mental-pain
Image source: Dreamstime.com

Sadly, many individuals suffering from borderline personality disorder (BPD) are stigmatized by others and, amongst other pejorative terms, are frequently described as ‘manipulative’.

However, in recent years, it has been increasingly recognized that intentionally manipulative behavior is, in fact, NOT a defining characteristic of BPD sufferers after all; this shift in attitude is best exemplified by the fact that the Diagnostic And Statistical Manual Of Mental Illness, Fifth Edition, or DSM-V (sometimes informally referred to as the ‘psychiatrists’ bible’), has ceased to list ‘manipulative’ as one of the personality traits associated with borderline personality disorder.

However, this begs the question: ‘Why has it been so common for those suffering from BPD to be scornfully dismissed as manipulative in the past?

According to the psychologist, Marsha Linehan (well known for having developed Dialectical Behavior Therapy (DBT) for the treatment of BPD), this mislabelling of BPD sufferers as manipulative has been based on a MISINTERPRETATION of certain types of their behavior.

Linehan puts forward the view that, often, some of the behaviors of BPD patients are wrongly perceived as being manipulative whereas, in fact, they are desperate manifestations of intense psychological and emotional pain.

Indeed, borderline personality disorder (BPD) is generally accepted as being the most excruciatingly, psychologically, and emotionally, painful of all mental health conditions; as I have stated elsewhere on this site, approximately one in ten of those suffering from BPD end their lives by suicide. (To read my article, Living With Mental Agony, click hereor to read my article, Anger May Operate To Soothe Emotional Pain, click here.)

Sometimes, an example some people may give of so-called ‘manipulative’ behavior from BPD sufferers is the threat of suicide. For example, someone with BPD may take an overdose of tablets but then phone a friend or family member to say what they have done. Lineham points out, however, that this is unlikely to be a coldly calculated ploy but, rather, a desperate and confused expression of inner mental turmoil (the intensity of which the individual may not have the words to convey) and ambivalence – ambivalence in the sense that a part of the BPD sufferer may genuinely want to die whilst another (say, instinctual) part may be driven to survive.

We know, too, that BPD sufferers have been found to have developmentally damaged brain regions due to growing up in a chronically, toxically stressful environment and one such brain region is the orbitofrontal cortex. This means the orbitofrontal cortex is not only structurally adversely affected but also harmed in terms of its functionality. THIS IMPAIRS THE BPD SUFFERER’S ABILITY TO PLAN AHEAD, CONSIDER FUTURE IMPLICATIONS OF THEIR BEHAVIORS, OR ACT IN A PREMEDITATED AND CAREFULLY DELIBERATED WAY.

Indeed, the fact that, as stated above, one in ten BPD sufferers eventually die by suicide suggests that any threat to do so should be treated extremely seriously. To dismiss expressions of suicidal ideation as ‘manipulative’ or as ‘attention seeking’ is potentially fatal.

David Hosier BSc Hons; MSc; PGDE(FAHE)