Monthly Archives: January 2014

#8 – A Unicorn: The Paradox of the BPD Label

It is my position that Borderline Personality Disorder is not a scientifically valid or reliable diagnosis. Here I’ll explain why this is the case, but also discuss how the diagnosis can paradoxically prove useful to sufferers and therapists.

First, I ask the reader to consider Rainer Maria Rilke’s short poem, The Unicorn. Like the mythical unicorn, Borderline Personality Disorder, when considered scientifically, exists in only in popular imagination.

The Unicorn

“This is the creature that has never been.
They never knew it, and yet, nonetheless,
they loved the way it moved, its suppleness,
its neck, its very gaze, mild and serene.
Not there, because they loved it, it behaved
as though it were. They always left some space.
And in the clear unpeopled space they saved
it lightly reared its head, with scarce a trace
of not being there. They fed it, not with corn,
but only with the possibility
of being. And that was able to confer
such strength, its brow put forth a horn. One horn.
Whitely, it stole up to a maid, to be
within the silver mirror and in her.”

Like the unicorn, BPD is a mythic construct, the existence of which has never been proven. It exists only because people believe in it. Nevertheless, it can be useful, as will now be described.

How BPD Is Useful – Helping Survivors Find Each Other

Despite its many flaws, the diagnosis of Borderline Personality Disorder serves valuable functions.

First, it allows those struggling with the difficult symptoms of BPD to find each other. Because the BPD label covers a range of serious difficulties in regulating feelings and managing relationships, it includes millions of people with different backgrounds and problems. Nevertheless, those diagnosed with BPD often have enough experience in common that they can understand and support each other in a way not possible for those who have never “been borderline.”

On this type of blog and on other online support forums; people diagnosed with BPD are often very empathic and supportive of one another. Rarely do I see “bad” borderlines who are only selfish and manipulative, as in one popular but misleading caricature of BPD. Rather, most diagnosed borderlines are looking for any help they can find, and are willing to provide encouragement to other with similar challenges.

If no such label as BPD existed, there might be no way for those struggling with emotional dysregulation, lack of identity, fear of abandonment, and so on to find one another. Therefore, labels such as BPD do have utility in that they allow for a form of consistent self-definition, and promote communication with others who so define themselves.

How BPD Is Useful – For Finding A Therapist

Borderline Personality Disorder is also useful because if one knows about the disorder, one can search for a therapist who is good at treating it.

Worldwide, there are many psychodynamically-trained and DBT-trained therapists who are excellent at treating borderlines. They have helped many former borderlines improve to the point where they can live a rewarding, meaningful life and are no longer diagnosable with BPD. I have met several of these therapists in my real life (yes, I do exist outside of this blog!). These included Gerald Adler in Boston, Lawrence Hedges in Los Angeles, James Masterson in New York (before he died), and three of my past therapists in the Eastern United States.

Searching for therapists who treat BPD can be a double-edged sword, because many therapists are still uninformed about the disorder. Some even refuse to treat borderlines because they do not understand how to effectively work with them. So it is critical to find well-trained therapists who are optimistic about working with this condition.

As an aside, far too many borderlines are not receiving treatment from a therapist competent at treating BPD. Hopefully this can change in the coming years. As noted in an earlier post, it is quite possible to find therapists who specialize in BPD and/or DBT via sites like Psychology Today’s Therapist Finder. Please refer to that earlier post below if you want more information.

https://bpdtransformation.wordpress.com/2013/12/15/what-to-do-if-you-are-diagnosed-with-bpd/

How BPD is Useful – For Therapists To Communicate about BPD

The BPD label allows therapists to communicate among each other in order to understand BPD and develop more effective treatment for it. In my opinion, the best psychodynamic-psychoanalytic and DBT-focused therapists are both oustanding at treating BPD already. If someone has sufficient resources to attend good treatment consistently over the long term, it can make a huge difference on one’s recovery journey.

Most of the public today does not know that psychoanalytic therapists had already created clear treatment plans for Borderline Personality Disorder by the 1970s and 1980s. In their books, these therapists give many detailed case studies of borderlines they treated who recovered fully.

As a teenager, I remember how encouraging it was to read James Masterson’s accounts of the dozens of borderline young adults  whose outcome he tracked in the Borderline Adolescent Trilogy of books (culminating in From Borderline Adolescent to Functioning Adult: The Test of Time). These borderlines were tracked over decades, with many of them improving to the point that they had few or no traces of the disorder left as older adults. Using both the DSM and his own experience, Masterson had a clear way of diagnosing BPD that helped him to create this study.

Some examples of books on successful treatment of adult BPD would be Borderline Psychopathology and Its Treatment (Gerald Alder), Psychotherapy of the Borderline Adult (James Masterson), Six Steps in the Treatment of Borderline Personality Organization (Vamik Volkan), and The Bad Object (Jeffrey Seinfeld). Reading these books was extremely useful for me in understanding BPD and drawing encouragement from those who had already recovered. If the BPD diagnosis had never existed, I would never have found them.

To conclude, without a clear term encompassing the symptoms of people who are severely neglected and/or abused in childhood, therapists would find it difficult to communicate about what sort of people they are treating and how to treat them. There has to be some common terminology and a framework in which to discuss approaches to different “types” of patients.

How BPD Is Useful – Validating One’s Problems

A final note is that I see some diagnosed borderlines who feel that the BPD label is useful because it provides some explanation for what is happening to them. It validates that there is something really wrong and that they are not crazy or just experiencing random symptoms.

Initially, it can be useful to know that your problems come from a “disorder” with a name. I see the value in this, although at a deeper level I disagree with it.  More importantly, knowing that one fits the BPD label can help a person find effective help via therapy, support groups, and fellow sufferers.

Why I Do Not Believe In BPD

Despite everything noted above, Borderline Personality Disorder is a fabrication. “Fabrication” refers to something conjured out of nothing, something misleading, untruthful, that does not actually exist.

To understand why many people doubt the validity of BPD, it is instructive to look at the history of its development. Psychoanalysts working in the first half of the 20th century began using the term “borderline” to describe patients they saw who were neither neurotic, meaning mildly troubled, or psychotic, meaning experiencing a break with consensus reality.

Such psychiatrists never diagnosed BPD via any physical measurement. There are to this date no blood tests, gene tests, brain scans, or other physical measures that can identify BPD. This obvious fact bears repeating because it tends to be forgotten when people discuss the disorder. Instead, BPD was always classified, in various ways, according to observed behaviors, thoughts, and feelings seen in individual patients.

Borderline Personality Disorder in the DSM

Eventually, “Borderline Personality Disorder” crystalized into its current Diagnostic and Stastical Manual of Mental Disorders form, in which 5 out of 9 subjective criteria must be assessed by a mental health professional for a diagnosis to be made. It is useful here to list those criteria in brief form:

1. frantic efforts to avoid real or imagined abandonment.
2. a pattern of unstable and intense interpersonal relationships
3. identity disturbance
4. impulsivity in at least two areas that are potentially self-damaging
5. recurrent suicidal behavior or ideation
 6. affective instability
7. chronic feelings of emptiness
8. inappropriate, intense anger
9. transient, stress-related paranoid ideation or severe dissociative symptoms

Here are some questions to consider about BPD as it is defined via these nine traits:

– Mathematically, there are at least 126 possible ways that one can be diagnosed with BPD, if any 5 out of 9 of these criteria is the threshold for a diagnosis. Is each of those 126+ “forms” of BPD an equally valid and meaningful form of the same disorder?
– Is it possible for psychiatrists to consistently determine the degree of each of the 5 (out of 9) traits that is needed for a BPD diagnosis? That is, how can a psychiatrist consistently say, for example, at what point a person’s interpersonal relationships are “intense enough” or “unstable enough” to warrant inclusion as a factor in a BPD diagnosis?
– Given personal bias and the differences in understanding of the English language between psychiatrists, are such treaters likely to consistently agree with each other about whether or not the same patient if borderline?
– Can psychiatrists determine when the approximately 100 billion neuron cells in a human brain have become arranged in a way that warrants a diagnosis of Borderline Personality Disorder?

These questions obviously cast doubt on the validity and reliability of BPD.  Perhaps “Borderline Personality Disorder” is a fantastic construct that exists only in the minds of psychiatrists, from where it is projected onto individual people.

We still understand relatively little about how the human brain’s 100+ billion cells interact with the environment in trillions of different ways. In this light, to think we can accurately create and then diagnose a “disorder” like BPD seems doubtful.

Why BPD Can Appear Valid

This is not to say that people (supposedly) diagnosed with BPD cannot appear very similar. Because of the imperatives for relating to peers and functioning independently that are part of every human being’s development, problems in these areas will manifest with related, but not identical symptoms based on each person’s unique history.

But the degree and kind of problems in  areas such as relating to others, relating to oneself, and functioning independently will always differ subtly (and sometimes greatly) in each case. Given the endlessly complex, individualized problems that people experience, it is naive to think that precise “mental disorders” can be clearly separated and accurately diagnosed.

Why BPD Should Be Rejected As A Medical Condition

Therefore, instead of developing an objective, scientific way of diagnosing the disorder – something which is admittedly difficult with a “disorder” based on observed behaviors and human emotions – psychiatrists left everything up to the treatment provider’s subjective judgment. The psychiatrist himself had to determine whether or not each problematic behavior, thought, and feeling was of a degree and kind to justify inclusion in the diagnostic picture.

In my view, this fact alone – that the subjective judgment of mental health workers supposedly determines BPD’s “presence” or lack therefore –  invalidates BPD as a diagnosis which can be taken seriously, at least in a strict scientific sense.

Psychiatrists face several quandaries in diagnosing BPD: 1) From patient to patient they cannot consistently agree who has BPD and who does not, 2) They cannot agree on what criteria should be used to diagnose BPD (the DSM’s is not the only model, and the words used for each traits, plus the number of trait, changes from year to year), and 3) They use complex, subjectively assessed human behaviors as the diagnostic criteria rather than physical, quantifiable phenomena. In this way BPD differs fundamentally from actual medical disorders like diabetes, for which insulin levels are measured, or cancer, for which the presence of tumors and observable cancerous cells are involved.

Given these challenges, psychiatrists and researchers are doomed to fail in their attempts to prove BPD’s statistical validity or its genetic basis.  I am often amused to hear therapists talking about BPD as a disorder which can be “studied” using twins or other genetic testing. To me they are out of contact with reality, to put it charitably. But since I am kind, I will not diagnose them with anything 🙂

Valid medical conditions absolutely have to be based on criteria which can be reliably and repeatedly diagnosed by different doctors. The scientific tradition requires that a theory not be accepted until it has been repeatedly proven by observable experiments. Since psychiatrists have not demonstrated beyond a reasonable doubt that BPD exists or that it can be reliably diagnosed, BPD itself should be rejected outright as a false diagnosis.

What Then, Is BPD?

For me, BPD represents people’s attempts to simplify and name complex problems in emotional and relational functioning. These problems really defy classification and naming, but it is comforting and sometimes useful to believe that, like a fly in amber, they can be “caught” and crystallized in a mythical diagnosis like Borderline Personality Disorder.

Much research shows that human beings are uncomfortable with ambiguity and uncertainty (not just those diagnosed with BPD, who are supposedly very uncomfortable with it). So it is not surprising that many psychiatrists believe that they can, in fact, accurately diagnose “mental disorders” based on the complex, related, but ultimately unique problems that their patients present. The books of Amos Tversky and Daniel Kahnemann (for example, Heuristics and Biases) gives numerous examples of how human beings distort reality based on a need for predictability and reliability which is not there in the real world.

In my view, BPD refers roughly and imperfectly to problems in human emotional development arising on a “spectrum” or range of early functioning that could be called “symbiotic.” Symbiotic is the term that psychoanalysts used to describe the way the young, 1-3 year old child relates to its parent. In symbiotic development, the child demands supportive responses and tries to play both child and parent to its parent.

When the parent is neglectful, unavailable, or abusive to varying degrees, the child becomes “stuck” or arrested in its emotional development. Many psychoanalytic writers describe this process, for example, Robert Stolorow in his book Psychoanalysis of Developmental Arrests. All of the borderline symptoms flow from different kind and degrees of problems in childhood symbiotic development. Rather than learn to regulate his feelings, relate positively to others, and become independent, the child becomes stymied by bad relationships and lack of love and support, and goes on to develop some or all of the symptoms of BPD.

Humans as a species have many common requirements for growing from childhood to mature adulthood – for example, learning to regulate feelings, learning to relate positively to others in friendships and love relationships, learning self-control, developing a sense of personal identity, and so on. Because we have much in common with our fellow human beings, problems in human emotional development have a lot of crossover.

One abused person may superficially look a lot like another abused one, and it is easy to pull five observed “symptoms” out of each of them and say they both have Borderline Personality Disorder. However, as noted above, the complexity and innumerable variations in each person’s development render this process impossible and meaningless.

Like the unicorn, BPD was a myth when it was created, and it is still a myth today. It only appears to have life when people believe in it.

With luck, the public will gradually realize what many therapists already know – that BPD is a fraudulent diagnosis, and that no one individual “has” BPD. Instead, it will be seen that, like the unicorn, BPD has more value as a metaphor referring to the spectrum of severe problems that emerge from abuse and neglect.

——————————————–

———————————

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes

Advertisements

#7 – Addiction Recovery , 12-Step Groups and BPD

A common symptom associated with Borderline Personality Disorder is the presence of addictive, self-destructive behaviors.

This can include drug abuse, alcohol abuse, and overeating. Other compulsions include sexual promiscuity, gambling, and eating disorders, which are related to overeating but can be more damaging and complicated.

It is useful to consider why these addictions develop. Many authors view them as methods of coping with and numbing severe emotional pain. When one is tormented by chronic anxiety, anger, and uncertainty, blocking out the feelings with an addictive behavior makes sense in the short term. A deeper view is that addictions are a compensation for some “lack” – that is, if one has low self-esteem and few good personal relationships, addictions can serve to compensate for this void.

In the long term addictions are destructive and do not make the underlying problems disappear. But in the absence of better ways of coping, it is not surprising that so many people turn to addictions to make their problems temporarily “go away”. Since powerful negative emotions and a lack of healthy interpersonal relationships are both frequently associated with Borderline Personality Disorder, it makes sense that many borderlines develop destructive addictive behaviors.

My Addiction

Between about ages 16 and 24, I developed the addictive behavior of eating massive amounts of junk food. My favorite items were a giant 500-gram family-sized bag of Utz potato chips, along with a big bag of Hershey milk chocolate candies. I would ravenously eat these snacks – often totaling 3,000-4,000 calories or more – and then feel very bad about myself afterward (but, while it lasted, eating chips and chocolate together did feel awesome!).

I overate most often when feeling hopeless, alone, and angry. At the time, I wouldn’t really reflect on why it was happening, but the behavior also related to my negative beliefs about myself. Namely, that people didn’t care about me, that I had no future, was unattractive physically, was worthless and so might as well do it, and so on.

Usually, my overeating would be followed by efforts to restrict my eating to “even things out”. The idea was to punish myself and to prevent myself from becoming overweight (and miraculously, I did not ever become obese). Obviously, this whole cycle was terrible for me emotionally and only made my self-esteem worse.

Early Efforts to Deal With My Addiction

At first, I viewed my eating habits in and of themselves as a primary problem, i.e. as a cause of my other problems. Later, I would realize this was mistaken. However, as a teenager I focused a lot of energy on forcing myself to stop overeating. As the reader might guess, such efforts of willpower normally failed. I would frequently call myself bad names, berating myself for my lack of self-control. A vicious cycle developed where the more I overate, the more such self-attacks would occur, the longer the subsequent “starvation” periods would become, the worse the next round of overeating would become, and so on.

Visits to 12-Step Groups

Eventually, I discovered that 12-step groups existed that specifically addressed overeating. I visited these Overeaters Anonymous groups starting at age 19 and attended regularly for give years. Many people will know something about these programs even if they have not attended. Such programs usually involve an addicted person getting together with other addicts in a church, hospital clinic, or other accommodation for for at least one hour a week. At meetings, one gets to verbally share one’s experience recovering from addiction with the group, while also learning and gaining encouragement from the “shares” of others.

In 12-step groups, people also “work the steps,” the steps being positive, spiritual guidelines that  encourage reliance on the help of fellow addicts and on God rather than on one’s own willpower. Often, a new person will get a “sponsor,” a more experienced member that mentors them in their recovery journey.

To oversimplify it, 12-Step groups involve a group of “addicts” sitting around a table and performing what outsiders might view as “mutual therapeutic sharing,” although 12-step leaders would not call it that.

Positive Aspects of 12-Step Groups

I benefited greatly from attending 12-step groups. Given that I had experienced very little honest sharing of feelings in my family, the openness of people in the 12-step groups represented both a new emotional world and a massive source of support. People would share their most intimate feelings about their personal and family problems, knowing that they were protected by the “anonymity” of a program in which everyone starts on a first-name basis.

Seeing that other people were conquering their cravings for food encouraged me that I was not doomed to suffer with this compulsion forever. Having to drive to the meetings bolstered my self-esteem, because it meant I was taking action to help myself. The general tone of the meetings was one of acceptance and tolerance, which became incredibly therapeutic for me.

Over time, I came to see that most of the people in 12-step meetings were genuinely kind, good people. I lost the image of addicts being twisted, innately disturbed freaks. Many of the better-adjusted men and women that I met functioned well in the outside world. They had real friends, spouses, children, and jobs that contributed to the community. But they struggled with an often-hidden compulsion that caused them great anxiety and lowered their self-esteem.

There were also some more disturbed people who attended meetings. Often these addicts did not have a regular job, were involved in abusive relationships, and had trouble trusting or sharing feelings with others in the group. They seemed to have had more severe abusive and neglectful family histories. Nevertheless, many of them were eventually able to share their experience meaningfully and to begin to make friends. I learned from meeting them that even the most severely disturbed people can still want help and love. Near the end of my time in 12-step groups, I made it a point to reach out to them and make them feel welcome.

Nevertheless, during the first 2-3 years that I attended 12-step meetings, I failed to make significant progress in reducing my destructive acting-out behavior. While I made friends in the program, I never developed a trusting relationship with a sponsor. This partly related to my fear of authority figures which came from my physically abusive father.

More importantly, I was having trouble trusting my therapist outside of the program. The lack of a good relationship there, which also related to my historical lack of trust in my parents, led me to continue to feel alone and uncertain. This lack of a good core relationship in turn drove me to continue the addictive behaviors that masked the bad feelings.

Why I Left 12-Step Groups – The Christian Focus

Eventually, I decided to leave 12-step groups. There were several reasons why I did this. At around age 23-24, I had begun to work full-time and found it difficult to consistently attend meetings in the evenings. Looking back, I was overworking but did not know it then.

More importantly I disagreed with some of the core viewpoints of the 12-step program. The 12-step program is a Christian program, and I am not a Christian. I never liked being forced to say the Lord’s Prayer, having to admit out loud that I was “powerless” over my addiction, and needing to submit my problems to God.

My personal belief is that the Christian God is a fabrication invented by primitive, tribal, pre-scientific people. For early humans, Christianity many important functions, among which two stand out for me: 1) To give an illusion of knowledge about the origin and structure of the universe, and 2) To protect them from the fear of death, via the illusion that they could transcend death by going to heaven.

To admit that we have no idea why the universe started can be unsettling. And to face the fact that we may die and nothing comes afterwards may be similarly disturbing and depressing. However, I do not find these things depressing – they are simply mysterious, fascinating, and perhaps tragic, although not in a bad way. I would rather face these uncertainties than blindly place my faith in something that is unproven.

I realize these last two paragraphs may sound arrogant to Christian readers, but in fact I am only agnostic, not atheist. I admit that I could be wrong and that the Christian God could exist. I just find it extremely unlikely, since I believe in evidence, not faith, and no evidence has thus far convinced me that a Christian God exists. I do believe that some non-human “god-like” force could exist which initiated the big bang and thus the universe. But what that might be is a mystery.

To conclude, I understand that others feel differently and I do not begrudge them that; everyone is entitled to their own religious beliefs.For the purposes of this article, what matters is that human relationships and human love “works” in terms of promoting recovery from addiction and BPD. I have gotten better with the help of humans alone. If other people need both their fellow humans and faith in God to recover,  that is fine!

To return to the 12-step group, my viewpoints about religion differed too fundamentally from the group’s. This contributed to my eventual decision to leave.

Addiction As a Disease

People within the 12-Step group also referred to addiction as a “disease”. This is ridiculous, since it ignores everything we know about diseases. Actual physical diseases are caused by a preexisting physical agent or genetic condition.

To start with, like BPD itself, addiction is not a discrete entity or syndrome like a physical disease. At what exact scientific point does overeating become an “addiction”? Doesn’t everyone eat more than they should at some point? So is everyone addicted? Etc. The brains of the severely addicted do look different, but these differences can plausibly and entirely be explained by environmental factors.

Second, even if someone does have a relative genetic weakness (vulnerability to stress), that would not be the cause of their addiction. In most cases, addiction could again plausibly be explained almost entirely by environmental stress, such as abuse, neglect, low self-esteem, and poor personal relationships.

Addiction cannot be reduced to the level of a physical disease; to do so is reductionist and dehumanizing to the addict. However, we should not be surprised that psychiatrists and drug companies are currently trying to label addiction as a disease, given that they stand to make billions of dollars in additional profit from doing so.

“Cui bono?” (meaning who benefits, financially or otherwise) should always be asked whenever Big Pharma and research psychiatrists are involved in making some pronouncement about addiction or BPD. More often than not, their self-serving conclusions should be rejected outright.

To return again to 12-step groups, their blind acceptance of the disease model of addiction caused them to lose credibility with me. Many overeaters in the group unthinkingly accepted this idea and referred to themselves as having a “disease.” They conceptualized it as some physical process that they could not control. This fit with the idea about needing to admit “powerlessness” over addiction, discussed below.

Powerful or Powerless over Addiction

One other aspect of the 12-step groups bothered me – their insistence on admitting one’s “powerlessness over addiction”. This never made sense to me. I wanted to build capacities and a sense of personal strength that would let me overcome my addiction. Why should feeling powerful be a bad thing? Today, I am probably burdened with an over-abundance of confidence, as the reader may see in this writing, but I am not ashamed of it. The 12-step program viewed “pride” as a sin, but in moderation I view personal pride as a virtue.

Neither the disease model of addiction nor the admittance of powerlessness over addiction are ideas that I am accept. Rather, I am proud to reject them wholesale. I never had an addictive “disease”, and I was never personally powerless to start recovering from my addiction.

In any case, the Puritanical, God-fearing, self-effacing aspect of 12-step groups were what finally led me to leave them. For a while, I continued to attend while trying to take the good things out of the group and ignore the “bad” things. However, this did not work, since as I developed more of an identity, the focus on “God” and “powerlessness” made me feel out of place there.

I searched for a similar but non-religious addiction recovery group, but did not find one. So, today I am without such a group. I feel the better for it, since I am being true to what I believe, and because I have found other ways of overcoming my addiction.

What Helped Me Overcome My Addiction

In reality, many complex interrelated factors helped me to overcome my addictive acting-out with food. Three of them stand out:

1) My work in therapy on not attacking myself for overeating, but instead compassionately understanding my acting-out behavior.

2) A focus on reducing the underlying need for the addiction, rather than on stopping the addiction itself.

3) A focus on building a positive,trusting relationship with my therapist, and later on with friends and family that replaced her.

I’ll discuss each of these in more detail.

1) Replacing self-blame with compassion

The psychotherapist Theodore Rubin wrote a great book called Compassion and Self-Hate: An Alternative To Despair. This book inspired me to start changing my attitude toward myself. Rubin describes dozens of ways in which people perpetuate destructive cycles by attacking themselves themselves rather than choosing self-compassion. He devoted a chapter to addiction in which he described it as one of the most insidious forms of self-hate.

Developing compassion for myself became a primary tool that allowed me to escape the metaphorical labyrinth of addictive behavior. I started by often repeating to myself the cliche that everyone is a person who deserves love and understanding, especially from themselves.

In various ways I would tell myself that I deserved better than to attack myself as worthless and horrible. I would particularly try to be gentle with myself right after I had relapsed and acted out, that being the time at which I most needed self-compassion. This eventually helped me to stop starving myself after the overeating episodes.

Eventually, it dawned on me how much energy I wasted calling myself names. My therapists often told me how “harsh” I was on myself, and their defense of my true self against the “false self” and its attacks proved a valuable model.

2) Focusing on what drives the need for the addiction, not the addiction itself

Early on in my addictive struggle, I obsessed over “stopping” the addiction. I would try to will myself to stop going and eating. Of course, this did not work, because underneath I still felt alone, unhappy, afraid, and hopeless. Even if I did will myself to stop overeating for a while, I would inevitably restart a few days or weeks later.

For long term recovery, my real need was to build an entirely new, healthy personality for the first time. This initially daunting task took years. Food did not drive my addiction. Rather, my entire borderline personality structure created and then drove the addiction.

My severe ego-splitting, low-self-esteem, inability to regulate feelings, and lack of identity created the fertile ground on which addiction grew. Some kind of addictive behavior was almost bound to develop, since the emptiness, hurt, and fear were so great that they could not be tolerated without an addictive distraction. If it were not food, it would have been something else.

Viewed in a more positive light, my lack of being nurtured in childhood created the personality problems that led to my addiction. I needed to find a good way to fill the emotional void created by my abusive childhood, and to begin to tame the swirling cauldron of fear, rage, and despair that accompanied it.

If I could come to trust other people, take in their love and comfort, and raise my self-esteem, I would have less need for the addiction and it would naturally diminish.

3 – Developing long-term good relationships

It is obvious, but it bears reminding ourselves that good, supportive human relationships are as crucial for a healthy personality as oxygen is for a healthy body. Without good relationships to real, external people, we do not develop adequate security, self-esteem, or the ability to regulate our feelings.

By around age 20, I had read extensively about Borderline Personality Disorder. From a psychodynamic standpoint, I understood that BPD reflected a faulty personality structure stemming from extremely poor relationships in childhood. It was hardly coincidental that so many borderlines reported abuse and neglect growing up.

To use Gerald Adler’s terms (from his book, Borderline Psychopathology and Its Treatment), the core of borderline psychopathology was a failure in the formation of soothing, comforting images (or functional introjects) of other people. This in turn resulted from a lack of sufficient good, comforting relationships in early life.

Since the ability to self-soothe never developed, the future borderline could not resolve splitting (which requires a predominance of positive over negative introjects) and continued to see themselves and others as all-good or all-bad into adulthood. All the other borderline symptoms like addictive behaviors, low self-esteem, suicidal ideation, etc. flowed from this central failure of nurturance and love in childhood development.

Given this research, I understood that I absolutely had to develop a trusting, dependent relationship with another person, or I would not get better in the long term.

This is what I worked so hard on with a series of therapists for several years. At the outset, it can be very difficult to trust someone when you have been let down and rejected countless times in the past. I often distrusted my therapists, telling myself that they cared about my money and not me, and that I was innately not worth caring about. However, over the years it gradually dawned on me that they were genuinely interested in helping me and that I did deserve help.

So much changed during the years that I pain-stakingly became able to trust my therapists and feel their support. It is impossible to describe it all here. But gradually, the external world became “real” and “in color” to me. For the first time, I became able to form real, loving relationships with people outside therapy as well as with my therapist. I developed real friends that I liked and that liked me. My relationship to my parents improved. I gained the courage to date women, and believed that a woman could love me for myself.

All of this internal and interpersonal progress helped my addiction. I felt less and less need – less desire – to overeat. I was not even thinking about it as much, because my focus shifted away from my inner world and toward the real, external world of human relationships. The previously exciting, addictive “thing” relationship to food held progressively less allure.

In this way I gradually conquered my addiction, replacing the inner emptiness and lack of love that drove it with real positive relationships and healthy self-esteem.

A Metaphor for Recovery from BPD and Addiction

This whole process of recovery makes me think of a long, slow version of the famous movie scene in which the Beast transforms into the Prince in Disney’s Beauty and the Beast. The curse on the Beast and his friends is lifted, the whole castle transforms into vibrant color, and the returned Prince can finally take in Belle’s love as a human being. It is a dream come true.

Although the Beast in the movie did not have an addiction (probably because Disney did not want kids to see a drug-addicted Beast!), he easily could have, given his isolation and despair in the castle for most of the story. The lesson that human love and taking the risk of opening up to another person transformed the the Beast is a timeless one and something I often remember.

That scene can be viewed here – http://www.youtube.com/watch?v=eM3j3S465oo

Or by searching for “Beauty and the Beast final scene” on Youtube.

———————————————

———————————

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes

#6 – Life After Borderline Personality Disorder – My Vacation

Spending the last two weeks visiting my extended family in England provided a great opportunity to reflect on my journey over the past few years.

I had not returned from America to my homeland for six years. In 2007, the symptoms of BPD had a powerful hold over me. Extended travel away from home was so stressful that I could barely appreciate the positive aspects of a holiday trip to visit loved ones.

In the past, overwhelming feelings of being alone, abandoned, and afraid would prevent me from relating meaningfully to my extended family. Being healthier emotionally than my own parents, my uncles, aunts, and cousins would make genuine efforts to reach me and make me feel accepted.

However, these efforts barely reached me, because my emotional suffering canceled out everything else, and because I had no idea how to love or be loved by others. In fact, I experienced my relatives’ efforts to show me love as a threat. Emotional closeness had barely existed in my immediate family, and so its sudden appearance in them seemed alien, strange, and frightening.

In the Lord of the Rings trilogy of movies, there is a scene where King Theoden of Rohan is possessed by the evil spirit, Lord Sauron. Theoden looks aged beyond his years, and is unnaturally cold, with his coat and beard covered in ice. He barely recognizes his loving daughter and son. When the heroes of the story visit him, he unfeelingly asks why he should welcome them.

As those who have seen the movie may remember, Theoden is freed after the wizard Gandalf exorcises Sauron’s spirit from him. With the curse lifted, Theoden appears immediately younger, warmer, and is shocked at how coldly he acted previously. He returns to life and becomes able to love his family again.

When I saw this scene, I immediately associated it metaphorically with the way in which traumatic, neglectful experiences “possesses” people who are later said to have Borderline Personality Disorder. Abuse and neglect can warp people’s personalities and transform them into shadows of who they otherwise would have been. In technical terms, they are possessed by “bad objects”, or negative experience from the past, which prevents them from becoming the loving person they could be in the present.

Back to my trip to visit extended family – I had a fantastic experience! For the first time, I could deeply feel the love they had for me. I was nervous about how my family might react, since I had not visited for many years. However, they went out of their way to make me feel welcome. They provided a warm place to stay, included me in family meals, helped me get around London, and showed real interest in how my life in America was going.

When I was swamped with borderline symptoms, it had never dawned on me that these people had their own work, relationships, and interests. But now, I could perceive my relatives as separate, distinct people and really come to know them in the meaningful sense of that word. Previously, I would use them, but have no interest in them beyond their ability to satisfy my immediate needs. This year, I discovered my uncles, aunt, and cousins as real people for the first time.

While exploring London, I was fascinated to discover how people in London, UK live so differently than in my American suburb – for example, they use public transport all the time, walk great distances, have few big cars, shop at tiny grocery stores, etc. Christmastime was fantastic – there were crafts markets full of international artisans, outdoor ice skating rinks everywhere, magicians and acrobats peforming in public parks.

These varied sights were meaningful in that when I was severely borderline, I would not have noticed them, or at least would not have delighted in them. I would have been like King Theoden, “possessed” by my negative emotions and prevented from taking in good things from the outside world. However, in 2013, a childlike sense of wonder and discovery dawned on me.

In his great writing on borderline conditions, the psychoanalyst Harold Searles described how the successfully treated borderline patient would eventually experience a psychic “rebirth”. The person would belatedly experience a sense of wonder and discovery, of being the child that joyfully explores the world for the first time.

It is important that such a regression not go on too long, because it is also critical to mourn the real losses in a childhood marked by severe abuse, and to develop mature adult emotional capacities in general.

However, every borderline deserves to one day feel this childlike joy – the delight of knowing that you are better, that you are alive, and that the world is there for you to discover.

Another primary emotion in me right now is vindication. This recent vacation is yet another, among hundreds of positive experiences in the last few years, by which I have disproven those who say that BPD is incurable and hopeless. I know that one can recover fully from Borderline Personality Disorder – and not even have the disorder at all anymore – because I am living that recovery.

If I’m to become more fully mature, I’ll need to fully relinquish the desire to get back at those who kept me down in the past. However, proving people wrong remains one of my favorite things, and so it won’t be too damaging to delight a little bit in my ongoing victory over the “false prophets of Borderline Personality Disorder.”

Among the “false prophets of BPD”, I include:

– Those therapists and laypeople who say that Borderline Personality Disorder is life-long, i.e. that once you have BPD it cannot ever fully go away, the implication being that it can only be managed while living a life periodically afflicted by its symptoms.
– Psychiatrists who believe BPD is biologically- or genetically-caused and needs to be treated primarily with medication.
– Anyone who says that borderlines are bad or evil, that they are not motivated to get better, and that they have a bad prognosis or are hopeless.

To all such pessimists, I am delighted to prove you wrong on a daily basis. There is a reason this post is titled, “Life After Borderline Personality Disorder.” Whether or not you believe what I write doesn’t matter one iota, because my feelings and experiences are 100% real to me. I am your reckoning.

I only hope that other borderlines will take heart from people like me who have recovered. Borderlines have enough challenges with which to deal on the road to recovery, without being burdened by the discouraging opinions of those who stigmatize them.

My message to borderlines reading this is – Don’t pay one bit of attention to the pessimists and liars that say you can’t get better. Borderline Personality Disorder can be fully recovered from, and life can be far better than you imagined. Let yourself dream of a better tomorrow for yourself and those you love.

—————————————————

———————————

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes