A Child-Like Mind Borderline Personality Disorder
I have sometimes thought that my three-year-old daughter seems borderline. One minute she is saying, I love you Mommy, and the next minute she is shouting, Go away Mommy! One minute she laughs, the next she cries hysterically.
Time with my daughter helps me understand the world through her eyes. Her world is exciting, yet frightening. Her behaviors and emotions fluctuate to express this. For me, and undoubtedly for her, it sometimes feels like a roller coaster. Thank God, she has me to hold onto.
Adults with BPD often experience emotions much like my three-year-old child. As such, their behavior seems reasonable to them. The problem or pathology arises because these individuals are not childrenthey are adults. In terms of emotion regulation, interpersonal and some cognitive skills, they are at times functioning like children. Growth in each of these areas can occur independently, which results in an adult with the emotional composure of a two-year-old.
The life of those with BPD is a roller coasterchaotic, erratic, and distressed. They frequently feel as though they have no one to hold onto and the ride is getting faster and more treacherous. It involves twists and turns of venting anger, numbing pain, and engaging in self-deprecation. Often this leads to isolation, with ever more shame, anger, and pain.
Although their behaviors may seem game-like, it is not always so. Their behaviors are complex defenses that serve to protect them from what they may perceive as harm, rejection, and inevitable abandonment. These behaviors can be traced back to those of a distressed child, searching desperately for an anchor.
If I feel it, it must be true
Just the other day, my daughter said, I feel sad Mommy. It must be a sad day. In general, emotionally healthy people can distinguish between feelings and facts. If you fail a test (fact), you may feel inadequate (feeling). But this does not mean that you are inadequate. It may be just one failed test out of many successes.
Individuals with BPD have difficulty separating feelings from facts. In their economy, if they feel it, it is true. As such, when these individuals feel bad, their self-destructive behavior seems completely reasonable to them. These individuals repeatedly need to revise facts to fit their feelings. This is why their perceptions and beliefs may seem distorted and unstable.
As my daughter cognitively matures, she is moving toward an understanding that just because I am angry does not mean I dont love her. However, for the most part at this stage of development, life remains polarized for her into good and bad. Like children, adults with BPD are unable to integrate situations and feelings that involve opposition. This leads to black-or-white thinking, overvaluation oscillating with devaluation, and a process known as splitting.
These cognitive mechanisms are efforts to protect themselves and make sense of the world. Life does not often come in black or white, but instead either black-and-white or many shades of gray. People are both kind and cruel, warm and cold, available and unavailable, depending on situations, needs and various factors. Because a person with BPD cannot cognize a world with complexity of this kind, it is necessary to separate people into black-or-white categories based on their most recent behaviors.
Recently my daughter blamed her oneyear- old brother when she tripped over her own toys. This was quite a feat, since her brother was sound asleep at the time! Projection and blaming are powerful weapons of denying ownership and avoiding responsibility. Projection is the process of attributing ones own unpleasant traits, behaviors, and/ or feelings to someone else. This primitive defense allows people with BPD to feel relief from self-condemnation. It also helps them avoid the fear of rejection and abandonment that would be stirred if they directly confronted their brokenness.
Emotion dysregulation is believed to be the core issue of BPD. Therefore, those with BPD manifest relational, behavioral and cognitive disturbances in an effort to achieve emotional modulation. They push others away for emotional protection; they inflict self-injury to numb emotional pain; they dissociate to avoid thinking about trauma; they create fantasies to ease the pain of reality.
Many of these people are intelligent and successful and seem to have everything going for them. However, inside they feel empty and incomplete. Their behaviorswhich may appear to be manipulation and game-playing to those who are targetedare usually done to self-soothe emotionally.
But in the midst of trying to achieve love and remain safe, individuals with BPD can inflict great pain, distress, grief, and anguish on those around them. Individuals with BPD can be frankly abusive. Parents, spouses, children, friends, and professionals involved with a person with this disorder are all vulnerable, not to mention the suffering individuals themselves.
As such, professionals who work with BPD patients or clients risk countertransference and burnout. Professionals and loved ones can spend years trying to understand the patients behaviors and validate feelings. However, this can prove exhausting and self-defeating. As with any dysfunctional behavior that involves abuse, the perpetratorno matter what the reason for his/her behavior must start taking responsibility.
So as a professional committed to working with these patients, it is necessary to bridge the gap between the adult person and the psyche of the disturbed child by not only validating, but also teaching self-capability enhancement. How do we do this?
Grace, Grace and More Grace
During the past ten years, advances in treatment of BPD have occurred in many areas, including biological underpinnings, psychotherapy and pharmacological treatment. One of the most innovative and effective psychotherapeutic approaches to BPD is Dialectical Behavior Therapy, developed by Dr. Marsha Linehan.1 This treatment addresses the extreme dichotomous thinking, for instance, by helping patients find a balance between overvaluing and condemning. It also focuses on developing skills, such as problem solving, selfsoothing, assertiveness, kindness, emotion regulation, and distress tolerance. These approaches, if integrated with Biblical principles, are quite effective.
Whatever treatment is used, Christian professionals know that the approach must offer Gods grace, kindness, and mercy. In an interview regarding his new book, Grace-Based Parenting,2 Dr. Tim Kimmel described grace as loving and honoring them when they are not loving back and loving your child when they dont deserve it. This attitude is necessary in working with BPD patients. In fact, such work can be thought of as grace-based therapy. As Christians, we are taught to love others (Matthew 22:39). Exemplifying Gods love is the only way to truly demonstrate validation, convey acceptance, and show understanding of these individuals.
However, like Christ, we do not accept unacceptable behaviors. Christ accepts and loves us as his children, but also wants us to become like him: go and sin no more (John 8:11). In treatment, then, in addition to validation, we must teach life skills and tools, not unlike what I am currently doing with my child. I teach her to self-soothe, how to deal with disappointment, and how to express and regulate her emotions. My prayer is that as she develops and individuates, she will mature into an independent and godly woman. That is the hope for patients suffering with BPD. One hopes that the gap between child and adult will narrow as they progress through treatment. Take help from telephone counselor.
Clearly, because of their profound skills deficits and intense emotional pain, working with BPD patients requires an emotional, physical and spiritual commitment from the therapist. It is, in a sense, raising and parenting children. What a way to honor God!
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