Tag Archives: abuse

#24 – How I Triumphed Over Borderline Personality Disorder

I recently rewrote my story of struggling with and overcoming the borderline diagnosis. The account below describes the beatings I endured as a child, periods of extreme hopelessness, encounters with stigmatizing psychiatrists, an argument that conceptualizing BPD as a life-long disorder can be harmful, analysis of how I deconstructed the borderline label, a very brief account of my therapy, and some of my proudest achievements in work and love.

Although it’s brief for a life story, I hope you find this account encouraging. I’m not better or fundamentally different than anyone else who gets labeled BPD, and given sufficient support anyone with “borderline” symptoms can do very well.

How I Triumphed Over Borderline Personality Disorder

Welcome to my story of recovery from Borderline Personality Disorder (BPD). This story will illustrate how I went from fearing this dreaded diagnosis, to being hopeful about it, to finally no longer believing in its validity.

Here are two early encounters with “mental illness” that show how I grew to fear psychiatric labels:

Vignette #1 – When I was eighteen, my mother and I sought professional help after years of emotional abuse at the hands of my father.

In our first session, the therapist said, “It sounds to me like your father has a personality disorder…You know, there are normal people, there are those who are a little bit outside our societal norms, and then there are people who are really beyond the pale. In this last group are the ones we call ‘personality disordered’. These people are very difficult to help, and many therapists consider them ‘untreatable’.”

Being unfamiliar with “personality disorders”, my mom and I didn’t know what to make of this. But despite my father’s abuse, I disliked this therapist’s cavalier labeling of someone he had never met.

Vignette #2 – At age twenty, I became suicidal and had to be involuntarily committed to a psychiatric hospital. The following example comes from a group therapy session inside the hospital:

“Mood disorders are biologically-based mental illnesses,” the psychiatrist announced authoritatively, surveying the fifteen young adults in front of him. “But while these disorders might be biological, it doesn’t mean you can’t manage them effectively.”

My mind reacted explosively: How the hell could you possibly know this? What evidence do you have? I desperately wanted to shout at him. But I remained silent, slouching backward in my chair.

These snapshots encapsulate the hopeless viewpoint with which psychiatry assaulted me. It would take everything I had to break free from the resulting fear and despair.

How I Became “Borderline” – A Very Brief History

As of this writing, I’m twenty-nine years old. I grew up in a family of four on the east coast of the United States. My father worked a demanding financial-sector job, and my mother taught school part-time while caring for my younger sister and me. Our childhood was marked by isolation, emotional deprivation, and physical abuse. Starting when I was six, my father regularly beat me for small infractions such as arguing with my sister, outside of which he remained emotionally distant. He often sat on our living room couch staring into space for hours at a time.

Two memories of the abuse stand out. On one occasion, when I was around ten, my father, who was about 6’3 and 225 pounds, chased me to my room, broke my locked bedroom door off its hinges, and attacked me with fists to my face. On another, he picked me up and threw me ten feet across a room onto the sharp edge of a table. He would usually follow these incidents by telling me that he loved me, but would then return to his catatonic-like state on the couch. My mother tried to protect me, but was too afraid and insecure to be of much help. Child services were never contacted.

By my late teens, I felt depressed, scared, and helpless. Despite doing well in school – I was a good student who enjoyed playing tennis and violin with school groups – I had no close friends, and didn’t know how to talk to girls. The growing pressure to leave home and function as an adult felt incredibly threatening. At the same time, my father’s mental health was deteriorating further – he had to be hospitalized multiple times for manic episodes and suicidal depression.

As our family life broke down, things felt increasingly hopeless. I felt furious at my parents, and suffered intense mood swings of rage, emptiness, depression, and terror. I wanted to get help, but couldn’t trust anyone enough to open up about what I was feeling.

Eventually I became suicidal, and after concocting a plan to kill myself, which almost succeeded, I was involuntarily hospitalized. This episode led to the diagnosis of Borderline Personality Disorder, given to me by a psychiatrist at the hospital. I spent two weeks at the hospital in a shocked, barely coherent state, getting little help from superficial group therapy and heavy medications. The only good thing was that I stopped being actively suicidal.

The First Phase – BPD: A Life Sentence?

In the year after my hospitalization, I extensively researched my “illness”. Most readers will be familiar with the core “borderline” traits:  they include black and white thinking (“splitting”), self-damaging behaviors, impulsivity, fear of abandonment, and unstable interpersonal relationships.

Through interactions with psychiatrists, internet forums, and pop psychology books, I found out the following “facts” about Borderline Personality Disorder:

  • BPD is a life-long mental illness; it can be managed but not cured.
  • Due to their reputation for being manipulative and demanding, most “borderlines” are avoided by therapists.
  • Twin studies show that 50% or more of vulnerability for BPD is transmitted through genes.
  • Brain imaging reveals that the brains of borderlines differ significantly from the brains of “normals.”
  • Borderlines suffer from a constitutional deficit that prevents them from regulating their emotions normally.

As a young person, I didn’t know how to evaluate these data. If a person had “Ph.D” or “M.D.” by their name, I tended to believe what they said. When I was already vulnerable, these ideas heightened the terror. I became possessed by the fear of being a “hopeless borderline”, of having a life-long mental illness that was impossible to cure. I was not only facing formidable challenges in reality – like my father’s abuse and a lack of social skills – but was further impeded by the intense anxiety and hopelessness surrounding the label “BPD”.

Questioning The Pessimism

By the time I was twenty-one, my parents had divorced and I’d chosen to live with my mother. For two years after my hospitalization, I was unable to work or attend college. Much of my time was spent at home, severely depressed, isolated, and brooding about being a “hopeless borderline.”

At this time, I was seeing a psychiatrist once a week for fifty minutes a session. Over a two-year period, he prescribed me twelve different antidepressant and antianxiety medications. We kept trying different pills, with nothing helping much. If I had known then what I know now – that many psychiatric medications are little more effective than placebos – I would never have taken so many.

To his credit, this psychiatrist tried to “do therapy” with me. Unfortunately, I was in such a traumatized state that I could not take in his empathy nor understand my family history. However, I gradually became aware that someone wanted to help. I noticed that although my psychiatrist knew I had been labeled borderline at the hospital, he never used this label on me.

This experience with the kind psychiatrist built up a sliver of hope. I realized that I felt a little better after talking to him, and wondered if that feeling could become stronger. Sometimes I would have the thought, “Maybe there is really nothing wrong with me.” Part of me wanted to fight, to become alive, to feel like a real person. When I had the daily thoughts about borderlines being doomed, a voice inside my mind started saying, “They are lying to you!” I wanted to find out what this meant.

Over time, I felt increasingly angry about the way borderlines were stigmatized. How could borderlines be so bad? Had none of them ever been “cured”? What if the things I’d read about borderlines were untrue, or the result of therapists who didn’t know how to treat them?

The Second Phase – “Borderlines Can Do Well”

With these doubts surfacing, I began to research BPD in greater depth. Up to that point, I had received most of my information from the hospital staff and internet forums where people spoke negatively about “their borderlines.”

I decided to go on Amazon and look for new information. The books that influenced me the most were older psychoanalytic texts. Their authors included Gerald Adler (Borderline Psychopathology and Its Treatment), Jeffrey Seinfeld (The Bad Object), James Masterson (e.g. The Search for the Real Self), and Harold Searles (My Work With Borderline Patients).

As I read about borderlines in long-term therapy, I was shocked to realize that many borderlines had fully recovered. The case studies showed people starting out hopeless and nonfunctional, but becoming able to work productively and enjoy relationships. It was crystal clear from the narratives that these “borderlines” were coming to trust others, working through their pain, and coming alive. I finally had some hope. Given enough time and support, former borderlines could improve greatly and even be “cured”.

I remember thinking, “Wow, a lot of what I’ve been told about BPD is completely wrong; this is not a hopeless condition! If other borderlines can recover, why can’t I do it?”

This burst of hope inspired me to seek help. I pursued psychodynamic therapy, interviewing several therapists and finding a kind psychologist who had worked with many trauma survivors. I went to see her twice a week for several years.

Gradually, painstakingly, I made progress. Through reading accounts of borderlines recovering and discussing the fears around diagnosis with my therapist, my anxiety and hopelessness lessened. I formed a really good bond with this therapist, coming to trust someone deeply for the first time. Being “reparented” and taking in her love was the most important step in my becoming well for the first time (I would call it “recovery”, but I had never been well before).

For the first time ever I had periods of feeling calm. I felt like Michael Valentine Smith, the Martian man from Stranger in a Strange Land who learns what it is to be human. Becoming able to trust other people, feeling safe in my own skin, appreciating the sun and the flowers and the trees, feeling that I was going to survive, it was all strange, incredible, and bittersweet.

Using online groups like Meetup, I tentatively started to seek out people my age. Feeling more capable, I earned a professional qualification and began teaching sports to young children. The more time I spent around energetic kids, the harder it was to remain pessimistic. Being still a child at heart, I found a talent for relating to children on their level.

The Third Phase: “My Way of Thinking about BPD Doesn’t Make Sense”

In difficult times, I continued to worry about the pessimists who said full recovery from BPD was impossible. I was still thinking of things in terms of “borderlines act like this, borderlines don’t act like that, borderlines can do well, borderlines can’t do well, etc.” The label still felt real.

But with life experience, I began to doubt BPD. I wondered if BPD – the disorder, not the symptoms – really existed at all. The following questions became increasingly problematic:

  • How can therapists reliably determine the degree of a given symptom that warrants its inclusion in a BPD diagnosis? For example, who can say when someone’s relationships are unstable enough, or when a person feels empty enough, to cross the threshold and suddenly become a “borderline” symptom? The subjective, descriptive nature of BPD symptoms seemed like a major weakness.
  • Person A could have only symptoms 1 through 5 from the DSM IV, and Person B could have only symptoms 5 through 9. The people might even be very different in how they express the one common symptom. Do persons A and B really have the same “disorder”?
  • Did researchers have strong evidence that BPD was genetically transmitted, or that brain differences between borderlines and “normal” were caused by biology?
  • Why does BPD have 9 symptoms? Why not 4, or 23, or 87? How was BPD’s existence as a 9-symptom “illness” first inferred?
    (I realize that BPD has magically “changed” in the new DSM V. But in slightly varied forms, all of these criticisms would apply just as much to the “new BPD”; these examples represent the time when the DSM-IV was current).

As far as I was concerned, there were no satisfying answers to these questions.

The Fourth Phase: “I Don’t Need BPD Anymore”

Something felt fishy about the whole psychiatric labeling system. I suspected that BPD, along with the other labels, represented a house of cards that would collapse under close examination. More research was in order.

This time, I discovered a group of writers including Stuark Kirk (e.g. Making Us Crazy), Paula Caplan (They Say You’re Crazy), Jay Joseph (The Gene Illusion), John Read (Models of Madness), Barry Duncan (The Heroic Client), Mary Boyle (Schizophrenia: A Scientific Delusion?), and Richard Bentall (Madness Explained). From their writing and through observing myself, I came to the following conclusions:

  • While all the borderline symptoms are real in different degrees and varieties, BPD itself is not a reliable or valid syndrome. In other words, there is no evidence that the symptoms labeled “BPD” occur together in people more frequently than would be expected based on chance alone;
  • No one can reliably draw a line for any of the borderline symptoms beyond which one is “borderline” and before which one is “normal.” In other words, the subjective, descriptive nature of borderline symptoms fatally undermines their reliability;
  • Twin studies do nothing to prove that “BPD” is transmitted through the genes, this is partly related to the non-validity of BPD and partly to methodological problems with twin studies;
  • There is no evidence that a constitutional deficit in regulating emotions exists in “borderlines”;
  • Because BPD is invalid and unreliable, biological researchers studying “it” are doomed to roam a circular labyrinth. They will continue to generate false hypotheses and misleading conclusions based on the illusory imposition of a “borderline” cluster of symptoms onto random mixes of severely distressed people.
  • Psychiatrists will continue clinging to the existence of “BPD” and other personality disorders. If they were to admit that BPD et al. are unscientific fabrications, their status as “experts” would be undermined.

It will be recalled that my young self had feared BPD as an incurable, genetically-based “illness”. By the time I was twenty-five, my thinking had evolved radically. If the placeholder “BPD” was a nonexistent ghost, then many of these ideas ceased to have meaning. It didn’t make sense anymore to worry about getting better from “BPD.” One cannot become free from a condition that is not diagnostically valid; one cannot be cured of something that cannot be reliably identified; genes cannot cause a fictitious disorder; medication and therapy cannot be compared for the treatment of a speculative phenomenon, and so on.

This is how I think about “Borderline Personality Disorder” now – as a ghost, a fiction, a figment of psychiatrists’ imaginations. In asserting this, I am never saying people’s painful experiences are not real. They absolutely are. But affirming people’s pain is very different from arguing that Borderline Personality Disorder exists as a distinct “illness”.

Further Emotional Growth

As I increasingly separated from the label “borderline”, further emotional growth took place. Based on my work teaching children, I started my own business, which involved advertising, accounting, hiring staff, and communications. I moved into my own house, living independently for the first time, while continuing to socialize more. I was happy a lot of the time.

In my late twenties, I had my first real relationship with a woman. She was an attractive college girl; we had several interests in common and got along well. After the hopelessness stemming from my abuse and the BPD label, loving another person had seemed like an impossible dream. I was glad to be proved wrong – loving her was better than I had ever imagined! This relationship was a first in many ways, teaching me a lot about emotional and physical intimacy.

I realized how, during the long years dominated by fear, despair, and anger, I had missed out on the best things in life. I realized that believing in “Borderline Personality Disorder” had only held me back.

A New Way of Thinking

If BPD didn’t exist, how could I understand my past “borderline” symptoms? The black and white thinking, emptiness, despair, fear, and rage had been very real. To understand them without the BPD label, I needed a new model of reality. I started by picturing distressing thoughts and feelings existing along a continuum of severity.

In my new thinking, each symptom was no longer “borderline” or “not borderline”; rather, my feelings and thoughts were the result of my family experience and everything that came from it. In particular, I needed to understand how my father’s physical abuse and my mother’s lack of emotional availability had contributed to my problems. In this way my past started to hold meaning (whereas, calling myself “borderline” didn’t really explain anything).

I modeled some of my thinking after Lawrence Hedges, a California-based psychologist. He rejects the DSM labels in favor of a system called “Listening Perspectives”. In this model, a person uses different ways of relating to other people at different points in time. Hedges describes these levels as “organizing (a term to replace ‘psychotic’)”, “symbiotic (to replace borderline)”, “self-other (for narcissistic)”, and “independence (for neurotic-healthy)”.

These terms do not denote distinct “disorders”, but rather fluid ways of relating which fade into one another along a continuum, which evolve based on environmental input, and which always involve others. A person will operate in different parts of this continuum at different times and with different people. In this model, one would never “have” a borderline or psychotic “disorder”; the words “organizing” and “symbiotic” would have no meaning outside of a specific relational context. The focus is on understanding and changing restrictive ways of relating, not on labeling or managing “illness”.

I probably lost some people here! This way of thinking is not proven science, but it works for me, and it’s far better than believing in the static, hopeless “Borderline Personality Disorder.” I mostly don’t even think about BPD now, because it’s not worth my time. I’m more interested in real things!

Helping Others Break Free

Two years ago, I revisited some internet forums about BPD that I had first seen as a teenager. To my surprise, these forums were alive and well; more people than ever were discussing such weighty topics as:

  • What’s the best way to manage “your borderline”?
  • You know you’re a borderline when…. (fill in the blank)
  • Can I have borderline, schizoid, and antisocial PDs at once?
  • Are borderlines more sexual than the average person?
  • Why won’t my family take my BPD seriously?
  • Do borderlines have a conscience?
  • Are borderlines more sensitive than the average person?
  • If BPD is biologically based, why do people blame us for our behavior?
  • How do you fill your spare time when you have BPD?

If these weren’t so sad, they would be funny (well, some of them are darkly humorous, but let’s not go there…). Anyway, hundreds of people were discussing how to “live with BPD”, “manage this illness”, “learn to accept my diagnosis”, and other twisted medical-model jargon. The level of distortion inherent in these questions is so massive that I will not even begin to discuss them; the reader can infer my opinion from the preceding paragraphs. It’s tragic that already-traumatized people are fed these lies about BPD being an “illness” they’ll have for life; for many it will only make the path to wellness harder in the long run.

After seeing these forums, I started a website telling my story of hope and critiquing the medical model of BPD. This project has allowed me to learn from other people so diagnosed. Talking with them has only reinforced my conviction that people labeled “borderline” don’t have the same “illness”. Rather, they are unique individuals, most of whom have had very difficult lives. Almost all of them want to understand their problems and get better; they are basically good people with good hearts. I would never want to label any of them “borderline.” My messages to them are,

1) Full recovery and healing from so-called “borderline” symptoms is absolutely possible, and
2) You don’t have to understand yourself through the invalid label “BPD”.

For some reason, people like these ideas a lot better than the prospect of managing a life-long “personality disorder”.

—————————————-

Coda

I will finish this article with a scene the movie Inception:

“You mustn’t be afraid to dream a little bigger, darling.” My goal is for more people to be able to say that to the idea that they can’t overcome the borderline label. The “enemies” in this movie could symbolize my fears of having BPD for life and never becoming truly well.  To be able to dream bigger, I had to explode these distortions with more positive experiences and with better data, as symbolized by Tom Hardy’s big gun!

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#22 – Proof That Borderlines Are Motivated for Psychotherapy and Can Fully Recover

This post will answer critics who say: “Borderlines are not motivated to attend therapy. Borderline patients don’t stay in treatment. At best, therapy can manage but not cure BPD.”

These statements are absolutely false. Yet these myths continue to appear online, often being communicated to people recently diagnosed. As the studies below demonstrate, most people diagnosed with BPD do want help, most will stay in good treatment, and most do recover to different degrees.

Earlier posts have elaborated my dim view of the (non) validity of the BPD diagnosis. Since it cites studies using the BPD construct, this post might be viewed as hypocritical. That may be a valid criticism! Nevertheless, these studies provide evidence that people with “borderline symptoms”, however defined, can be motivated and recover both with and without therapy

Study 1:  88 Borderline Patients Treated Twice a Week for Three Years

Highlights: Led by Josephine Giesen at Maastricht University, Dutch researchers treated 88 borderline patients for three years with twice-weekly psychotherapy. Patients were randomly assigned to either Schema-Focused Therapy or Transference-Focused Psychotherapy, which are described in detail below.

After three years, a large majority of patients showed significant improvement, with many considered fully recovered and no longer diagnosable as borderline. In the group of 45 patients undergoing Schema-Focused therapy, more than half were no longer diagnosable as borderline after three years, and many more had improved significantly.

The researchers commented, “These treatments demonstrate that patients with BPD can be motivated for and continue prolonged outpatient treatment… Three years of treatment proved to bring about a significant change in patients’ personality, shown by reductions in all BPD symptoms, increases in quality of life, and changes in associated personality features.”

Here are details from the study:

Patient Population:  88 Dutch patients diagnosed with BPD. Average age around 30 years, with most patients in their 20s or 30s. Over 90% of patients were female. The group had average educational levels for Holland; about half had attended some college or completed a degree. As for functioning before treatment, around 50% were on state disability, 20% were working, and the remainder were students or stay-at-home wives/mothers.

Trauma in Patients’ Histories:  Over 85% of the patients reported childhood physical abuse. About 90% reported childhood emotional abuse or neglect. More than 60% also reported sexual abuse. Over half the patients had seriously contemplated or attempted suicide within three months before treatment. About three-quarters were taking some type of psychiatric medication.

Intervention: For a three-year period, patients attended two 50-minute sessions per week of either Schema-Focused Therapy (SFT) or Transference-Focused Psychotherapy (TFP). Treatment occurred at outpatient medical centers in four Dutch cities. The type of therapy given was randomized.

Definition of Schema-Focused Therapy: SFT is a psychodynamic treatment which assumes the existence of schemas (mental models of relationships) expressed in pervasive patterns of thinking, feeling, and behaving. The distinguished modes in BPD are detached protector, punitive parent, abandoned/abused child, and angry/impulsive child. Change is achieved through a range of behavioral, cognitive, and experiential techniques that focus on (1) the therapeutic relationship, (2) daily life outside therapy and (3) past traumatic experiences. Recovery in SFT is achieved when dysfunctional schemas no longer control the patient’s life.

Definition of Transference-Focused Therapy: TFP is a psychoanalytically-derived therapy which focuses on the transference relationship between patient and therapist. Prominent techniques are exploration, confrontation, and interpretation. Recovery in TFP is reached when good and bad representations of self and others are integrated and when fixed primitive internalized object relations are resolved.

Therapist Composition: 44 different therapists treated the 88 patients. Over 90% of the therapists had doctoral or master’s level training. All therapists had previous treatment experience with BPD patients. Therapists averaged 10 years of experience working with borderline individuals.

Outcome Measures: Patient progress was assessed every 3 months for 3 years. The primary outcome measure was the BPDSI-IV, a 70-item scale measuring the severity and frequency of borderline symptoms. Patients also completed regular quality-of-life questionnaires. These included the World Health Organization quality of life assessment, a 100-item questionnaire covering level of satisfaction with interpersonal relationships, level of independent functioning, psychological wellbeing, and physical health.

Dropout Rate: Of 45 patients treated with Schema Therapy, only 11 dropped out during the entire 3-year period. So 75% of this group persevered in intensive therapy for at least three years.

Of 43 patients treated with Transference-Focused Therapy, 18 dropped out during the 3-year period. However, the study notes that 10 of these 18 drop outs disliked the therapy method or their therapist, and 5 of 18 had issues around TFP’s method of enforcing contracts. Many of these dropouts occurred in the first few months. In my opinion, TFP is a more rigid, less effective form of treatment, and so it’s unsurprising that more patients dropped out. There’s no reason these patients couldn’t do better in another treatment.

Understanding Improvement in these BPD Patients

So how was improvement in these patients measured?

To answer this, one has to understand the measures used in the study. The primary gauge was the BPDSI-IV scale, which was filled out by patients every three months for three years. The BPDSI consists of 70 items arranged in 9 subscales. For each of the 9 DSM symptoms, 7-8 questions are asked to determine how severe and frequent the behaviors/feelings have been over the past three months, from the patient’s perspective. Each question is rated on an 11-point scale, running from 0 (never, not at all, low) to 10 (daily, very intensely, high).

For example, several questions would ask about the intensity/frequency of a patient’s feelings of emptiness (DSM BPD criteria #7), several questions would ask about the intensity/frequency of a patient’s suicidal thinking/behavior (DSM criteria #5), several questions would ask about how unstable or intense the patient feels their relationships to be (criteria #2), and so on.

The scores relating to each symptom are then averaged, producing an overall rating for that symptom. (For example, the scores for all questions about emptiness would be averaged to produce one “emptiness score”, a number between 0 and 10.) These 9 average rating for the 9 symptoms (numbers between 0 and 10) are added up to give a “BPDSI-IV” score, which represents the severity of the patient’s borderline problems over the last three months. This number will be anywhere between 0 and 90, with 0 being perfect mental health and 90 being the severest borderline disorder.

Although I dislike the BPD diagnosis, I don’t mind the method used in this study, because it involves asking the “borderline” patients how they feel. In other words, the BPDSI scale is not a judgment by clinicians, it’s a report from patients.

Improvement in BPDSI and Quality of Life Scales during the first year:

With this understanding in mind, here is how the patients did over the first year:

borderlineimage1

In the top left graph, we see that in the schema therapy group (line with squares), the patients started out at an average BPDSI rating of around 35 (out of 90, with 90 being the most severe, representing the worst rating for each of the 9 BPD symptoms), but this had dropped to almost 15 by the end of the first year. The patients in the transference therapy group also improved, but a little less so.

The other measures are as follows:

The bottom left Euro-QOL scale is a measure of the patient’s subjective feeling of well-being on a scale from 0 to 100, with 100 being the best. We can see that it improved significantly for both patient groups over the first year.

The top right WHO-QOL scale is another quality of life scale, and the bottom right scale is a measure of psychopathology, neither of which I researched in depth. But the trend lines in each case are positive

Outcome In Terms of Symptom Reduction

Now let’s take a look at how the patients did in terms of each of the 9 BPD symptoms. Here is the graph of the treatment groups’ averages for symptom severity over time:

borderlineimage4

The left-hand numbers on each graph represent the average BPDSI rating for the group for that symptom. For example, for item C (top right), the “Identity Disturbance” rating (DSM symptom #3) started at an average of 5 out of a worst-possible rating of 10. This rating is an average for all the patients in the group. It then drops to an average of less than 2 out of 10 after the first year, an impressive reduction.

Average group ratings over time for all 9 BPD symptoms can be seen. From the top left, the items are: Abandonment score, Unstable Relationships sore, Identity Disturbance, Impulsivity, Suicidality, Emotional Instability, Emptiness, Anger, and Paranoid/Dissociative Tendencies. All of these ratings are from the patients’ perspective. The reader can see that in every case the trend is positive (symptoms getting less intense and frequent).

Detailed Outcomes Over Three Years

Lastly, here is data showing the patients’ progress over three years:

borderlineimage3

We can see that the patients improved a lot in the first two years, and tended to maintain that improvement between years two and three. I don’t interpret this pessimistically. After a significant period of early improvement, there is often a time where a person works to become more secure in their new level of functioning and relating. This may partly account for the “leveling off” of the scores between years two and three. If the patients continued in treatment (or on their own), they could improve further.

After three years, at least half of the Schema therapy group’s patients had recovered to the point where they felt well enough to no longer be considered “borderline”, and more than two-thirds were considered highly improved. “Recovery” was defined in this study as achieving a BPDSI score of lower than 15 out of 90, and maintaining that level through the end of the study. Other patients who improved a lot (e.g. going from a BPDSI rating of 50+ down to 25 or 20) would only barely be diagnosable as borderline, even if they weren’t considered “fully recovered”.

These studies tend to be very binary (e.g. people are either “recovered” or “not recovered”, but reality is not like that). It’s important to remember that improvement is a process; it’s never all or nothing!

Jeffrey Young’s Comments

Dr. Jeffrey Young of Columbia University is the developer of Schema Therapy for BPD. He commented on this study as follows: “With Schema Therapy, patients with BPD are now breaking free from lives of chaos and misery. Not only are they learning skills to stop self-harming behaviors, as they have with Dialectical Behavior Therapy, but a high percentage of BPD patients are finally making deeper personality changes that have not been possible until now.”

For Young, this study demonstrates that therapy for BPD can lead to full recovery, and that longer-term psychodynamic therapy can be very effective. However, his comment might be a little grandiose, as people with borderline symptoms made “deeper personality changes” long before he invented Schema Therapy.

Young’s group added that this intensive schema therapy may have advantages over Dialectical Behavioral Therapy. According to Young, “DBT relieves many of the self-destructive behavioral symptoms of the disorder, but may not reduce other core symptoms, especially those related to deeper personality change.”

Interestingly, Young noted that part of schema therapy’s success may involve its emphasis on “limited reparenting”, i.e. on the creation of a loving relationship between patient and therapist. This is closely related to what I discussed in article #10, in the phase of Therapeutic Symbiosis:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

More information is available at www.schematherapy.com, and I adapted the statements above from this webpage – http://www.schematherapy.com/id316.htm

My View on Schema Therapy

I am by no means an expert on Schema Therapy, and I have no affiliation with Dr. Young. My understanding is that SFT involves a mix of cognitive-behavioral and psychodynamic techniques. It focuses on building a positive therapeutic relationship, on better managing daily life, and on working through past traumatic experiences. These elements are common to most therapies.

Schema therapy also contains an object-relations (psychoanalytic) foundation, in that it conceptualizes the borderline patient as using “schemas” in their mind to represent and relate to themselves and others. Examples of these are punishing parent and angry child, uncaring parent and abandoned child, etc.

Schema therapy helps the borderline patient understand how these faulty models developed – often due to trauma and poor parenting – and to stop the replaying of negative past interactions from destroying the potential for new, better relationships in the present. In this sense, it is based on Fairbairn’s object relations model, discussed below.

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

As Fairbairn said, “The psychotherapist is the true successor to the exorcist. His business is not to pronounce the forgiveness of sins, but to cast out devils.” 🙂

How Individuals Get Lost in Group Studies

My biggest criticism of this type of study is that it obscures individuals’ experiences behind numbers and averages. Of course, its intent is not to provide individual detail. But,I would like to hear from individual patients what their life experience was like at the end of treatment compared to the beginning. I’m sure many would speak very positively about their progress. Since we don’t have that, I recommend the reader to case studies referenced in these posts:

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

https://bpdtransformation.wordpress.com/2014/08/17/18-heroes-of-bpd-jeffrey-seinfeld/

The Mystery of Why People Are Still Pessimistic About BPD Treatment

In the bigger picture, this study’s results are obvious. Intensive help helps people, just like the sky is blue and the sun rises in the east. “Borderlines” are no exception to this. If they can access effective support – and are given a reasonable sense of hope – people diagnosed with BPD will do very well. What we need to be doing is getting more people access to effective treatment, and leaving behind the outdated myths that BPD is untreatable or incurable.

It’s amazing how such common sense escapes people who say, “borderlines don’t seek help, borderlines won’t stay in treatment, borderlines can’t be cured etc.” In my opinion, they are about as well-informed as people who think the Earth is flat.

Here is the original study of the 88 Dutch patients: http://archpsyc.jamanetwork.com/article.aspx?articleid=209673

Other Studies on Psychotherapy’s Effectiveness for BPD

This study is one of many investigating psychotherapy’s effect on BPD. Below are additional examples, one from a hospital outpatient program, one from DBT, and one comparing different psychotherapies:

Treatment of Borderline Personality Disorder with Psychoanalytically-Oriented Partial Hospitalization, An 18 Month Follow-up: http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.158.1.36

Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug Dependence: http://www.ncbi.nlm.nih.gov/pubmed/10598211

Evaluating Three Treatments for BPD: A Multi-wave Study: http://www.borderlinedisorders.com/images/AJPRCT.pdf

All of these studies show positive results. Again, this is not rocket science – good treatment helps people diagnosed with BPD!

What If Borderlines Don’t Get Good Therapy?

But what is people diagnosed with BPD don’t get good long-term psychotherapy? Do they inevitably do badly?

No.

Several studies address this question, including the one summarized below:

http://www.borderlinedisorders.com/images/AJPRCT.pdf

Here are the highlights of this study:

Study 2:  290 Borderline Patients In Massachusetts

Patient Population: 290 patients diagnosed with BPD, assessed at McLean Hospital in Massachusetts. They were first treated as inpatients during brief hospital stays.

Method of Study: This was a longitudinal-observational study. The patients were interviewed every two years for at least 10 consecutive years, starting in the early 1990s. During interviews, their level of functioning in work/school, satisfaction with interpersonal relationships, and degree and frequency of borderline symptoms were measured. After 10 years, 90% of the original cohort of 290 patients were still participating.

Therefore, this study followed the “natural course” of BPD. This medical-model idea is misleading (the notion that BPD has a “natural course”), but I won’t go into that now. Suffice it to say that the researchers in this study did not “treat” the patients – they just followed them after hospitalization and went to great lengths to see how they were doing every two years.

High Remission of Symptoms: After 10 years, 93% of the formerly borderline patients had experienced at least two consecutive years during which they no longer qualified for the BPD diagnosis, according to DSM criteria:

Time to Remission

Low Recurrence of Symptoms: After 10 years, among the 93% of patients who achieved symptomatic remission, only 29% became “borderline” again. In other words, once they improved to the point of no longer being diagnosable as borderline, a large majority did not get worse and become “borderline” again:

Time to Recurrence

Good Social and Work Functioning: After 10 years, 78% of patients had achieved good psychosocial functioning – defined as good performance in a job for at least two years, along with at least one emotionally sustaining relationship with a partner or friend:Good Functioning

To me this last slide is questionable, as it’s not clear how “good work performance” was defined (and a certain period of work is not a prerequisite for “recovery”, anyway). Nevertheless, this study shows how, in a group of previously hospitalized borderlines, most people improve to the point where they are able to function in a job and have an intimate relationship. Again, the study authors provided these patients with no treatment beyond brief hospitalization, although many probably sought help on their own.

Other Longitudinal Studies of Borderlines Are Also Positive

There are many other ways to critique this study; for example, one could say it only applies to “borderlines” in the northeastern United States who went through McLean hospital. However, other studies following borderline patients for decades reach similar conclusions.

These include Thomas McGlashan’s Chestnut Lodge study (Maryland, USA), Michael Stone’s “Fate of Borderline Patients” study (New York, USA), and Joel Paris’ longitudinal study of borderlines (Montreal, Canada). All of these studies concluded that a large majority of borderline patients improved significantly, and many recovered in the long term. Collectively these studies included over a thousand patients. These studies can be found by searching online, as well as through the books by McGlashan, Stone, and Paris on Amazon.

The Limitations of Naturalistic Studies Based on Diagnosis

The anti-psychiatry side of me says that these longitudinal studies reveal what a meaningless and unreliable diagnosis BPD is. It doesn’t make sense that some percentage of people are initially borderline, then at varying points in time they are suddenly no longer borderline, then a few of them are borderline again, and so on.

Maybe BPD was never a valid illness to begin with. But such common sense seems to escape Harvard-educated researchers like Zanarini 🙂 Then again, to admit that what they’re studying is an unscientific fabrication wouldn’t be great for their careers, nor for receiving funding from the National Institute of Mental Health.

Although these studies have flaws, I hope readers will see that people diagnosed with BPD do seek help, and that they can recover to be emotionally well and free of “borderline” symptoms. These are not just opinions. They’re facts.

On The Nature of Quasi-Experiments

Lastly, it is important to understand that these studies – like most in psychology – are quasi-experimental. This means they are not perfectly controlled experiments, because when studying human beings many factors simply cannot be controlled. One can never study a person as reliably as one studies solar radiation or the molecular structure of uranium.

No one quasi-study can “prove” a point definitively. Nevertheless, quasi-experimental studies can estimate the effect of a variable(s) on a group of people under certain conditions. And a pattern of quasi-studies with similar results can show that something real is happening

These studies should also not be interpreted as applying to any particular person. Rather, they are averages of many different people’s outcomes, and only have meaning on a group level.

Wow, I am exhausted thinking about all this data. Time to get a beer!

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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

#19 – Hope, Meaning, and the Elimination of Borderline Personality Disorder

My goal for this blog has been to promote a new, more hopeful understanding of what is today called Borderline Personality Disorder. In writing this post – which will discuss hope for recovery from emotional trauma, but later argue that this hope might be better served by eliminating the diagnosis of BPD entirely – the following quote from Macchiavelli comes to mind:

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from fear of their adversaries, and partly from the incredulity of mankind, who do not truly believe in anything new until they have actual experience of it.”
– Niccolo Macchiavelli (1469-1527), The Prince

For the purposes of BPD’s validity, this quote can be understood in terms of the “old order” of psychiatry – which profits both financially and via creating the illusion of scientific knowledge in psychiatrists – being opposed by those of us who argue as “reformers” that psychiatric diagnoses are invalid, unreliable and unhelpful. The reform position is that recovery from severe emotional trauma can be achieved without the need for psychiatric diagnosis. As the quote suggests, the idea that BPD does not exist as a valid diagnosis can initially be hard to believe.

Hope for Recovery, In All Its Forms

Today I’ll discuss what is among the most important topics for Borderline Personality Disorder: Hope. When a person is struggling with “borderline” symptoms – meaning intense difficulty managing their emotions and relationships, among other things – having realistic hope for improving one’s situation is critical. During difficult times, hope has felt as important for me as the oxygen a climber on Mount Everest carries for survival, or the fuel that a rocket returning from deep space uses, without which an astronaut would be doomed.

People may prefer to think of their hoped-for state as recovery, freedom, improvement, achieving goals, or something else; it is very individual. However their hope is defined, most BPD-diagnosed people express a strong desire to improve their situation.

Realistic hope

What makes hope realistic? I would suggest at least two things; 1) That hope is not taken for granted, and 2) That it is based upon convincing data.

#1, “Not taking hope for granted”, means realizing that improving one’s situation demands serious commitment and work, requires a willingness to confront oneself about difficult issues, and involves depending on other people for help.

#2, “Based upon convincing data”, means that realistic hope (for one’s desired outcome) must be based upon reliable and trusted information. To hold onto hope, a person needs a view of reality that is as accurate as possible in terms of representing the external world.

When I first searched for information about improving from BPD, a lot of what I found appeared pessimistic or even hopeless. Many publications said that the best outcome possible involved learning to better manage this painful lifelong “illness”, and some said that borderlines were untreatable or evil. Family members ranted about how difficult and unchanging their “borderlines” were. None of these things made me feel hopeful.

In earlier posts, stories and data were presented that, for me, provide realistic hope for recovery, healing, and achieving a “cure” of symptoms approximating what is described in the BPD diagnosis:

https://bpdtransformation.wordpress.com/2014/08/07/five-myths-about-bpd-debunked/

https://bpdtransformation.wordpress.com/2013/11/23/how-did-i-recover-from-borderline-personality-disorder/

The “Information War”

This data contrasted sharply with the earlier pessimistic, hopeless accounts about BPD I’d encountered. Sometimes it felt as though I was reading about two completely different conditions. For some time I fought an “information war” in my mind, trying to judge which of these conflicting versions of reality was right – or perhaps, whether both were correct, acting as self-fulfilling prophecies in different situations.  The increasingly numerous accounts I found of individuals with BPD diagnoses doing well, combined with my own life experience, eventually convinced me that realistic hope for getting better from what I then thought of as BPD did exist.

In my case, realistic hope meant that with sufficient support from family, friends, and my therapist, I had a very good chance of doing well, like many others who had encountered similar challenges before me. For other people, the hopeful narrative may be somewhat different; this makes sense given that we are unique individuals, and given my contention that BPD is an invalid, unscientific label which does not represent the same phenomenon from person to person.

Now, let us turn to look at some societal obstacles that impede realistic hope for BPD recovery.

The Failure of the American Mental Healthcare System

It can be useful to analyze the notion of realistic hope in the context of American psychiatry and its conceptualization of Borderline Personality Disorder. It is my position that psychiatry’s “medical model” approach to psychiatric diagnoses, its biological reductionism, its overemphasis on medication, and its oversimplification of an individual’s emotional struggles, all impede the spread of realistic hope regarding BPD (or more correctly, the hope for recovery from severe emotional trauma and/or the lack of healthy emotional development, in all its variations).

A Story: Emma

Let us discuss these ideas with a fictional example. Emma is a 21-year-old woman who grew up with an alcoholic, abusive father and an overstressed, emotionally neglectful mother. As a young girl, Emma was sexually molested several times by her father. Since finishing high school, Emma has lived at home with her mother, who works two jobs to provide for Emma and her younger sister. The father abandoned the family several years before, increasing the stress on the remaining family members.

Over the past three years, Emma has felt increasingly depressed and anxious most of the time. She is unsure how to make meaningful relationships with other young people. Never socially confident, Emma has become increasingly socially isolated as her old high school friends move out of town.  Due to her depressions, she cannot keep a regular job, and she goes through a series of short-term boyfriends who use her for sex and then abandon her, reminiscent of her father’s behavior. Unable to tolerate her increasing feelings of aloneness, and frustrated with her mother’s lack of understanding, she begins binge eating and purging, and also cuts herself when feeling particularly hopeless.

Finally, Emma overdoses on psychiatric medication in a desperate gesture that is really a call for help, leading her to be hospitalized for the first time. When evaluated by a doctor, she is seen as fearing abandonment by her mother, having an unstable self-image, practicing self-injurious behaviors, being unable to regulate her feelings, seeing others as all-good or all-bad, and so on. Obviously, she would be a prime candidate for receiving a BPD diagnosis according to traditional American psychiatry.

However, I want to focus on two possible ways that the hospital doctor could respond to Emma, and how these approaches might or might not promote realistic hope in Emma’s mind.

The Medical Model’s Diagnostic Approach

In the traditional psychiatric (medical model) approach, the treatment provider might communicate something like the following, “Emma, you’re suffering from a psychiatric illness called Borderline Personality Disorder. We don’t know what causes this condition, but it’s believed to result from a combination of genetic, biological, and environmental factors. BPD causes people to have problems regulating their emotions, and that is what is creating your symptoms like depression, anxiety, and rage. This is a tough condition to have – there’s no cure for it – but if you take medication and attend therapy, the symptoms can be managed.”

Usually, such an approach involves the doctor asking Emma what her symptoms are, but not going into detail about possible causes for these symptoms based on her personal history. Several emotional messages are conveyed by this approach. The first would be that there is something innately wrong with Emma. Emma would probably feel that she has a mental “disease”, that she is stuck with this illness for life, and that her prospects for finding personal fulfillment are poor.

The second message is that Emma’s past history and relationships are unimportant in relation to her “diagnosis”, or perhaps not related at all to her present problems. Rather than her current feelings and actions being understandable reactions to the deprivations she has experienced throughout life, she is told that a “disorder” is mysteriously causing her symptoms. Paradoxically, getting diagnosed with BPD does not give Emma any deep insight into why she is behaving or feeling the way that she is. The last, related message is that Emma is seen as a label, rather than as a person.

In my view, the ideas presented to Emma in the above example – i.e. “you have a psychiatric disorder called BPD, this mental illness is causing your symptoms, there is no cure for it” – are examples of outrageous lies coming from the pseudoscience that is psychiatry. In the posts below these distortions are expanded upon:

https://bpdtransformation.wordpress.com/2014/03/16/the-science-of-lies-psychiatry-medication-and-bpd/

https://bpdtransformation.wordpress.com/2013/12/09/is-borderline-personality-disorder-caused-by-faulty-genes/

https://bpdtransformation.wordpress.com/2014/01/16/a-unicorn-the-paradox-of-the-bpd-label/

In this last article – “A Unicorn: The Paradox of the BPD Label” – I originally wrote that BPD has value as a label allowing people to find help and support. My thinking here has changed, such that I would now strongly endorse only the second half of the article – i.e. starting with “Why I Do Not Believe in BPD.” As I’ve read more about how psychiatric diagnoses oversimplify people’s stories, fail to meaningfully address the causes of people’s problems, and lack scientific validity, I’ve become increasingly reluctant to attach value to the label “Borderline Personality Disorder”.

Formulation: An Alternative to Diagnosis

Returning back to Emma’s case, if labeling her with BPD is not helpful, how might she be understood instead?

The Formulation approach, which has been pioneered by mental health workers in the United Kingdom, would offer something like the following:

“Emma, you’re obviously in a lot of pain right now. From what you’ve told us, things have been incredibly hard over the past few years, and you’re not able to rely on your mother for emotional support. The way your father treated you has also had an incredibly powerful negative influence. Given your history, you must feel incredibly alone, and it’s no wonder that you feel hopeless, scared, and abandoned. Your behaviors of purging and cutting yourself make sense; after the trauma you’ve experienced, anyone might react this way to manage their overwhelming feelings.”

“Although it’s difficult, we feel that your situation is far from hopeless. But to feel better, you’re going to need help. You may benefit a lot with support from someone who can understand your story, assist you in managing your current feelings, and help you find practical ways to improve your current life. We have therapists who have successfully helped people with similar family histories to yours, and when you come to feel better and leave the hospital, we can refer you to an outpatient therapist who can continue to help you.”

Differences Between Diagnosis and Formulation

Obviously, this approach is starkly different from the traditional psychiatric approach. Firstly, Emma is not diagnosed with anything – the terms “Borderline Personality Disorder” or “BPD” are never mentioned. Rather, her symptoms are understood as perfectly logical reactions to the trauma she has experienced. In that way, Emma can start to make sense of what has been happening to her, and she will be less likely to feel crazy or defective. Emma’s past history and present circumstances are used to create a narrative explaining her present problems.

Secondly, a message of hope is strongly promoted, with the idea being that recovery is likely if Emma receives effective support. “Illness” and “disorder” are never mentioned as causes of her problems; therefore, Emma is not led to feel that there is something innately and irreparably wrong with her brain. Instead, Emma is told that her personal history matters, and that understanding how it relates to her presenting problems can help in managing her distress and improving her life.

Obviously, these approaches are poles apart, and might be considered black and white examples of how an actual mental health worker would deal with a patient such as Emma. Nevertheless, I have read about many people who are treated similarly to the first example, in which a psychiatrist diagnoses them with a mental “disorder”, while completely failing to understand the individual as someone with a history contributing to their problems. In my opinion, this traditional psychiatric approach is destructive to and precludes realistic hope.

Lucy Johnstone and Formulation

I must give much credit here to Lucy Johnstone, a British clinical psychologist whose writing on formulation inspired me. Here is an excerpt of her viewpoints on traditional psychiatry and the destructive effects of psychiatric diagnoses:

“Psychiatric diagnosis underpins the whole biomedically-based model of mental health. Any science needs to be able to demonstrate that it is based on a reliable and valid classification system, in order to develop testable hypotheses and hence the general laws that constitute a body of scientific knowledge. If this cannot be established, the whole model breaks down and all psychiatry’s other functions – indicating treatment, carrying out research and so on – will be fundamentally undermined.”

“ ‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong – scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress. We already have a situation where the strongest defence of DSM is: ‘We know it’s flawed, but it’s the best we have – what could we do instead?’ The simple answer is, ‘Stop diagnosing people.’”

These quotes come from the following source: http://www.madinamerica.com/2013/01/time-to-abolish-psychiatric-diagnosis/

Lucy Johnstone’s positions are very close to my thinking on the pseudo-diagnosis of Borderline Personality Disorder. To promote hope in people who have been severely traumatized and have great difficulty managing their emotions, perhaps it would be helpful to stop diagnosing them as “borderline.” Instead, we could understand them as individuals with unique histories that have contributed to their current problems, while encouraging them that they have strengths that can lead to recovery.

And here are some of Johnstone’s thoughts on “Formulation” specifically, in this case related to a person labeled as “psychotic”:

“In Britain, formulation is considered to be the core skill of the profession of clinical psychology… Formulation can be defined as the process of co-constructing a hypothesis or ‘best guess’ about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It draws on psychological theory and evidence in order to suggest the best path to recovery.  Unlike diagnosis, it is not about making an expert judgement, but about working closely with the individual to develop a shared understanding which will evolve over time…”

“We can see that the formulation is personal to (the patient), and helps to make sense of her experiences… It suggests an individual pathway forward, which will probably include developing a trusting relationship with a worker or therapist, learning ways to manage and cope with her voices, perhaps gaining support from others with similar experiences, and talking through her past. All of this is in stark contrast to the messages of shame, damage, hopelessness and despair that are conveyed by a diagnosis, and that too often lead with tragic inevitability to medication, admission and a lifetime career as a psychiatric patient.”

Source: http://www.madinamerica.com/2013/01/thinking-about-alternatives-to-psychiatric-diagnosis/

When Belief in the System Fades

In my view, psychiatry and its zoo of imaginary diagnoses militate against hope, personal meaning, and understanding. Psychiatry’s diagnosis-based ideology could be likened to a precariously perched house of cards. As more people understand that diagnoses like “Borderline Personality Disorder” are scientifically invalid, they may increasingly question the medical model underlying them. Over time, increasing numbers of patients and professionals may become unwilling to accept these labels. At a certain point, belief in the current system – the ideas that psychiatric diagnoses are real entities, that they can truly explain a person’s emotional problems, and that medication should be the first line of treatment – may fade and then collapse.

The vested interests of psychiatry will inevitably resist these changes because of the threat they pose – to making billions of dollars for drug companies, sustaining psychiatrists’ high incomes, and maintaining the fiction of psychiatrists as authorities who can diagnose emotional “disorders”. As Macchiavelli implied, the old order profits from defining reality in a way that benefits it, and some people may have trouble even considering that emotional problems could be understood in a radically different way.

Nevertheless, it is my hope that people will be open to the following idea: that promoting hope and restoring meaning for those suffering from the symptoms associated with “Borderline Personality Disorder” might be better achieved in many cases without labeling people as BPD. If some people still find benefit from being labeled as borderline, then so much the better. People ought to be free to use what works for them. But if other people are helped more by a “formulation”-like approach, one which connects their symptoms to their personal history and life circumstances without labeling them as having an “illness”, then perhaps we should shift our mental health practices in this direction. There might be still other approaches that work better for some people than formulation.

These ideas, some of which may seem confusing, relate to the arguments I have repeatedly made in previous articles: that BPD is an invalid and unreliable diagnosis, that no biological or genetic basis has been found for BPD, and that the medical model approach with its emphasis on medication is not useful for many people. For more information, the reader is again referred to the articles linked to above and their links to other websites.

The Idea of a Borderline Spectrum

However, part of me remains sympathetic to the idea of a borderline spectrum of emotional problems, which does not mean that BPD is a literal psychiatric illness. Instead, it means that people with similar-appearing emotional struggles as adults can be understood as using similar psychological defenses (e.g. splitting and projection), resulting from related histories of neglect and/or abuse. In this model, people and their problems are understood as existing along a continuum of functioning and symptom severity, and they are not understood to have the same “disorder”.

This spectrum-based model may have some value in allowing people to relate their emotional problems to other people’s (similar) problems in a meaningful way, and in allowing treatments to be developed for similar-appearing emotional problems that might be called part of a “borderline” spectrum. However, this idea conflicts with some of what I have written earlier about the lack of validity of the borderline concept per se. As can be seen from the trouble I’m having writing about it, it can be quite tricky to discuss emotional problems without using labels!

To conclude, it is fascinating how the words we choose to describe emotional problems, along with the theoretical models we base them on, are such powerful influences on our thinking and feeling about what is possible for us. I would be interested in what others think about what makes hope realistic, about formulation as an alternative approach to diagnosis, about the (lack of) validity of the medical model of BPD, and about the idea of “borderline” symptoms as occurring along a spectrum. Please feel free to share your views in the comments!

#16 – An Eastern Approach to Recovery: Lao Tzu, Sun Tzu, and BPD

Below are five quotes from the ancient Chinese philosopher Lao Tzu, author of the Tao Te Ching.

Please consider them first for their beauty and their applicability to any human being. I will then suggest ways in which they relate to the person recovering from Borderline Personality Disorder.

1. “Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”

2. “At the center of your being you have the answer; you know who you are and you know what you want.”

3. “The snow goose need not bathe to make itself white. Neither need you do anything but be yourself.”

4. “If you do not change direction, you may end up where you heading.”

5. “Those who have knowledge, don’t predict. Those who predict, don’t have knowledge.”

Lao Tzu was probably an amalgam of several Chinese philosophers from the early centuries BC. As a symbolic figure, he is regarded as the father of the religious and philosophical movement called Taoism.

A statue of Lao Tzu in China

A statue of Lao Tzu in China

Some fundamental ideas of Taoism include: feeling contentedly at one with the “Dao”, which is an unseen, transcendent force flowing through all things; reaching a state of freedom from earthly desires called “wu wei”, which can be translated as “flowing with the moment” or “not acting”; and a return to nature. Taoism’s emphasis on inner peace make it an interesting philosophy for people with borderline issues who need to develop self-comforting capacity.

tangyin5a

A Taoist painting illustrating Taoism’s focus on nature and personal contentment

During the arduous years of getting better from BPD, I encouraged myself using quotes like these. They helped create a sense of purpose and motivation. I’ll discuss the quotes above one by one:

1. “Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”

This first quote implies the reason why borderlines feel emotionally weak. They do not feel truly loved, nor can they trust other people deeply. Being dependent on and vulnerable toward another human being is the most crucial experience a borderline needs to grow emotionally. It is trust in another person that leads to feeling deeply loved. This was described in the phase of “Therapeutic Symbiosis”, in article #10 on this blog.

I can attest that feeling loved as a person was the critical ingredient that helped me become non-borderline. It was a feeling I first reached in psychotherapy and secondarily with several trusted friends.

After one feels loved for oneself, one can then love others, and this gives courage. Loving someone else deeply makes one feel that one is truly alive, that nothing can stop you. It lessens the fears of failure, aging, dying, and unfulfilled potential.

2. “At the center of your being you have the answer; you know who you are and you know what you want.”

This is a lovely quote, but again not something that borderlines start with – they don’t know who they are. But at the center of their being, they have the answer – their innate desire to get better, to be loved, and to feel fully human.

This again relates to quote #1. Love, trust and dependence on other people is the simple answer to the question: What allows a healthy child, or adult borderline, to grow and become emotionally healthy? Finding the answer to this question allows borderlines to develop a personal identity, to know who they are and what they want.

After my abusive childhood, the awareness dawned on me that I fiercely desired to be loved and cared for. Following this desire led me to attend psychotherapy and support groups, to make new friends, and to take risks. These resources allowed me to grow into an individual with an identity, to know who I am and what I want. It’s really true what Lao Tzu said – in my heart I always knew what I needed to get better. The challenge was taking the risks, fighting through fears, and overcoming psychic defenses to reach human help and love.

3. “The snow goose need not bathe to make itself white. Neither need you do anything but be yourself.”

This quote is attractive in the simple self-acceptance it implies. In my late teens and early 20s I hated myself. On the one hand, I felt pressured to achieve in academics, sports, and work so that others would like me. On the other, I believed my personality and appearance to be unlikeable and unattractive, and so never felt genuine or spontaneous. Instead, I was always trying to mold myself into what other people wanted.

How different I am today! I’m not afraid to say what I think, and don’t adapt myself for anybody. I am what I am, and if people don’t like that, too bad. I take delight in being myself.

This quote represents the ultimate ideal of self-acceptance that human beings, including borderlines, can aspire to. Like the snow goose which is naturally white, you don’t have to do anything to be yourself. Again, to approach this ideal, borderlines need the experience of being loved and accepted by an outside person, so that they can adopt the same attitudes toward themselves.

In article #15 on Gerald Adler, and in article #10 on Seinfeld’s four phases, it was discussed how self-acceptance – based on internalizing and believing the positive support of another person – is crucial to becoming non-borderline and developing genuine psychological stability.

4. “If you do not change direction, you may end up where you heading.”

This obvious but humorous quote really strikes home. It reminds me of the old-timers in my 12-step group who used to say, “If nothing changes, nothing changes,” and “Doing the same thing over again and expecting a different result is the definition of insanity.” Hard experience has taught me that transforming oneself  – while very doable – requires a lot of work and time, plus a willingness to take risks and try new things. Radically changing one’s emotional status quo is not comfortable, but it’s much better than stagnantly staying in an unhappy place. This was discussed more in post #14, about how risk-taking promotes recovery in BPD.

5. “Those who have knowledge, don’t predict. Those who predict, don’t have knowledge.”

This is true wisdom! A wise person understands how complex, ambiguous, subjective, and unpredictable the world is. Therefore, they don’t try to predict exactly what will happen to themselves or others.

While it can be fascinating to make predictions, such predictions, especially about mental illness, ultimately demonstrate a lack of knowledge. If prognosticators appreciated how people are extremely “complex” systems (influenced by many unpredictable sources of input) rather than “linear” systems (influenced by a limited number of clearly known variables), they would show more restraint.

I learned much about this subject from reading Dan Gardner’s book Future Babble. Two of his points stand out. First, the statistical study of past predictions made in various fields, including economics, politics, sociology, medicine, etc. indicate that the more certain someone is about a given prediction, the more likely they are wrong. Gardner thus warns the reader against trusting people who seem very sure of their predictions. He argues that those who think about a range of possible outcomes and speak in terms of ambiguity and uncertainty are more likely to be correct.

Second, Gardner showed how astonishingly quickly predictions can go wrong if even one factor inside the complex system unexpectedly changes. For example, with the weather, if the moisture level, cloud cover, wind direction, or one of dozens of other factors shift slightly, the whole outcome can totally diverge from the original prediction.

This is why human life courses are so difficult to predict over the long term. Human beings are not balls rolling down a hill whose paths can be precisely laid out! 🙂 They are complex systems like the weather, subject to millions of influences that we cannot map out in advance.

I have no respect for therapists who try to predict the outcome (via a “prognosis”) of people with Borderline Personality Disorder. Human emotional problems are way too complex to be medicalized like a physical disease. How someone does emotionally depends on literally millions of personal and environmental factors. Thus over the long term, we can only suggest factors that tend to promote success or hinder progress, while remaining humble about our lack of foreknowledge.

It is not only love and dependence, but aggression, cunning, and taking action that drive recovery from BPD.  With that in mind, I love reading a Chinese philosopher of a very different nature. Here are quotes from Sun Tzu, author of “The Art of War”:

1. “The general who wins a battle makes many calculations in his temple before the battle is fought. The general who loses a battle makes but few calculations beforehand. Thus do many calculations lead to victory, and few calculations to defeat.”

2. “The reason the wise general conquers the enemy and his achievements surpass those of ordinary men is foreknowledge.”

3.  “If you know the enemy and know yourself you need not fear the results of a hundred battles.”

4. “What is of supreme importance in war is to attack the enemy’s strategy.”

5. “The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”

6. “Let your plans be as dark and impenetrable as night, and when you move, fall like a thunderbolt.”

Sun Tzu was a Chinese military general and philosopher living around 500 B.C. during a period of warring kingdoms. In this era, rivals groups fought constantly over territory, and survival was a zero-sum game in which hesitation, unpreparedness, and lack of knowledge proved deadly.

sun-tzu

An artist’s impression of Sun Tzu

Sun Tzu recorded many of his strategic military insights in “The Art of War.” His writing emphasized the psychology of how to wage war, especially how to outmaneuver one’s enemy by understanding his emotional strengths and weaknesses. Sun Tzu believed that both objective (e.g. the physical landscape; the resources of each side) and psychological (e.g. the enemy’s mindset) considerations needed to be taken into account when conducting a military campaign.

Sun Tzu emphasized that a military strategy was not a fixed, unchanging list of actions to be followed; rather, the reality of war dictated that conditions and thus strategy constantly evolved. This meant that leaders had to be ready for the unexpected situations that arose when their plans interacted with the enemy’s plans in unpredictable ways.

A battle from the Warring States period of ancient China

A battle from the Warring States period of ancient China

Sun Tzu’s viewpoint has Macchiavellian qualities, in that it promotes doing whatever is necessary to survive and triumph. This is familiar for me, since I often felt forced to do “whatever it took” to survive the emotional war I was fighting after being diagnosed with BPD. I was somewhat ruthless back then, and am still a bit that way, as described in article 12, “Cracking the Borderline Code.”

So, how can someone apply Sun Tzu’s quotes to fighting for recovery from Borderline Personality Disorder? Here are his quotes again:

1. “The general who wins a battle makes many calculations in his temple before the battle is fought. The general who loses a battle makes but few calculations beforehand. Thus do many calculations lead to victory, and few calculations to defeat.”

As I recovered from BPD, this insight helped because it indicated that if I did not plan ahead, I was unlikely to prevail in the long multi-front war against BPD. I had studied many books about BPD, seeing which patients improved and which did not, analyzing which factors promoted recovery and which hindered it. I plotted out a rough plan to overcome Borderline Personality Disorder in an analogous way to how a general calculates a military strategy.

From my reading, I knew the primary goal was to develop dependent, supportive relationships in which I could be “reparented”. This process would develop the positive self-and-object units (see article #9, “A Fairbairnian Approach to BPD) and develop healthy ego functions to eradicate the borderline symptoms. I also knew that medication was ineffective at achieving these goals and so I stopped taking it, as indicated in article #13 on medication. Instead, I researched psychoanalytic-psychodynamic therapists and found one who had experience and success treating borderline conditions.

I started going regularly to therapy and continued for several years. To supplement this supportive relationship, I attended 12-step groups and developed friendships with people like Gareth, the older man who helped me work through my childhood trauma as described in Article #2. I was quite conscious about working to trust and depend on other people, because my research and experience indicated that it was only through building long-term positive relationships that I could recover.

So I had a long-term plan, and it worked. Today I enjoy my relationships, am successful in my work, and have no remaining borderline symptoms. Like the general in SunTzu’s quote, I made many calculations in the “temple” of my mind before beginning my battle against BPD in earnest, and they led to victory.

2. “The reason the wise general conquers the enemy and his achievements surpass those of ordinary men is foreknowledge.”

This quote is similar to the first. It could be viewed as a bit arrogant and presumptive to apply this to BPD. In truth, I did not know for sure that I would recover, or exactly how things would work on the journey.

What Sun Tzu probably means is that the successful general is better informed than most people from the outset– in this case, about the terrain, the psychology of the enemy, the enemy’s positions, strengths, weaknesses, and how to engage him. He studiously prepares in order to know as much as possible about what is likely and how the enemy might act. It doesn’t mean the general is clairvoyant and can see the future, because as indicated in Lao Tzu’s quote about prediction, that is impossible. But the general plans for a range of scenarios and is as well-informed as possible.

As indicated in other posts, education about BPD and how it is effectively treated is crucial. To me, knowing a lot about BPD and how others recovered from it is the closest we can come to “foreknowledge” about what facing BPD will mean for us. I benefitted greatly from studying many books, talking to therapists, and reading websites and blogs about BPD. Educating oneself is in my opinion the “wise” thing to do with BPD and it provides a better chance of getting the results you want in recovery.

3.  “If you know the enemy and know yourself you need not fear the results of a hundred battles.”

This is another similar quote to the first two. It is of course simplistic to apply these quotes to a complex emotional condition, but it can be inspiring and motivating.  Knowing “BPD” means understanding how the condition works in depth. Borderline defenses like splitting and projection are initially powerful, tenacious, and deceptive mechanisms. It is useful to understand how they work, and I intend to write future posts on how splitting and projection/projective identification operate.

The early part of “knowing yourself” when dealing with BPD, in my experience, was understanding how defenses based on past trauma (“the enemy”) were constantly coloring how I viewed the external world. They tricked me into distrusting and rejecting other people’s help, since I misperceived everyone in my present day world as untrustworthy like my father.

With a better understanding of how my mind was working, I felt more confident in stopping my defenses from recreating past trauma in my present day life. Although I didn’t win every battle at first, I felt more confident about defeating BPD in the long term.

4. “What is of supreme importance in war is to attack the enemy’s strategy.”

This is more relatable to BPD than one might think. The “strategy” of defenses in BPD is that they cause a person to negatively distort the external world, tragically recreating their traumatic past into the present. It renders the borderline unable to take in support from other people in sufficient quantities to develop a healthy sense of self. In Article #15, Adler described the necessity of confronting psychic defenses which “block” the development of positive introjects, and in Article #10 Seinfeld analogously described how the bad internal object situation prevents the borderline from internalizing the therapist as a positive new person.

Although it’s a bit simplistic, and to repeat from the last quote, these defenses which “trick” the borderline into rejecting human help are “the enemy.” When I was borderline I had two selves – a “healthy” self which wanted to trust others and get better, and a “trauma” self which was emotionally frozen at the time of my physical abuse, distrusted others, and refused to believe that people cared.

I became able to track the operation of the “trauma” self and to reject its deceptive attempts to make me distrust others. I did this by understanding how splitting and projection pulled the wool over my eyes, so that I perceived emotionally only peopl’s negative aspects and refused to take in their good sides. I countered this tendency by putting myself in more and more “good” situations like therapy, 12-step groups, and with supportive family and friends.

Over time, I began to find more and more of the good in other people and in myself. Eventually others’ good intentions started to break through my resistance. I gradually learned that truly good people did exist, that it was safe to depend on others, that I was worthy of love, and so on. I attacked the strategy of the BPD defenses which were blocking my progress, and as Sun Tzu indicated, attacking the enemy’s strategy is paramount.

5. “The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”

I relate this quote to Article #14, “How Risk-Taking Promotes Recovery From BPD.” It’s a bit of a harsh description (poor victim!) but it emphasizes how good decision-making is decisive and timely. In the “Risk-Taking” article, I described how changing therapists, stopping medication, moving home temporarily after college, asking for help from Gareth, etc. were all situations in which I had to take decisive action. Over the years I’ve become more and more decisive about “pulling the trigger” on things that are in my best interest. The way the falcon quickly swoops down on its prey is a good metaphor for the way a tough decision must be made decisively to be effective.

There is only a very loose correlation between this quote and BPD, but effective decision-making is important when dealing with BPD or any other serious challenge.

6. “Let your plans be as dark and impenetrable as night, and when you move, fall like a thunderbolt.”

This quote doesn’t really relate to BPD. I just put it on here because it sounds cool! I’m a big fan of action movies, spy thriller novels, and adventure video games, and it’s too bad we don’t have Sun Tzu around to write snappy dialogue for them.

I hope this article gives the reader a different perspective on how to think about BPD reccovery. There are many useful approaches to healing from trauma, and we should not hesitate to use the insights from many  different people and cultures to help us.

The_Art_of_War-Tangut_script

Sun Tzu’s “The Art of War”

#14 – How Risk-Taking Promotes Recovery from BPD

Reflecting on the last 10 years, several key decisions accelerated my recovery from Borderline Personality Disorder. In these moments, I took risks that moved me further along the road to becoming well.

At the time, these actions did not stand out as turning points. Today, their importance is obvious.

Below is a scene from the movie The Dark Knight Rises that illustrates this type of decision. Bruce Wayne has been imprisoned in a pit-like prison from which escape seems impossible. The jump to freedom is too far. Bruce Wayne fails on his first attempt to escape, but he eventually triumphs:

Short 1-minute version – http://www.youtube.com/watch?v=7BNW2By7ppo

Longer 3-minute version – http://www.youtube.com/watch?v=sdQFRf-KqNw

It’s notable that Bruce Wayne has to feel anger about his horrible situation before he can make the leap. The feelings of doubt, uncertainty, hope and determination which we can imagine in Bruce Wayne as he looks across the gap are feelings I often had before making the decisions below.

The dark, hopeless conditions of the prison are an apt metaphor for the unfulfilling, frustrating life in which many borderlines are trapped after a traumatizing, neglect-filled childhood. Continuing the metaphor for BPD, the open world that Bruce Wayne sees after leaving the prison could represent mature adulthood and all its possibilities for fulfillment (although in the movie, Bruce Wayne’s story is very different, and he was never a borderline!).

I had to take risks – the metaphorical leap out of the prison – over and over again in order to escape into the open world. Not all of my ideas worked; there were many failures and frustrations that are not mentioned below. But here are some of my ideas that did work:

Age 17 (2003) – Asking My Mom for Help

As an awkward, overweight high school junior, I became increasingly depressed and thought seriously about committing suicide. My parents’ relationship was falling apart, I had no real friends at school, and I hated myself. Other kids were dating and talking about colleges, concepts that felt alien and threatening for me. I desperately wanted to tell someone how I felt, but could not trust anyone. I remember listening to songs like Green Day’s “Boulevard of Broken Dreams” and feeling the songs were about me.  I felt totally alone through my sophomore and junior year of high school, not allowing myself to turn to anyone for help.

I decided I had to do something. Since my mother had not overtly abused me and had provided some support, she was the only person I dared open up to. But it was too difficult to go to her directly. So instead, I emailed her. That email read something like, “Mom, I am not feeling well. I feel really depressed and need help. Can we talk about this? Maybe there is someone I could see that could help me.” To my surprise, my mother came immediately and told me how concerned she was. She was healthier and stronger than I had realized. I was so emotionally weak that I could barely respond. But to know that someone cared was a great relief.

A week later, my mother took me to see a psychiatrist. Although he was a poor therapist who knew nothing about BPD, it was a relief to have done something to help myself. It made me feel less hopeless. And it set a precedent for everything that would come later. Interestingly, at this age, I had never even heard of Borderline Personality Disorder.

Key Point – If you have BPD and feel desperate and hopeless, look in your surrounding environment for others who might be understanding and supportive. Your splitting will likely cause you to doubt whether they really care. Once you identify a person or group that might help, fight past your fear and take the risk of asking them for help. In most cases, you have nothing to lose by asking.

Age 17-20 (2003-2006) – Making a New Trusted Friend

Toward the end of high school, I met an older man in our neighborhood, Gareth, who took an interest in me. We shared a common interest, tennis, and would meet at the local courts to play. At first, because of my great expertise at hiding my emotions, Gareth had no idea how hopeless I felt. Nevertheless, I often struggled to avoid breaking down and crying on the tennis court.

My vulnerable child-self identified Gareth as a potential helper. There ensued a great internal battle – should I or should I not make myself vulnerable and ask for help from someone outside the family? Should I risk rejection? Not asking for help felt safer.

I vividly remember the moments leading up to my opening up to Gareth for the first time. We were sitting in a steamroom at the local health club. The other people walked out, leaving us alone. After about 30 seconds of painful deliberation, I forced myself to haltingly tell Gareth how my father had physically abused me. I told him how school was a terrible struggle, how I felt depressed and suicidal most of the time.

Gareth responded very kindly. He empathized with how difficult and unfair everything was. He got me to tell him as much as I was comfortable about my family. Over the following months, he became a regular confidant. He went out of his way to be available to talk via phone, email and in person. For the next few years, I cried many times with him and worked through grief and anger surrounding my father’s abuse. He taught me that men could be trustworthy and safe, unlike my father.

My and Gareth’s relationship did not always flow easily. At times, I became provocative, manipulative, and withdrawn. A couple of times, Gareth became so frustrated by this behavior that we briefly cut off contact. However, each time we reconnected and made up, because each of us cared about the other.

Key Point – True friends are an invaluable support for anyone, but especially for those working to recover from BPD. Letting someone really get to know you can make a critical difference in recovering from BPD. Even if you don’t think you know how to form a real friendship, risk opening up to an acquaintance whom you think might be supportive.

Begin with telling them how you really feel, even if what you feel is terrible! Being honest with someone else about your negative feelings, while difficult, can be a freeing experience if they respond supportively. It can be the start of a long-term relationship that is transformative. In my experience, most people really do want to help – often more than we realize.

Age 18 (2004) – Beginning to Research BPD

In 2004, I read about Borderline Personality Disorder on the internet. It terrified me. I “knew” that I was borderline. I found online forums where family members of supposed borderlines complained about how difficult, manipulative, provocative, unchanging, frustrating, and wicked borderlines were.

When I first read about BPD, I had a visceral physical reaction where a lead-like despair overtook me. I felt sure that I had BPD, and that my chances of recovering were low to nonexistent. The pessimism of many writers who talked about BPD being life-long, severe, genetic, and untreatable greatly influenced me.  I was so distracted by the fear that I had difficulty walking around school, listening in classes, or having coherent conversations.

But part of me wanted to fight the idea that borderlines couldn’t recover. I felt a fierce desire not just to survive, but to live. I searched on Amazon for books about treatment of BPD. At first, I ordered popular books like Walking on Eggshells and I Hate You, Don’t Leave Me. Since they weren’t addressed to sufferers, these books did little to help, and I interpreted them pessimistically.

Then I found Jeffrey Seinfeld’s The Bad Object. From it I gained a weapon to use in the battle against the negative thoughts. For the first time, I saw a writer clearly describe several borderline patients with similar abusive histories to mine. They recovered – fully, in several cases. They had the kind of good life that I desperately wanted.

I particularly benefited from Seinfeld’s “Four-phase” description of BPD. It fit me perfectly. I understood myself, at age 18, to be somewhere between the Out-of-Contact and Ambivalent Symbiotic phases. Seinfeld’s writing gave me a roadmap, making the origin of my problems clear. More information on his writing is here:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

The key point here is that I did my own research. If I accepted the status quo expressed by many writers 10 years ago – that BPD is a valid medical diagnosis that cannot be cured – then I would not be where I am today. These early readings were only the first among dozens of books on BPD and other personality disorders that I read.

Key Point – Education matters. Do not unquestioningly accept what any one person tells you about BPD, including me. No authority has all the answers on the disorder. Cultivate a healthy skepticism. Do your own research, think critically about what you learn, compare different viewpoints, and come to your own opinion about what is right. Trust yourself. How you define BPD and how you view the recovery process will evolve over time. There is no exact right way to think about BPD or recovery.

Early 20s – Confronting My Fears About BPD

Throughout my early 20s, I feared that BPD was a hopeless, incurable condition. I kept finding sources that espoused pessimistic, gloomy views of BPD sufferers. Their view of borderlines as people trapped in painful, inevitable destructive cycles from which they could not recover seemed cruel and terrifying. I had also read books like Seinfeld’s that asserted the opposite, i.e. that BPD, while challenging, but very treatable and even curable. But I could not trust the positive view or reconcile it with the negative. And what you don’t trust cannot reassure you.

I worked hard to overcome my fear about BPD with my therapist, who was positive about BPD, but could not fully trust her either. The authoritative-sounding writers of the pessimistic books continued to haunt me. I needed a way to more strongly refute them, to understand why these writers (falsely) thought that BPD could not be “cured”, and to convince myself that BPD could be fully recovered from.

Many things helped me to eventually believe that I could become well. One of the most important was my “systematic investigation” of BPD’s treatability. I decided to cold-call some of the most renowned therapists in the United States. I asked them their view of the “bad” writers, the ones whose views scared me Many of these therapists did not answer, but some did.

Among others, I spoke on the phone to Gerald Adler (author of Borderline Psychopathology and Its Treatment), Lawrence Hedges (author of Working the Organizing Experience), and James Masterson (author of Treatment of the Borderline Adult). Within the psychodynamic-psychoanalytic community in the United States, these are three of the “big guns” of writing about BPD and personality disorders in general. Their books are all on Amazon.com . Adler’s book on borderlines is even available for free download on http://www.freepsychotherapybooks.org

Between 2007-2009, I met Adler, Hedges, and Masterson in person, traveling to meet them in Boston, Los Angeles, and New York respectively. I told them how afraid I was about BPD being a hopeless, incurable disorder. Each of them described multiple borderlines they had treated who made great progress and in some cases recovered fully.

Adler, Hedges and Masterson also analyzed the “bad” writers, i.e. those writers whose pessimistic views about BPD scared me. They explained that these writers were inexperienced and/or poorly trained therapists whose personal failure at treating BPD had become rationalized into the mistaken view that the diagnosis had a poor prognosis.

They also described how the field of psychotherapy had become fragmented into different “schools”, and how many therapists were unaware of more effective models for how to treat BPD. They made it clear that the disorder presented serious challenges to therapists as well as patients, so it was not surprising that poorly trained, inexperienced therapists often failed to help borderlines. But they said that with good training, many therapists had had great success at treating BPD.

These three writers all encouraged me to continue treatment with my own therapist and to be optimistic about recovery. Hearing their optimism about the disorder in person made a big impact on me. They were very kind.

In retrospect, I over-idealized Masterson, Adler, and Hedges, seeing them as perfect, infallible authorities. But this all-good splitting served a useful purpose, as it allowed my fear about BPD to be gradually conquered by the belief that recovery from BPD was truly possible.

In the technical way I understand it based on object relations, I subjected the “all-bad” aspect of my anxiety-producing views of BPD to real-world analysis in a way that weakened my identification/attachment to those all-negative views. This allowed me to “correct” or make “less bad” those all-negative views, which in turn led me to stop splitting so severely. As I took in more positive ideas about BPD, I could eventually integrate the negative views with these new, more positive views. More information about object-relations and splitting is here:

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

Although I’m not a Christian, my great relief at the loss of the old fears about BPD caused me to think of this image from the famous novel, Pilgrim’s Progress:

pilgrimsprogress

Key Point – Anxiety is almost always related to specific environmental causes or lack of support. Whatever progress you want to make in your life, identify the fears that are holding you back. Brainstorm creative ideas in which you can challenge your preconceived beliefs and fears. Execute them. Do not be afraid to be take risks and be rejected.

Our fears are often like the ghosts in Super Mario Games. When you run away from them, they seem scarier. When you face them, they stop chasing you. Here’s a funny example:

http://www.youtube.com/watch?v=yqY7uFGroTo

Early 20s – Going to 12-Step Groups

At college, I began to overeat to cope with my depression, gaining 40-50 pounds. I mostly isolated myself from other students, having difficulty attending class regularly. As the twin problems of overeating and isolation intersected and reinforced each other, I realized that I needed something to address both of them.

I researched online and found something called 12 Step Groups. The vulnerable, dependent part of me quickly realized that 12 step groups might be helpful. But my antidependent side, being identified with my abusive father, feared that I would be rejected and disliked. I eventually fought past this fear and forced myself to attend a meeting of Overeaters Anonymous.

I walked into a small group filled with men aged from about 35-65. I was 20 years old. The first meeting intimidated me. But at the end, an elderly man came over and made a point of welcoming me. He told me how hopeful it was that I came to get help at a young age with my whole life ahead of me. This idea had never occurred to me. Over the next few years, I made many friends in 12-step groups, benefitting greatly from the fraternal, warm, encouraging nature of the group. I also disagreed with some aspects of the program, which eventually caused me to leave. But overall, it helped. Here is more about my 12-step experience:

https://bpdtransformation.wordpress.com/2014/01/11/addiction-recovery-12-step-groups-and-bpd/

Key Point – Look for support groups, whether 12-step, group therapy, Meetup.com groups, or other networks that might help you. Especially if you are socially isolated, these groups can be a great way to safely learn how to trust and be intimate with other people. Such groups are usually free or very low-cost.

Mid-20s (2008-2009) – Leaving a Therapist Who Wasn’t Working

By my early-to-mid 20s, I had made significant progress, getting a regular job and developing some meaningful friendships. I still got depressed and had problems with splitting, handling anger, and maintaining my self-esteem. Since I had found my first regular job, my mother required me to start paying for my own therapy.

Once that happened, I suddenly “discovered” that my therapist of three years, with whom I had been making quite good progress, was charging me for sessions while I was on vacation or if I couldn’t attend the regular time. My therapist had a rigid policy that patients had to pay for the same weekly time 50 weeks out of the year. There were no early cancellations. I thought this was outrageous, and I confronted her. She agreed to change the policy for me only. However, I lost my trust in her, feeling that she was not treating her other patients fairly and that she mainly cared about money.

I tried very hard to come to trust this therapist again, but it didn’t work. So I made the difficult decision to seek someone new. It made my life really unstable for a while, because the loss of the old therapist created a void, and who knew if I would find a good replacement. I searched extensively for a new therapist who had successful experience treating borderline patients, using the criteria described here:

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

Eventually, I found someone who proved to be a great fit. Shifting therapists involved a lot of research and some discomfort in the short term, but it had great value in the long-term.

Key Point – If a given relationship or work situation is not working, be open to making radical changes which give you a better chance of feeling good about the situation. That may mean ending a frustrating relationship or job, seeking a new one, or fundamentally changing how you deal with a person or situation. Don’t be afraid to experiment and to take calculated risks –the idea of taking a leap of faith is again important.

Mid-to-late 20s (2010-2014) – Dating and Getting My Own Place

Over the last few years, my independent functioning and relationships continued to improve. While I felt better, my problems did not all suddenly vanish. Instead, I confronted new challenges. Two of the most important were dating and moving out from living with my parents. I will discuss each of these topics briefly.

Many healthy, non-borderline men have anxiety about asking out attractive women. This was certainly the case for me, even after my self-esteem improved a lot and I was no longer borderline. Drawing on my earlier risk-taking experience, I forced myself to ask women out and go on dates.

In my early 20s, I had been so shy that I had barely dated, and had thought that women found me unattractive. But the real issue was my lack of confidence.Once I talked to more women and starting asking them out, I found there was no shortage of women willing to date a decent looking, athletic, friendly guy with his own job and house.

As for moving out from my parents, this is another phase that even healthy young adults can find challenging. In my early 20s, I became more and more frustrated at living at home with my mother. I was working and saving money, but didn’t like bringing friends to my mom’s house, or being on top of her all the time (although I do love my mom!).

Although it cost more to move out and rent, the potential benefit to my psychological wellbeing justified the added expense. I rented in two places, and finally bought my own house. Being a homeowner and having to manage my own place has only been a good thing!

Key Point: Challenging situations and the need to take risks do not suddenly disappear after we recover from Borderline Personality Disorder. Life is full of challenges, not in a bad way, but in an enlivening, interesting, meaningful way. To prevail through these challenges, it helps to stay open to the value of risk-taking and trying new things throughout life.

———————-

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, 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

#10 – Four Phases of BPD Treatment and Recovery

In their treatment of Borderline Personality Disorder, certain psychodynamic therapists developed a four-phase object-relations approach. The four phases included:

1)      The Out-of-Contact Phase

2)      Ambivalent Symbiosis

3)      Therapeutic Symbiosis

4)      Resolution of the Symbiosis (Individuation)

The Washington, DC-based psychoanalyst Harold Searles originated this approach in his work with hospitalized psychotic patients in the 1960s and ‘70s. He later adapted it to use with less disturbed borderline-spectrum patients. In the 1990s, New York social worker Jeffrey Seinfeld updated Searles’ four-phase model in his book The Bad Object.

Over the last 10 years, as I worked to transform my borderline illness in therapy, I passed through these four phases sequentially. They describe a severely troubled person’s emotional experience at different stages of treatment, while providing an object-relations model which delineates the relative strength of positive and negative self-and-object units. For me, they are the most accurate way of conceptualizing the progress of a borderline individual in recovery.

None of this is meant to minimize the great differences which exist among individual people diagnosed with BPD. These phases are not meant to be exact descriptions of what each borderline in recovery experiences. Rather, they are a rough map of the recovery journey.

This model’s four phases of therapy for BPD can be subjectively described as follows:

1)      Out-of-Contact Phase – In this earliest phase, the borderline individual is emotionally cut off from the outside world, existing in a “closed psychic system” where little to nothing from the outside world influences them in a positive way. Searles described the patient and therapist in this phase as being “isolated in their own psychic territories”. Out-of-contact patients experience themselves passing through life like automatons, with little to no subjective emotional experience. They experience profound depersonalization and derealization (not feeling real).

These people bring to mind tragic characters from Franz Kafka’s novels, individuals who experience life as meaningless and the outside world as full of capricious, heartless persecutors. They are symbolized in T.S. Eliot’s The Wasteland as “men who have lost their bones”. The wasteland represents the internal psychic world of people who, because of overwhelmingly severe neglect and/or abuse, have lost all hope of forgiveness, love or redemption. Instead of hope, there is the view of the outside world as cold, empty, unforgiving, and punishing.

The out-of-contact phase represents the most severely emotionally ill borderline individuals. These individuals usually have chaotic lives in which they are unable to commit themselves consistently to jobs, living places, or relationships. In therapy, they experience the therapist in his empathic helping role as being like “an alien creature from another psychic planet” (Seinfeld). They do not tend to develop a positive relationship to the therapist, or to understand what therapist is about.

2)      Ambivalent Symbiosis – This second phase represents those borderlines who have had enough positive emotional experience to hope that recovery is possible. They believe in the possibility of reclaiming a good relationship with the outside world. They form an ambivalent relationship in which they want to trust the therapist, but at the same time fear being retraumatized and thus maintain distance.

Searles described this phase as “the therapist and patient driving each other crazy.” There is a constant struggle between accepting versus rejecting the therapist’s help. The feeling tone between patient and therapist is primarily one of aggression, wariness, and provocation. In this phase, the patient will find complex, often subtle ways to maintain distance from the therapist and prevent the development of a therapeutic symbiosis.

The struggle of an ambivalent symbiotic patient to trust their therapist, and accept loving support from the world in general, brings to mind Joseph Campbell’s classic conception of the hero (from The Hero with a Thousand Faces). The archetypal hero must struggle against demons, ghosts, monsters, or human enemies to reunite with good people with whom they have lost contact.

A famous example is Homer’s Odyssey, in which Odysseus must prevail against monsters, sirens, and traitorous suitors to reunite with his beloved wife and son. Analogously, the ambivalent borderline patient must overcome the metaphorical demons of past neglect and abuse, fighting through their distrust and fear of closeness to become able to love other people again.

My favorite example of this transformation occurs in the Disney movie, Beauty and the Beast. The Beast must overcome his distrust and anger toward the outside world, and learn to love another, or be forever cursed to live in non-human form. His castle metaphorically represents the type of “closed emotional system” that many borderline individuals live in.

Compared to out-of-contact patients, ambivalent borderlines tend to commit themselves much more consistently to regular jobs, living places, and relationships. They have more real, positive emotional investment in the outside world, and thus more basis for hope that things can improve further. However, because they are afraid of intimacy and of really trusting others, their overall personality structure remains fragile, and they are vulnerable to separation stress.

3)      Therapeutic Symbiosis – If the borderline patient can come to deeply trust the therapist, the phase of therapeutic symbiosis gradually emerges.

Searles described the feeling tone of therapeutic symbiosis as characterized by “maternal care and love.” In this phase, the vulnerable, childlike aspect of the borderline reemerges and is nurtured by the therapist, who is idealized as a perfect parent.

For the borderline patient, who has struggled his whole life to achieve psychological wholeness, it is difficult to overstate the benefit of a prolonged therapeutic symbiosis. A genuine therapeutic symbiosis is a psychic rebirth or redemption, a transformation in which the person comes to feel truly alive for the first time. It marks the beginning of the subjective sense of self, and the first true awareness of psychological separateness from other people.

During this phase, the borderline’s independent functioning is enhanced. They become more assertive in achieving goals in work, study, or other interests. They begin to be able to tolerate separation from other people better, without always feeling lonely or abandoned. And their self-esteem improves dramatically.

Because of the awareness of separation and the gain in self-esteem, the (former) borderline in therapeutic symbiosis usually develops healthier, rewarding relationships with new people in the outside world. They become increasingly aware of how many positive experiences they have missed out on during their earlier years as a borderline personality.

4)      Resolution of the Symbiosis / Individuation – In this final phase, the (now former) borderline comes to function increasingly independently, and to need the therapist less and less. Gradually, the patient becomes disillusioned with the therapist, realizing that the therapist is not their parent, cannot solve all their problems, and will not be there forever.

In this phase, the patient increasingly develops an individuated sense of themselves as a unique and valuable person. In a parallel fashion, they become more and more aware of other people’s separateness and of the individuality of others. In a successful treatment, the patient gradually tapers down the frequency of meetings with the therapist, coming increasingly to manage life’s challenges using their own inner resources.

Comments on the Separability of The Four Phases

In reality, these four phases are not strictly separate. For example, a given patient could have periods of being out-of-contact, alongside periods of being ambivalent toward the therapist. Often, one phase at a time will predominate. But sometimes, the patient will show aspects of multiple phases at once.

Searles described how patients may oscillate between phases, progressing in a two-steps forward, one-step back fashion. This is particularly the case when a patient is transitioning from one phase (e.g. from being mainly ambivalent and doubtful toward the therapist) into another phase (e.g. to trusting and accepting the therapist’s support).

Like the diagnosis of Borderline Personality Disorder itself, these phases are not scientifically validated or based. They are based purely on the observation of therapists working with borderline patients. For that reason, they should be viewed with caution, since they may not be useful or a fit for everyone diagnosed with BPD. However, in my experience, these phases and the underlying object-relations they are based on (to be discussed below) form a remarkably accurate and useful way to conceptualize BPD recovery.

 An Object-Relations Analysis of the Four Phases

To better understand them, it is helpful to describe the four phases using object-relations terminology. For an overview of object-relations, please see my last article below, on the theories of Ronald Fairbairn, one of the founders of object-relations theory.

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

Writers like Searles and Seinfeld thought about early psychological development in terms of the “good” and “bad” object relations units theorized by Fairbairn. They then integrated these units into the sequential four-phase theory of treatment for borderlines which I am outlining here.

Here are the four phases again, this time considered in terms of the relative strength of positive and emotional self and object images within the mind of the borderline patient:

Out-of-contact Phase’s Object Relations – This phase features a strong dominance of all-negative mental images of self and other. These self-and-object units actively reject internalization of anything positive from the outside world. The patient continuously maintains a “closed system” in which he is “attached to the bad object” (Fairbairn). There is no symbiotic interaction with the therapist, no recognition that a positive relationship is even possible, and no projection of a hoped-for good object into the transference relationship.

Ambivalent Symbiotic Phase’s Object Relations – The all-negative images of self and other are still stronger, but there is a larger (minority) proportion of positive images compared to the out-of-contact phase. This relatively greater quantity of positive images result in the patient becoming aware that a positive, nurturing relationship with the therapist is possible. In other words, the patient possesses an internal “hoped-for good object.”

However, the dominance of the all-negative images during ambivalent symbiosis result in the patient distrusting the therapist and using projective identification to reject them. The patient distorts the therapist, turning him “all bad” in their mind in order to block the development of a positive relationship. In other words, the patient sabotages himself by actively attacking his potential positive relationship to the therapist.

The patient turns the therapist into someone disappointing and rejecting, even when the therapist’s actions in reality do not warrant this view. As long as it continues, this projective activity maintains the dominance of the negative self-and-object units by rejecting the internalization of the therapist as a good object.

As an ambivalently symbiotic relationship evolves, the patient will gradually reveal more of themselves to the therapist, coming to feel more trust and support. This process happens gradually, in a two steps forward, one step back fashion. Like a slow drip, like grains of sand in an hourglass, each positive experience makes the patient’s positive self-and-object images slightly stronger. This gradually tips the internal balance away from the negative images toward the positive self-and-object images.

Therapeutic Symbiotic Phase’s Object Relations – This phase begins to predominate when the all-positive images of self and other become stronger than the all-negative images. Once this internal balance shifts, the patient comes to fully trust the therapist and to strongly internalize the therapist’s positive attitudes. Of course, the therapist must be a truly “good” person in reality for this to happen.

Therapeutic symbiosis is still based on splitting, in that the patient unrealistically sees the therapist as all-good, disavowing and splitting off any less-than-perfect aspects of the relationship. Emotionally, the patient feels the therapist to be an all-good parent figure relating to the patient as a perfect child.

This stance is maintained via extensive projective identification by the patient, who now maneuvers the therapist into the role of good parent, expecting to be treated well (a contrast to the earlier phase of ambivalent symbiosis, in which the patient unrealistically rejects the therapist as untrustworthy, projecting past bad objects into the present transference relationship).

As therapeutic symbiosis proceeds, the dominance of the positive images of self and other grows. The patient feels gradually less vulnerable to the now-unconscious, persecutory, all-bad self-and-object images. Over time, the patient internalizes the psychological functions that can only come from an extended good-object relationship. These include the ability to comfort themselves, regulate negative emotions, maintain self-esteem, and delay gratification.

Resolution of Symbiosis / Individuation Phase’s Object Relations – In this phase, the patient begins to integrate the all-good and all-bad sets of images (resolving splitting). They will gradually realize that the therapist is not a perfect parent. Like in the ambivalently symbiotic phase, but in a less distorted way, the patient will again perceive the therapist’s imperfections. However, this time, with a stronger positive set of self-and-object images as a foundation, he will arrive at a “whole object” integrated view of the therapist as a mostly good, but slightly “bad” person.

In a parallel way, the patient will “update” their view of themselves. They will see themselves as mostly good and worthy, but possessing some shortcomings and weaknesses. They will finally see themselves as a whole person.

The therapist now becomes a repository for the patient’s remaining all-bad object images. By practicing his independent functioning while objectifying the therapist as an imperfect, disillusioning, sometimes needy parent, the patient feels increasingly separate intrapsychically from the “bad objects” of his past. Over time, he individuates, coming to develop his own unique interests, preferences, identity, and sense of self.

#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.

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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