One of the greatest difficulties of managing borderline personality disorder (BPD) is that the symptoms it creates tend to feed off, and intensify, each other; often this will end in a crisis point at which the affected individual will become suicidal and/or require hospitalization. Until the disorder is properly treated with the relevant therapy, the individual is likely to keep experiencing such crisis points throughout his/her life.
In this post, I want to look at how the symptoms of BPD can keep reinforcing and worsening each other, leading to a downward spiral from which the majority will find it impossible to break free without professional intervention. In order to do this, it is worth revisiting the main symptoms of BPD:
– almost always full of painful and distressing emotions
– becomes intensely attached to others very quickly, leading to feelings for, and expectations of, others that are not warranted given the context and/or history of the relationship
– expects to be rejected by those s/he forms an emotional attachment to
– is simultaneously deeply needy of, and rejecting towards, others ; feels deep need of emotional intimacy with, and caring from, others but then will tend to reject it when it is offered
– interpersonal relationships become unstable and chaotic
– experiences great difficulty in controlling (regulating) emotions which quickly become powerful and overwhelming ; these frequent powerful, intense, uncontrollable emotions frequently spiral out of control and then have a very adverse effect upon normal functioning
– inability to self-soothe (it is theorized that this is due to damage to the area of the brain known as the AMYGDALLA,thought to be caused by severe trauma and high levels of stress during childhood)
– suffers from impulsivity and recklessness
– frequently, or continuously, prone to severe depression and anxiety
– feels, and almost always is (by non-experts), misunderstood
– tends to constantly expect utter and devastating calamity (a mind-set referred to by psychologists as CATASTROPHIZING, a state of mind cognitive behavioural therapy, and other types of therapy for BPD, seek to correct).
HOW SUCH SYMPTOMS INTERACT AND INTENSIFY ONE ANOTHER:
Because the symptoms of BPD trap the sufferer in a downward spiral, as I shall illustrate below, it is just about impossible for individuals to cope with, let alone manage, the condition on their own. Professional intervention is therefore imperative. Because BPD is frequently misdiagnosed, it is worth noting down relevant symptoms and presenting them to the relevant professional in advance of an appointment. Also, there is nothing to prevent one seeking a second (or even third!) opinion. It is important to seek out a therapist who is expert in the condition and one is, of course, free to ask any potential therapist what experience s/he has of the disorder, together with their views about treatments (eg medication, talk therapy, a combination?) What is your own instinct on this? Let the therapist know.
Let’s now look at how the symptoms of BPD may become so mutually, destructively intertwined:
Because the person who suffers from BPD can be in such continuous, painful emotional distress it is very common for him/her to turn to alcohol or drugs in an attempt to numb these intolerable feelings.
The individual may well then castigate him/herself about this alcohol/drug use, seeing him/herself as an alcoholic or drug addict which lowers even further his/her already greatly damaged self-esteem. S/he may then seek psychological support from a friend, but, as a consequence of his/her distress, become clingy and demanding. In response to this, the friend may set down boundaries which the BPD sufferer interprets as rejection, thus further lowering his/her self-esteem and causing further painful emotions leading to yet more excessive drinking or drug taking…
Of course, this is just one example of how symptoms of BPD may unhelpfully feed off each other, though an almost infinite variety of harmful interactions between other symptoms can be easily imagined. Essentially, the BPD sufferer LACKS INTERNAL RESOURCES TO COPE WITH MENTAL PAIN AND STRESS, so will turn, with depressing regularity, to DESTRUCTIVE EXTERNAL RESOURCES such as one-sided relationships or activities which allow temporary, psychological DISSOCIATION from the emotional distress being experienced, such as ALCOHOL, DRUGS, PROMISCUOUS SEX or GAMBLING – in other words, maladaptive (unhelpful) coping mechanisms.
As these maladaptive coping strategies continue to aggravate and worsen one another, the BPD sufferer is likely to become increasingly desperate
and to undertake increasingly self-destructive behaviours. How can s/he break free from this vicious cycle? Sometimes, as I said in the opening paragraph of this post, hospitalization may be required to interrupt the cycle; however, this has its negative side: being placed in a psychiatric hospital can significantly worsen, yet further, damaged self-esteem, making the sufferer feel like a pariah – stigmatized, demeaned, humiliated, and on the bottom rung of society’s ladder. S/he will also be burdened with the often acute worry of how s/he will now be perceived by others for having being placed in a psychiatric ward, making him/her less capable still of finding the confidence to interact successfully with acquaintances, friends and society in general. In extreme cases (eg when the sufferer is actively suicidal), however, there may, sadly, be little alternative.
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Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).