Borderline

No, I'm not referring to Madonna's 1980's hit song. The title refers to a psychiatric condition found predominantly in young women - Borderline Personality Disorder.

Symptoms include such things as: intense personal relationships, fear of abandonment, low self image, damaging impulsiveness, suicidal thoughts or self harming behaviour, feeling empty or bad, and mood swings including difficulty with anger/angry outbursts.

Now, any psychiatric diagnosis can come as a shock. But I have noticed that the individuals who receive the diagnosis of Borderline Personality Disorder tend to feel gravely misunderstood and rebel against such labeling. Some might argue that such intensely emotional reactions are typical of the condition - and this may be true, in part. However, I suspect that what fuels their reaction is something like 'blaming the victim'.

The majority of young women with a 'Borderline diagnosis' have been victims of physical or sexual abuse or have been permanently separated from parents at an early age. In this sense, Borderline is simply a diagnosis of extreme trauma - the symptoms are a result of this trauma. Sadly, when the diagnosis is given without explaining it is trauma-driven, the individual simply continues to feel there is something wrong with them. With proper explanation, this diagnosis can be liberating; giving a framework to their pattern of troubling emotions and behaviours.

Come here, go away...

Individuals who fit the Borderline diagnosis tend to seek out relationship with an uncommon intensity, and in the same breath they cannot allow themselves to have the relationship. They sabotage, withdraw, become mistrustful, attack and abandon their relationships. This pattern applies especially to boyfriends/girlfriends, but also to their therapists, friends, doctors and caregivers.

This can feel like a version of the game "Come here, go away". It can be enormously frustrating for everyone involved. The reason for this behaviour is because there has been some major trauma in the area of relationships. For example, it is common that the individual has lived through childhood abuse, the death of a beloved parent, or major violence in the family home.

All these events demonstrate to the individual that relationships are not safe, that the normal boundaries of relationships will be broken, and that ultimately all you can expect from relationships is pain and hurt. On the one hand, they crave deep, loving connection - because this is what was lacking in their life. On the other hand they are terrified that if they allow themselves to feel close, they are making themselves vulnerable once again to be hurt or mistreated. This is the cause of the push-pull dynamic. If partners or carers do not understand this dynamic, and instead take it personally, they will begin to feel resentful, confused, hurt, angry and defensive very quickly - and this only further complicates an already tricky relationship process.

I am nothing

The emptiness and sense of worthlessness comes from being treated as though one were worthless (in the case of abuse, assault or violence) or feeling empty, worthless and non-existent after a tremendously significant loss. These feelings carry an intensity that is resistant to questioning and logic. It simply feels true to the person - I am worthless; I am unlovable; I am nothing; I don't exist.

Whilst loved ones and support workers know that the person before them is not worthless, it can be hard to remain consistently loving when the individual rejects and challenges you at every turn and attacks you for no apparent reason. This behaviour may go on for years, and is for the individual a way to test whether you will leave them or hurt them as others have done before. Not many people are capable of enduring such intensity and hostility in relationship. Many people interpret this as belligerence, vengefulness, immaturity, hatred - and confirm everything the person fears by walking away!

Self harm and suicidal feelings are intricately related to this underlying belief of valueless-ness and to the deep feelings of pain and emptiness. Self harm, misunderstood for many years, is now understood to be a coping mechanism for dealing with certain experiences; need for recognition (my physical pain mirrors my emotional pain), sense of unreality or non-existence (if I hurt I am real); physical pain (physical pain is easier to deal with than emotional pain). The person affected by Borderline needs help to understand their behaviour and more importantly, effective strategies for dealing with the pain, emptiness and worthlessness they battle on a daily basis.

Making the world safe again

For many children, the death of or separation from a parent can leave them wondering "What did I do to deserve this?" "I must have been a bad child!" 'My parent didn't love me enough to stay around". These thoughts clearly don't make any sense - but they serve an important function. They help the child or teenager to get the world back under control.

You see when something so painful and unexpected happens, the safety and predictability of the world is shattered. Because children depend so deeply on the emotional and physical bonds they form with their parents or caregivers, when this is taken away or abused, the results can feel devastating. The child's anchor in the world has effectively been ripped from them. One of the strongest feelings at this time, accompanying the immense grief, is a sense of spinning out of control. Self blame helps the child to get the world back under control. If they can find an explanation for events then the world will feel safe and predictable once more. It is easier to believe that you are responsible for the way people treated you, or the loss of loved ones than to believe that the world is unpredictable and unsafe.

Survival Tips

Some things you need to know if you identify as having Borderline symptoms:

• You are not crazy
• You are not bad
• You are most likely recovering from some kind of deep trauma in your relationship life
• You are not worthless or non-existent, although you may feel this way often
• You can learn to manage your symptoms and have more fulfilling relationships
• You can learn to deal with a world that is sometimes unpredictable and unsafe

Things that can help include:

• Getting good therapy
• Joining a support group
• Reading relevant books
• Finding loving and understanding friends/partner
• Writing thoughts and feelings in a journal
• Practicing mindfulness meditation
• Considering medication (if you are suicidal or chronically depressed)