilities of completely taking care of someone. The three Cs need to be reviewed: The therapist did not Cause it; the therapist cannot Control it; and the therapist cannot Cure it. Consolation should be the fourth C, and it is never enough for a Borderline. Becoming a surrogate parent, unfaltering friend, love object, support structure, or omnipotent rescuer to save someone from a lifetime of dysphoria and loneliness is a recipe for disaster. There is no pier strong enough to stabilize The Great Ship of Desperation. The therapist will need a bigger life vest to endure the Borderline’s self-generated waves of anxiety. No single individual can successfully meet all of the emotional and physical needs of another. Being emotionally supportive and empathic should never drift into the realm of everlasting availability. Likewise, clients should be discouraged from providing transference-based gratification to their caregivers by association. The ephemeral anodyne of validation may satisfy desires for human connection on both sides of the couch, but therapists may never find their way back home once the process of BPD pacification begins. If a clinician falls off the Cluster B tree during the therapeutic process, they’re likely to hit every countertransference branch on the way down. Codependent quicksand is a formidable force.

*There’s much debate regarding the term codependency and the popular idea that all individuals who accommodate or enable a person with Borderline Personality Disorder are essentially “codependents.” Codependency being defined as excessive emotional or psychological reliance on a partner, typically one who requires support on account of an illness or addiction. However, “Codependent Personality” is not recognized in the DSM, because codependency is considered a non-clinical psychological construct. Furthermore, human psychology is a soft science that does not allow for all statements, or any declaration that demands 100% certainty—to suggest otherwise would be committing the fallacy of illicit transference. Although a common pairing in borderline relationships includes partners with Narcissistic Personality Disorder and nominal codependents, there are plenty of healthier-minded individuals who find themselves caught up in borderline relationships before understanding anything about the disorder (often several years after the relationship has ended; sometimes never). In many cases, the partner of a Borderline has tried everything at their disposal to make the relationship work until a combination of confusion, frustration, exhaustion, and unexpected consequences forces a contentious separation. Perhaps this is testimony to a partner’s patience, compassion, commitment, and resilience rather than a tendency towards codependency. Interpreting and managing a Borderline’s unpredictable moods, while simultaneously attempting to solve the riddle of object inconstancy, would be highly counterintuitive and difficult for anyone. In fact, the BPD’s emotional reasoning and need for reassurance are the primary sparks that ignite the codependency powder keg. Many individuals stay locked into these relationships because Borderlines will assert, in no uncertain terms, that their partner has the cure for what ails them (aka love and support). These assertions can be so compelling that their partner will work even harder to “do better.” Furthermore, a delayed onset of traits can appear long after the relationship has been consolidated by cohabitation or marriage. Besides, most couples rationalize red flags when intoxicated by the early stages of companionship, and no one is immune to making interpretive mistakes about another person’s character (intermittent positive reinforcement is a powerful incentive that offsets the initial confusion caused by Borderline splitting). Hope is a helluva drug. There must be a distinction between codependency as a toxic predisposition and codependence as an emergent behavioral dynamic that occurs during the process of communication and negotiation with a person suffering from Borderline Personality Disorder, or any other Cluster B pathology. Just as there are people who possess borderline traits, but do not meet full criteria for the disorder, there are also people who exhibit codependent traits (high sensitivity, self-sacrifice, and empathy) without being considered lifetime codependents. However, a person who continues having relationships with pathological individuals may meet criteria for Dependent Personality Disorder. It should be recognized that Borderlines also share traits of Dependent Personality Disorder because of their core insecurities and emotional dependency (for this reason, they’re also vulnerable to being taken advantage of in relationships—especially with narcissistic or psychopathic partners). Any behavior that occurs in relation to others should be evaluated on a spectrum. That being said, adult children of a Cluster B parent are far more likely to become subconsciously attracted to and enmeshed with someone suffering from Borderline Personality Disorder. Atavistic familiarity is the most consequential vulnerability for those individuals who come from traumatized families. Trauma bonds do not make good investment bonds.

Borderlines presume that they will be abandoned, and then act in a manner that makes such abandonment virtually certain. — Jordan Peterson

What’s interesting about Borderline Personality Disorder is that it represents a subset of pathologies that can upend therapy as a result of trying to effectively respond to it. Very few disorders have the power to expose a caregiver’s gullibility and naïve optimism like Borderline Personality Disorder. Therapists must be very grounded in their personal lives to withstand the strenuous provocations involved with BPD psychodynamics. Those suffering from Cluster B disorders unconsciously exploit the compassion of others, because they’re starving for special recognition. As with all Borderline relationships, there are only three options for therapists to consider: Avoid, challenge, or appease. For any progress to occur, these clients need be challenged rather than appeased; however, BPDs don’t like being challenged because introspection and change is seen as evidence of their imperfections. Furthermore, the power of love is only powerful if the BPD can learn to love themselves while acknowledging the limitations and imperfections of others. It’s not that Borderlines are irredeemably “bad” people, or fundamentally unworthy of love; rather, they’re completely baffled by the give-and-take dynamics required for healthy relationships. They confuse their inner experiences with the outer world until the two inevitably collide. Assuming that everyone will abandon them, there is no room for negotiation or compromise. To be clear, BPDs would benefit immensely from stable companionship, but they must first develop the skills that allow for individuation, fear reduction, anger management, self-acceptance, and self-regulation. Therein lies the great Borderline paradox: Part of the solution to a Borderline’s suffering is the availability of a stable relationship, but part of the reason why this disorder persists is because of how they behave in relationships. Granted, relationships aren’t easy for anyone. Borderlines split in relationships in the same way that therapists split regarding their opinions about those suffering from this counterintuitive, misunderstood, and stigmatized disorder. Nonetheless, silver linings must exist for both the client and the therapist if meaningful insights are to be realized after such emotionally charged imbroglios. In hindsight, the message and value of compassion should not be determined by the origins or magnitude of our fragility.

We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time. — T.S. Eliot

In summation, the therapist was flummoxed by the Borderline’s victim identity, false self, emotional reasoning, and incomparable powers of projective identification when the therapeutic relationship was in its infancy. An underestimation of the BPD’s psychic disturbance resulted in depathologizing what was clearly pathological. An erroneous confirmation bias was tenaciously defended, and the therapist allowed their own emotions to undermine the protective protocols of professionalism with an emotionally unstable client. Instead of detaching and observing, the therapist has absorbed, deferred, and enabled—thereby becoming an enmeshed participant in the client’s internal fantasy structure. Subsequently, the therapist’s shield of reason was systematically broken down by the BPD’s intense fear of abandonment and demands for excessive emotional support. What was easily recognized in the Borderline’s family of origin was completely unrecognized in the client until it was too late. Something that should have been ruled out was regrettably overlooked, and the therapist-client enmeshment has taken its tragic toll. The appeasement to this type of mindset was partially preconditioned by the therapist’s own upbringing. This uncanny familiarity comes from a complicated dance that was set in motion many years before the clinician and client finally met on that fateful therapeutic stage.

Life can only be understood backwards; but it must be lived forwards. — Kierkegaard

Exploring adverse childhood experiences to understand how our family history conditions us in adulthood is what matters in the end. Embedded memories from interacting with our families of origin are reactivated for all participants during every therapy session. Many therapists are unable to identify the innumerable faces of transference, or successfully recognize and manage their own countertransference. Likewise, their clients are equally unaware of the influential depth that these symbolic-based forms of communication have on their own psychological motivations. Countertransference is the Achilles heel for therapists who become too personally invested in establishing meaningful relationships with their clients. A good question for therapists to consider is why they chose to work in the profession of caregiving to being with. For many, it could be related to the power of human connection; the virtue of compassion; the alleviation of suffering; and not wanting others to feel alone in their experiences. Most would agree that these values embody the essence of effective altruism. But can such aspirations become problematic? Are there exceptions to unconditional acceptance? Some clients require impossible standards of care that can only be assuaged by learning how to love and care for themselves. A therapist should never abandon their professional identity to alleviate a Borderline’s fear of abandonment. As a final caveat, be careful what you care about.

There are two tragedies in life. One is to lose your heart’s desire. The other is to gain it. — George Bernard Shaw

Borderline Personality Disorder is perhaps the greatest paradox in the Analects of human psychology. It’s a disorder that craves love, but it doesn’t understand the meaning of mature love. It’s a disorder that seeks relationships, but it doesn’t grasp the dynamics and limits of healthy relationships. It’s a disorder that yearns for proximity, but it doesn’t trust the sincerity of anyone who gets too close. It’s a disorder that begs others to experience its suffering, but it cannot see that this is the very reason why it continues to suffer. It’s a disorder that desperately seeks transfiguration from the outside, but it doesn’t realize that transformation comes from within. It’s an existential insecurity that cannot believe in the power of accepting itself, because it was not accepted when it began. It’s an anachronism desperately searching for the ideal resolution. 

And your long-time curse hurts, but what’s worse
Is this pain in here
I can’t stay in here
Ain’t it clear?
That I just don’t fit
Yes, I believe it’s time for us to quit. — Bob Dylan

Stacking a house of unstable cards is naturally going to collapse if you don’t understand the true nature of what you’re stacked up against. Therapists who prematurely fold their boundaries in the face of something they don’t understand will lose the game every time. Betting against a Borderline’s nature is impossible, because they can always read the hand of accommodation that you’re holding. Even when the mysteries of chaos are finally revealed, the embers from that raging Queen of Hearts will continue to burn.

This should have been a noble creature:
A goodly frame of glorious elements,
Had they been wisely mingled; as it is,
It is an awful chaos—light and darkness,
And mind and dust, and passions and pure thoughts,
Mix’d, and contending without end or order,
All dormant or destructive. — Lord Byron

For more information:

https://www.bpdglobal.com/about/bpd-explained/

Borderline Personality Disorder

Click to access 4Linda%20Baird,%20Childhood%20Trauma2.pdf

https://www.borderlinedisorders.com/public.php

Warning Signs And Complications Of Borderline Personality Disorder

https://www.psychologytoday.com/us/articles/201309/the-chaos-borderline-personality-disorder-can-cause

https://digitalcommons.pcom.edu/cgi/viewcontent.cgi?article=1064&context=psychology_dissertations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342993/

https://www.medicalnewstoday.com/articles/327098

https://www.verywellmind.com/borderline-personality-disorder-symptoms-425175

Borderline Personality and Abuse

https://www.penguinrandomhouse.ca/books/553315/5-types-of-people-who-can-ruin-your-life-by-bill-eddy-lcsw-esq/9780143131366/excerpt

Psychology Today: Borderline Personality and Custody

https://www.psychologytoday.com/us/blog/toxic-relationships/201909/the-drama-loving-borderline

http://www.bpdcentral.com/blog/?Distorted-Beliefs-and-Attitudes-of-People-with-Borderline-Disorder-42

Relationships and Borderline Personality Disorder

https://www.verywellmind.com/bpd-and-misdiagnosis-425176

https://www.bpdfamily.com/content/how-borderline-relationship-evolves

https://www.mysideofthecouch.com/blogs/why-is-setting-boundaries-with-a-person-with-borderline-personality-disorder-bpd-so-difficult

https://www.researchgate.net/publication/268232962_Sexual_Feelings_Toward_the_Therapist_Among_Patients_with_Borderline_Personality_Disorder_A_Case_of_Erotomanic_Delusional_Disorder

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857277/

https://www.psychologytoday.com/us/blog/5-types-people-who-can-ruin-your-life/201710/4-biggest-mistakes-high-conflict-personalities

https://www.borderlinepersonalitytreatment.com/self-soothing-bpd-treatment.html

https://www.ncbi.nlm.nih.gov/pubmed/6846667

https://psychcentral.com/lib/loving-someone-with-borderline-personality-disorder/

Things which people suffering from Borderline Personality Disorder may do.

https://www.psychologytoday.com/us/blog/5-types-people-who-can-ruin-your-life/201804/6-tips-avoid-becoming-someone-s-target-blame

FAMILY GUIDELINES

http://www.bpdcentral.com/blog/?Fear-Obligation-and-Guilt-FOG-in-High-Conflict-Relationships-36

Psychology Today: Borderline Personality and Custody

https://www.psychiatrictimes.com/borderline-personality/borderline-personality-disorder-splitting-countertransference-0

https://www.psychologytoday.com/us/blog/theory-knowledge/201404/one-self-or-many-selves

https://www.psychologytoday.com/us/articles/201811/the-challenge-borderline-personality-disorder-in-relationship

Loving a Borderline

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330531/

Borderline Personality and Abuse

https://blogs.psychcentral.com/caregivers/2017/09/15-things-not-to-do-with-someone-with-borderline-personality/

How Personality Disorders Drive Family Court Litigation

https://www.ncbi.nlm.nih.gov/pubmed/8633685

https://psychotherapy.psychiatryonline.org/doi/pdf/10.1176/appi.psychotherapy.2015.69.3.331

https://www.highconflictinstitute.com/hci-articles/when-helping-hurts-how-professionals-become-negative-advocates-or-not

Click to access Beth-High-Conflict-Family-Law-Matters.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071095/

https://expertpages.com/news/litigation_forum_acting_out.htm

https://nationalpsychologist.com/2014/01/legal-pitfalls-in-treating-borderline-personality-disorder/102395.html

http://www.continuingedcourses.net/active/courses/course093.php

https://www.zurinstitute.com/clinical-updates/borderline-one-away-from-losing-your-license/

https://nationalpsychologist.com/2014/01/psychodynamic-dangers-in-treating-bpd/102401.html

View at Medium.com

Recommended reading:

Indiscretion in the Modern Era

There is no doubt that healthy-mindedness is inadequate as a philosophical doctrine, because the evil facts which it positively refuses to account for are a genuine portion of reality; and they may after all be the best key to life’s significance, and possibly the only openers of our eyes to the deepest levels of truth. William James

The Sleep of Reason Produces Monsters is a phantasmal etching produced in 1799 by the Spanish painter Francisco Goya that depicts the imagined artist slumped over his desk, in a posture of nihilistic defeat, as ominous owls of madness and shadowy bats fly erratically overhead. This was Goya’s artistic commentary on Spanish society that he interpreted as succumbing to a lunatic’s brew of unmitigated fear, social antipathy, unrivaled corruption, and the liabilities of political unreason. The haunting image would persist as a representation of chaos whenever, as the poet W. H. Auden reminded us, the values of the enlightenment are driven away.

A little over two centuries later, in America’s post-fact zeitgeist of partisan sensationalism and multimedia gossip, the emergence of a toxic brand of emotionally volatile, identity-imbued populism threatens to destabilize society by appealing to authoritarian panaceas in the wake of geopolitical uncertainties. Relinquishing the faculties of reason, objectivity, dignity, and civil ethics when offered specious solutions for security or prosperity is as irresponsible as it is pernicious. After all, “total solutions” of Manichean simplicity are never realistic or sustainable in a world of increasing complexity and irreversible diversity. Just as Freud exposed the mind’s obsessive desire for a paternal caregiver during periods of crisis or vulnerability, we witness other parallels of uncritical yearning when people seek the mana-personality from Jung’s description of the collective unconscious. To mistake narcissism for competence is to mistake stentorian bravado for guidance. Likewise, to assume that personal significance or the assurance of safety can only be achieved through divisiveness is to perpetually recreate the very atmosphere of tyranny that one wishes to escape. 

It appears that a grave deficit of cognition exists in the populace’s mind that prefers herd instinct to the arduous pursuits of objective analysis, social justice, moral philosophy, civil discourse, and scientific literacy. This belligerent lack of compassion, crude mockery of applied intellect, degradation of scientific methodology, and a selfish unwillingness to concede heterogeneity among communities has resulted in an abeyance of decency under the guise of exceptionalism.

Ideologies replete with paranoia, conspiracy, and mistrust were central to the atrocities of the twentieth century when varieties of fascism compensated for national insecurity. Balkanization was both anthropological and geographic in nature. As a result, mass trepidation created an isolationist vacuum for opportunistic absolutists to emerge. And their insatiable need for adulation would come at the endangerment of civilization.

As Thomas Hardy recognized, “If a way to the better there be, it lies in taking a full look at the worst.” Indeed. The evolved predicament of our human condition demands an identification of suffering; vigilant protection of social liberties; the maintenance of empathy; and an intrepid guard against the dangers of despotism if there’s any hope of achieving the means to an auspicious end. Otherwise, there will be no monster left behind.

The Borderline Mother: Matriarchy and Its Discontents

Disclaimer: This essay is not intended to characterize all mothers suffering from Borderline Personality Disorder (BPD), nor does it suggest that Borderline mothers are inherently responsible for having mental illness. In addition, the following material is not meant to discount the positive outcomes or life lessons that can sometimes occur as a result of being raised by a BPD mother. However, it must be emphasized that Borderline Personality Disorder is considered one of the most serious and complex mental health disorders in modern psychology. Like most disorders, considerations should be taken to evaluate levels of functioning and severity on a full spectrum to avoid over-pathologizing, or underestimating, the psychological disturbance of the sufferer. Unless BPD mothers are in treatment; willing to seek treatment; or willing to admit there’s a problem, they’re not going to be aware that they have a disorder—it’s up to their children, partners, and extended family members to develop this awareness. Generally speaking, BPD mothers are exceptionally resistant to being confronted or challenged, and they will invariably refuse to see themselves as disordered (from their perspective, being disordered implies being defective, “bad,” inadequate, or less than perfect). As long as the mother maintains control of her environment, while hiding behind a fortress of denial, there will be no incentive for cultivating self-awareness or embracing the process of change and recovery. Because of her resistance towards self-reflection, she will dismiss, minimize, or rationalize her behavior. In essence, a BPD mother is a psychologically damaged parent “doing her best.” The problematic thoughts and behaviors of a person with Borderline Personality Disorder are not deliberate; they’re automatic. A BPD mother “means well,” according to her distorted perceptions, but she is not well. What needs to be understood are the devastating effects that BPD mothers can have on their children’s emotional development, mental health, physical health, relationships, and ability to successfully achieve autonomy in adulthood. No one chooses to suffer from mental illness, and no one chooses their parents. Likewise, no child can be held responsible for their parent’s emotional well-being; they can only offer compassion and work to discover themselves through the filter of time with the courage of honest reflection. To be clear, Borderline Personality Disorder is not a premeditated way of being; it’s a predicament. Furthermore, this information is not designed to exculpate adult children of BPD mothers from their own contributions to unsatisfactory life outcomes, but it may offer clarity as to how their own behaviors and ways of thinking were formed, influenced, and reinforced in toxic family environments. Borderlines don’t know how to interact in relationships, and a relationship with their children is just another type of relationship. Sadly, parental analysis and family of origin issues are generally the last frontiers of discovery for adult children of BPD mothers (children instinctively shy away from objective assessments of their parents out of respect, fear, or because they may feel like a traitor within the family system). Because Borderline Personality organization stems from a combination of neurobiological predispositions (genetics) and maladaptive survival mechanisms that were developed to cope with childhood trauma, it’s a condition that’s not designed for effective parenting or intimate relationships. It’s not about blame; it’s about understanding.

If it’s not one thing, it’s your mother. — Sigmund Freud

In a previous post entitled Chaos and Elucidation: The Borderline Koan, I focused on the clinical challenges and professional liabilities that therapists may encounter when working with an undiagnosed or misdiagnosed client suffering from Borderline Personality Disorder. More specifically, emphasis was placed on the preemptive identification of BPD in treatment settings; the Vulnerable BPD subtype; and what to expect during emotionally charged clinical encounters. Here’s a quick review of the two-tier classification system:

Authoritarian BPD Interpersonal disposition: Compulsively self-sufficient, domineering, mesmerizing, intrusive, anxious, dysphoric, demanding, passionate, presumptive, judgmental, perfectionistic, fearful, competitive, impatient, pessimistic, combative, easily angered, petulant, stubborn, critical, paranoid, and envious. Attachment style: Fearful/Disorganized. Intimacy style: Erotophobic. Rationale: “I have needs for stability, predictability, and approval that were not met during childhood; therefore, I must be in charge to survive.” Valence: Aggressive, flamboyant, anxious, intense, and irritable. Parenting style: Over-involved. Objective: Control of self-image, others, and their environment (overtly expressed).

Vulnerable BPD Interpersonal disposition: Dependent, charming, captivating, coercive, desperate, mercurial, seductive, playful, helpless, passionate, anxious, perfectionistic, dysphoric, duplicitous, suspicious, solipsistic, fearful, affectionate, labile, docile, hypersensitive, desultory, fantasy-prone, childlike, vindictive, and jealous. Attachment style: Anxious/Preoccupied. Intimacy style: Erotophilic. Rationale: “I have needs for safety, validation, love, and nurturing that were not met during childhood; therefore, I must be taken care of to survive.” Valence: Coy, mischievous, needy, desperate, and enigmatic. Parenting style: Under-involved. Objective: Control of self-image, others, and their environment (covertly expressed).

For comparison, the Vulnerable BPD is similar to Theodore Millon’s Discouraged, Self-Destructive, and Impulsive subtypes, whereas the Authoritarian BPD strongly resembles the Petulant subtype. In relation to Christine Ann Lawson’s fairytale archetypes, Vulnerable BPDs would align with the “Hermit” and the “Waif,” whereas Authoritarian BPDs most closely resemble the “Queen” and the “Witch.” Of course, none of these categories are mutually exclusive, and there can be considerable overlap given the right environmental stressors, interpersonal variables, or social context. Although Authoritarian BPDs can be highly functional and self-sufficient, they are emotionally dependent. Conversely, Vulnerable BPDs tend to be both circumstantially dependent and emotionally dependent. Authoritarian BPDs were usually parentified as children, whereas Vulnerable BPDs were often infantilized. When old enough to become parents themselves, this typology is reversed. In other words, the Authoritarian mother will infantilize her children, and the Vulnerable mother will parentify her children. When the bell rings, Authoritarian BPDs walk into the ring swinging with a surplus of fear and misplaced aggression. Vulnerable BPDs, on the other hand, are so fragile that they’re already lying on the floor and begging for assistance that will be used against the paramedics later on. Having what is considered an externalizing disorder, BPD mothers search for external sources of stimulation, validation, and emotional regulation. They also look for external sources of blame to avoid feelings of shame.

In this essay, we’ll be examining the Authoritarian BPD (over-involved and emotionally immature) from the perspective of motherhood; how this disorder affects the mother’s children during development; and the ramifications of long-term exposure caused by interacting with a mentally ill parent.

People often say that “every family is dysfunctional,” but family of origin problems are disproportionately devastating whenever children are raised by an emotionally unstable or abusive parent. Most children of BPD mothers have learned to normalize the abnormal, because the abnormal is all they’ve ever known. Likewise, BPD mothers have unconsciously normalized the abnormal due to their own traumatic childhood experiences. However, mental illness among primary caregivers is not the same as mental illness among siblings or relatives. Proper emotional attunement with one’s biological mother is arguably the most influential factor for developmental congruency and success in adulthood. Some of the most common traits of Borderline mothers include the following:

  1. Fear of abandonment and the perception that others are rejecting or separating from them, whether this is real or imagined. Intolerance of aloneness (autophobia).
  2. Having volatile and unstable relationships. The person on the other end of the relationship is either idealized or perceived as malicious, cruel, and uncaring. Posing ultimatums in relationships and searching for validation/attention in social situations.
  3. A distorted perception of self, commonly manifested as feeling flawed, victimized, or invisible. Lacking a stable identity which results in deep insecurity and compensatory grandiosity.
  4. Paranoia, which can last from a few hours to a few days. Typically high levels of stress cause these paranoid feelings. A general mistrust of others is common with hypersensitivity to criticism or slights (real or imagined).
  5. Impulsive behavior that resembles impatience, inflexibility, entitlement, or panic. These overreactions are linked to perceived delays in gratification or fears of being separated from loved ones. Impulsivity is associated with low distress tolerance and a hyper-competitive need for control.
  6. Rapid mood swings based on interpersonal triggers. A person with BPD may experience euphoria, anger, guilt, anxiety or panic all within a few hours. Psychosomatic manifestations of emotional instability can include muscle tension, fibromyalgia, ulceritis colitis, IBS, hypertension, dermatologic delusional disorders, and insomnia (the BPD’s anxiety and need for control takes its toll on the body through conversion-based somatization).
  7. Feelings of numbness or emptiness. Easily bored with a need to stay busy. Socially awkward, unsettled, worried, tense, and insecure.
  8. Intense feelings of anger or rage. Extreme and inappropriate emotional reactions to perceived disappointment or imagined threats. Loss of temper, which can be accompanied by verbal or physical aggression. Critical and judgmental with unrealistic expectations of others. Deploying the “silent treatment” after contentious encounters and rarely apologizing or admitting accountability.
  9. Dichotomous thinking (black & white thinking or “splitting”). Situations and people must be bifurcated into “good” or “bad” categories to reduce ambiguity and anxiety. Other people are seen as either enemies or allies. Stressful or challenging situations are filtered through a distorted and reactive emotional lens. Adversity is the equivalent of personal threats. Poor conflict negotiation skills. A preference for simplicity and zero-sum transactional approaches during most interpersonal encounters.
  10. Emotionally immature (arrested psychological development). Often thinks like a child or displays childlike behaviors during periods of euphoria or stress. Cannot tolerate challenging emotional confrontations and will resort to detachment, projection, or rage.

As noted in the classification section, there exists two basic parenting styles among Borderline mothers: Over-involved or under-involved. But these polarized approaches to parenting can temporarily switch according to various changes in the BPD’s perception or mood, while exacerbated by splitting or passive-aggressive behavior. For both Vulnerable and Authoritarian BPD mothers, an inability to regulate conflicting emotions during stressful interpersonal interactions creates havoc for other family members as they try to interpret or respond to such perplexing, contradictory, and unpredictable dynamics. BPD mothers are infamously known for being erratic, dramatic, and emotionally volatile. BPD mothers are also known for choosing either narcissistic or passive/codependent partners, but they often end up living alone because of recurring marital, romantic, and interpersonal conflict. BPD mothers are intense and exert a persuasive hold on their children’s feelings (emotional incest). This dynamic occurs when a child feels responsible for attending to their mother’s emotional well-being; it also occurs when the mother cannot get her emotional needs met by her spouse or other adults. In tandem, the mother’s children will feel obligated to predict, interpret, and appropriately respond to their mother’s conflicting feelings, thoughts, and needs.

Borderlines have an uncanny ability to notice details about others, but they lack insight when it comes to their own behaviors or how others perceive them. The BPD’s interpersonal awareness is vigilant, but it’s filtered through a distorted lens of mistrust. BPD mothers can acknowledge the hardships of their children, but they cannot authentically connect because of their own anxious preoccupations. A Borderline’s empathy is limited, ephemeral, and undeveloped. The mother has affective empathy but lacks cognitive empathy (theory of mind). But when a BPD’s immediate needs are frustrated, empathy is the first thing that goes out the window. Most importantly, they cannot understand the perspective of others. An inability to integrate diverse experiences, or to see other people as autonomous beings, is paramount to understanding the Borderline mindset. It is the mindset of trauma, and trauma cannot get outside of itself. For her children, the mother’s attempts to relate may feel superficial or insincere, because BPDs have problems with differentiated relatedness and mentalization. Borderlines can identify the emotions of others, but they have difficulty interpreting them in a non-personal way. BPD solipsism will ultimately override any intrinsic concern for the emotional needs and limitations of others. Because the mother cannot fully understand the intense nature of her own emotions (alexithymia), she is unable to comprehend the emotional experiences of her children. Emotionally speaking, the Borderline mother cannot stand on her own two feet. As a consequence, her children become representational objects who are expected to be supportive of their mother’s unending concerns. In a fundamental sense, the children of a Borderline mother are instrumentalized. Minimizing ambiguity reduces fear, so it’s easier for the mother to invalidate her children’s emotional experiences and personal struggles rather than being overwhelmed by their complexity. The mother’s priority is, paradoxically, to rely on her children for stability, security, reassurance, validation, and emotional comfort. As a result, children become involuntary enmeshees via psychological fusion with their mother through a process of incremental enmeshment. The children unwittingly fulfill important psychological functions for their mother by becoming her external regulators and “redeemers.”

Regrettably, the image of motherhood is more important to BPD mothers than the effective mechanics of parenting. Since most Borderlines were raised in abusive and invalidating environments, they’re unable to give to their children what they themselves did not receive. BPDs typically experienced life in a chaotic household with emotionally negligent, disruptive, or physically abusive parents who also suffered from personality disorders or other forms of mental illness. Subsequently, the survival mechanisms that Borderlines developed to cope with childhood trauma are systematically incorporated into maladaptive ways of thinking and behaving whenever they leave home to establish their own lives. These primitive defense mechanisms may have been useful for protecting a hypersensitive and traumatized child, but they invariably outlive their usefulness in adulthood. Regardless of its immediate survival value, fear conditioning does not bode well for optimizing human flourishing over time. The Borderline’s fight or flight response never turns off because they’re forever fractured by trauma. Ironically, the BPD mother recreates in her own family the very toxic conditions that she tried to escape from when she was a child. The trauma bond that the mother had with her parents is reestablished with her children. Because the most abusive parent maintained power within the family unit, the Borderline mother learned to “covet the bully.” This dysfunctional family system continues because the BPD mother personally identifies with abuse, instability, and impending doom (borderlines are victims of narcissistic abuse who later become purveyors of narcissistic abuse). As Christine Lawson states in Understanding the Borderline Mother, “Chronic psychological degradation of a child, or an adult, can have deadly consequences.” Fear, paranoia, panic, impulsivity, confusion, irritability, anger, and a constant need for reassurance to avoid feelings of abandonment (severe separation anxiety) are the hallmarks of an anxious child who never developed a secure attachment to a reliable caregiver during the first few years of life. The BPD mother is living in a state of eternal recurrence with “the world is against me and it’s your job to recognize my suffering” mentality (aka unrelenting crisis). Consequently, BPD mothers fear the prospect of meaningful change, because change symbolizes the unpredictability of their childhood and reminds them of not being in control. Receiving mixed messages from abusive parents translated into assuming mixed messages from others, thus setting the stage for the mother’s paranoid ideation. There’s a war going on inside of her head and no safe space can be found. BPDs often grew up in a state of emotional deprivation, so they will spend the rest of their lives trying to over-compensate for developmental and attachment deficits. However, their method of compulsive over-compensation causes lifelong relationship problems. To make matters worse, the Borderline mother will subconsciously seek psychological equilibrium at the expense of her children and significant others. Because unresolved trauma keeps the Borderline mother in a state of arrested development, she’s essentially a child trying to raise children of her own. The Authoritarian BPD mother is overprotective to a fault because she is symbolically protecting herself.

From the FOG website: I have been emotionally wounded and crippled by my early life experience, from which I have never healed. The pain and neurotic anxiety drive me to live vicariously through my children. I somehow believe that if I can keep them under my control, the scared little girl that lives within me will at last feel safe and protected. I am putting my emotional needs ahead of my children’s developmental needs, and on some level I know this. I can’t stop because I’m addicted to the soothing feeling of reassurance that having control provides.

Simply put, what happens in childhood does not stay in childhood.

Children of Borderline mothers are also at high risk of developing BPD themselves, or some other personality disorder, due to strong hereditary and multi-generational factors. More often, they become collateral damage left in the wake of their mother’s overwhelming desire for control and enmeshment. As the child’s need for healthy exploration is stifled by the mother’s need for control, so is the child’s capacity for developing independence in adolescence and early adulthood. The emotional neglect, drama, and abuse that the mother endured during childhood is unconsciously reenacted in her intimate relationships and approaches to parenting (i.e., poor communication; feelings of victimization; interpersonal conflict; defensive projection; inappropriate anger; emotional reasoning; controlling behaviors; and intense overreactions to perceived slights or threats). Although the BPD mother may feel that she is nothing like her own parents, she has unwittingly internalized faulty perceptions from enduring adverse conditions during childhood. The chaos of the Borderline’s mindset is later projected onto their surroundings, because they see the environment as a canvas to capture and reflect their inner suffering. In other words, “my pain must be painted onto my surroundings to verify that my suffering is not in vain.” Likewise, children of BPD mothers may subconsciously mirror or endorse their mother’s values, beliefs, behaviors, and attitudes through projective counteridentification. By introjecting the mother’s tension-infused, fearful, inflexible, and paranoid worldview, her children will receive validation and support, but they ultimately sacrifice their own sense of identity through the maintenance of such an unhealthy bond. Over time, the mother’s children become the equivalent of codependent zombies, anxiously waiting for their next set of instructions (the Norman Bates effect). Disagreement with the values, feelings, and beliefs of a Borderline mother is not an option, and she will invariably get her way in the end.

The following are commonalities in parenting behaviors that typify mothers with Borderline Personality Disorder: (1) they use insensitive forms of communication; (2) are critical and intrusive; (3) use frightening comments and behavioral displays (Hobson et al., 2009); (3) demonstrate role confusion with offspring (Feldman et al., 1995); (4) inappropriately encourage offspring to adopt the parental role (Feldman et al., 1995); (5) put offspring in the role of “friend” or “confidant” (Feldman et al., 1995); (6) report high levels of distress as parents; (Macfie, Fitzpatrick, Rivas, & Cox, 2008); and (7) may turn abusive out of frustration and become despondent (Hobson et al., 2009; Stepp et al., 2012).

Unfortunately, adult children of BPD mothers often succumb to problems with low self-esteem, depression, anxiety, PTSD, compromised identity formation, addiction, age regression, hypervigilance, derealization, depersonalization, obsessive-compulsive behavior, substance abuse, escapism, defensive posturing, rebellion, rumination, sexual repression, confusion, apathy, despair, and suicidal ideation. Adult children of BPD mothers are also more susceptible to being involved with high-conflict or dysfunctional relationships through programmed familiarity (operant conditioning through experience with insecure attachments). However, some adult children of BPD mothers resign themselves to permanent isolation because of chronic self-doubt, feelings of unworthiness, hopelessness, or fears of inadequacy. Other traits that may emerge among children of Borderline mothers include excessive rumination, self-criticism, inhibition, apathy, stress-induced health problems, and a negative (pessimistic) attributional style. Worst of all, children of BPD mothers often fail to achieve autonomy, which results in lifelong problems with insecurity and feeling as though they have been “left out” of the adult world. Ultimately, there’s a failure to launch, or a failure to launch correctly. Since the BPD mother has a monopoly on all aspects of interpersonal control, her children may grow up feeling helpless, guilty, or ashamed for trying to assert themselves. Because these children have learned to mistrust their own intuitions, they’re usually convinced that the problem must be with them instead of their mother or the family system. Subsequently, the children often end up with the exact same mindset as their mother (i.e., feelings of unworthiness, fear, and shame). If the children are lucky enough to escape the impact of family chaos by early adulthood, they may continue to live in a state of vicarious repression and unconsciously deny themselves the freedom of psychological separation. Essentially, the mother’s emotional dysregulation fosters developmental dysregulation in her children. Inconsistencies in parenting are a force multiplier for creating inconsistencies in a child’s ability to acquire self-esteem or manage their own lives as they get older. Sometimes these delays in childhood development are overcome in adulthood through experiential contrast, therapy, healthy relationships, career involvement, or the establishment of adequate spatial and emotional distance from the BPD mother. More often, these children remain in the dark; become disillusioned; continue to suppress their emotions; experience low levels of confidence; embrace futility; resort to self-sabotage; and eventually wonder what in the hell went wrong.

The stress of parenting causes Borderline mothers to disregard healthy discipline that promotes independence and self-respect in favor of various forms of abuse that foster inhibition, confusion, shame, and fear (abuse that was normalized during their own upbringing). However, BPD mothers don’t think of themselves as abusive, because their combative behavior is a side-effect of their disorder (misplaced aggression); besides, it’s all they’ve ever known (ego-syntonic rationalizations for ego-dystonic states). Psychological abuse through emotional neglect, verbal attacks, criticism, or “smothering” and/or physical abuse enacted by draconian methods of punishment are the methods of choice for BPD mothers when raising (aka controlling) their children. But when her children become adults, the mother’s need for control will likely manifest along more surreptitious delivery systems (e.g., financial control, ultimatums, or unreasonable demands for attention and geographic proximity). In such cases, children may feel intimidated by their mother’s intrusiveness and neediness while simultaneously feeling compelled to acquiesce for the sake of comity. Furthermore, children often question their own sanity as the mother assumes absolute authority concerning the nature of reality. BPD mothers see their children as extensions of themselves, or much needed parts of the self (need-gratifying objects), to stabilize their fragmented sense of identity. Furthermore, BPD mothers will unconsciously rely on their children for purposes of object constancy and emotional regulation, which turns the mother-child relationship into an indispensable support structure for the clinging parent. Love becomes a conditional possession for the BPD mother, but her children are repeatedly subjected to tests and confirmations to prove unconditional love for their mother. Because of the mother’s unrivaled need for control to avoid feelings of abandonment, her children will invariably feel obligated to serve as their mother’s emotional wet nurse, surrogate partner, surrogate parent, best friend, confidant, savior, apologist, negative advocate, or consigliere. However, the enormous pressure placed on any child to fulfill such unsustainable roles will eventually result in a codependent relationship that’s both emotionally exhausting and counterproductive. Subsequently, there will be nothing left when it comes to the children’s emotional needs and personal growth. The underlying message is that independence is a rejection of the mother and justification for her to reject the child. Of course, this dilemma places a great amount of stress on her children. Manufactured divisions among siblings may include “the hero child,” “the scapegoat child,” or “the caretaker child.” These narrowly defined roles often become self-fulfilling prophecies in dysfunctional families. Instead of having a broad range of independent qualities, the children become typecast members of a disorganized pedigree.

BPD mothers employ a combination of fear, obligation, and guilt (FOG) to ensure that their children remain loyal and continually invested in the mother’s inconsolable emotional needs. However, the mother’s desperate search for stability, ironically, results in more instability. Because of the mother’s intolerance of being alone, her children may feel compelled to rescue her from drowning in uncertainty, loneliness, and fear. In many cases, the children provide their mother an opportunity to establish a corrective relationship to compensate for a lifetime of insecure attachments. In fact, this is why BPD mothers often perceive their children’s friends or romantic partners as potential sources of competition who inconveniently take away from the mother’s need for attention, affection, resources, and dominance. The need to isolate her children from the influence of diverse socialization allows the BPD mother to feel in control of family commitments while avoiding feelings of abandonment. Ironically, the mother may even compete with her own children, or become visibly envious, as if they were rivals that must be subdued and defeated. The mother’s envy can become so virulent that it extends to being envious of other people’s accomplishments, happiness, and stability. She will prefer gossip when faced with the challenges of healthy social interaction and her resentment is always lurking in the shadows. Borderline mothers continually compare themselves to others and unknowingly influence their children to doubt themselves by default. If the mother compares her children’s upbringing with her own childhood, this only demonstrates that she has not recovered from childhood trauma. Healthy parents do not compare themselves with their children. Subsequently, the children’s need to believe in themselves as autonomous beings is overshadowed by the belief that they’re integral to their mother’s capricious emotional needs. Afraid of her children’s potential for individuation, they do not have permission to thrive without her consent or authorization. She sees her children’s growth and maturity as a sign of rejection. If something positive happens to the children, it must include the mother, or it must be facilitated by the mother’s oversight and approval (no differentiation without representation). Again and again, the family’s attention returns to the center stage of BPD predominance—held together by the clinging weight of propinquity. The mother’s tendency towards jealousy and suspicion often results in disapproval of her children’s acquaintances or accomplishments to displace her own insecurities and fear of abandonment. Likewise, BPD mothers often triangulate family members by means of splitting, gaslighting, favoritism, scapegoating, gossip, criticism, shaming, and forced allegiances. The mother will frequently alternate between praise (idealization) and criticism (devaluation) of her children. If guilt is habitually weaponized by the mother, it usually manifests by letting her children know how unappreciative they are of the sacrifices that were made for them. However, it’s often the case that many of these “sacrifices” were not requested by the child. More often, these sacrifices represent a means of manipulating the child’s emotions by making them feel undeserving, inferior, indebted, and shamefully dependent. In response, her children may start feeling like Pavlov’s dog instead of feeling free to roam the yard. A BPD mother may complain about enabling her children, but what she has really been doing is enabling herself to assume martyrdom. Tendentious charity presumes that the provider should be praised and the receiver should be grateful. Instead of promoting sustainable independence and healthy self-esteem, the provider maintains power through resource allocation while the receiver remains disabled. According to Tom Bunn, LCSW: “She cannot tolerate feelings of abandonment. She must, no matter what it does to the child, cripple at least one child so that the child will never, even as an adult, be able to leave her. This means destroying at least one child’s ability to function as an independent person. The child must never outgrown the feeling of being a part of the mother. As Dr. Masterson put it, “There is a belief by each of them that if one dies, the other will die.” The concept of psychological blackmail is now visible, for if a child believes his very existence depends upon his mother’s existence, and is thus responsible for her life, how can he venture far from her? What if she should have a heart attack and he is not there to save her? In summation, the self-sufficiency and self-actualization of the child is supplanted by occasional donations to prolong a cycle of guilt and dependency that has been engineered by the mother because of her own needs. The Cluster B exchange rate inevitably leaves a trail of bemused children who feel ambivalent about their own prospects for acquiring self-efficacy. In families where money and possessions are the currency of love, it’s like putting a fresh coat of paint on a house that’s already been eaten by termites.

A Borderline mother cannot tolerate separation, and her overbearing presence can feel suffocating, intrusive, or “cannibalistic” to her children as they attempt to claim sovereignty in adulthood. The BPD’s children are unconsciously used as props to stabilize their mother’s unstable emotions while also serving as attendants to soothe her all-encompassing anxiety. A BPD mother clips the wings of her children because her own wings are not stable enough for flying solo in the stratosphere of life’s daily challenges. Nonetheless, providing reassurance and emotional support is randomly rewarded through a process of variant ratio scheduling to keep her children compliant. BPD mothers do not teach their children self-respect; they teach their children to respect the needs of the mother. Likewise, the desperate neediness of the mother is reinforced by the approval-seeking behavior of her children. After all, what child doesn’t yearn for love and approval from their parents? However, children who have surrendered themselves for the sake of parental acceptance (being defined by the Borderline) will invariably become more dependent over time—sacrificing their potential for fulfillment as adults. In addition, the mother’s need for control can undermine her children’s ability to express themselves, feel confident, or take initiative. As a result, the children often feel emotionally paralyzed, defensive, guilty, and helpless while deferring to their mother’s relentless crusade for supremacy (similar to what happens with Stockholm syndrome). In some ways, children of BPD mothers are not allowed to grow up, because growing up represents a threat to the mother’s need for enmeshment. In this sticky situation, the emotional dependency and psychological immaturity of the mother is subconsciously projected onto her children through projective identification. The mother’s fear of abandonment is often so insurmountable that the very idea of her children establishing a life of their own is considered a threat and form of betrayal. Ironically, the mother may later blame her children for their continued dependence while simultaneously disapproving of her children’s efforts to individuate—it’s like trying to escape a mobius strip of irrationality. In other words, the psychological health and independence of her children triggers the mother’s worst fear (abandonment). Incentivizing enmeshment is how the BPD sausage is made.

The mask of normality (false self) is perhaps the most impressive adaptive mechanism of Borderlines—a Trojan Horse for social acceptance. Because the Borderline inhabits a traumatized-dissociative self, she must construct a functional armor through presentation management. As mentioned in The Borderline Koan, BPDs can go “under the radar” for extended periods of time by appearing composed, charming, ambitious, vivacious, generous, and ostensibly reasonable to those who encounter them during brief interactions (aka the halo effect). Dissembling prevents exposure, because exposure means death to the Borderline’s defense mechanisms and fragile ego. However, the Borderline’s public persona (aka coping self) is usually quite different from their private persona, especially when their precarious mood begins to shift during encounters with frustration. If interpersonal conditions do not remain auspicious, the mother’s impulsive hostility will take over (some BPDs have a ceiling to their episodic rage, while others do not). Being masters of theatrical performance and blame-shifting, Borderline mothers may convince close acquaintances that their primary difficulties in life are caused by ungrateful children, lackluster partners, evildoers, and “those damn people” (attribution errors). As the art of gaslighting, splitting, triangulation, and projection reaches a fevered pitch, the mother conveniently avoids insight or accountability for her unreasonableness and behavioral inconsistencies. As a reminder, BPDs do not see themselves as disordered (anosognosia) and believe passionately that their thoughts, feelings, and reactions are entirely justified. Being chronically irrational, BPD mothers rely on emotional reasoning rather than logic and confuse their children during communication through selective memory, inattentiveness, anger, or complete denial (there are significant neuroanatomical differences in the BPD brain that also drive these responses). In other words, the mother’s memory is biased towards information that avoids personal blame or feelings of shame (emotional memory blocking). Revisionism is a Borderline trademark, regardless of the historical evidence. Whatever a BPD remembers during periods of conflict will likely be someone else’s fault, because their defensive reactivity and hypersensitivity to criticism cannot tolerate the burden of developing insight, apologizing, or accepting accountability. BPD mothers do not have the temperament, maturity, or attention span to engage in emotionally challenging conversations, and they will preemptively shut down topics that might lead to questioning their thoughts or actions. No matter how tempting, children should never broach topics that will trigger their mother’s reactivity (unfortunately, this excludes most substantive conversations). The children’s repeated attempts to JADE (justify, argue, defend, and explain), no matter how articulate or reasonable, never work. The nuances of logic, independent thought, and autonomy are a threat to the emotional biases of the mother. Keeping things light and superficial is the only way to avoid an avalanche of aggressive defense mechanisms. A Borderline’s lack of self-awareness is utterly astounding, but it’s a protective mechanism to avoid deep feelings of insecurity, self-loathing, and shame. Ironically, the BPD’s abundant use of criticism towards others is another way of maintaining fantasies of omnipotence to compensate for feelings of low self-worth. Whatever is wrong, it can’t possibly have anything to do with them (projection). In fact, the denial of the mother can be so tenacious that her family often lives in denial by proxy. However, never letting them see you sweat is the gateway to future regret.

Borderline mothers never learned to trust their environment while growing up because it was always unpredictable. Defensive and suspicious, the mother will interpret the most innocuous comments as criticisms or insults, evidenced by her paranoid-infused inquiry: What did they mean by that?The mother may have competed for her parent’s attention with other siblings, or she may have received validation within the family unit based only on her performance. In a home that’s gone haywire, there’s no such thing as self-acceptance, emotional equanimity, or self-love. You either succeed or you suffer. Subsequently, the BPD’s relentless drive for perfectionism in childhood and adolescence results in trying to control anything that offers the promise of stability, safety, and validation in adulthood. This “passion for the perfect” is how high-functioning BPD mothers are capable of accomplishing tasks that provide order, structure, and a solid formula for unambiguous results. Perfectionism is an amulet against feelings of unworthiness, because vulnerability is seen as an imperfection that must be hidden from others. BPD mothers don’t improvise because they are too obsessed with what can be finalized. Never underestimate the mother’s need for certainty and centrality. Inflexibility is a BPD trademark and paying attention to superficial details is often more important than seeing the bigger picture. Task completion distracts the mother from uncomfortable feelings, so she must always keep herself busy. Furthermore, situational inconveniences will not be tolerated and efforts to maintain control prevent her from feeling emotionally overwhelmed. Ambiguity is the enemy, and a vehement devotion to gaining the upper-hand is the BPD’s anodyne. This intensity of focus allows the mother to experience the gratification of being in command while providing a means of self-soothing to temporarily assuage her anxiety and tension. However, because effective solution implementation takes away from the Borderline’s need to identify with their problems, a continuation of chaos in some realm (i.e., major life changing decisions) is to be expected. Catastrophizing is a close second to its first cousin control on the branching tree of BPD modality.

Borderline mothers do not recognize or respect the boundaries of their children. In fact, they don’t understand the definition of boundaries because their own home life was most likely a boundary free zone. BPDs unconsciously expect others to “soak up” their suffering, but even sponges have limits. Consequently, BPD mothers will double down on their unreasonableness by resorting to bullying, intimidation, and weaponizing guilt if their children exercise their right to say “no.” BPD mothers can cause their children to feel self-conscious about making their own decisions, or for trying to define territory within the family structure. The desperation and fear of the BPD mother intensifies whenever her children express opposition or demonstrate self-determination. When the mother is dismissive of her children’s concerns, gaslighting is the primary tool she uses to leverage this dynamic. In other words, the child is deemed as unreasonable or crazy for questioning the warped logic of the mother. Unfortunately, “obedient” children end up feeding their mother’s pathology by acquiescing to her demands and pathological unreasonableness. Besides, no matter what the children do to appease their mother, it’s never enough. This unsavory predicament is accurately described in the following passage by the clinical psychologist Daniel S. Lobel: “Borderline mothers see their children as forever obligated to them by rite of birth. They feel entitled to demand from their children unlimited support and service. The dependency of the Borderline is so great that the child is always seen as coming up short with regard to meeting their needs. This often sets up the mother to be the victim and the child to be vilified.”

The story of a Borderline mother and her children might be explained as a case of misaligned sensitivity. The traumatized mother is highly sensitive to anything that makes her feel emotionally uncomfortable. By contrast, her children become sensitive to the emotional discomfort of their mother. When the mother insists that her children must care exclusively about her emotional needs and most urgent fears, the children become hypersensitive to their mother’s illness and never develop the ability to properly take care of themselves. This pattern of identifying hypersensitive reactions and responding with hypersensitive attempts at remediation (co-dependence) subsequently bleeds into every situation and relationship that the children encounter for the rest of their lives, or until the spell is finally broken. As night follows day, the children are eventually converted into anxiety-ridden radar detectors without a rudder (just like their mother).

Many years later, adult children of BPD mothers may experience shock, incredulity, outrage, bewilderment, and resentment when they finally learn about the psychological anatomy of Borderline Personality Disorder. There’s also a compelling tendency among adult children of BPD mothers to relapse into previous patterns of dysfunctional family interaction and denial after the game has finally been revealed. Being dragged back into the drama is just another example of how powerful FOG can be. Rationalizing the irrational is to be expected, especially when the majority of a person’s life has been spent attending to the shifting needs of an emotionally unstable parent. Making elaborate excuses for one’s mother is natural, but at some point there will be no excuse left for not seeing things as they really are. Denial subsidizes sickness. Acceptance requires understanding, and understanding is the only way that forgiveness can have meaning. We must first understand our parents before we can understand ourselves. A common statement made by adult children after educating themselves about this baffling disorder is: “I always knew that there was something wrong with my mother, but I just couldn’t put my finger on it.” Unfortunately, those raised in dysfunctional families will sometimes spend their entire adulthood trying to rework their childhood (vicarious traumatization and psychological enmeshment are exceptionally difficult variables to overcome). Upton Sinclair once said, “It’s nearly impossible to get a man to understand something when his paycheck depends on him not understanding it.” To paraphrase Mr. Sinclair: It’s nearly impossible to get a person to understand the influence of childhood trauma when their survival depends on them not understanding it.

While the adult child comes to terms with what happened during their formative years, a crushing sadness and loss will prevail—sadness for the mother they never had; sadness for their mother’s predicament; sadness for their own suffering; and a feeling of loss for the years that were wasted. However, the stages of change that occur during any grieving process are necessary so that more favorable changes can eventually emerge. That being said, the bargaining stage of grief is probably the most difficult to overcome. Cognitive dissonance is resolved by maintaining psychological distance after giving up all illusions of healthy reconciliation. The only way for children to avoid feeling disabled by their mother’s need for control is to find creative ways in adulthood to disable the drama (i.e., avoiding intense emotional engagement; learning to observe rather than absorb; building a support system outside of the family; studying the disorder; creating boundaries; and seeking therapy). On a more positive note, adult children may experience a deeper sense of compassion that’s based on understanding their mother’s disorder rather than relying on superficial interactions and trauma bonding under the guise of love. As eloquently stated by Dr. Tara J. Palmatier, “Sacrificing yourself at the altar of someone else’s pathology is not a measure of your love for them; it’s a measure of your willingness to be abused by them.” Most importantly, children must accept the fact that their mother may never have the capacity to understand the negative impact she’s had, or is having, on her family. No mother is perfect, but BPD mothers wish that they and their families were perfectible based on impossible standards that were usually set in motion by their own parents. Unfortunately, the problems that perfectionism creates (e.g., disillusionment, insecurity, shame, anxiety, paralysis, and relentless self-criticism) are far more damaging than the problems that perfectionism pretends to solve. Reverse engineering the psychological damage done by interacting with a BPD mother is an arduous and time-consuming process, but it should not be postponed for the sake of maintaining appearances. Children need stability, confidence, and a strong sense of self-reliance to develop independence in adulthood; otherwise, they’ll blindly perpetuate the mindset of their mother without having the tenacity to land on their own feet.

As the Borderline mother ages, her intensity may diminish when she finally loses steam and relegates herself to a life of resentful dissatisfaction, or when she finds another audience to take the place of her children (the most extreme symptoms of BPD often relinquish over time). The reigns of control will slowly unwind as the mother begrudgingly settles for disappointment in lieu of her strained efforts to sculpt the family according to her will. For other BPD mothers, their insatiable need for control will decidedly follow them to their graves; but hopefully before the family is forced to dig their own. Life is too short for marinating in a multi-generational melting pot of maladaptive misery.

As with all Borderline relationships, there are only three options for adult children to consider: Avoid, challenge, or appease. Most of the time, the children of BPD mothers will find themselves reluctantly pedaling between all three positions, or avoiding contact altogether. It’s not that BPD mothers don’t love their children, it’s that they don’t understand the meaning of mature love any more than they understand the meaning of what’s required for healthy relationships. Love is conflated with psychological and behavioral control to attenuate the mother’s fear of abandonment. The mother needs someone to love her, but love is insufficient because she has not addressed her own trauma. Jealousy, need, control, and desperation are the antithesis of love; they’re manifestations of fear. The Borderline Mother was not loved, or not loved consistently by her parents, so she is lost and continually searching for what she does not understand. Perhaps it’s most accurate to say that the BPD mother loves what her children represent (emotional security). She creates her own version of love and decrees by fiat that it’s the correct version. However, it’s a mutation of love born from the origins of a dysfunctional childhood. The mother must learn to face, accept, and resolve her core wounds, and her children must recover separately. Until, or if, that day arrives, BPD mothers will never fully understand or effectively love their children because they were never able to fully understand or love themselves. In such families, regression is rewarded and independence is frowned upon. Nevertheless, Borderline mothers can be endearing, energetic, intelligent, inspirational, affectionate, talented, and benevolent. BPD mothers are human beings, and informed observations about the effects of childhood trauma and mental illness are not meant to be merciless accusations. The task for adult children is to process this information with dispassionate honesty rather than capitulating to self-indulgent parent bashing. Animosity towards an affliction is not the same as animosity towards the afflicted. Borderline Personality is a disorder and not a choice. However, it’s usually expected that the family will be playing by the mother’s rules and allowing her to take full control of the court. Borderline mothers are not casual cooperators, because they insist on holding all of the cards that were unavailable to them in childhood. Adult children must learn to trust their own intuitions rather than acquiescing to the impulsive instincts of a disordered parent. If they don’t, they’ll eventually abandon themselves.

Borderline mothers are suffering from a disorder that’s built upon a shattered bedrock of identity diffusion, attachment deficits, emotional extremes, anxiety, insecurity, fear, and a profound lack of insight. Without self-awareness, how could they possibly begin to understand what’s required to optimize the well-being of their children? However, the legacy of family trauma should not be perpetuated in the minds and lives of a mother’s children. There are some obligations that should never be fulfilled.

For more information:

https://www.psychologytoday.com/us/articles/200707/borderline-walking-the-line

https://www.bpdglobal.com/about/bpd-explained/

https://www.psychologytoday.com/us/blog/the-intelligent-divorce/201405/the-borderline-mother

https://psyche.media/growing-up-with-a-mom-with-bpd-1-the-four-types

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819472/

https://www.psychologytoday.com/us/blog/toxic-relationships/201808/12-clues-relationship-parent-is-toxic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268672/

Click to access 3685_BORDERLINEPDF.pdf

Having a parent with Borderline Personality Disorder (BPD)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131660/

Click to access mahan-kors-simmons-macfie-2018.pdf

Borderline Mother : Four Types

http://www.bpdcentral.com/blog/?Enmeshment-in-Family-Relationships-1-1-1-35

https://www.yourtango.com/2017307359/11-signs-you-were-raised-bad-parent-and-its-affecting-you-now

https://www.europsy-journal.com/article/S0924-9338(17)30456-X/fulltext

https://blogs.psychcentral.com/caregivers/2017/01/4-signs-you-have-a-mommie-dearest-parent/

https://www.psychologytoday.com/us/blog/the-intelligent-divorce/201503/is-your-mother-borderline

https://www.anniewright.com/the-impacts-of-being-raised-by-a-borderline-mother/

https://theestablishment.co/witch-queen-mom-fairy-tale-lessons-for-surviving-borderline-parents-869527f7cccf/index.html

https://www.psychologytoday.com/us/blog/the-intelligent-divorce/201406/the-borderlinenarcissistic-mother

https://psychcentral.com/blog/emotional-incest-when-is-close-too-close/

https://patch.com/california/carlsbad/bp–how-mothers-spread-borderline-personality-disorde37ca7270a9

https://cooperativeparenting.com/being-raised-by-a-borderline-personality-disordered-parent/

https://www.mysideofthecouch.com/a-day-in-the-life-with-bpd.html

https://www.psychologytoday.com/us/blog/resolution-not-conflict/201210/when-your-mother-has-borderline-personality††

https://www.psychologytoday.com/us/blog/the-intelligent-divorce/201411/the-borderline-parent-survival-guide

Resource and recovery site for family members of personality disordered individuals: https://outofthefog.website/

Breakdown & Its Discontents

https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/

https://www.psychologytoday.com/us/blog/in-therapy/200811/therapist-burnout

https://www.telegraph.co.uk/health-fitness/body/i-was-an-nhs-psychologist—but-i-suffered-from-depression/

https://www.psychologytoday.com/us/blog/campus-confidential-coping-college/201604/depressed-psychologists

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156844/

From burning bright to simply burned out

The Phenomenology of BPD

View at Medium.com

https://themighty.com/2017/08/worst-symptoms-borderline-personality-disorder-bpd/

https://www.bustle.com/p/11-little-tips-for-spotting-borderline-personality-disorder-in-yourself-54305

https://themighty.com/2018/03/bpd-borderline-personality-disorder-self-sabotage/

https://www.thecut.com/2018/06/what-its-like-living-with-borderline-personality-disorder.html

https://themighty.com/2018/07/code-words-dont-leave-me-borderline-personality-disorder-bpd/

https://www.psychologytoday.com/us/articles/201811/the-truth-about-borderline-personality-disorder-in-relationships

Here’s what it’s like to be in a relationship with someone with Borderline Personality Disorder

https://www.healthyplace.com/blogs/borderline/2016/05/creating-boundaries-with-borderline-personality-disorder-sufferers

https://www.healthline.com/health/borderline-personality-disorder-what-i-wish-you-knew#2

19 Signs You Grew Up With Borderline Personality Disorder

Smoldering Limits

 

https://www.psychologytoday.com/us/articles/199707/why-shrinks-have-problems

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156844/

Click to access cb9d9ba0d6124b7d0987209444b6d9272eb7.pdf

https://ct.counseling.org/2018/08/the-hurting-counselor/?utm_source=ciaug30&utm_medium=ciaug30&utm_campaign=ciaug30&utm_term=ciaug30&utm_content=ciaug30thehurtingcounselor

https://www.quora.com/Why-do-psychologists-therapists-counselors-quit