Dealing with someone who suffers from BPD is like playing chess with someone who has taken LSD

Many years ago when I started as a psychotherapist, it was difficult for me to discern between a patient who suffered from poor impulse control and one who suffered from Borderline Personality Disorder.  There was and still is a stigma around having a personality disorder and I have not met many people who self-identify as having Borderline Personality Disorder.

To distinguish between poor impulse control and BPD, I employ the analogy of manslaughter vs. murder: if someone rolls through a stop sign and accidentally kills someone it is manslaughter; if someone wakes up in the morning and premeditates killing someone later that day, it is murder.

Glenn Close in “Fatal Attraction” wasn’t casually chilling with Michael Douglas when she impulsively decided to horrifically boil his daughter’s bunny alive.  She woke up that morning wanting to let him know exactly how upset she was with him.  She had the intention of rocking his world, blowing up his life.

And she did.

In the last ten years I have not had any patients who I would diagnose with BPD.  But when I did have such patients, I equated it with playing chess with someone who had taken LSD: someone who was not playing by the agreed upon rules of the game, someone who was 100% committed to winning the game – on their terms.  And if winning to them meant doing something incendiary, such as setting the board on fire – or even setting the building on fire – then by god they were going to win that game.

I revere Dr. Marsha Linehan for acknowledging her own struggle with BPD, incorporating Buddhist mindfulness practices into Western psychology to treat BPD, and creating what we now refer to as DBT (dialectical behavior therapy).  Seeing as most people who suffer from BPD are highly intelligent, if we can inspire them to observe their thoughts and self-regulate rather than impetuously and spontaneously act on these passing thoughts, they can often make healthier, less extreme, long-term decisions.  

Le petit lapin will see another day. 

In addition, language tools such as Marshall Rosenberg’s “Nonviolent Communications” as well as the Gottman’s myriad devices for connecting authentically and compassionately with others, often help people who suffer from BPD try new, calmer approaches. 

I disagree with the definition of BPD from the “Diagnostic and Statistical Manual of Mental Disorders” and think BPD should be classified as a mood disorder rather than a personality disorder.  To me, the symptoms of BPD can usually be seen as emotionally dysregulated, extreme reactions to re-openings of primal abandonment wounds.  The person feels betrayed and thinks that doing something conspicuous will inform the betrayer that they have behaved improperly.  But the message often gets lost in whatever explosive medium is chosen.

Abraham Maslow said, “When the only tool you have is a hammer every problem resembles a nail.”  Providing sufferers of BPD with a wide array of tools helps them avoid the nuclear option.