7 Tips for Working with Clients with Borderline Personality Disorder
Clients with borderline personality disorder (BPD) suffer from constant “emotion dysregulation” (wide mood swings, sudden anger, unnecessary suspiciousness, inappropriately intense excitement, misplaced loving feelings, etc.), as the accompanying article by Shehrina Rooney describes. This is not something over which they have conscious control, unless they are learning to regulate their emotions in some form of therapy. In fact, such emotion dysregulation is at the heart of most of their problems in relationships, with romantic partners, family members and professionals. With this in mind, here are seven tips for those working with someone with BPD:
Is This Really a Crisis? People with Personality Disorders Often See Internal Crises as External Crises
Is This Really a Crisis? People with Personality Disorders Often See Internal Crises as External Crises ©2019 Bill Eddy LCSW, ESQ. As I wrote in my latest article in Psychology Today, people with personality disorders often see their own internal crises as external crises caused by someone else. Since I began working with clients with borderline and narcissistic personality disorders over thirty years ago, it has been clear that these individuals spend a great deal of time reacting to situations they perceive as crises that are really internal upsets projected onto others. In fact, one of the first things I learned to teach them was to regularly ask themselves: “Is this really a crisis?” This article briefly reviews some of what I have learned as a therapist and lawyer. Crisis-Prone Characteristics Personality disorders are characterized by the DSM-5 as including “significant distress or impairment in social, occupational, or other important areas of functioning.”1 This internal distress may be triggered by a wide variety of outside events or even the person’s own internal ruminations. In addition, this pattern is unchanging over time, as it “is inflexible and pervasive across a broad range of personal and social situations.”2 Lastly, what is important in this discussion is that this includes “ways of perceiving and interpreting self, other people, and events.”3 This is not all that the DSM-5 says about personality disorders, but the theme of misperceptions of crises is what will be discussed in this article. Targets of Blame Because of these misperceptions of other people, those with personality disorders often have what I call Targets of Blame, who they believe are responsible for causing their feelings of distress. I have seen this many times in legal disputes, when one person is convinced that another person (husband, wife, neighbor, co-worker, supervisor, or even a stranger) is out to harm them, when they really are not. This could be someone almost at random, but it is most commonly someone close to the person or in a position of power over the person. I have observed many people lose a legal case because it was based on such misperceptions about a fantasy Target of Blame. (This is not to say that people with personality disorders don’t also have valid claims some of the time.) Two brief examples help demonstrate this. Borderline Personality Example Many years ago, I represented a young woman in her divorce as her lawyer. She had numerous problems, including a drug addiction, an incident of violence against her soon-to-be ex-husband, a brief hospitalization for danger to self and others, and two young children who were the subject of a custody dispute. Fortunately, we were able to put together an excellent treatment team including a hospital psychiatrist, a clinical social worker as therapist, daily involvement in a 12-step program, and I was her lawyer with a background as a therapist. The team agreed that she had borderline personality disorder, as well as substance use disorder, and she became motivated for treatment—especially because the issue of care of her children depended on her sobriety and a significant improvement in her mental health. Since her case was active in family court, we needed to discuss strategy and her progress on a regular basis. One day she told me that a key part of her recovery (from substances and her personality disorder) was to ask herself these two questions every day: “Is this really a crisis?” And: “What is my part in this problem?” She realized that the incident of violence by her against her husband was an overreaction to fears that he was taking the children away from her forever, when he was really just driving away with them for his routine parenting time. It was not really a crisis, but she misperceived that it was and thereby created a real crisis for herself and everyone else around her. Over the next months and years, she stuck with her recovery from drugs and also her symptoms as someone with borderline personality disorder. She was a good example to me of someone who out-grew the diagnosis of borderline over the next few years. And the other good news is that she was able to become a much better parent and the custody battle in court turned into an out-of-court agreement for shared parenting which both parents handled quite well (he also was in recovery from a substance abuse problem). Narcissistic Personality Example In another case I worked on as a divorce lawyer, my client was a husband who was also a recovering alcoholic for about ten years before I met him. In his case, he was falsely accused of child sexual abuse of his young son by his soon-to-be ex-wife. (I have worked on many true cases of child sexual abuse, as well as many false cases—some honestly believed but false and others knowingly false to the extent of court sanctions being imposed. So I make no assumptions about each case.) After a thorough investigation determined that the accusations were completely untrue, it was not surprising that he was on the defensive and understandably angry. At first he wanted sole physical custody to punish her for her allegations, especially because she told the world about them, including people at his son’s preschool and their church. It became clear that she had a problem, possibly a personality disorder, which may have explained her misperceptions about him. For various reasons, the case eventually evolved into an shared physical custody plan, which endured for several years. They were both able to let go of blaming each other enough to co-parent successfully. But during his family court case he had regular crises or near-crises, which is understandable given the above facts. At one point, he raised the issue of whether he had a narcissistic personality disorder. (He had read one of my books on this subject in divorce.) He was in therapy and he raised it with his therapist. He said they agreed that he may have had some traits, but not the disorder. I said that made sense to me. Soon after
Walls, Wars and Parades: Understanding Narcissistic Leaders
©2019 Bill Eddy, LCSW, Esq. WALLS: Dividing people into winners and losers.WARS: Highly defensive, the slightest criticism may send them into battle.PARADES: Demands excessive doses of admiration and takes credit for what others have done. A bio/psycho/social theory of why their patterns of behavior are predictable. It may be a narcissistic supervisor, business owner or political leader, but the basic patterns of their behavior can actually be quite predictable. Of course, these personality types exist on a continuum from narcissistic traits (which may be mildly annoying to those around them) to narcissistic personality disorder (social impairment without self-reflection or behavior change) to malignant narcissism (a cruel and sadistic combination with antisocial personality disorder). I have observed all of these personalities in dysfunctional families, legal cases, workplace conflicts and business disputes. The Basic Pattern Not all narcissists desire to be leaders. Many are simply self-absorbed, brag a lot and may primarily sabotage themselves without self-awareness. But when narcissists desire to be leaders, it is often to fulfill personality-based goals which may have little to do with their job descriptions. Instead of focusing on leading a successful enterprise and motivating others, they are preoccupied with three basic drives: 1) being seen as very superior, 2) expanding their own power and 3) being admired by all. Walls: For this reason, much of their efforts go into dividing people into winners and losers, with those below them being berated as losers and those above them being charmed as winners. (Think of this as “kicking down” and “kissing up.”) Of course, as time goes by, they attempt to scramble higher and higher by walking on the winners who helped them up and who they now view as losers. In a sense, they arrogantly erect walls (mostly verbal, but sometimes physical) between themselves and those who are “beneath” them. To convince themselves of their own greatness, they have to constantly insult others (their Targets of Blame). Wars: They are also highly defensive, so that the slightest criticism may send them into battle as they try to prove that they are really superior and that their critics are really inferior. They see all relationships as inherently adversarial and therefore are ready to go to war (verbally or otherwise) at the drop of a hat. This can totally distract them from the work at hand, but they can’t help themselves. They are constantly rebounding from one “crisis” to the next, even though these are mostly self-inflicted. Yet they pride themselves on how powerful and superior they are, so that they are almost eager to pick a fight just to prove how great they are or to move up the organizational ladder. Parades: Lastly, this basic leadership pattern includes demands for excessive doses of admiration. They are driven to get compliments for themselves, if possible by impressing other high-status people, but often by demanding deep respect from the same people they have been insulting. They take credit for what others have done and deny responsibility for their own mistakes. They are constantly fighting to overcome their own “narcissistic injuries” (when their imperfections are exposed) by attacking those who don’t admire them enough. They are constantly seeking trophies that they can show off to others and pushing for public displays of affection for themselves, such as parties (or parades). Child Abuse Theory Why would someone behave like this, often to their own detriment? The leading theory is that they were abused as a child, or had an insecure attachment in early childhood. Growing up, the person tries to overcompensate for being belittled and powerless by creating a superior “false self” that he or she presents to the public as particularly talented and special. Of course, this false self keeps having narcissistic injuries, so the person tries harder and harder to prove how superior he or she is. But it’s a vicious cycle because it can’t get resolved by proving superiority. It gets resolved, if at all, by healing the abusive past, learning to accept one’s ordinary place in real life, realizing that setbacks are normal, and experiencing empathy for simply being a person. These learnings can happen in therapy, but few narcissists are willing to go. Entitlement Theory Another theory is that the child grew up in an indulgent family environment, which taught superiority on a daily basis. Rather than being abused, the person had no limits and their needs and wants were eagerly met. They expect to be indulged as an adult, by their partner, their boss and their community. Wannabe King Theory My theory is that many leaders with narcissistic personality disorder are that way because of heredity. I have worked with many families with several children who are quite different, even though they were raised in the same household in the same basic way. Yet, one of them has this personality disorder and the others don’t. Often there’s no abuse history or a minor abuse history. Yet the person grows up with the same full-blown Walls-Wars-and-Parades mentality. I believe that this personality “disorder” may be in the human gene pool because it was once very functional. These patterns of behavior could be holdovers from ancient times in a very specific way. They are what I call Wannabe Kings. In ancient times, narcissistic leaders often arose because they were very adversarial and took power and held onto it. At first, village chieftains were at the top of the village social hierarchy. They organized the village to feed itself, get along and also to protect itself from outsiders. Narcissists are good at getting people together and sweeping them up in their grandiose schemes. Over time, as humans grew in numbers, village chieftains were replaced by more powerful leaders, eventually kings and occasionally queens. For protection, ancient kingdoms had to have walls. They kept out the dangerous enemies who would try to attack them and take over the kingdom. These leaders were also constantly at war, both to protect themselves and to expand their kingdoms. Lastly, in order to show the king’s power and the people’s love, they would have parades. This constant pattern of kingly behavior seems very