Wednesday, December 22, 2010

An Interview with a Therapist

I visited an experienced licensed therapist / psychiatrist recently. The reason I had originally booked the appointment was to learn anger management techniques. When I went there I told him it wasn’t as much that I fly into fits of rage but that when I feel irritated, attacked, or angry, I get sarcastic and it can lead into escalating fights. In the first session, to my surprise the focus shifted away from me. In subsequent sessions, the focus shifted back to me. So our conversation in the first session went something as follows after a bit of a preamble:

Me (M): I need to learn to control my temper.

Counselor (C): What causes it?

M: Well when I get highly irritated, have to repeat myself more than twice, or when feeling attacked. I don’t seem to have the problem at work. At home it started occurring in the spring but lately I've been dead silent and kept to myself. I want to learn to control myself from being sarcastic or angry even when pushed.

C: When do you get angry then?

M: Long story. I don’t know what I need right now – grief counseling or anger management therapy or both. I have been in pain and tears. I was in love with a woman in `97 - `98. She meant and means everything to me. However, she had some issues going on  in `98 so she left me suddenly without any apparent reason. Then I started talking to her 22 months ago and my spouse found out 9 months ago. Before then I didn’t fight with the spouse. But I was never in love with her. As for the woman (my ex), she and I have had a loving and passionate yet bumpy relationship. Just today, her sister sent me an email saying their family would lay down their lives before I would ever marry her. So I have two separate issues, one is the anger issue, the other is the dual relationship issue. In fact, I came here because I promised the ex I would deal with my anger issues. But just a few days ago, she left again. The deal breaker was when I sarcastically asked if she was in love with her ex. I had asked her many times not to even mention her exes because previously I had to compete with other men - she had told 4 of us simultaneously that she didn't want to lose any of our love for her. Previously she had mentioned that an ex would serenade her with a guitar and that everyone knew she was his woman and that he was incredibly smart and she remembered his taste. Being a possessive type of man, I took issue with her even mentioning her exes. So when she did mention his name on an unrelated issue during our very last fight, it triggered something in me to make that sarcastic comment. That’s when she said it’s over. I don’t think that should have been a deal breaker but she said things had been piling on for so long that she couldn’t take it any more. The other thing that caused me to make that sarcastic comment was I was at my wit's end dealing with her enormous mood swings. She always said it was my fault though, and I believe it. Sometimes she would think very highly of herself, and on another day she would say she felt worthless. On those occasions I would re-assure her and remind her that she had accomplished more than most women could ever hope to achieve. But she is a perfectionist.  Whenever I said something I didn't mean though I would apologize. I've probably apologized to her 70 times in the course of 1.5 years whenever I said anything hurtful or even when I didn't say anything hurtful intentionally! She has sworn and cursed me regularly and quite often would say hurtful things as well since the beginning and has apologized perhaps 5 times in total. Interspersed with the swearing and cursing has been incredible love. The type of love that would make me forget that she and I were two separate individuals, the type of love that would make me feel like she was inside my mind and body, and it felt like we were one collective entity - one indivisible being. But then when she would get furious over little things, I would sometimes wonder if she had a grip on reality. She is very sweet, caring, intelligent, extremely affectionate, thoughtful, but carries a fierce temper. She can get extremely angry over minute things and can stay that way for hours or days. She can get angry even when there is no apparent trigger. Sometimes she gets angry for legitimate reasons but her anger on minute issues was strange. I have been in tears because I felt I pushed her away. I feel guilty. A few weeks ago she cut herself and banged her head on the wall and cried her heart out till her mother discovered her and took her to the ER. I had said very hurtful things to her in anger on the phone and that lead to it. I wasn’t there or I would’ve stopped her and I feel like it would never have escalated that much if I were physically present there. She would tell me she loves me to death and then in the next day or same day that she hates me more than anything. Then she would call and say she didn't mean it and that she only said it because she felt I would leave her. I have never seen anyone with as fierce a temper as hers that could be triggered on a dime or someone with such fluctuating moods. She said that I always instigated her fury. But I always thought of her as my soul mate and that she was everything I wanted in a woman. She even told me that there wasn't a day in the last 10 years that she didn't think about me. She also told me once 'I don't think I have hated anyone like you'. I felt like I was at a disadvantage walking in. But she's the only woman I ever was in love with and I don't think I'll ever fall out of love with her. She was perfect to me in every way except the emotional roller coaster. I consider myself a rational and sincere person but prone to believing in incredible tales of love. Every time we fought though, I would ask myself whether I triggered it and if so I would apologize and if I felt that I hadn't triggered it then I'd wonder if it was just the geographical distance between us, or the fact that I was under stress in graduate school, the guilt of sinning, or because she was under stress waiting on her medical residency, or because she told me she felt like a 'mistress' and 'other woman' or because she lived in a city known nationally for high depression/stress and suicide rates or whatever other external causes I could attribute it to. She also felt like she had been mistreated by everyone especially relatives (not immediate family), and men. So she had very high expectations for me.

C: We can work on your issues. Your ex sounds like classic Borderline Personality Disorder (BPD). Two signs are the self-mutilation and extremes in emotions. BPD is more common in women, and I’ve seen it in effeminate gay men too. She didn’t have to cut herself nor bang her head on the wall, that was a choice of hers, she could’ve hung up.

M: But if I controlled my tongue she wouldn't have cut herself.

C: You have to realize that you didn't force her to do that, no matter how bad the fight was. This is really important for you to understand. You never forced her to cut herself. It was her choice. BPD’s sometimes do that to attract attention to themselves or to mask the pain they feel inside. I bet you that was not the first time she cut herself and she probably has been doing it for a long time. And not wanting to lose the love of others - that's a central theme in BPD as well - abandonment issues.

M: BPD? Could I have helped? She does have a history of cutting herself. She also threatened suicide several times and said she had strong urges to do so. I was very much on edge for days on end when she threatened that. I called a counselor and tried to get her on 3-way with her. I had trust issues going into the relationship because she had abandoned me once without explanation. It took me a very long time to trust her love for me.

C: Suicidal tendencies are common too among BPD sufferers. If you knew about it, you could have encouraged her to go to therapy. Often, the success of the relationship hinges on the BPD sufferer wanting to go to and sticking to the therapy.

M: But she's normal and highly intelligent and extremely loving when she wants to be. I just felt her emotions were all over the place. Me having a temper didn't help either because she she would lash out, I would lash back or I would lash out and she would lash back. I feel like if I had controlled my tongue she wouldn’t have blown up. I know I have a lot of testosterone and that mostly manifests itself in sports but she told me that for women she was on the highest end of testosterone levels as she had checked once. So there was often high levels of aggression. She told me once that she wished she was a man because then people would understand her better. When she was growing up she faced major trauma at least twice, once around 6 or 7 years of age, and the other when she was around 16. She told her mother but her mother told her to not talk about it and to forget it and she was very angry with her mother about it. Inside me, I was very angry at the perpetrators.

C: I figured. BPD sufferers have that history sometimes. Of my own patients, I haven't found a single BPD diagnosis that didn't also have an abuse history. She may have felt abandoned and BPD sufferers hate being alone and sometimes pre-empt it by abandoning the person they are having a relationship with before they abandon her. I am treating a gentleman now whose wife is BPD and I can tell you it takes a lot of patience to deal with that. She will always accuse him of being the cause of her misery and hardly take responsibility for her actions because they can't think of things that way. Their emotional development is not complete and brain function is different, even though they can be highly intelligent and seem normal otherwise.

M: Well in any case, my temper exacerbated things. Had I kept silent she may not have reacted that way.

C: But what you need to understand is that she still would carry that baggage anyway – BPD is very hard to treat. It takes intensive therapy and sometimes group sessions in addition to the one on ones. They reel you in and they don’t even know it. And you of course don’t know about it. You believe every word they say. And they themselves believe it. What they say feels real to them, and what you hear sounds real to you.

M: No, I know it was real on both our ends. She was all that I ever wanted. I feel very terrible because she is the only woman I ever loved and still love and ever dreamt of being with. We have incredible unimaginable chemistry. Like bodies were put on our souls just for one another.

C: This is all it was – a dream. BPDs are very good at coming extremely close to you and then yanking back and withdrawing. They see things in extremes.

M: That was one of my complaints! That she always sees things in extremes, in black or white, never in the various shades between good and bad. In fact I told her that many times 'why do you see things in black or white?' Something was either extremely good or extremely bad in her eyes. Something could be slightly offensive in reality, but in her eyes it was extremely bad. And I felt very frustrated. Sometimes it wasn’t even bad but she would take it that way, get furious for hours or days, and later say ‘well why couldn’t you have said it this way’. When I got frustrated with all these swings, I would also say mean things to her sarcastically, and she would bite back 20 times as hard. One of her chief complaints was that I attacked her character, but I felt that she attacked mine directly as many times as she said I attacked hers or more but she never realized it. If she was telling me a story about someone and she made some unnecessary comment and I told her not to backbite, she would take that as a personal attack against her character and start screaming and crying. She would accuse me of supporting her enemies against her and I would just be flabbergasted because the reality was so far from how she would percieve it. I had an argument with her about veils twice and the second time she said if you really cared for me and loved me you would send me articles about it instead of telling me. A week or two later when I sent an article, she went ballistic! I told her I did exactly what she asked me to do. Later on after the huge fight she explained that she just needed me to be there to help her out, so I finally understood. But to get to that point, we had to go through two unnecessary mind-draining fights. And she took those to be character attacks. She cried and attacked me for the next 3 days. I was losing my wit day by day because on the one hand was my deep unrequited love and on the other hand was my inability to understand her moods. I did make sarcastic comments about the past that could be construed as character attacks - they were real occurrences, it's just that she didn't want me to speak of them. Understandably so. I toned that down tremendously too until the wall banging episode. That's why I need to learn how to control my tongue so that when I get frustrated I don't bring up her past. I'll give you one example of how she would get furious over nothing...I retaliated in 98 after she left by calling her family members and telling them how she 'used me' because I had erroneously felt that she was just out for fun and one day I told her that the good that came out of that was that it brought her family together. She said I was so sick in the head for thinking that way. She probably thought I was speaking in favor of the retaliation but what I was doing is something I have been taught theologically which is that in very bad situations you can sometimes see one good that came out of it, and to try to see some wisdom in it if you can, and so I was pointing out the one good that came out of it and not negating all the bad that the retaliation entailed. But she never understood things that way. Once she complained that she was stressed over whether she would get residency, and I told her not to worry and then told her if it doesn't go through, you'll find something else to do. I was just trying to encourage her to not worry and to look at the bright side. But she went haywire and started cursing and was absolutely heated up. I actually ended up apologizing to her! And I didn't know why, I just wanted to pacify and mollify her. After she had cooled down she explained that she wasn't needing a solution from me but a reassurance that I love her. Then in subsequent fights I practiced reassuring her by telling her I love her. That didn't work as I expected. It made absolutely no difference. Once I told her I was going to move to the mideast temporarily so I could clear my head out and be a better man for her. We weren't even fighting but upon hearing that she started dropping f-bombs left and right and it was in these repeated instances of unexplained temper tantrums that was slowly making me lose my wit and making me feel like anything or everything I say could trigger her anger. It was all either extremely good or extremly bad in her eyes.

C: That’s again common with BPD sufferers, they live in extremes…they can be extremely loving one moment and vicious the next. After they cool down, they at times may have forgotten what they had said in anger to you or they distort it in their mind. And forget about reasoning with them while they're angry, they cannot process anything in that state.

M: During our relationship in the last 22 months, she admitttedly crafted elaborate lies about two different men she claimed she was going out to picnics with and other types of outings. She said one of them was extremely handsome. And that the other one was tall and muscular and made her laugh. She said one of them kissed her lips’ borders and sent her a Starbucks gift card and she could see the deep love in his eyes and that she told him not to expect oral after marriage. That she had fights with her parents about these two. And that her father loved one of them and would hang out with him and in a social setting told one of them how she had stolen pencils from the bank as a child. I don’t know if the story of these 2 guys was a lie or not because only recently did she say that she created those two men in order to protect herself in case I didn’t come for her and I told her 'don’t you see how much damage and distance that created in us'. We fought about those two guys endlessly. She would tell me stories about them numerous times. And we fought totally unnecessarily!! She said I was being hypocritical because I have a wife and I tried to explain that the point was that you want me to come for you while you are telling me you are considering other suitors. And I had an issue with other men anyway, she was clearly aware of that. Plus the picnic guy who she said was very handsome was very early on when we just started talking so I think that may have been real and not protection mechanism but I don’t know for sure. On the one hand she told me stories about them for months and on the other hand recently she told me in person that she had crafted these two guys as a protective mechanism and none of that was real but that the 2 guys exist but nothing happened between her and them. I also found her contradicting herself before in our first relationship quite a bit – but she claims she does it for self-protection or she says she never lies or that she lied only to protect me. When she had joined college after our first break up, she told me she tutored an "attractive black basketball player" (her words) and then suddenly stopped. So she said because she stopped tutoring him, the guy sent a friend of his to drag her out of her dorm room and the police were called. She then said her parents were called by the police and she told me she told her parents that she blamed the whole event on me. Later on she told me that she told her mother that it wasn't me who sent a guy to drag her out of her dorm room. When I questioned her once why a guy who was being tutored would send a guy to drag her out of her dorm room, she was enraged. On the day we had a fight recently, a few minutes before she banged her head on the wall, I asked her where she was, and she replied she was in the car. Then a minute later she said she was in the bathroom at her house. I asked her well which one is it? She said she just made up the car thing. Because of the repeated contradictions over the course of the relationship, I got totally confused and I questioned myself whether she was actually banging her head on the wall because I thought it sounded like someone knocking on the door – that was a bad mistake on my part. That whole episode was my fault for not controlling my temper. But her temper was extremely fierce and often I complained that it was disproportionate to the infraction. I don’t understand though because she has very good relationship with her siblings. She told me that her brother was the ideal man. But later she claimed she had said 'ideal brother'. I always wondered why I couldn’t share a stable relationship with her like she did with her siblings. When times were rough with me and her, they were really rough. When times were good, they were euphorically good. I always complained about this instability and always wanted to stabilize.

C: That’s how some BPD sufferers work – she created those two men or talked to you about them because she was afraid you would abandon her. They can be very bright so it’s not easily discernible they have BPD – displays of disproportionate anger is common among them. See, they come in to therapists for other problems like depression or suicidal thoughts and BPD sufferers can be quick to dismiss that they have any disorder. Then they switch therapists out of anger. And the stealing of pencils – impulsive behavior is common with BPDs.

M: That's what she told me recently! That she didn't like the therapist she had started going to and was going to switch to another one. I love her and I wish I came to you earlier because that would help me get her and me into therapy sooner and perhaps into couples’ therapy. The abandonment thing you mentioned - she told me many times that she would treat me with rage because she was afraid I would not come for her, that I would leave her. She told me of her fear of me leaving her on the wedding day i.e. I would not even appear. I think she had a huge fear of me leaving her that manifested itself in the form of unexplained rage. I even remember I was in a lab once when she verbally skewered me over something small and then followed that by 'don't you dare leave me'. She told me once 'I hate men and men hate me, cheat on me, destroy me, but never love me.' She once wrote to me at the very beginning of our recent relationship 'I have trust issues, so I always assume the negative.'. She also wrote 'Whether you call it bossy or whatever, I always like to be in control'. As far as I know her romantic relationships haven't lasted longer than a year and a half - in our case a little less than 2 years. She always breaks the relationships as far as she's told me. She dated one of her exes from age 20.5 to 21.5 that's what she told me. She did say she had a non-romantic friendship with one man for 10 years and it ended because he tried to kiss her and so she kicked him out of the apartment.

C: What she gave you was a dream. I bet she told you she would die without you?

M: Yes how did you know??!

C: And it was like walking on egg shells when you talked to her because you didn’t know what would set her off?

M: That’s the exact phrase I told her several times!!! - “walking on egg shells”. She even told me she felt bad that I felt like I was walking on egg shells. I felt so helpless so many times because she is my love yet I couldn't help her or understand her. Later on, a month or two later, she turned that phrase around on me because she said I would twist her words and use them against her. I felt like I was walking on egg shells because I didn't know what the next thing I would say that would set her off.
C: I’ve treated enough of them to know it sounds like classic BPD to me. There's a famous book about them called "I hate you, don't leave me". Borderlines are in a continuum with BPD being on one end and NPD Narcissistic Personality Disorder being on the other end. But she doesn’t sound like an NPD. She sounds like on the other end – BPD. The control issue where she said she wants to be in control is about trying to get a handle on their self-identity and to get a control over their lives which they feel has always been broken.

M: Well she claimed that I was the cause of all her problems and grief. And I tried so hard to mold myself to be what she wanted. Yet my ego and temper would get in the way. And my tongue of course.

C: BPD sufferers cannot easily hold down long term relationships. They find it very very hard because most men either completely shut down and tolerate it and think they themselves are the problem and not her or they leave her. But the silver lining is that with intensive therapy they can improve quite a bit. What you need to figure out is what you want to do because you have her on your mind and you have your wife.

M: Well I wanted to be with her and I thought I would in a few months but that option is out because her family threatened to lay down their lives in order to make sure I couldn’t get to her and she herself has washed herself off of me. She is full of grief and rage now – at least that’s what I could tell from the YouTube song about a jar of hearts her sister sent me saying that’s what she listens to all day. Her sister has practically been repeating the same complaints to me that she had towards the end. Her sister wrote “she told me everything you both said to each other in the last 3 weeks and what you told her was far worse, I can’t believe she put up with you”. Well I didn’t tell her anything about the things she used to say beyond the 3 weeks ago. Things that made me feel like she was possessed when she was angry. Things that she would leave on my voicemail that would make me cry on several occasions and made me even tell her once that she had broken me. Her sister or family knows none of that. In fact I don't think she even remembers herself. I told her sister I would not sully her name by informing her of the things she'd tell me. So I can't even defend myself without exposing things that should not be exposed.

C: She just gave you a dream. You will be alright. They may not know that she may have BPD.

M: I'm sure her mother knows because she reached out to therapists on her behalf in the past. But it hurts like hell - I feel like I can't live without her. I only wanted to be with her forever. She made me feel like no woman can ever love me like she can. 

C: That’s how close they get to you – they swing between being completely with you so close and then they get far away. But it’s not real. In their mind and in your mind it’s real. Their emotions are swinging between extremes. They form attachments very quickly and sometimes leave abruptly. You will always be at fault with them and in their mind their fault is minimal if at all. Regardless of how your temper was, she would still carry that baggage till she got intensive therapy. It's very difficult to live with BPD both for the sufferer and the partner.

M: She did tell me that she prided herself in forming instant attachments to anyone whether a 4 year old or 80 year old and she cried when every one of her patients died - I guess that makes sense now about how quickly attached she could get. But I want to learn to control my temper anyway and my tongue. She is getting her own therapy although she never told me what the therapist diagnosed her as.

C: I’ve seen BPD sufferers who are good at diagnosing and telling everyone else what is wrong with them but they never figure out what’s wrong within themselves. See it’s hard for even therapists to self-diagnose themselves. And long distance relationship with a BPD? Forget about it! Almost impossible. There is a reason for that. Also, BPD sufferers sometimes quickly idealize people and get attached deeply and if you veer away from that ideal you’re in trouble.

M: That was one of my complaints too! I told her it was her way always or the highway. I even gave it a name based on her name. I’ve actually seen it in her where she highly praised a person one day and a week later when there was one or two or three faults she found, she totally brought down that person. With me, she would tell me she absolutely loved everything about me and later that day or a few days later she would tell me she hated me and everything was my fault. Towards the end I started believing that everything was my fault and that I was the one responsible and frankly I still think I am because I said hurtful things to her in anger but sometimes she got angry with me over just one thing and she would blow a gasket and leave 25 minutes worth of voicemails saying things that would make me cry and even sending me 150 txt messages in 1 day blasting me. I felt like she was another human being when she was angry. I never told her family about that side of hers and the things she said to me because she loves them and they love her. But I feel like I love her more than they do, as misplaced as her family may think that is. But while she told her whole family all of my faults towards the end, I didn’t say a peep about all the extremely hurtful, profanity-laced and gut-wrenching things she told me in 2 years in anger. I felt like a passenger in a roller coaster she was piloting. I pretty much told her sister that most of it was my fault because I guess that's what a chivalrous man is supposed to do. I was very frustrated. She made a villain out of me every single time even when I said things with good intentions. That was probably the most frustrating thing - me getting skewered when I said things with good intentions and I think it harkens back to her admission that she always assumes the negative. And yes, she was also a therapist in one of her rotations, diagnosing other people’s mental states!

C: Listen, it was all your fault in her eyes. BPD’s hardly ever take responsibility and on the rare occasion they do, it is to give an illusion of fairness. The worse part is that in her mind she believes she's right and you're wrong. When she cut herself, you didn’t put a gun to her head to make her do it. She could have hung up the phone but she wanted attention from you or others around her. BPDs do things with a lot of drama. Dragging the family into it was to help her get support for what she would have ultimately done anyway – leave. BPDs have unstable romantic relationships.

M: I can't believe this - this all sounds surreal. I don't think she did it to seek attention. But I should have stopped myself regardless from escalating it. The comments I was making was about what she used to do in the past and I was pissed off because I felt she minimized the pain I had felt when she left the first time. And the thing is she said it wasn’t one or two things and that it had been accumulating over time.

C: She told you she can’t live without you. That she would die without you. I have two words for you.

M: Bull shit?

C: Exactly. And it’s okay to speak French in my office. Remember, they think in extremes so they are never able to hold long term relationships unless they get extensive therapy or unless the poor man just shuts down and tolerates it and gets brainwashed into thinking everything’s his fault. Do you have temper issues with anyone else?

M:  I make sarcastic comments once in a while and people may consider it dry humor but I seldom get into arguments or fights with people. I have been accused of condescension by her and I've been told that my sarcasm is at times condescending. So I need to work on that too. I am sure I need to learn to let go to resent her for what she did to me in the past. She also claimed that her temper was only stoked by me but I know for a fact that's not true. As far as it being bull shit, I don't think it's fair because I believe she meant it when she said it.
C: That's exactly it, she meant it only when she said it. Do you feel validated?

M: Validation will not lead to satisfaction. I’ve got immense grief now and I regret I didn’t come sooner so perhaps I’d know how to deal with her better and fix my own issues. I can't believe there's actually a disorder out there about what I had to deal with daily. I miss her and I had told her once that no matter what happens to her, physically or mentally, I'd always be with her supporting her. That fact that I cannot be there is devastating.

C: It’s okay to grieve the loss.

The session ended around here and I was surprised how I had gone into the session full of guilt, utter sadness, and to work on my temper but the focus swiftly had turned on to her - the one I still love more than anyone in the world. Even after the session, I was skeptical about what he had said because I thought perhaps it was his way to alleviate my guilt. Besides, I know for a fact that if I had controlled my tongue, things would not have exacerbated. Anyhow, I thought I’d do some research and see what BPD is and how to treat it and how to handle those who have it (the latter part I would’ve paid gold for if I could’ve gotten it earlier). What I read opened up my eyes and I wondered if I could have saved my relationship with my beloved had I known all this earlier. Some of the things I read below shocked me because she fit those exactly to the letter sometimes word for word – if only I had known earlier, I would have adapted and helped her and helped myself. After reading some of the things below it was like an epiphany as if so many many things she had said or done during the 22 months made perfect sense and I grieve even more because I now know that she experiences life differently than other people because biologically her brain is different - that she feels and processes pain, pleasure, happiness, sadness in more extreme ways than normal. I feel very bad for her and for myself and for us – for her because if she does suffer from BPD then I should have adapted to it and given her leeway and helped her. I feel so bad for what happened to her in her life. I feel pissed off at myself for not going to the therapist sooner. I wonder if she knew about this and hid it from me or if she doesn't know and needs intervention. I have no doubt she loved me. But I question myself now as to what kind and type of love is it that when your man admits he has an anger problem and says please stand by me while I get professional help and we can work through it after having invested so much in each other, that she leaves me stranded with a broken home. One thing I know about her is once she makes up her mind, only God Almighty can change it. In the entire relationship she never admitted fault except one particular evening when she admitted she was temperamental and impatient. Well, just when I needed her to exercise patience while I sought professional help, she could take it no more and had broken. I found an excellent resource on how to deal with someone with BPD, if only someone had told me:
When I broke down the categories of fights that we had they come under the following umbrella and sequence:
1) I instigate the fight by saying something sarcastic --> she lashes back and says hurtful things 20 times as worse as my initial infraction --> I lash back  (fault: mine) (percentage of all fights in this category: 25%)
2) I instigate the fight by saying something she misunderstands to be negative when in fact it is neutral or positive --> she lashes out and says hurtful things --> I lash back  (fault: nobody's) (percentage of fights in this category: 50%)
3) She instigates the fight --> I respond back with sarcasm --> she lashes back (fault: hers) (percentage of fights in this category: 25%)
Intuitively I knew this breakdown was occurring. I tried my hardest to control what I could i.e. category 1 fights. Category 2 fights were extremely frustrating and made pock marks in our relationship. It could have been avoided by practicing silence or validation which requires utmost patience and understanding of what she was going through in her mind. Category 3 fights were frustrating as well because they were absolutely unnecessary and often I would try to escape those by saying "I don't like to fight or argue, can we drop it, can we talk some other time?" But once she started, it was very difficult to side track her or to make her stop. Category 3 fights could also have been mitigated by my practicing self-control or silence. This is much easier said than done. It requires you to know your partner's condition so you can empathize and understand her. In fact all 3 categories could be effectively handled by silence or by using the techniques presented in the URL above.

What is BPD?

The Borderline personality disorder is often diagnosed among women. Borderlines are characterized by stormy, short-lived, and unstable relationships - matched by wildly fluctuating (labile) self-image and emotional expression (affect).They may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Most often, borderline patients present to psychiatrists with repetitive suicidal attempts. We often see these patients in the emergency room, coming in with an overdose or a slashed wrist following a disappointment or a quarrel.

About 80% of patients are women. BPD is usually chronic, and severe problems often continue to be present for many years. About one out of ten patients eventually succeed in committing suicide. However, in the 90% who do not kill themselves, borderline pathology tends to "burn out" in middle age, and most patients function significantly better by the ages of thirty-five to forty. BPD creates enormous suffering in those afflicted with it. Most patients describe a continuous state of emotional chaos, swinging from extremes of depression, anger, and anxiety. Borderline patients often need to feel suicidal in order to know that they can escape from their dysphoric feelings. The road to recovery in BPD is often long and difficult. However, borderline patients are often attractive and productive people.

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation.

BPD is more common, affecting 2 percent of adults, mostly young women.There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behavior, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterize the person with borderline personality disorder. These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes, viewing others as either “all good” or “all bad.” A person with borderline personality may form an intense personal attachment with someone only to dissolve it when the person is percieved to have slighted her. Fears of abandonment may lead to an excessive dependency on others. Self-multilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of boredom or emptiness, and bouts of intense inappropriate anger are other traits of this disorder, which is more common among females.

Fears of abandonment in Borderlines seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.


Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.

Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. Group therapy can help change self-destructive behaviors. Having peers reinforce appropriate behaviors may be more successful than one-on-one counseling, because people with this condition often have difficulty with authority figures, which can prevent them from learning.

Medications can help level mood swings and treat depression or other disorders that may occur with this condition.

Borderline people also show great difficulties in controlling ragefulness; they are unusually impulsive, they fall in and out of love suddenly; they tend to idealize other people and then abruptly despise them. A consequence of all this was that they typically look for help from a therapist and then suddenly quit in terrible disappointment and anger.

And their relationships are unstable. They may sacrifice themselves for others, only to reach their limit suddenly and fly into rageful reproaches, or they may curry favor with obedient submission only to rebel, out of the blue, in a tantrum.

Acting-in borderlines often appear deceivingly competent.

But while the borderline may act quite competent and normal to the general public, behind the scenes the borderline is splitting, projecting, manipulating, and self abusing, creating a situation where the spouse feels he is "walking on eggshells" always in fear of disturbing the delicate balance of emotions the borderline is constantly battling.

Emotional blackmail is certainly not exclusively a tool of borderlines, but every time a person with BPD threatens to self harm, or threatens to do anything in an attempt to manipulate somebody else, it is called emotional blackmail.

One researcher, (Marsha Linehan) said "People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement."

A study of BPD patients at Harvard University produced a theory of genetic predisposition to developing BPD. The study found that in PD patients, the hippocampus and thalamic glands don't function the way they are suppose to, so once a BPD starts to feel an emotion, they can't control it (like an emotional hemophiliac).

It seems that there are two pathways by which one may develop BPD. The first is by way of early life abuse/neglect and the second is by way of having a bipolar disorder. Of course some of the people diagnosed with BPD have a history of both."

When there is a history of neglect/ abuse without a personal or family history of bipolarity, medications have less to offer and psychotherapy becomes the primary treatment
Inevitably, however, the person fails to live up to her fantastic expectations. When disappointed, she may furiously denigrate the same person whom she so recently adored.

Sexual abuse is one reason, among others, for the failure to create healthy partnerships. An abused child’s sense of powerlessness may lead to surrender and to a method of escape that psychiatrists term “dissociation”, in which the victim mentally stands aside watching the assault occur. The same phenomenon has been observed in victims of other trauma including war. The out-of-body experience generates protective feelings of indifference and emotional detachment that can remain for years after the event, even for a lifetime. Children are especially vulnerable. “Repeated trauma in adult life erodes the structure of the personality already formed,” notes Dr. Judith Lewis Herman, a psychiatrist at Harvard Medical School, “but repeated trauma in childhood forms and deforms the personality.”

A well-known BPD trait is "self-mutilation", whereby the distressed person cuts or otherwise mutilates their own body in an effort to escape inner pain. Always alert your partner's doctor or therapist if you see this happening, or even if it is merely threatened.

People with BPD tend to have intense, unstable relationships, characterized by frequent wavering between strong clinginess/dependency and sudden withdrawal. In addition, many of the symptoms of BPD (e.g., suicidal gestures, impulsive behavior) are extremely frustrating and scary for romantic partners, and can introduce more stress into the relationship.

Given all the difficulties that exist in BPD relationships, why would anyone start a relationship with someone with BPD? First, it is important to remember that despite these intense and disruptive symptoms, people with BPD are frequently good, kind, and caring individuals. Often they have many positive qualities that can make them great romantic partners some of the time.

Because people with BPD struggle with dichotomous thinking, or seeing things only in black and white, they can have trouble recognizing the fact that most people make mistakes even when they mean well. As a result, they may quickly go from idealization to devaluation (or thinking that their partner is a horrible person).

Intimacy will be incredible. She will be instinctually tuned in to reading your needs. It will seem wonderful - for a while. The intensity of her erotic passion can sweep you away, but her motive is double-edged. One side of it comes from the instinctually built-in, turbulent emotionality of her disorder. Intensity is her trump-card. But the other side of her is driven by an equally instinctually and concentrated need to control you. The sexual experiences, while imposing, are motivated from a desire to dominate you, not please you. Her erotic intensity will be there in a cunning way tailored so you will not readily perceive it.

“I love you” means – “I need you to love me”. “That was the best ever for me” means – tell me “it was the best ever for you”. Show me that I have you.

When you're in love with a person with Borderline Personality Disorder (BPD) you feel alive and buoyant when your BPD partner is attentive and loving - and you feel tortured and empty when they are distant or cruel. Extreme highs and lows are commonplace in “Borderline” relationships.

Often we obsess and ruminate over what our BPD partner might be doing or feeling, or who they might be seeing. We wonder if they ever really loved us and how we could be so easily discarded. Our emotions range between hurt, disbelief, and anger.

You've felt certain that your BPD depended on you and that they would never leave. However challenging, you have been committed to see it through.

Unknown to you, your BPD partner was on a complex journey that started long before the relationship began. You were their “knight in shining armor”, you were their hope, and the answer to disappointments that they have struggled with most of their life. Together, this made for an incredibly “loaded” relationship bond between the two of you.

Many of us struggle with some of the following false beliefs.
We often believe that our BPD partner is the master of our joy and the keeper of our sorrow. You may feel that they have touched the very depths of your soul.

Idealization is a powerful “drug” - and it came along at a time in your life when you were very receptive to it. In time, you will come to realize that your partner's idealization of you, no matter how sincere, was a courting ritual and an overstatement of the real emotions at the time. You were special - but not that special.

You will also come to realize that a lot of your elation was due to your own receptivity and openness and your hopes.

Your BPD partner also has the rather unique ability to distort facts, details, and play on your insecurities to a point where fabrications are believable to you. It's a complex defense mechanism, a type of denial, and a common characteristic of the disorder.

As a result, both of you come to believe that you are the problem; that you are inadequate; that you need to change; even that you deserve to be punished or left behind.

The idealization stages of a relationship with a BPD partner can be intoxicating and wonderful. But, as in any relationship, the "honeymoon" stage passes.
The idealization that one or both of you would like to return to isn't sustainable. It never was.

We often cling to the positive words and promises that were voiced and ignore or minimize the negative actions.

People with BPD hear and read very well. But when emotions are flared, the ability to understand diminishes greatly.

Most of what you are saying is being interpreted as dogmatic and hurtful. And the more insistent you become - the more hurtful it is - the less your BPD partner feels “heard” - and the more communications break down.
Your BPD partner will not likely validate or even acknowledge what you have said.

People with BPD also have real object constancy issues - “out of sight is out of mind”. They may feel, after two weeks of separation, the same way you would feel after six.
Absence generally makes the heart grow colder.
You might want to stay to help your partner. Possibly to disclose to them that they have borderline personality disorder and help them get into therapy. Maybe you want to help in other ways while still maintaining a “friendship”. The fact is, you are no longer in a position to be the caretaker and support person for your BPD partner - no matter how well intentioned.

Understand that you have become the trigger for your BPD partner's bad feelings and bad behavior. Sure, you do not deliberately cause these feelings, but your presence is now triggering them. This is a complex defense mechanism that is often seen with borderline personality disorder when a relationship sours. It's roots emanate from the deep central wounds of the disorder. You can't begin to answer to this.

Well, at the end of any relationship there can be a series of break-ups and make-ups - disengaging is often a process, not an event. However when this process becomes protracted, it becomes toxic. At the end of a BP relationship, this can happen. The emotional needs that fueled the relationship bond initially, are now fueling a convoluted disengagement as one or both partners struggle against their deep enmeshment with the other and their internal conflicts about the break up. Either partner may go to extremes to reunite - even use the threat of suicide to get attention and evoke sympathies.
Borderlines show great difficulties in controlling ragefulness; they are unusually impulsive, they fall in and out of love suddenly; they tend to idealize other people and then abruptly despise them.

The one word that best characterizes borderline personality is “instability.” Their emotions are unstable, fluctuating wildly for no discernible reason. Their thinking is unstable — rational and clear at times, quite psychotic at other times. Their behavior is unstable — often with periods of excellent conduct, high efficiency and trustworthiness alternating with outbreaks of babyishness, suddenly quitting a job, withdrawing into isolation, failing.

The effect upon others of all this trouble is profound: suicide threats and attempts, self-inflicted injuries, outbursts of rage and recrimination, repeated starting and stopping of jobs and school careers, and a pervasive sense, on the part of the partner of being unable to help.

Like both narcissists and psychopaths, borderlines are impulsive and reckless. Like histrionics, their sexual conduct can be promiscuous, driven, and unsafe. Lack of impulse control is joined with self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury.

The main dynamic in the Borderline Personality Disorder is abandonment anxiety. Like codependents, borderlines attempt to preempt or prevent abandonment (both real and imagined) by their nearest and dearest. The fierce attachment is coupled with idealization and then swift and merciless devaluation of the borderline's target.

This latest research goes a long way toward explaining why some children in a given family will develop Borderline Personality Disorder, and others will not. However, no biological research to date can answer the psychological questions of why people with Borderline Personality Disorder exhibit such negative, sometimes abusive, behavior, and why they seem to forget, or alter, their memories of those behaviors.

Whether it is due to repeated exposure or from an inherited disposition toward traumatic replaying of past memories, or both, some people dissociate when confronted with certain memories. In other words, they psychologically “turn off,” or mentally remove themselves from the scene. Theorists speculate that dissociation is the brain's way of coping with traumas, or memories of traumas, that the person with Borderline Personality Disorder interprets as posing a threat to their safety (whether it really is an actual threat or not).

Many researchers now view the repeated need to dissociate, as often observed in Borderline Personality Disorder, as a form of extended memory impairment. According to leading researchers Dr. Bessel van der Kolk and Dr. Judith Herman, the severe trauma overwhelms the brain, and the memories for currently-experienced events become fragmented and not accessible to one another, so the memory is not stored as a retrievably complete whole. This is a reasonable explanation as to why a person with Borderline Personality Disorder can give a quite different story of their memory of an event than someone else who was there; so, perhaps, it may be true that the persona with borderline personality disorder is not truly responsible for their gaps in memory storage and later recall – that they really are not lying.

Splitting: BPs have a hard time seeing gray areas. To them, people and situations are all black or white, wonderful or evil. Dividing the world into good or evil makes it easier for BPs to understand. But it means that if you don't agree with everything the BP says, you are a horrible person who is against them.

Apparent Manipulation: People who are about someone with BPD often feel manipulated and lied to. This may be the result of BP's of trying to get what they want the only way they know how--through emotional blackmail. This usually is not purposeful. Rather, it is the result of the BP not being as skilled in relating to others.

Since a large part of the treatment of BPD stems on a healthy relationship with a therapist, treatment can be difficult. However, once a treatment program is established, and the Borderline starts treatment, many of BPD’s damaging behaviors can be controlled, and a degree of recovery can even be observed.

If you have a loved one with BPD you may be familiar with the turbulent ups and downs that are characteristic of their relationships.

How to deal with BPD
If you think the woman you love has Borderline Personality Disorder, but don’t want to end the relationship, I suggest you learn some basic psychological survival tips for coping with this woman’s frequent and erratic emotional storms.
The only way to deal with these women, should you choose to continue the relationship, is to:

1) Set reinforced steelboundaries and clear limits in regard to her outrageous behavior.
2) Hold her accountable.
3) Stay calm and focused on the central issue when she spirals out of control. She enjoys nothing better than when you spiral into the outer orbits with her. Why? Because then she can depict you as the nasty angry jerk later on when she’s in victim mode and avoid taking responsibility for her own behavior, which probably causes her to feel a great deal of shame.

Remember, you’re not the crazy one. One of the most damaging effects of being involved with a BPD woman is that you become programmed into believing her distortions–you’re the bad guy, it’s your fault, you’re angry, you’re not loving, you’re not understanding, she’s a saint to put up with you, you’re beating her down, you’re selfish. Borderlines generally resort to name calling and verbal degradation.

Common side effects of being with a BPD:
1) Censoring your thoughts and feelings. You edit it yourself because you’re afraid of her reactions. Swallowing the lump in your throat and your hurt and anger is easier than dealing with another fight or hurt feelings. In fact, you may have stuffed your own emotions for so long that you no longer know what you think or feel.
2) Everything is your fault. You’re blamed for everything that goes wrong in the relationship and in general.
3) Control freak. She engages in manipulative behaviors, even lying, in an effort to control you.
4) Dr Jekyll and Ms Hyde.One moment she’s kind and loving; the next she’s flipping out on you. She becomes so vicious, you wonder if she’s the same person. The first time it happens, you write it off. Now, it’s a regular pattern of behavior that induces feelings of depression, anxiety, helplessness and/or despair within you.

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