Have you ever had a relationship that was significant to you, but one which drained you and demanded too much of you emotionally? The relationship might be going smoothly with the other person contributing a lot of warmth and support and then suddenly the bottom falls out, and you wonder what happened. Your friend has now become your enemy and you're left questioning why. This is not the first time it has happened and you know it won't be the last. Deep down inside, you're coming to the realization that you'll never be able to give this person enough—they will always be takers/users in the relationship. Psychologists would give this behavior the label of Borderline Personality Disorder.

Borderline personality disorder (BPD) is a pervasive pattern of behaving and thinking. Behaviors such as marked impulsivity, poor self image and instability of interpersonal relationships are generally the first signs and symptoms that manifest. This is a very incapacitating disorder! Unlike many other major mental health disorders, there is no specific medication that can treat these symptoms. It must be noted that people with BPD often suffer from depression and anxiety, and both of these mood disorders can be clinically treated with medications, but this does not change the basic way this individual thinks and behaves.

Research indicates that the prevalence of BPD is estimated to be around 2% of the general population. Ten percent of the people seen in outpatient mental health clinics and 20% of psychiatric inpatients also have this behavioral disorder. Research data has shown there is a greater tendency for females (teenagers and young adult women) to be diagnosed with this disorder than males.

In our culture, many people have been exposed to or had to live with someone who suffers from BPD. There are many individuals that exhibit traits or characteristics of this disorder, but in actuality, they may not manifest enough of the signs and symptoms to be diagnosed with borderline personality disorder. They may exhibit borderline behavior, but it does not totally permeate and control their lives. However, these symptoms are plentiful enough to have a negative impact on their relationships.

Essential Features of Borderline Personality Disorder

• Instability in relationships – alternating between extremes of idealization and devaluation;
• An impaired self image;
• Mood disturbances, i.e., depressed»»to very anxious»»to happy within a short time span. You never know what to expect and neither do they;
• Impulsivity – e.g., substance abuse, overspending, inappropriate sexual behavior, reckless driving, binge eating, etc.;
• Very sensitive to environmental circumstances;
• Manifestations of a lot of inappropriate anger»»rage»»resentment»»bitterness;
• Driven through life acting on their feelings versus logical reality;
• Intolerance of stress, i.e., lacking a sophisticated repertoire of coping skills;
• Poor money management with the expectation that others will bail them out;
• Recurrent suicidal gestures, threats or self-mutilating acts. The research indicates that they don't really want to die, they just want the pain to go away. BUT we must be aware of the fact that eight to 10 percent of these individuals diagnosed with BPD do succeed in their attempts to take their lives. Therefore we must never minimize or ignore suicidal behavior or threats;
• Chronic feelings of emptiness;
• Stress-related paranoid ideation (suspiciousness and mistrust of self and others); and
• Tremendous fear of abandonment:
    - attributed to unresolved painful childhood issues;
    - internalization of feelings of little worth; and
    - internalization of being a "bad" person and deserving of abandonment.

Fear of Abandonment
People who suffer from borderline personality disorder deal with a number of abandonment issues and fears. For this reason, they have a high intolerance of being alone, preferring that someone be with them most of the time. If they are alone for too long a period of time, they may create a crisis (legitimate or not) requiring attention from others. As a result, when they are really in need, their support system may not be available because they've "cried wolf" too often.

In an effort to hold on to their relationships, they attempt to develop intense alliances and will idealize significant others and caregivers, frequently giving them gifts that they cannot afford. This is an unconscious effort on the part of the individual to obligate the other person. Often they prematurely share with other people intimate details about their lives. When all this happens, it is usually overwhelming for the other person who then quickly backs out of the relationship. In order to tolerate the loss of the friendship, the borderline person must then "devalue" the significant other by being cruel and punitive to them. Thus they end up thinking others don't want to nurture them so they pull back, fulfilling their own prophecy: "They've abandoned me!" and "I knew I couldn't trust them in the first place."

It should be noted that oftentimes people with BPD will profusely repent when their sins and offenses are uncovered and pointed out to them. However it has often been observed that the offender is sorry he got caught and not sorry for what he did, i.e., he is repenting for getting caught, not repenting for the offense.

This repentance, because it appears so sincere and is often accompanied by tears, tends to mislead the victim to believe that the offender is truly sorry for what he did when, in actuality, he is not. At this point the victim lets down his guard (his boundaries become vague) and embraces the offender. Ironically the offender will behave until he is absolutely sure he has re-hooked the victim. When that has happened, the offenses occur again. Thus, the offensive behavior becomes a cycle.

The victim must be aware that the only way they can be sure that the offender is truly repentant is by observing changed behavior over time (Matt. 3:8, Luke 3:8). One could ask "How much time? Must changed behavior be observed before it can be trusted?" Unfortunately there are no pat answers to that question. Depending on the offenses, it may take a year or more before repentance and changes are believable. During that time, and later, there may be relapses. If the person won't try to defend and make excuses for their offending behavior but rather acknowledge it, apologize for it and turn away from it, they can continue on their path of healing. At this time the victim has to be careful not to act as a codependent by trying to rescue the offender. The offender needs to experience the lack of fellowship and alienation of the victim and bear the consequences of their choices and behaviors. Such consequences include: feelings of rejection, anxiety, frustration, insecurity, loneliness, anger, hostility, misery, inadequacy and discouragement. Only when they feel these consequences is there the possibility for change to occur.

Self Esteem
Individuals who suffer from BPD have experienced multiple situations in which their self image has been compromised. They are unable to see themselves as God sees them and often are unaware that God says they have tremendous worth ( Psalms 119:73, 139; Isaiah 49:1, 5, 15-16; Matt. 6:26; Rom. 8:28-39). Their reality is contaminated by low self esteem and emotional woundedness. Thus, they may experience sudden and dramatic shifts in their opinions, behaviors, attitudes, values and life goals. Sometimes they even become confused about their sexuality and engage in promiscuous sexual activities with either gender. Because they possess an "I've been bad" mentality, they may sabotage their work or school performance. In time they are perceived as unreliable, underproductive and contentious. They also believe that when things go wrong for them they must retaliate and seek vengeance. Actually this makes them feel worse and compromises their self esteem even more. "Vengeance is mine, says the Lord," (Rom. 12:9, Heb. 10:30).

It must be remembered that the individuals who manifest symptoms of BPD are in a great deal of emotional pain from which they cannot escape. In an attempt to numb their pain, these individuals tend toward addictions, eating disorders, reckless driving, engaging in unsafe sex, etc. Because of their tendency toward addictive and unpredictable behaviors, they frequently find themselves in legal difficulties, with many ending up in prison. It is sad to note that a large percentage of incarcerated women have been diagnosed with BPD.

During the course of their lives, borderline individuals find it difficult to invest in relationships over the long haul. They tend to be very reactive to others, which may result in the development of a sarcastic attitude and denigration of their character, leading to a root of bitterness taking hold in their lives (Heb. 12:15, Eph. 4:29-32). Since they are so hypersensitive to others, they usually perceive that they are being neglected, shunned or persecuted in some way. When they become aware of these feelings, they are willing to compromise their integrity and strike out and abuse others. This abuse takes on many forms: verbal, physical, sexual, property, financial, emotional, spiritual, etc.

People with BPD can become easily bored and tend to flit from one activity to another. One day they are in school, the next day, they are out; one day they have a good job, the next day, they hate it. They're suddenly very much in love and just as easily disillusioned about the object of their affection. Because they're so easily bored, they are wishy-washy, hard to understand individuals. They are very difficult to live with, i.e., hot one minute and cold the next. Clinically their prognosis is guarded; however, with Christ all things are possible (Phil. 4:13; II Cor. 9:8).

What can I do to help?

• These individuals can be helped. But in order for this, the best course of action is for them to be referred for therapy to someone with experience in working with borderline personalities.
• Let them know you love and accept them unconditionally and that you'll be there for them.
• When they get into trouble (and they will), let them know that you won't condemn or reject them. Make it clear that you like them even when you do not like their choices.
•  In a loving and firm way, be very precise and clear in setting boundaries with them. Never set boundaries in a harsh or punitive way. They are very needy people and will demand more than any person is able to give. Let your "yes" be yes and your "no" be no.
• You may have to detach if they don't respect your boundaries. In doing this say, "I love you and don't want to abandon you, but you leave me no choice except to pull back for a time." This gives both of you a cooling-off period and a time for reestablishing of individual emotional equilibrium.
• When these individuals get angry and have trouble expressing their feelings, they will "act out," usually in a destructive way. Thus, they become alienated from others and themselves. Let them know you do not approve of their actions and that you want to help them. Show them that there is a healthier way to get their needs met (Prov. 26:4-5).
• Help them develop impulse control and learn to delay gratification.
• Give them positive feedback when they change their behavior in a constructive way.
• Help them learn to stand on their own two feet as well as to develop interdependent coping skills.
• Assist them to establish priorities and to develop a schedule so that both short and long-term goals will be met.
• Help them to stay on course if they are wanting to quit a job or drop out of school at the last minute, etc. If they see you coming alongside of them, they might be more willing to stick with it (Phil. 3:12-14).
• Encourage them to feel better about themselves. Remind them that God created them in His image and that He loves them just as they are (Gen. 1:27; Psalm 8; Isaiah 40:26; Matt. 10:29-31; John 3:16-17; Rom. 5:8). Let them know that you also care about them and will not abandon them, although you will hold them accountable for their choices. Be ready to set some limits. This will allow their self esteem to begin to heal.
• These individuals suffer from high levels of boredom, so aid them in identifying  their skills. In addition, help them engage in activities and develop hobbies in which they would be interested.
• These individuals are often easily distracted and may suffer from ADD (attention-deficit disorder) or ADHD (attention-deficit hyperactivity disorder) which probably will require medical intervention. Encourage them to get the medical help that is indicated.
• Because their behavior is often destructively manipulative of others, allow them to experience the unwanted consequences that result from their choices.
• Encourage them to see that they can develop meaningful relationships with others without being destructively manipulative. Help them:

Become aware of and identify their manipulative behavior;
Verbalize their feelings concerning their behavior;
Become aware of and identify how their their behavior affects others in order to help them gain some sensitivity to the impact of what they do to others:

Set limits with them and be Christ-like in doing it (John 8:1-11);
Help them to realize they will have to accept the consequences of not complying with another's boundaries (II Samuel 24:1-25); and
Let them know that their insensitive behavior will always have a negative impact on their relationships and will be of great cost to them.

• Help them learn to moderate their lives so they don't engage in addictive behaviors. Help them learn that it would help to structure their lifestyles so that they don't turn to negative behaviors when they are feeling bored, neglected, alone. Addictive behaviors help them  numb out instead of feeling their pain. They need to develop a safe and sound plan to follow when they would otherwise gravitate toward behaviors that would hurt them.
• Assist them in learning to deal with and resolve a crisis and to problem solve.
• Take it seriously when you see signs of suicidal tendencies. Make the environment safe for them; get the proper medical help if necessary.
• When self-mutilation takes place, get the proper medical treatment. Take the focus away from the act itself and try to address the person's feelings which precipitated the decision to hurt themselves.

Because of the nature of this malady, it is easy to see that these individuals are people with whom it is difficult to live and interact. Hopefully these suggestions will help bring about positive changes in their behavior and in your relationship with them.

People with borderline personalities or behaviors can be helped. They can change and emotional growth can take place. For this to happen, what is needed is an individual who is willing to change and seek professional help and for significant others to be consistent in their dealings with them.

God has promised that He will supply all that we need in every situation and circumstance (Phil. 4:13&19; II Cor. 9:8).  He will exchange the distorted thinking and reasoning of the person suffering from borderline personality disorder for the truth of what is real "If you abide in My word, then you are truly disciples of Mine; and you shall know the truth and the truth shall make you free" (John 8:31-32). Read also Psalms 15, 25:4-6, 43:3-5, 91; John 1:14, 17:17; Ephesians 4:15-27, 5:8-17, 6:12-18.
 
 

References:

American Psychiatric Association. (1994). Diagnostic & statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Cloud, Henry and Townsend, John. (1992). Boundaries: When to say yes, when to say  no to take control of your life. Grand Rapids, MI: Zondervan Publishing House.

Cloud, Henry and Townsend, John. (1995). Safe people. Grand Rapids, MI: Zondervan  Publishing House.

Eaton, M.T., Peterson, M.H. and Davis, J.A. (1981). Psychiatry: Medical outline series.  Garden City, NY: Medical Examination Publishing Co., Inc.

Kaplan, H.I. and Sadock, B.J. (1990). Pocket handbook of clinical psychiatry.  Baltimore: Williams & Wilkins.

Kernberg, O.F., Selzer, M.A., Koenigsberg, H.W., Carr, A.C. and Appelbaum, A.H.   (1989). Psychodynamic psychotherapy of borderline patients. New York: Basic  Books, Inc., Publishers.

Mason, P.T. and Kreger, Randi. (1998). Stop walking on eggshells. Oakland, CA:   New Harbinger Publications, Inc.

Masterson, James F. (1981). The narcissistic and borderline disorders: An integrated developmental approach. New York: Brunner/Mazel, Publishers. 
 

Copyright 2002, El Rophe Center, Inc