by Dr. Neil Lavender
It seems that whenever I blog about borderline personality disorder, I get a good deal of angry letters telling me how very insensitive I am and that borderlines need to be understood rather than avoided. I do, in fact, give that advice frequently. I would like to reply to that criticism.
I have spent most of my professional career researching, treating, teaching, and writing in the field of personality disorders. Along with my colleague and friend, Dr. Alan Cavaiola, I have published three books giving advice to those involved in the workplace and in their personal lives with individuals with personality disorders. Sometimes the advice we give is to simply stay away.
Do you think that is mean-spirited?
Well, I don’t. And here’s why. But let me say this up front:
I get it.
I know that individuals with personality disorders – and especially individuals with borderline personality disorder – really have a rough time and who suffer enormous amounts of psychological pain from moment to moment. It is a miserable and incredibly debilitating disorder. These individuals have most often been terribly abused both physically and emotionally and my heart goes out to them. In fact, I have devoted hundreds of hours of my professional practice in treating them most often at low or no cost. I want to help these folks. I have friends, even family members, who suffer from this disorder.
But I have to tell you this also. My heart also goes out to alcoholics and drug addicts. They too suffer inordinate amounts of misery. But I try not to get involved with them in my personal life as well unless there is someone close to me who is ready to be helped or someone I’m treating. In fact, I would advise most people not to engage in professional and business relationships or intimate personal relationships with an addict.
I think that’s good and sound advice. And the same thing is true for borderline personality disorder.
So here is why I won’t apologize. There are way too many people who are unaware and innocently get themselves involved with an individual with borderline personality disorder. These things can end very badly; often in divorce, abuse, as well as corporate destruction and financial ruin. That was the whole point of our book Toxic Coworkers… It was making people aware that many of the problem individuals in their lives actually had a psychological disorder and needed to be treated differently than people who did not have these disorders. Consciousness-raising if you will. Even psychotherapists, who have received special training in the understanding, diagnosis, and treatment of personality disorders, will tell you that many times they are outgunned by an individual with personality disorder. In fact, any psychotherapist will tell you that treating borderline personality disorders is an formidable challenge. Researchers such as Marsha Linehan[1] have even gone so far as to suggest that individuals with borderline personality disorder need two psychotherapists; one to deal with the daily brushfires that seem to pop up on a continuous basis in their lives and another to get to the root of many of the abandonment and self-esteem issues which underlie this disorder. So if people with special training have a difficult time interacting with individuals with borderline personality disorder, imagine the struggles of someone who doesn’t.
So. I will repeat my standard advice: Better stay away if you can. Use the same caution you would use with someone who is an addict. You can, as many 12 step programs advocate, “distance yourself with love”. Hope the best for these individuals; indeed, prayfor them to recover, but it is best to keep your distance if you can. Avoid them at work and in your personal relationships whenever possible. Learn to recognize the symptoms and stay away if possible. If they are a friend or loved one, point them to professional psychotherapy.
That’s still some really good advice and I certainly won’t apologize for that.
Find out more about BPD
http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=symptoms
[1][1] Linehan, M. M. (1995). Understanding Borderline Personality Disorder: The Dialectic Approach program manual. New York: Guilford Press
Related articles
- Types of borderline personality disorder (psychscoop.wordpress.com)
- Schema Therapy for Borderline Personality Disorder (authorjaenwirefly.wordpress.com)
- Are you Borderline or do you have BPD? (authorjaenwirefly.wordpress.com)
Drs. Cavaiola and Lavender
Amy Karon
September 5, 2012 at 12:42 pm
Good food for thought. I agree it’s important to set calm, clear boundaries with people who have marked traits of BPD, even though doing so can result in attacks and turmoil. What do you think about the idea that borderline personality disorder is not necessarily a lifelong diagnosis? How does that fit into your advice to “stay away?” Many thanks.
nlavender
September 14, 2012 at 9:13 am
True, people get better and that’s great. And when they do, you shouldn’t stay away. There is so much more about BPD to be said and I couldn’t do it all in one blog but your comment is correct. Thanks for your insight,
Best wishes
Neil
Pinki-Tuscaderro Rachel-Gill
September 6, 2012 at 5:34 am
Why I Won’t Apologize to Doctors who encourage the public to practice Bigotry …
Hmmm … I have Borderline Personality Disorder and find it hard to believe you are sincere about wanting to help people like me when you refer to those with BPD as borderlines. Dehumanizing language is hardly helpful, but I am sure you know that since you wrote three books and have Dr. in front of your name, (gentle sarcasm) and by the way, Doc, you would be wise to do your homework first before claiming yourself and expert on BPD.
Honestly, your paraphrased explanation of Linehan’s Dialectical Behavior Therapy is not even accurate enough to fit into the lowly respected field of pop psychology. So, if you have not already took off running for the hills as soon as you saw my diagnostic label, I, the dastardly intolerable patient, will educate you, the prestigious expert, a little on the facts you failed to relay.
So your two-therapist argument has a grain of truth, (See how nice I can play, validating you even though I am angry, not very borderline of me is it?) Now, in DBT there are two modes of therapy, individual therapy one a week for working on suicidal behavior, therapy interfering behavior, and so on and a weekly group session where us intolerable people with BPD can learn skills sets in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. This mode is more oriented toward the social problems associated with BPD while individual sessions focus on the client’s internal experience like self-loathing, obsessive rumination, and other problematic forms of thinking that are common amongst us people with BPD
Now as to your misunderstood reference, first, there are only a handful of programs throughout the U.S. that implement DBT as a fully integrated program, facilitating the treatment strictly according to the evidence-based research Linehan has dedicated her life to scientifically validating. Second, since there is no accreditation for DBT therapists, the only specially trained therapists you can really count on are the few who have had the privilege of being a graduate student under Linehan’s tutelage. Otherwise, anybody who attends a 3-day DBT workshop can (and often do) call themselves DBT therapists. Lastly, while it may be ideal that a person in a fully implemented DBT program have two separate therapists one who facilitates one-on-one sessions and one who serves as a group skills training leader, it is not unheard of to have the one therapist for both modes of the treatment process.
Either way, I get the impression that your cited Linehan reference was more for the purpose of impressing an air of authority to your value-laden argument rather than offering objective facts/information about BPD and DBT,
Now, tell me, again. Why should people stay away from people like me who have BPD again? So, here is the reason why I will not apologize. I am proud of the skills I have learned in DBT because I have learned to value myself in spite of all the hurtful, depersonalizing, dehumanizing, unilateral judgments you and so many other, so-called doctors, have made about BPD sufferers since its defining in the DSM and what I found is that I am emotionally vulnerable, have extreme emotional tendencies that are difficult to control but I am NOT the big, bad deviant, pariah you have so determinedly portrayed to the world. Look, if you do not want to treat people with certain diagnostic labels with common respect and dignity, then that is your prerogative, (even though it violates the spirit of professional ethics according to the APA) but what I really am struggling to understand is why you feel it necessary to actively seek to convert people to your polarized and prejudicial line of thinking? If you could enlighten me on this question, I would sincerely appreciate it.
Respectfully,
Rachel Gill et aliae Pinki Tuscaderro
With BPD and working toward a Ph.D. in clinical psychology
And a true expert on DBT and BPD
nlavender
September 14, 2012 at 9:07 am
Well stated and kudos for your recovery. But the people who have been hurt by people with BPD need help also, you did not mention them.
But you have a unique point of view. Would you like to discuss your journey here as a guest blogger? Let me know.
Best wishes with your education and career, we can always use more good therapists!
Best wishes
Neil
Saddened and lost
April 27, 2013 at 6:16 pm
My children’s father has bpd and the tone of your post sounds very defensive and like Dr. N replied you failed to acknowledge the main reason why people are advised to stay away from bpd’s: they are a destructive force to anyone who will deal with them on a close personal level. Your post was 15 paqragraphs of you you you and no mention of the people that get hurt in the process.
The intense psychological and emotional turmoil bpd’s experience on a daily basis is very real and I get that but the problem is they usually cope with that by inflicting that same pain onto others. Hopefully you understand when a non bpd is hurt by a bpd it is very real too. Actually, personal association with one can ruin one’s life or result in PTSD of the loved one. To make a long story short, I lost everything I worked for because I was caught in the wrath of a bpd male. He spun me in circles with the cycle of love/hate charm and rage. One minute we wre fine and next we were fighting on level 10 over a level 1 event because the slightest stressor or conflict (which is life) triggered him into unimaginable rages. Thank God he wasn’t physically abusive but he was extremely verbally and emotionally abusive and thats just as bad as physical. Once he vented and calmed down whether 2hrs later or 24 hrs later he’d be sweet as pie and act like nothing happened. Ive never seen anything like that before. The abusive things he would say to me and his mother (male-mommy problems huge trigger-big suprise there) I never even heard enemies speak so viciously to each other as he does. He was verbally and emotionally malicious and vicious. I literally walked on eggshells for five years. Ive lost jobs and job interviews because of the vindictive wrath, the cycle of rage. Ive been put down and manipulated, Ive lost all my self esteem and confidence. He made it so he can do whatever he wanted despite it violating my boundaries and the boundaries of respect in our relationship-but I was under a microscope 24/7. Everything I did was wrong. And I was punished.
Untreated borderlines are Very abusive and Very destructive. There is No reasoning with a borderline. No matter how badly they behave, in their mind during the conflict, they are being abused and violated and the non-bpd is wrong. The non-bpd is wrong no matter what. There was no reasoning with him. There were never happy peaceful holidays (holidays triggered him). Everyone else deserves punishment for their wounds. It doesnt matter what the conflict is whether real or perceived-noone deserves that treatment and I think that borderlines behave that way because they were shown how to behave that way. Afetr a couple of years of observing his mother I started noticing female bpd chatracterisitics in her then I realized he was probably traumatized early through different events and this is the behavior that was modeled for him. I wish he would get help in managing stress and anger and not react so level 10 viciously. Well..for me Thats the bottom line in why people are advised to stay away from non-treated bpd’s. Unfortunately, 9 out of 10 times their narcissistic reasoning tells them they dont need help so they never seek it despite the hurt they inflict. Its everyone elses fault and everyone else is wrong. Its heartbreaking.
Sandra
September 6, 2012 at 11:35 am
I was diagnosed with BPD three and a half years ago. DBT has been my life saver. And I couldn’t agree with you more. The workplace is just that–work. If my co-workers had spent all their time taking the constant roller coaster of emotions I was riding no work would’ve been achieved and my chaos would’ve been everyone’s chaos. If you care about someone, absolutely urge them to get help. But work is work and in order for me to recover I had to learn the skills necessary to comport myself in a work-like manner to keep my job.
Your point of view is realistic and practical and not at all lacking in compassion. It’s a horrid disorder that will take down not only the sufferer but all those close to them. If you think someone is suffering from the disorder
I recommend going to Marsha Linehan’s website to educate yourself.
nlavender
September 14, 2012 at 9:08 am
Best wishes for your recovery and thanks for your comments.
Jaen Wirefly
September 28, 2012 at 8:12 am
I appreciate the links to my posts in your article, it’s generated some nice traffic.
I don’t think “keeping away” from borderlines is all that realistic – since it affects “between 1 – 2 percent of the general population” according to NAMI. Plus, many borderlines are aware there’s something not quite right internally and will wear the “Normal Mask” in fear of being found out.
In any case, you can certainly try to keep away if that’s what you want. Most borderlines are desperate for acceptance and will keep away from anyone that doesn’t show them approval anyway.
nlavender
September 28, 2012 at 9:14 am
Thanks for your interest, glad we can help generate traffic!
Just want to restate here that distancing does not mean rejection or even disapproval. I believe the concept is called “distancing with love” a 12 step program concept.
Thanks again.
nlavender
September 28, 2012 at 9:16 am
Just a note to readers, check out Jaen’s site. Great stuff on BPD! I’m a follower. Thanks Jaen!
Jaen Wirefly
September 28, 2012 at 9:17 am
YW
JenB
October 17, 2012 at 3:41 pm
There are always exceptions and it is widely accepted that most mental health professionals are prejudiced against those with BPD. I wonder why you aren’t warning the general public away from other specific (albeit defunct) personality disorders instead, like Passive-Aggressives or Narcissists, as they are increasingly more common, more insidious and potentially more treatment resistant. I encounter these destructive individuals on a regular basis (including some practitioners in the mental health field) but have never met another borderline outside of treatment.
I have BPD, diagnosed at the early and controversial age of 15. 27 years later I still struggle with it. Since my treatment began when I was very young, has been consistent, and I have comorbid OCPD, I have worked very hard to improve and made huge strides. My treatment team are amazed that I am so highly functioning when they hear what is behind the curtain. I am of the belief that BPD can be managed with a lot of work, and the impact on others can be lessened, but the underlying issues rarely go away. Much like treatment for the suicidal, BPD management is focused on making others feel better as opposed to making the patient feel better. DBT groups and ill-suited meds only get you so far. Quality BDP crisis management needs to be made more available to the common patient.
In regards to relationships, from my personal perspective: When I met my now husband I told him I had BPD and gave him books to learn more about it. He decided my positive attributes outweighed the negative. He still believes this 14 years later and has been a tremendous help in keeping me grounded. But I continue to have problems in some relationships, just not for the reasons you might think.
My learned skills of empathy, self-awareness, assertive communication and my ability to admit and examine my behavior when I am wrong seems to be problematic for many people, especially the passive-aggressive and narcissistic members of my family. To expand on your addict analogy, I want to make the point that sometimes successful treatment can create a “dysfunctional family” dynamic. These people in my life buy into the pervasive prejudice exhibited in this post and blame me for their problems instead of taking any personal responsibility and getting treatment for themselves. I have considered “distancing them with love” as you put it it, but I empathize. Let’s not perpetuate the use of “borderlines” as scapegoats.
Nobody is perfect. Would you also advise not getting involved with someone who is paraplegic or has cancer as it may become a burden? BPD is not a choice, it’s an illness.
nlavender
October 25, 2012 at 11:39 am
Thanks. Your post is excellent and informative.
Blogs are really limited insofar as you really can’t give a complete account of the topics blogged; there will always be things neglected or unsaid.
But I would like to be clear on 2things:
I never said and I don’t believe that people with BPD are undeserving of love, respect or compassion; I have indeed spent a career trying to help these folks and there are people in my personal life I do love but who have this disorder. But as one of the major symptoms of BPD is a disturbance in relationships it should be evident that the average individual is ill equipped to take on this challenging disorder and stay away if possible. And, while every case needs to be assessed on its own merits, BPD is very different from cancer or loss of limbs because of this very symptom that distinguishes it from other disorders.
I hope that helps you to understand my position.
Thanks for your being so candid and best wishes for your pursuit of recovery!
JB
October 17, 2012 at 9:09 pm
My biggest dilemma with your article is that I don’t think anyone is in any position to say that someone should or shouldn’t be loved. Last time I checked, every last person on this planet has some sort of imperfection. I don’t know if you have an mental/emotional issues, however, coming from someone who has an anxiety disorder (I realize this is not the same as borderline personality disorder), I have found that I am happier than ever being able to connect with someone who has issues like mine. In fact, being able to talk through these issues with someone who can actually understand and not make judgmental calls based upon a clinical standpoint has been more helpful than any other option. I know that having a disorder does not make me the easiest person to deal with, but I would hope that as humans we could work on helping each other get better and deal with our issues rather than kicking someone while they are down. I realize that having an anxiety disorder doesn’t make me “normal,” but having dealt with anxiety I think that I have become more capable of handling problems that “normal” people couldn’t even dream of tackling. I entirely understand that you are entitled to your opinion, but I must say that this post is a little insensitive and unfair. It’s just like saying avoid a handicapped person because they aren’t “normal.” At the end of the day, hardships shape people, the easy times definitely don’t. I think you shouldn’t be so quick to criticize or tell people to stray away, because maybe you could learn something like patience and understanding from these people that you should apparently avoid.
Rose
October 21, 2012 at 11:17 pm
My goodness. Harsh but valid points. Are you recommending BPD’s and drug addicts to isolate and not have social relationships?
nlavender
October 25, 2012 at 11:19 am
Good point. This article was really written for people dealing with “toxic coworkers” and not really those suffering from the disorder. But to those who have it, I could not really give blanket advice; some should stay away until symptoms are managed while others need not. You would have to take it in a case by case manner.
Ginnie
November 25, 2012 at 5:37 am
As the child, now a grown adult of a mother with borderline personality disorder reading the comments here from others with the same disorder it’s eerily familiar. The waspish tones, the condescending, the petty correction, the putting the Author in his place, it’s all there and all too familiar.
I didn’t have the choice to stay away and as clearly demonstrated in these responses, things like, “benefit of the doubt”, civility, reasonableness are just not going to happen. You tred unwittingly into some touchy area and you will be subject to venom.
I fully agree that staying away is good advice, there is just too much collateral damage. Love my mom but without doubt she’s toxic. So are the fumes coming off some of these responses.
nlavender
November 25, 2012 at 10:54 am
Thank you so much, very helpful and insightful. It is good to have the responses of those involved, I would like to have more.