Borderline Personality Disorder and The Fake

Originally I just wanted to tell the story about the stand underneath my fish tank, how I found it at Bed Bath and Beyond while shopping for a gift for a shower (yes, I had the coupon), shlepped it to the office myself, borrowed a screwdriver, for mine is never where it's supposed to be, and put it together in little under two hours. Of course I knew the secret about the cam screws. Put them in, tighten them up, last.

I see this sort of behavior as fairly normal, if a little impulsive, sure, because ordinarily I'd ask FD to put it together for me. But doing something physical and challenging is a nice way to distract a person from thinking, and sometimes we just think too much. So I'm always telling people to do something. You feel better if you can distract.

And the computer desk that supported the tank just didn't cut it.

Then I found myself talking about Borderline Personality Disorder, BPD. This disorder is very much about impulsivity, which substantiates the rule that things that are thought to be pathological can be perfectly normal in a different context.

Impulsively buying a bookcase that matches your furniture, even if it weighs more than you do, and putting it together yourself, even if your best tools are a hole puncher and a nail file, beats impulsively getting drunk to feel less edgy (a "borderline" thing to do), impulsively cutting one's self (another "borderline" thing to do), or impulsively whacking someone across the face because you're jealous or in a bad mood. You get the idea.

And if the impulsive act also functions to build your self-esteem, as opposed to, say, lowering it, then it's a good thing to be impulsive, right?

But people who suffer from BPD have a helluva time trying to reign in their impulsivity, and the folks who try to love them, who want to help them, get worn out by the drama.

It's easy enough to start to write something, quite another to finish, and that's what happened to this post. Then then something cool happened. Retriever wrote to me to ask what I thought about something going on at Dr. Helen's Blog and Dr. Bliss's blog over at Maggie's Farm. Both docs are writing about BPD, and lo and behold, Doc Helen has a video interview with my new favorite self-help guru, Randi Kreger.

Randi Kreger (Walking on Eggshells) has a fairly new book, The Essential Family Guide to Borderline Personality Disorder. I read it cover to cover in a night only a few weeks ago, found it a terrific resource, funny, easy to read, and full of information that everyone should know. Especially if you have someone in your family who is "impossible", who can't regulate his or her emotions, who acts impulsively to dampen heightened negative arousal, like anger.

And she has a great section called Tools in the back of the book.

I'll throw one at you right now, a favorite I've suggested many times to people in therapy. Randi would call this intervention an incompatible behavior. I've always called it The Fake.

The idea is that a person can't be obsessing and angry about something if something else is a more attractive option. It's no different than distracting a whining three year old with a shiny yo-yo. All of a sudden the icecream he wants isn't important anymore.

With kids it's always,

Outsmart them. You're older. You can do it.

With older people who simply can't let something go, who are stuck on abusing you or raging about something or someone, who really will not stop to listen to anyone else's point of view or entertain other positions, it has to be,

Did you hear the one about. . .

Or

Did you hear what happened to So and So?

Good gossip is sheer genius. Gets 'em every time.*

My favorite fake is laughter. You laughing at your tormentor.

This person is tormenting you, criticizing you, ranting, and you break into hysterics, literal belly-bending, on the floor, doubled over with laughter hysterics. You do it respectfully, though, for you are complimenting the person who is clearly trying to upset you. But now the abuser sees himself, herself, as a good person, someone who can make you laugh, not just laugh, but laugh hard, and that fleeting self-esteem returns with your praise. Now we're all comedians, should work stand-up.

If you throw someone off like this, anger and blame are impossible.

And the truth is, most people with this disorder are smart, and they can really be very funny.

Traditionally with people who have Borderline Personality Disorder, once they're flying, meaning angry, there's no stopping them. The anger is a manifestation of pain. If you can't see that, then there's no helping your spouse, your child, your friend, your mother, whoever it is who is unable to regulate emotion. When the plate needs shattering, it will shatter. When they need love, they'll find someone to sleep with. When a car needs to be keyed, it will be keyed.

When it's all over, it's What's for Dinner? As if nothing happened. So in therapy we're forever working on strategies that will work, that will distract, end an episode.

If you think of this as an episode of true psychopathology and pain, then it's a lot easier to swallow the negative behavior.

And you have to see them as capable of seeing life differently, seeing themselves as their greatest allies, capable of rational, laudable behavior. Good lives.

I work dialectically with suicidal, self-destructive people who have BPD , for you have to do this, dialogue in an empathic way, one that reaches them, meets that place in the ego that wants to live. Typical questions from me include:

(1) Would you want your niece to cut herself? No? Then why are you setting an example? You think she doesn't respect you, look to you as a role model?

(2) Do people deserve to have quality lives?

(3) Aren't you a person?

People tend to agree. They deserve better. They are capable of better. They want more out of life. They want quality lives.

Then the question becomes how to get it.

And it isn't an impossible quest, an impossible, reprehensible therapy. I've referred to ACT, Acceptance and Commitment Therapy here in this blog, and it helps to know DBT, Dialectical Behavioral Therapy, and Schema Therapy. There is progress and people do get better, so I'm a little miffed, frankly, at all the negativity I read on the Internet about BPD, avoiding BPD patients.

Yes, people can be difficult. They can be high maintenance, and yes, group therapy surely helps, and for sure, without a team it is so, so hard to work a successful therapy. I get it that people with Borderline Personality Disorder can be more than difficult, that they can and will make your life a living hell without help. And yes, therapists try to avoid treating the disorder, need help for ourselves to cope with all the drama.

But with help? With time? (lots of this, endurance is the essence)

There's no greater therapy, no greater pleasure, no greater success than helping someone with this disorder get well.

That's all I'm gonna' say. I have some algae to scrape off my tank here at home, and spilled some sugar behind a cabinet. There's a lot to do, basically.

therapydoc

*Okay, not every time. Go ahead, talk about it.
See the Second Road on Self-Pity.
Other posts by me about BPD