Borderline Personality Disorder

By Nick Afanasiev
 “Just because I don’t show it, doesn’t mean that I don’t feel it.”
-Patient X

Disclaimer: This article is not intended to diagnose, treat, cure, or prevent borderline personality disorder (BPD) (and/or other
mental health problems). I (the author) am not a physician, psychologist, or a licensed therapist. This article is not intended for
any professional or scholarly purpose(s) and is written simply to inform. The information in this article is accurate to the best of
my knowledge. In this article, I (the author), refer to an individual as ‘Patient X.’ This name was chosen to keep the identity of
this individual private and is not intended to imply that she is (or was) an actual patient of mine (nor that I am anybody who
would have a patient [such as a physician, psychologist, etc.]). Patient X is an individual with BPD who I was in a personal
relationship with. Since I knew this person closely, I use examples from our past relationship BPD throughout this article to
demonstrate some concepts about BPD. This article was originally intended to be helpful for Patient X, but I have since modified
it to be a general article on BPD instead. Since this article is not written for any professional or scholarly purpose(s), I use my
own style forciting references(instead of using APA, MLA, etc.). The numbers following quotations (or lines of text) correspond
to an ordered list of references at the end of this article,which is simply a list ofbook (and research article) titles and authors
and links to websites from where I got the information and/or quotations.The majority of the information in this article comes
from scholarly and/or professional sources (e.g.,scientific/psychology research articles, books written by physicians and/or
psychologists who treat BPD, etc.),although some information comes from informal sources (e.g., books written by individuals
with BPD [who are not “professionals in the field,” but have valuable insight to provide about their condition and are, in my
opinion, typically at least asintelligent, if not more intelligent, than many, if not most, other individuals [who do not suffer from
any severe mental illness[es]). I will keep my personal opinion(s) to myself [for the most part] throughout this article.
Preface
I became interested in studying borderline personality disorder (BPD) when my personal
relationship with Patient X (an individual suffering from BPD) came to an end. BPD is a serious and
severe mental illness that is, unfortunately, often overlook. It is associated with high rates of suicide
and, in extreme cases, homicide. However, in many, if not most, cases, it is difficult to recognize
that someone is suffering from this disorder (and it is often misdiagnosed). Someone could be
suffering from BPD and mostof the people in that individual’s life would never know it. “What
eludes most people is the high functioning, intelligent, [and] capable person, who looks
successful on the outside [but is suffering from a serious mental illness on the inside]” (4).

Dr. Russel Meares, psychiatrist, describes a patient with BPD:

“Adele has a pleasant demeanor. She is attractive in an unobtrusive way, and has
a nice smile. Those who know her find it hard to believe that there is anything
seriously wrong with her. . . For the first 15 minutes or so of my meeting with her,
this demeanor prevailed. When, however, she began to tell of the abuse she had
received, this ‘front,’ as she called it, broke, and she began to cry._____________
Was this front a defense, as she implied by the use of the word, or was it
something else as well?. . .This front, which is discontinuous [from her] emotional
state,[represents an] aspect of her disconnectedness. There is a ‘split’ between. . . an
‘apparently normal personality’ and another, ‘emotional personality’” (85, pg. 2-3).

An individual with BPD writes,__________________________________________

“What happens [in early childhood] is that the emotional part, the feeling part of
a person gets locked away, to keep it out of sight. Because somehow that person, as
young as she is, has encountered experiences that make her think that she is very,
very, very bad, because she gets the feeling that her own parents don’t love her and
don’t like her. And that person pulls that experience to herself, she thinks that her
parents don’t love her and don’t like her because she is a very bad person. Other kids
might think ‘my parents are so wrong, I’ll show [them]’, this kid however thinks it’s
all her fault. So she locks away her true self, so that nobody will discover that she is
actually a very bad person. _______________________________________
She does that at such a young age that a) she doesn’t really know that she is
doing that and b) she will later not remember doing that. ___________________
As a consequence, a borderline is not aware that her true self, her Feeling, is not
present. She goes through life on her Mind alone. She tries to copy behavior from
others but lacks in details, because there is no real feeling behind it. Basically a
borderline learns to act appropriately, but she has trouble generalizing the things she
learns.
I am not saying though that a borderline is pretending. That would mean that
she is doing it on purpose and that she is aware that she is pretending. A borderline
 is not aware of this, at all. She thinks that the way she is, is normal. Because for her it
is. As long as she can remember, she has been like that. And since people generally
don’t know this about borderline. . . they don’t challenge that belief.”
Source:Quora - Borderline Personality Disorder_..

Dr. Richard Moskovitz, psychiatrist, admits:

1

“People with BPD have been among the most engaging as well as the most
provocative of my patients. . . Their treatment has been ridden with crises,
challenges, and opportunities for both patient and therapist to learn. [In the
therapeutic setting, individuals with BPD] test our limits and probe deeply at our
inadequacies.
During my years of teaching medical and psychiatry students, I have seen
powerful emotional reactions to people with BPD. Some trainees become deeply
entangled with such patients and develop fantasies of rescuing them from their
suffering. Others find themselves suddenly involved with their patients in intense,
often hostile power struggles. . . [Individuals with BPD] have provided both the
sweetest successes and the most bitter failures of my years as a psychotherapist, for
[they] have brought to the therapeutic arena the full fury and poignancy of years of
emotional turmoil” (87, pg. xi-1).

Introduction
BPD is aseriousmentalillness characterized by identity disturbance, emotional
dysregulation, transient dissociative symptoms, unstable and intense relationships, fears of
abandonment, chronic feelings of emptiness (104), and many others features that will be
described. The prevalence of BPD in the United Statesis in the range of 0.5 – 1.4% (102),
although some estimates are as high as 6% (61). Approximately 75% of those who are
diagnosed with this disorder are women (103). There are reasons why women are more likely
to develop BPD and there are also reasons why men who suffer from BPD might be less likely
(than women) to get diagnosed with it, which will be touched upon later in this article.

The DSM-5 classifies BPD as a cluster B personality disorder, along with narcissistic
personality disorder (NPD), histrionic personality disorder (HPD), and antisocial personality
disorder (ASPD) (104) (the last of which [ASPD] includes what is commonly referred to as
psychopathy and sociopathy [104, Pg. 659]).Personality disordersare ego-syntonic (11) (as
opposed to ego-dystonic, which is what most othermental illnesses are). This means that
individuals with BPD (and other personality disorders) do not perceive their symptoms as
intrusive thoughts, feelings, and/or behaviors that are caused by a mental illness(as someone
with an ego-dystonic mental illness would).This does not mean that individuals with BPD (or
other personality disorders) do not suffer as a result of their disorder, but that they attribute
their suffering to other causes (such as their relationship partner). It is important to note that
BPD often occurs comorbidly (or together) with other disorders, so simply perceiving symptoms
as intrusive thoughts, feelings, and/or behaviors caused by a mental illness does not necessarily
eliminate the possibility of having BPD (or another personality disorder).

A rather extreme (but real) example of how an individual might suffer as a result of their
personality disorder (specifically BPD) without realizing that their suffering is caused by
symptoms of a personality disorder involves Patient X: Towards the end of our relationship,
Patient X and I got into an argument in which she saw me trying to stab her with a knife (or
threatening her with a knife). I assume that she experiencedsome level of emotional distress (or
suffering) as a result of thisincident, which she probably perceived as being my fault (because,
to her, I was the one trying to stab her with a knife [or threatening her with a knife]). While this
incident will be explained in greater detail in a subsequent section, the point here is that she
likely did not (and possibly still does not) realize that her suffering (and mine) was the result of
a stress-induced visual hallucination (which is a manifestation of a transient psychotic symptom
[not to be confused with transient dissociative symptom] of BPD, which occur in20 – 50% of
cases of BPD [100]).The various other ways that someone suffering from a personality disorder
might not realize that they are suffering fromsymptoms of a personality disorder are not
thisextreme (i.e., other ways do not involve hallucinations or other psychotic symptoms. In fact,
most personality disordersdo not involve any psychotic symptoms in the first place [and in the
20 – 50% of cases of BPD in which they do occur, they are transient and do not occur frequently
[i.e., they are not present the vast majority of the time]]).

(As an interesting side note, hallucinations that occur as a result of a mental illness [not
referring to any substance abuse disorders] typically cause a lot of mental distress [or suffering]
to the individual experiencing them because they might not realize that they are hallucinating
[since they are not prepared to hallucinate]. On the other hand, hallucinations that occur as a
result of taking hallucinogenic drugs [such as psilocybin mushrooms] are typically a pleasurable
experience because the individual is prepared to hallucinate [i.e. they are aware that they are
experiencing hallucinations], which is something that I learned in one of my psychology
courses.)

The DSM-5 lists nine diagnostic criteria for BPD, five (or more) of which must be met in
order to receive a diagnosis (104). This means that there are 256 different ways that someone
can have BPD (i.e., there are 256 different combinations of diagnostic criteria that meet the
minimum requirement for a diagnosis). This also means that “two individuals receiving a
diagnosis of BPD could potentially overlap on only one diagnostic criterion” (61). However,
since BPD involves several symptoms that are considered core features of the disorder, which
are present in the vast majority of cases, the overlap in diagnostic criteria among individuals
with BPD tends to be greater than one. In reality, most individuals with BPD have a large
amount of symptoms in common. Two of the symptoms that are considered core features of
BPDareemotional dysregulation [CITE] and identity disturbance (which is present in 90% of
cases of BPD [CITE]).

Personally, I refrain from using the term ‘symptom’ when referring to diagnostic criteria
because some of the diagnostic criteria are the result, or outcome, of several distinct symptoms
of the disorder (e.g.,the criterion ‘unstable and intense interpersonal relationships
characterized by alternations between extremes of idealization and devaluation’ is the result,
or outcome, of several distinct symptoms of BPD, including‘hypersensitivity towardspersonally-
relevant emotional stimuli,’INSERT, INSERT, and the use of ‘splitting’ as a psychological defense
mechanism, as well as others). This highlights the fact that the diagnostic criteria are simply
what they are intended to be (i.e., criteria that are set forth in order to provide a ‘short cut’ for
diagnosis). The reason why I point this out is to emphasize the fact that the list of diagnostic
criteria is not a comprehensive list of the individual symptoms of BPD (nor is it intended to be).
The list of diagnostic criteria is included below for reference, but each diagnostic criterion will
be described in greater detail in a subsequent section:

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability [emotional instability] due to a marked reactivity of mood (e.g.,
intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only
rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of
temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
 Source: DSM-5 Diagnostic Criteria for Borderline Personality Disorder

In my opinion, the best way to understand BPD is by first understanding its origins and
causes, which is the topic of the following section.

Etiology
Severalfactors contribute to the development of BPD, which include certain genetic
factors (or genetic predispositions) and particular adverse experiences during early childhood
(i.e., environmental and social factors present during the first few years of life.It is difficult to
determineprecisely how large of a contribution is made bygeneticvs. environmental(or social)
factors, but“Torgerson and his colleagues (2008) provide a reasonable estimate. . . Their
statistical analysis provided heritability estimates for [traits of Cluster B personality disorders,
with theheritability of BPD traits determined to be] 35%” (85, pg. 230). Thissuggests that
genetic factorscontribute to the development of BPD, but that social and/or environmental
factors play a bigger role.

There is strong evidence to support a link between different forms of child abuse and
BPD (17).The majority of individuals with BPD have experienced at least some form of abuse
during their childhoods (and many, if not most, have experienced multiple forms of abuse).
There are cases of BPD that do not involve any explicit forms of abuse during childhood, but
these represent a minority of cases (and there are various explanations for how these cases
develop, but I will not get into that here). Studies show that approximately 75% ofindividuals
with BPD had been emotionally abused during childhood (101). As many as 73% were physically
abused, and up to 76%were sexually abused as children (18). While not everybody who is
abused as a child developsBPD, child abuse is a strong contributing factor to the development
of BPD as well as many other mental health problemsand disorders (which manifest in a variety
of ways later in life).

Emotional child abuse is when a child is subjected to emotional attacks, such as verbal
abuse or degradation (18).It is also emotional child abuse when a child’s emotional reaction is
ignored or dismissed, or when a child is shamed or humiliated. Furthermore, “treating [a] child
as unlovable or as a ‘bad child’ [(e.g., telling a child that they are a ‘bad child’)] is also
considered emotional abuse (CITE) (and, as hard to believe as it may sound to some, this sort of
abuse manifests in the symptoms of BPD later in life [in some individuals with BPD], although I
will not get into explaining it here). It should be made clear that yelling at an adult partner in a
relationship is not considered emotional abuse.Similarly, “[it is not emotional abuse] when a
husband and wife, or parent and child, yell at each other (this is just a normal expression of
emotion). Once the emotion has been expressed, it is a good idea to sit down and talk about it
to find a solution to the problem”(17) (many individuals with BPD have not learned the ‘skill’ of
talking about problems from their parents when they were children). The reason why verbal
abuse and degradation towards a young child can be psychologically damaging is because their
brains have not yet developed completely (i.e., their brains are still developing and brain
development during this stage of life is highly sensitive towards, and dependent upon,
interactions with the environment [including social interactions]).Another potent form of
emotional child abuse is when a child ismade to witnessreal life violence, such as domestic
violence (which can be highly traumatizing towards a young child).When Patient X was young,
her father would beat her mother in front of her as she watched. He would yell and curse at her
as he beat her, which is why Patient X ‘re-experienced’ her traumatic memories of these
experiences as intrusive recalls (or flashbacks, depending on how she experienced them) when
Icursed at her in the context of our relationship (i.e., the cursing was the ‘common stimulus’
between the present and the past, which then triggered a variety of her symptoms
[unknowingly to me at the time], which will be explained throughout this article).Cursing is not
normally as hurtful to others as it was to her, due to her mental illness (due to my cursing
[unknowingly] causing her to re-experience some of the same feelings [i.e., sadness, fear,
anger, etc.] that she experienced when she watched her father beating her mother in front of
her when she was a young child). Being subjected to these sorts of experiences is especially
traumatizing to a child because they have no way to escape or to do anything about the
situation (which is, in a sense, a similar sort of experience as individuals in the military
experience when they develop PTSD).

Physical child abuseis the infliction of “direct harm to a child’s body” (104),including
hitting,beating,injuring,or purposely hurting a child. Physical child abuse does not have to ‘leave a
mark’ in order to be considered abuse.Although spanking children is not illegal in the United
States and is not too uncommon, it can also be considered a form of physical child abuse
(although it is often inflicted by well-meaning parents who are unaware that it can be
psychologically damaging to a child [CITE]). Spanking, on its own, is very highly unlikely to lead
to a serious mental illness such as BPD, but it can be psychologically damaging nonetheless
(although the connections between the potential psychological damage caused by spanking and
the effects are not easily observable as they manifest in a variety of ways later in life, as studies
have shown[CITE]). Many individuals with BPD, however, have experienced much more severe
forms of physical child abuse. When Patient X was a child, her chore was to take down cry
clothing from an outdoor clothing line—one day she forgot to take down an article of clothing
and her father beat her with a weapon “until he was tired” (as she put it). In scientific terms,
this can be considered a severe form of physical child abuse. Additionally, she was a
punishment for making an innocent mistake, which likely added to her psychological damage.

[Note: Many, if not most,parentswho hurt their innocent children are either unaware of the
potential psychological damage that it can [and often does] cause, or are [especially in the
more severe cases of physical abuse] suffering from psychological problems themselves [which
they should consider getting help with].

“Of all of the psychosocial factors, childhood sexual abuse [(CSA)] is considered to be
the most specific in the etiology of BPD” (101),although it is not necessary to the development
of this disorder (i.e., not every case of BPD involves CSA as a contributing factor).As an
interesting comparison, up to 76% of individuals with BPD experienced sexually abuse when
they were children, and as many as99% of individuals with DID experienced sexual abuse when
they were children (CITE).“[The] trauma sustained from sexual abuse is more likely to lead to a
greater dissociation with reality as the child attempts to block out what has been done to them
by someone they love and depend upon (if the abuser is a member of their family). . . [And
since] girls are more likely to be sexually abused than boys this may explain to some degree
why women are more likely to suffer from BPD than men” (16).Sexual child abuse is defined
as“a child being subjected to a sexual experience [(with or without the use of force]) or
exploited in a sexual manner by someone older” (CITE). While CSA is typically perpetrated by
members of the family, anyone older (such as babysitters) can be responsible as well. Reporting
CSA in therapy opens up the opportunity to talk about it further, which sometimes uncovers
memories that have been repressed from conscious awareness (which unconsciously maintain
the individual’s symptoms).“Reporting memories of sexual abuse by siblings, grandfathers or
other family members could, in some cases, be a ‘screen’ for parental incest, which some may
find intolerable to recall” (101).
[Side note: Studies show that approximately 20% of girls and 5% of boys in the United States
have experienced childhood sexual abuse (CSA). According to mental health experts, the public
tends to deny and ignore information that is uncomfortable to discuss (such as the existence
and high prevalence of child abuse [especially childhood sexual abuse [CSA]], despite scientific
data, which, in my opinion, is disturbing. (Note to self: LOOK UP IF YOUNG CHILDREN SHOULD
BE TAUGHT TO REPORT CSA, possibly in school as early as kindergarten). As hard to believe as it
might be, it is not too uncommon for children to be sexually abused by family members
(including aunts and uncles) or babysitters. [My personal advice would be for individuals to
install more hidden cameras in their homes, as the prevalence of CSA is disturbing, and starting
a ‘war on child molesters’ [who, as Dr. Moskovitz explains, are ‘human predators’] would
benefit society as a whole [in the long run] beyond most peoples’ comprehension].

“One of the most dominant [developmental models of BPD] is Linehan’s biosocial

[model]. [It explains one of the major pathways that can [and has been shown to] lead to BPD].
According to the biosocial model, BPD is characterized by marked emotion dysregulation, which
arises from a transactional relationship between pre-existing emotional vulnerability
(characterized by emotional sensitivity, reactivity, and slow return [of emotional reactions] to
baseline) and an invalidating childhood environment” (5). “Emotional invalidation is when a
child is told (or somehow made to feel) that their “expression of feelings is wrong. The
‘invalidator’ may deny, ignore, ridicule, deliberately misinterpret, or be critical of [a] child’s
feelings and emotions” (26).“[Emotional] invalidation may occur in a variety of forms; broadly
speaking however, an invalidating environment is one in which a child’s inner experience and
expression of emotions, thoughts, and behaviors are frequently criticized, trivialized, ignored,
and/or punished [rather than talked about]” (CITE). For more on emotional invalidation, see the
following: INSERT LINKS

When Patient X was a child, someone told her that ‘displaying (or showing) [her]
emotions is a sign of weakness” (whichit is not). Not wanting to seem weak in front of others,
she began hiding her emotions (probably in an environment where shefelt intimidated or not
accepted [or in an environment in which she believedthat others would not accept her if she
was her[vulnerable] self]). She began hiding her emotions in order to fit in (or, in a sense, to be
able to survive in her environment). She put on a sort of ‘façade,’ which she thought made her
look stronger (because she began to believe that her real emotions made her seem weak).

Interestingly,the following video on emotional inhibition uses ‘emotional expression is a

[sign of] weakness’as an example of one of the characteristics of the ‘emotional inhibition
schema’ in BPD (which will be explained in a subsequent section):
Emotional Inhibition Schema (Video)

Dr. Linehan’s model that individuals who develop BPD are born with
biologicalvulnerabilities (i.e., with genes involved in neurotransmitter signaling pathways [I
assume] that cause them to experience heightened sensitivityand reactivity to emotional
stimuli [i.e., they experience their emotions with greater intensity and longer duration than
most people]),whichpredisposes them to experience greater levels of emotional invalidation
during childhood. The emotional invalidation then leads to greater emotional dysregulation(by
failing to teach the child how to identify, label, and understand what they are feeling [which are
components of normal emotional regulation], and instead, causing them to develop
maladaptive coping strategies [which include emotional inhibition, or the suppression of their
feelings], which are less effective at controlling intense emotions in the long run). This causes
them to “shift rapidly between extreme emotional inhibition and extreme emotional expression
[11]” (105), which leads to even moreemotional invalidation.Thus, “the transactions between
individuals with [these] biological vulnerabilities and specific environmental influences [(i.e.,
emotional invalidation)]” (CITE) compound each other and create a vicious cycle of emotional
invalidation/emotional dysregulation, which can eventually lead to BPD.“Every experience of
invalidation (during childhood) compounds the intensity and dysregulation of their emotions,
and feelings of abandonment, isolation, and shame increase” (93).
“[Emotionally] invalidating environments contribute to emotion dysregulation by 1)
failing to teach the child to label and modulate their emotions, 2) failing to teach the child to
tolerate distress, 3) failing to teach the child to trust his or her own emotional responses as
valid interpretations of events, and 4) actively teaching the child to invalidate his or her own
experiences by making it necessary for the child to scan the environment for cues on how to act
and feel” (27).“As a result of these environments, children do not learn how to define, regulate,
or tolerate their [own] emotional responses to others”(105). “When [the emotional
invalidation] occurs consistently throughout a child’s emotional development, there can be a
thwarting of the development of the child’s emotional self” (19).

Children who are born with these biological vulnerabilities are more likely to experience
emotional invalidation (as their parents might not understand that they experience their
emotions with greater intensity than other people), but if they are not emotionally invalidated
during childhood, they will be unlikely to develop BPD. Thus, not everyone who is ‘sensitive’
and ‘reactive’ goes on to develop (or has) BPD.Conversely, emotionally invalidating
environments can lead to emotional dysregulation, but not necessarily BPD, for anyone (not
only individuals with genetic predispositionsfor BPD) (CITE).
 Well-meaning parents can and do unknowingly invalidate their children’s emotional
expression (for various reasons, including a lack of information about the potential harmful
effects). “Normative research in child development suggests that parents who often discuss the
cause and consequences of emotion and encourage emotional expression have children who
express higher levels of emotional understanding [(which is an important aspect of emotional
regulation)] (Denham and Grout 1992; Denham et al. 1994)”(82). Emotional understanding can
(and is, and should more often) also be described ‘emotional intelligence.’ An individual with
BPD (as an adult) told me (in reference to an image that I asked them to help me interpret),
“From my perspective, the image takes me back to my childhood when I was often alone with
just my ‘balloon’… The wording makes me think of reflection. Who I am now, reporting on who
I was then. With the now me wondering how I’d have turned out if my parents would have
been curious of the balloon.” [Note: This individual is not referring to an actual balloon when
talking about their own childhood]

ADD NOTE RE: While children in higher socioeconomic households are less likely to be
physically abused (LOOK THS UP AND CITE), there are many individuals with BPD who come
from higher socioeconomic status (CITE)… (INSERT EXPLANATION: These cases may develop
when children with certain genetic predispostions feel emotionally neglected by their parents
(who are often busy or emotionally disconnected themselves). [In essence, emotions [which
most, if not all, individuals in our society trivialize] have a lot to do with BPD and other [very
serious] problems].“Young children rely heavily on caregivers to be available, sensitive, and
responsive to their needs, especially insofar as their own coping resources are developmentally
immature” (20) (Note that this refers to emotional needs and needs for connection)

Until fairly recently, I have trivialized the importance of emotions, as do most people
(but not people with BPD, because, in a sense, they are their emotions [like a child is [CITE]].
Normally, “the expression of feeling is one of the most personal and intrinsic parts of one’s core
self,” (19) so when a child grows up in an emotionally invalidating environment. . .it follows that
there is a base denial of [the child’s sense of] self. . . The child learns that their internal
experience is wrong and inappropriate and the true self becomes increasingly corroded and
disorganized as the psyche constructs defensesto deal with and tolerate their environment”
(19). Many, if not all, individuals who go on to develop BPD begin usingmaladaptive strategies
for regulating their emotions (such as emotional inhibition, emotional suppression, or ‘numbing
out’, etc.) when they are children, which they bring with them into adulthood.
 REWRITE THIS PARAGRAPH: As a whole, our society has been increasingly trivializing the
importance of emotions and becoming more emotionally-invalidating as a whole. (INSERT INFO
RE: “borderline-like society”). In today’s society women are sometimes viewed as ‘overly-
emotional’ (although they are not), while there is actually more of a societal pressure on men
to refrain from expressing their emotions (or showing their vulnerable side), which is actually
problematic because it can prevent men who might need help from admitting that they do
(CITE).(INSERT INFO RE: As I realized recently, this can have some very serious
implications).(INSERT EXPLANATION RE: What they said on the news re: ‘these children [re: who
become mass shooters? Or murderers?] often show no emotion at all).(INSERT INFO RE: I
believe that talking about the causes and consequences of emotions [and encouraging
emotional expression] in school may provide a protective factor against BPD [and may, in the
long run, even help prevent school shootings, etc.) ((INSERT INFO RE: Emotional intelligence.).

Another experience during early childhood that has been associated with BPD is the
experience of prolonged or permanent separation from a parent, especially in the case of early
maternal separation (20, 21). Separation can result from divorce, a death in the family, or a
variety of other causes.Dr. Masterson explains, “Despite the fact that many contemporary men are
more interested and involved in parenting than their counterparts in previous generations, in most
families the mother is still the primary caretaker,” (86). In essence, a child develops a special kind of
bond with and needs for their mother [but the mother is not necessarily, biologically speaking, the
‘primary caretaker,’ although it [due to various other reasons] is often that way in our society. Hence,
“absence of maternal protection is associated with the development of BPD
pathology(5).Author and life coach A.J. Mahari (who suffered from BPD herself) goes so far as
to say, “the basis of borderline personality disorder lies in the primary relationship–that broken
relationship between a child and their mother” (22) (although this statement might be too
general).As long as a child has at least one parent (or guardian) who provides a secure base for
attachment, who loves them unconditionally and does not abuse them, who supports or even
encourages their needs for self-expression and individuation,andalso allows them to feel safe
by providing protection when needed(and who can connect with them emotionally by talking to
them and asking them how they are feeling), they will have what they need to develop into a
healthy adult.Most individuals with BPD have been abandoned, at least emotionally, by both
parents (CITE).

Because this will help me demonstrate a point later in this article, I will share Patient X’s
story of the day when her mother left her (when she was a young child). On this day, Patient X
did not want to let her mother see her crying, so she kept it all inside. She kept it inside as
everyone was getting ready to escort her mother to the car that was taking her away.She kept
it inside as her mother said goodbye to her sister (who was crying). When her mother went to
say goodbye to Patient X, she asked her why she was not crying (butPatient X still kept it all
inside). She kept itinside as she watched her mother get into the car that was taking her away.
She kept it all inside even asthe car drove off and everyone was wavingher away. She kept it all
inside all the way to the point when she could no longer see the car in the distance. Then, she
ran to where no one would be able to see her, and then she let it all out. She cried.Patient X
told me this story as an adult and she told me, “she [her mother] thought that it [not crying]
meant that I didn’t care as much, but just because I don’t show it, doesn’t mean that I don’t feel
it.” When she said this, it was as if she was that part of her who remained a young child who is
upset about her mother leavingand confused as to why her mother could not understand that
she reallydoes care (even though she does not show it).
Some cases of BPD do not involve child abuse or parental separation, but these
represent the minority of cases (and there are various explanations for how they occur
[including cases that are thought to develop primarily due to genetic factors and even cases
that involve parental over-protection without affection [as perceived by individuals with BPD]
(5) [i.e., parents who are ‘helicopter parents’ who constantly hover and rush to fix problems for
the child, yet remain emotionally unavailable [64]]). Of course, BPD is a complicated
developmental disorder with many factors that contribute to its development (which differ case
by case), but it is also, in my own words, a disorder that develops during childhood.

Disclaimer: For this next part, bear with me (it makes more sense after reading the
whole article).
It is worth noting that “there are many theories about why borderline personality disorder
often includes identity disturbances. One is that patients with BPD inhibit [their] emotions” (24).
Personally, I find it interesting that Patient X hid her emotions in front of her mother on the day when
she left (i.e., she inhibited, or suppressedher emotions). However, by hiding her emotions,was
shealsohiding a part of her‘self’?Her ‘real self’? Her Feeling? Was this when she began to build
her ‘more acceptable’ social façade? A sort of ‘false self’ that was created when, as a young
child, she was overwhelmed with pain?Was this the beginnings of a sort of defense? A mask of
behavior? A mode of relating in which she spends most of her waking life? A mode in which she
is disconnected from her own emotions and does not experience the emotions that generate
links between interpersonal events and models of attachment? Was this the birth of
an‘apparently normal personality’ (ANP), which is disintegrated from other‘emotional, (parts of
her) personality’ (EPs)?Was this the birth of the ‘detached protector,’ a maladaptive schema
mode in BPD?
“For many borderlines that separation from self occurs at a relatively young age when,
emotionally there is too much pain, abandonment, and abuse experienced to hold onto one's
real self. . . Here's where the borderline puts on the first mask of false self” (25).

“…What starts out as deceit for protection often leads to outright lying to live” (25).

“It leaves those [with BPD] buried so deeply within the defense mechanisms of trying to
protect ‘self’ that a ‘self’ really doesn’t get to emerge as such. What emerges, instead, is a ‘false
self’” (32).
 “Lacking one's true self one then lacks the truth of who they [really] are. . . The masks of
the borderline are walls that block him/her from him/herself as much as they block others from
him/herself” (25).

According to A.J. Mahari, “[If you have BPD, your authentic] self. . .has been left behind
at the developmental stage at which [you were]last able to be, for the most part, [yourself]”
(25).

Childhood. Childhood. Childhood. The origins of BPD lie in childhood.

“I didn’t realize how muchyour childhood could affect you as an adult.”

-Patient X

DSM-5: Diagnostic Criteria for Borderline Personality Disorder

While the social and environmentalfactors that contribute to BPD occur in the first few
years of life, the ‘symptoms’(or diagnostic criteria) of BPD do not begin to presentthemselves
until the teenage years or early twenties (31). Dr. (Meares? Masterson? Moskovitz? [look IT
UP]) explains the possible reasons for this in his book (INSERT NAME OF BOOK), but I will not
attempt to explain it here beyond saying that the symptoms are more-or-less ‘masked’ by other
factors until the teenage years or early twenties.

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
 6. Affective instability[emotional instability] due to a marked reactivity of mood (e.g.,
intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only
rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of
temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.”

Source:DSM-5 Diagnostic Criteria for Borderline Personality Disorder

Next, I will go through each of the diagnostic criteria individually (EXPLAIN FURTHER [ex:
individual symptoms that comprise diagnostic criteria])

1. Frantic efforts to avoid real or imagined abandonment

Many individuals with BPD describe that their fear of abandonment is an ‘intolerance of
aloneness’ (or fear of being alone).In relationships, many individuals with BPD go to great
lengths to avoid abandonment. They often misinterpret benign separations as signs of
abandonment. As an example, some individuals might feel abandoned by their therapist if the
therapist goes on a vacation (even when given fair notice). They may then accuse their
therapist of not being there for them and then ‘devalue’ their therapist. Individuals with BPD
also tend to ‘sabotage’ relationships in order to avoid their own abandonment (i.e., the
individual with BPD might ‘abandon’ the other person before the other person can abandon
them) (CITE).
Interestingly, for many individuals with BPD, the ‘flip side’ to their fear of abandonment
is a fear of engulfment (or a fear of intimacy) (93, pg. 191). When a relationship reaches a
certain level of intimacy, an individual with BPD might feel smothered by the other person
(CITE) and want to leave (or sabotage) the relationship. In essence, individuals with BPD cannot
hold on to feelings of love, and although they fear abandonment, they also, in a sense,
encourage their own abandonment (thus perpetuating their own beliefs that they will always
be abandoned by others as they were abandoned in childhood). Similarly, individuals with BPD
are known to leave therapy prematurely (although there may be different reasons for this).
 Image Source: Healthyplace.com - BPD Quotes

Criterion #2(A pattern of unstable and intense interpersonal relationships characterized by

alternating between extremes of idealization and devaluation)
The symptoms of BPD are usually apparentin the context of interpersonalrelationships
(especiallyromantic relationships andtherapeutic relationships[i.e., relationships [but not
intimate or romantic relationships] between individuals with BPD and their
therapists]).Individuals with BPD tend to demonstrate the same or similar trends (or behaviors)
towards their therapists as they do towards their partners (in terms of trends and
behaviorscaused by BPD).Other types of relationships can be affected in similar ways in some
cases, but individuals with BPD tend to “appear [completely] normal in [most] aspects of their
lives” (79?Po). There are several reasons for this, some of which will become apparent later in
this section (and does not mean that individuals with BPD do not experience symptoms outside
of relationships [even though others may not be able to see them]).
While my purpose hereis to remain descriptive and to keep my personal opinion(s)to
myself, Iinclude two excerpts that come from posts in online message boards where other
individuals discuss their opinions and experiences with dating individuals with BPD. I chose
these posts because they are representative of some of the common trendsin intimate
relationships involving those with BPD (these are not simply menventing over women they
dated [as these trends do not occur in relationships with women who do not suffer from BPD]).
The purpose of including these posts is to provide a comprehensive look at what BPD
relationships can involve. Their opinions, however, do not necessarily reflect my own:

“[Women with BPD] tend to be hotter than your average girl [which I think is
related to their issues of low self-esteem]. . . At first BPD relationships are insanely
awesome, there is this hot girl that IDEALIZES everything you do, and compared to
most girls this is a breath of fresh air. ‘Finally, someone gets me!’ you think when you
are not drugged into pleasant stupor by the constant sex they engage in. There are
always a few red flags, like the strange childhood drama, or things like that. From my
own experience and others, they tell you things at really weird times. .
.__________________________
Then…the darkness slowly starts. It will be a cold day. She won’t be friendly,
something will be ‘wrong’. Maybe a mild lash out at first depending on how ‘deep’ her
hooks are in you. ‘Fuck this bitch, she is out of here’ you might think in moments of
clarity, but then she is all lovey-dovey and sorry and sexual and you forget. . . They
areMASTER manipulators. Do not underestimate this. .
.___________________________
There is a message board called bpdfamily which I used to go to for a while, the
stories there will chill your spine. There are bpd women out there that routinely
cuckold guys, leave marriages of many years, live secret lives, endlessly abuse then sex
the males in their life. The sad thing is, it took me about 6-9 months of serious
emotional pain, but I would go back to that board every few months for about a year
to drop encouragement about guys to leave their BPD girls, and the same guys were
still on there bemoaning ‘should I leave? does she love me?’ etc. . . Being on the other
side I wanted to shake and slap these guys ‘wake the fuck up! I was there, I know your
pain! Run away from that girl as fast as you fucking can!’ but…when you are addicted
to intermittent reinforcement relationships there is little you can do barring huge
willpower” (https://eruditeknight.wordpress.com/2014/03/10/borderline-personality-
disorder-girls/).
 “I also dated a BPD chick which seriously fucked my life up. . . I personally think they
are fucking evil. There is something about them, when they get ‘on one’ it's almost like
they become possessed by a demon or some shit. . . BPD women really know how to
get into your heads, and what pushes your buttons, but really it goes beyond that. . .
Over time they slowly figure you out, what makes you tick, etc., and they want to
completely mind fuck you, and have you under their control. . . At the end of the day I
want to feel bad for BPDs, but once you've been in their clutches and seen their
madness and evil, it's hard to muster up much sympathy and compassion. My best
advice is if you figure out a chick is BPD is to walk away and never look back, no matter
how hot she may be and how outrageous the sex may be, relationships with BPD never
end well, trust me the last thing you need is to get a false rape accusation, a bogus
domestic violence charge, catching a serious STD. . . all things that are very likely to
occur with a BPD” (https://www.rooshvforum.com/thread-52542.html).

Intimate relationshipsinvolving individuals with BPD tend to take on distinct patterns,

beginning with what somecalla“honeymoon phase” (CITE).During this phase, an individual with
BPD modulates their emotions (39) and thus, comes into the relationship with a sort offaçade
(i.e., hiding their problematic symptoms [explosive emotions]). Things typically move quickly
(individuals with BPD are usuallyquicker to have sex and to want to move in with their partner
than most other individuals) and there is little conflict at first. In fact, people are often “drawn
to individuals with [this] disorder because of the initial excitement and passion they bring to a
relationship” (92).However, Dr. (Moskovitz? Masterson?) explains that mentally healthy
individuals tend to spend more time probing the personality of their potential partner prior to
moving forward (CITE).
In the beginning of the relationship, an individual with BPD idealizes (not to be confused
with ‘idolizes’) their partner. Idealization, which stems from a failure in their thinking to bring
together the dichotomy of two seemingly opposing aspects of themselves and others, means
that the individual with BPD forms a fragmented representation of their partner in which
positive qualities are emphasized and negative qualities are undermined.In a sense,
theydevelop an unrealistic understandingof their partner by putting them ‘on a pedestal.’The
problem with this is that ‘what goes up, must come down’ (meaning that the individual with
BPD will eventually be disappointed [not because their partner [or therapist] gains bad traits or
loses good ones—but because the individual with BPD failed to form a realistic (and complete)
representation of them in the first place. This does not mean that everyone who an individual
with BPD idealizes actually has more negative qualities than they first imagined, but that
individuals with BPD fail to understand that everybody has bad qualities in addition to their
good qualities [and that everyone makes mistakes] (i.e., they fail to understand things in a
realistic way). A tribute to this is the fact that individuals with BPD tend to idealize (and then
devalue) their therapists and doctors (who would never actually do anything to hurt them on
purpose, and tend to have even more good qualities [and less bad qualities] than the majority
of individuals in our society).Dr. Moskovitz writes, “If you are borderline, you may put me on a
pedestal today and topple me tomorrow when I inevitably fail to meet your lofty expectations
[(emphasis on ‘your expectations’)]” (87, pg. 14).
It is important to emphasize that their thinking does not allow them to develop a
realistic understanding that everyone has flaws and mistakes.Their deeply-rooted reliance on
splitting (or ‘black and white,’ ‘all-good’ vs. ‘all-bad’thinking), which will be explainedin greater
detail later in this section, makes it difficult (if not impossible) for them to validate that
everyonemakes mistakes (and then forgiving their partner for their mistakes) (92). This is not a
choice that individuals with BPD make—it is a deeply-rooted style of thinking (and it is difficult
[if not impossible] for them to think otherwise, unless… Well, I will save it for later).As one
individual with BPD (who is already in therapy) told me, “For BPD stuff has to be perfect”
(despite what they might say).
A relationship with an individual with BPD is bound for trouble becausethey come into a
relationship with a façade [i.e.,bymodulating theiremotions, which they know are explosive and
intense] and becausethey fail to form acomplete representation of their partner from the
beginning [which is nota choice but a deeply-ingrainedpattern in their thinking]). In a sense, an
individual with BPD will eventually gain problematic traits (i.e., by ‘unmasking’ their
problematic symptoms) and become fixated onnegative trait(s) intheir partner (which the
individual with BPD ‘signed up’ for [butfailed to ‘see’] from the beginning [as a result of
thedeeply-rootedproblem in their thinking, which is a near-inability in their thinking to bring
together the dichotomy of two seemingly opposing aspects, or concepts, of themselves and
others at any given time]).This leads to conflict, which is just the beginning.
Mentally healthy individuals can look past their partner’s flawsandmistakes(or at least
find ways to work things out), but individuals with BPD have extreme difficulties with
forgiveness (orcomplete inability to forgive). Mentally healthy individuals tend to work towards
conflict resolution, while individuals with BPD tend to behave in ways that escalate or maintain
conflict (which will be explained later in this section).Towards the beginning of my relationship
with Patient X, I volunteered to give up the one negative trait that she became fixated on
(which was always there and she chose to ‘signed up for’ in the beginning [and then asked me
to ask her to be my girlfriend, which I was not interested in but did for her anyway) under the
condition that she gave up the one negative trait thatIead to relationship turmoil by making it
difficult to resolve conflict. In essence, I agreed to give her what she wanted under the
condition that she gave me what is good for the relationship (which was a step towards
resolving future conflict, had I been in a relationship with a mentally healthy individual). She
agreed to this deal, but little did I know, she was ‘unable’ to control herself and stick to it (and
by mistakenly making my end of the promise conditional upon her behavior, I gave her all of the
control, or power (which would not even be my way of seeing things, had I been in a
relationship with a mentally healthy individual [with whom there are no such things as control
and power, at least in the context of relationships]).
In any case, individuals with BPD tend to create conflict by becoming fixated on their
partner’s negative traits (or the traits which they perceive to be negative) (and then blame the
conflict on their partner).They lack introspective abilities and do not take responsibility for their
own behavior (in the context of intimate relationships). They do not work towards conflict
resolution and make it more difficult for their partner to resolve conflict, almost as if doing it on
purpose.However, the truth is that the conflict is almost neverreally what they say (or actually
believe) that the conflict is about—the conflict is a result of their disorder.Furthermore,
individuals with BPD are hypersensitive towards emotional stimuli (e.g., words that offend
them), are emotionally reactive and intense, provocative and argumentative, abusive and can
become violent, constantly blaming, and are known for ‘playing the victim’.
If a relationship with an individual with BPD continues past the initial devaluation (which
I suppose marks the end of the ‘honeymoon phase’), it tends to take on a pattern in which the
individual with BPD alternates between idealizing and devaluing their partner. Devaluation
means the opposite of idealization (i.e.,forming an incomplete representation of their partner
in which negative qualities are emphasized and positive qualities are undermined.Devaluation
phasestypically do not last forever, and eventually, an individual with BPDtends to swing back
towards the opposite pole and idealizes their partner again.Devaluations are
usuallyprecipitated by an argument, some kind of conflict, a differences in opinion (or interest),
or real or imagined signs of abandonment or betrayal (which will be explained later in this
section), so an individual with BPD always has some kind of ‘reason’ (or in their minds, a
‘cause’) for their devaluations (and since this ‘reason’ [or in their minds, the ‘cause’] is always
something that their partner did wrong [or something wrong with their partner], they will
always perceive their own devaluations as reasonable responses to problems caused by their
partner [which is not how mentally healthy individuals approach relationship issues and is due
to their lack of introspective abilities). In reality, it is the deeply-rooted and problematic pattern
in their thinking (in the context of relationships) that contributes to, and maintains, conflict.
During the devaluation phases, an individual with BPD might claim that the relationship
is over (CITE) and then completely disregard their partner as well as their own responsibilities
(and commitments) towards the relationship. For individuals with BPD, it is as if the devaluation
phases are discontinuous (in terms of bonding, responsibilities, and commitments, etc.) from
the other parts of the relationship (again, due to a deeply-ingrained and problematic [but in
their distorted minds, defensive] pattern in their thinking). For example, towards the beginning
of my relationship with Patient X, shetold me, “lets both promiseto each otherthat we will
never ignore each other’s phone calls when we argue—no matter what.”We both agreed to this
commitment (orher ‘relationship rule’), but for the next three years she ignored my calls every
single time that we would argue (because she would devalue me), while I kept my end of the
deal (except for a couple of occasions).During the devaluation phases, individuals with BPD
tend to disregard the promises and commitments that they made during the phases of
idealization and may even seek revenge (in one way or another). They mightbelieve that their
partner is someone ‘bad’ who deserves to be ‘punished’ for whatever they did wrong (and then
use that as an excuse for their own ‘bad’ behavior). In a sense, these dynamics are
representations of their problematic childhoods.

Next, I will summarize the various means by which BPD leads to relationship turmoil and
causes them to become ‘unstable and intense’ and‘characterized by alternations between
extremes of idealization and devaluation.’

I. Disorganized/Unresolved Attachment Style

In her memoir The Buddha and the Borderline, Kiera Van Gelder (a womanwith
BPD) writes, “I’m always fairly good at the beginnings,it’s when I get attached that all
hell breaks loose” (interestingly, she wrote a another variation of this in a different part
of her book that will appear later in this article).Attachment Theory is “an important
developmental paradigm formulated to explain both normal development and
psychopathology” (CITE). It addresses a specific facet of human relationships: how
human beings respond within relationships when hurt, separated from loved ones, or
perceiving a threat (CITE). Attachment Theory explains that every shuman being, during
the first two (to three) years of life (CITE),develops a particular pattern (or style) of
attachment depending on how they experienced their early caregiving environment
(CITE) and reflects the quality and kind of care received (84, pg. 26).

The fourstyles, or patterns, of attachmentin childhood are: INSERT STYLES. A

child develops (normally one) particular style, or pattern, of attachment, which remains
with them and becomes a ‘template’ for their style, or pattern, of attachment in future
(primarily adult) relationships(CITE). The four classifications of attachment in adults
(which correspond to the four classifications from childhood) are: (INSERT STYLES).

Fairly recently, “psychopathology researchers and theorists have begun to

understand fundamental aspects of BPD, such as unstable, intense interpersonal
relationships. . . as stemming from impairments in the underlying attachment
organization (Blatt, Auerbach, & Levy, 1997; Fonagy et al., 1996; Gunderson, 1996; Levy
& Blatt, 1999; Yeomans & Levy, 2002). These investigators have noted that [the hallmark
 symptoms of BPD] occur in an interpersonal context and are often precipitated by real
or imagined events in relationships (benign separations may be perceived as rejection,
bids for intimacy may be seen as intrusive or engulfing, differences of opinion may be
seen as personal attacks)” (94).

Dr. Judd and Dr. McGlashan explain thatmany individuals with BPD develop
multiple, dissociated (or loosely integrated) models of attachment, which can be
described as a disorganized/disoriented [or unresolved] model that fluctuate among
features of the preoccupied [anxious and ambivalent] and
dismissing/detachedmodes[84, pg. 6; 84, pg. 25]). This may result from the
contradictory experiences that many individuals with BPD had with their caregivers (i.e.,
when their caregiver(s) is/are at times abusive but must still be relied upon for survival
[CITE]).

“These multiple [(and loosely integrated) models [of attachment] underlie the
emotional, behavioral, and cognitive dysregulation. . . and interfere with the
development of sustained intimate relationships” (84, pg. 25).“Under person-specific
stressful conditions, the [individual’s] predominant [(preoccupied or dismissing)]model
collapses, with attendant emotional, behavioral, and cognitive disorganization and
dysregulation” (84, pg. 25). This may be one reasonwhy“there may be no continuity in
the way the borderline views [their] partner. [Their view] shifts moment to moment and
is either totally good or totally bad. . . The lover is never perceived as a complex, richly
ambiguous person embodying faults and virtues simultaneously. Consequently, the
borderline becomes a kind of ‘fair weather’ lover whose emotional investment in the
partner will wane in times of disagreement or when tempers flare” (86, pg. 112).
Dr. Judd and Dr. McGlashan explain that “the predominant mode of insecure
attachment (preoccupied or dismissing) and the degree of disorganization under
stressful conditions [may] constitute the primary determinant of variations in BPD
course and severity of impairment. The possibility for increased organization of the
attachment system [(in therapy)] also explains the significantpotential for improvement
in many BPD patients” (84, pg. 25).

II. Hypervigilance (and paranoia)

Individuals with BPD tend to be hypervigilant towards signs of potential harm,
betrayal, abandonment, etc., which can lead them to misinterpret interpersonal
situations and result in conflict in relationships. According to Patricia Judd, Ph.D. and
Thomas McGlashan, M.D., “A general suspiciousness about the actions and motives of
others colors [the] interpersonal [worlds of individuals with BPD]. [People with BPD
have] learned to be hypervigilant to interpersonal cues to manage anxiety and guard
against potential harm. [As] maltreated children, [they learned] to watch for signs that
they might be hurt. . . [Their] parents were often so unpredictable. . . that only
continuous attention afforded a modicum of protection” (84, pg. 197).In other words,
because individuals with BPD have been maltreated as children, they developed chronic
expectations that they will be maltreated (or hurt) again. This causes them to be
hypervigilant (or ‘on the lookout’) for signs of potential harm, betrayal, or abandoned,
to the point of paranoia.
One problem with this is that it can lead to a sort of “self-fulfilling prophecy,” in
which an individual’s expectations lead them to behave in ways that cause their
expectations to be ‘fulfilled.’When I took a psychology course in college, the concept of
a self-fulfilling prophecy was explained to me as follows: Imagine yourself going to a
party believing that people do not like you (and thus, an expectation that they will not
talk to you). This expectation would, in all likelihood, influence your behavior in such a
way that you wouldavoid talking to people at the party (i.e., because you believe that
they do not like you). You would thenhang out in the corner by yourself. People at the
party might see you in the corner and simply think that you are trying to avoid them
because you would rather be left alone, and so they will not bother you (which would
‘fulfill’ your expectation that they will not talk to you and confirm you irrational belief
that they do not like you).However, if you went to the same party with the belief that
people do like you (and thus, an expectation that they will talk to you), you would be
more likely to behave in ways thatconfirm your expectation(i.e., you would talk to
people yourself rather than trying to avoid them). This would ‘fulfill’ your expectation
that people will talk to you (and confirm your belief that they do like you). In this way
(and others), an individual’s ownexpectationscan lead to a‘self-fulfilling prophecy,’which
tends to operate at a subconscious level in real life.
Since individuals with BPD tend to expect that others will either hurt, harm,
betray, or abandon them, they often behave in ways that actually lead to the
‘fulfillment’ of their own (irrational)expectations,sometimes by simply misinterpreting
interpersonal situations. It is well known that “[individuals with BPD] frequently
misinterpret others’ behaviors as signs and portents of harm and abuse,” (84, pg. 197).
An individual with BPD might expect that their partner will cheat on them (or, in a sense,
hurt them emotionally or betray them [because they were hurt emotionally and
‘betrayed’ during childhood]), which would lead them to be hypervigilant towards signs
of betrayal (i.e., they will look for signs that their partner is cheating on them). This
hypervigilance can lead them tomisinterpret a situation in which, for example, they
observe their male partner talking to another female (which the individual with
BPDobserves happening as they come back from a restroom) as a sign that their partner
 is cheating on them (when, in reality, the femalemay have been a stranger simply asking
for directions).Due to their paranoid expectations that their partner will cheat on them
(and their hypervigilance towards signs of betrayal), the individual with BPD is likely to
misinterpret this situation as a ‘confirmation’ (or ‘proof’) that their partner is cheating
on them—and then react to it as though it was true (i.e., an individual with BPD might
yell at their partner or become completely convinced that their partner is cheating on
them and then be extremely upset because of it).In essence, if someoneis constantly ‘on
the lookout’ for signs of betrayal, etc., they are likely to find what they are looking
for(which is ‘signs’ or ‘evidence’ ofbetrayal[whether real or imagined]).
III. Emotional dysregulation
While the specifics ofemotional dysregulation and affective (emotional)
instability will be discussed in a subsequent section, their application to intimate
relationships will be touched upon here. “Affective instability [is] a key aspect of
emotional dysregulation. [It is] is related to [the] emotional vulnerability [of an
individual with BPD], which is characterized by an unusual sensitivity to personally
significant emotional stimuli (low threshold) coupled with abnormally strong reactions
to those stimuli. Once elicited, these emotional responses are slower than normal to
return to baseline” (84, pg. 31).However, “[When] not affected personally, [individuals
with BPD] often appear impervious to emotion” (84, pg. 31).In other words, individuals
with BPD are highly sensitive towards emotionalstimuli (e.g., words that offend them)
and experience strong emotional reactions in response to those stimuli (i.e., they
experiencenegative emotions with greater intensity and longer duration than most
people), although typically only in the context of close relationships (i.e.,this sort of
reactivitywould typically not be observable by someone outside of a close relationship
with someone with BPD).
This means that “[relatively trivial matters] can trigger [relatively] intense
reactions. And once upset, [individuals with BPD] have a hard time calming down” (69).
For example, earlyin my relationship with Patient X, we had a small argument in which I
said something that offended her (and she offended me as well). This argument de-
escalated quickly, so I went back to studying and she laid down in bed. After a couple of
hours, I finished studying and started getting ready to go to bed.The argument was no
longer on my mind (i.e., I ‘let it go’).I laid down next to Patient X and tried to hug her
(like I did every night), but to my surprise, she was stilly crying and angrilypushed me
off. I apologized to her for offending her and tried to hug her again, but this lead her to
become more angry and it lead to another argument.
In her memoir The Buddha and the Borderline, Kiera Van Gelder (a woman with
BPD) explains that, “[emotions] that might pass through others in minutes might keep
cresting in [individuals with BPD] for hours, sometimes days” (CITE, pg. 122). She
writes,“With [my boyfriend] Taylor, the pattern is that I accuse, we argue, and I cry and
accuse some more. If I’m feeling horribly victimized, I might crawl into bed and not
come out. If my anger reaches the point where I’m afraid of what I might do, I pick up
my bags and head out the door” (CITE, pg. 122). It is worth noting that she isactually
afraid of what she might do (i.e., she does not simply say it to her boyfriend). She
actually uses avoidance (which is considered a maladaptive coping strategy [at least for
mentally healthy individuals]) as a means to prevents herself from doing whatever it is
that she might do (which shows that she can become angry to the point of ‘losing
control’ [which is a tribute to emotional dysregulation in BPD]).
“It’s easy to understand how this [sort of] emotional volatility and [an] inability
to self-soothe [can lead] to relationship turmoil” (69). Furthermore, Dr. Moskovitz
explains that“mood lability [(or, ‘mood swings’)],in [individuals with BPD are] often
triggered by the misperception of subtle events in the environment (Gurvits et al., 2000;
Yeomans & Levy, 2002). Once the mood state is obtained, it can rapidly lead to
aggressive, impulsive, self-destructive, interpersonally intrusive, or extremely isolative
behavior (Gurvits et al., 2000; Yeomans & Levy, 2002)” (94).For those with BPD,
“feelings may sometimes become so intense that they distort [their] perception of
reality. At such times, [they] may imagine [themselves] deliberately persecuted by those
who have merely let [them] down.” (87, pg. 6-7).
Patricia Judd, Ph.D. and Thomas McGlashan, M.D., write, “One of the most
common and debilitating features of the borderline disorder is distorted interpretation
of interpersonal situations. Although BPD patients hear what others say, their emotional
experience of the message short-circuits their ability to process the whole message in its
social context. Thinking is hijacked by emotion” (84, pg. 196).In order to illustrate how
the emotional experience in BPD can lead to a distorted interpretation of an
interpersonal situation (i.e., by ‘short-circuiting’ their ability to process an entire
message in its social context), I will provide an example from my relationship with
Patient X:
I got a call from Patient X saying that she was on her way to my house from
school and that she got a flat tire on the way. She told me that she still needed to stop
by her house in order to pick up clothes at some point in the evening—and she was
wondering if she could use my car in order to do that. Itold her that she could and that I
would see her soon. When she got to my house, she rushed into my room and hastily
demanded, “Give me your keys!” I was taken aback by this (as she was rudely
commanding me rather than asking me for my keys politely), so I told her, “Don’t talk to
me like that!”This made her angry and then she jumped to conclusions and replied,
 “Well, if you’re not going to give me your keys, then fine…,” after which she stomped
out of my room and drove her own car home with a flat tire. Clearly, her own emotional
experience ‘short-circuited’ her ability to process my entire message (which was that I
did not appreciate being spoken down to, especially when I was the one doing her a
favor)and lead to a distorted perception of reality (believing that I was no longer willing
to let her borrow my car [which I was, of course]). Furthermore, it likely lead to a whole
range of distorted beliefs (such as ‘my boyfriend is an asshole for not letting me borrow
his car’ [and lacking introspective abilities, she probably never realized that she was
being rude and that I was simply trying to point it out to her before I gave her the keys
to my car]).
IV. Inappropriate and intense anger

While anger is, of course, also an emotion, the DSM-5 separates ‘inappropriate
and intense anger’ into a separate criterion from ‘affective (emotional) instability,’
probably because of its unique ways of presentingitself and because individuals with
BPD tend to have a particularly difficult time with regulatinganger [CITE]).The specifics
of ‘inappropriate and intense anger’ in BPD will be discussed in a subsequent section (as
is the case for emotional dysregulation), but its application to intimate relationships will
be briefly touched upon here.

In her memoirThe Buddha and the Borderline, Kiera (a woman with BPD) admits,
“[Whenever I feel that I am being ignored in a relationship,] I get so angry that I want to
destroy the relationship” (93, pg. 175).This demonstrates one aspect of the
‘inappropriateness’ of the anger associated with BPD (i.e., it is the result of a trivial
matter and aimed towards a purely destructive purpose). Beyond simply wanting to
destroy a relationship, however, “[individuals with BPD] are capable of acting-out
unresolved anger (from childhood) by inflicting physical harm to anyone who's close--
which can include their child or partner” (39).Individuals with BPD are sometimes
puzzled by their own anger (or afraid of what they might do because of it).

V. “Trauma triggers”
Trauma triggers are otherwise neutral (or relatively neutral) stimuli in the
present (e.g., words, gestures, a tone of voice,etc.), which resemble aspects of
unresolved traumatic experiencesfrom the past,that cause an individual to‘re-
experience’ aspects of their traumatic experiences (65). While most people have
probably witnessed or heard of military veterans suffering from PTSD that experience
“flashbacks” when triggered (and sometimes reacting in emotional or even violent
ways), most people have probably never heard of a similar phenomenon in BPD.While
individuals with BPD re-experience their past traumas differently from those with PTSD
(and are actually less likely to be consciously aware of the fact that this occurs), the
concept is somewhat similar.
For individuals with BPD, “trauma triggers” occur primarily in the context of
interpersonal relationships (essentially, when attachment plays a role). Patricia Judd,
Ph.D. and Thomas McGlashan, M.D., explain that, “BPD may, in many instances,
represent developmentally ‘internalized’ PTSD. The emotional dysregulation inherent in
BPD may result, in part, from a PTSD-like generalized stress-response pattern of
hyperarousal and/or numbing, but the trigger is not a specific traumatic memory. The
traumatic trigger is re-created in the context of a current relationship in which closeness
exposes the BPD patient to actual or feared abuse in the form of emotional neglect,
abandonment, or attack. The trauma is thereby re-created and relived rather than
recalled, and the psychological and physiological stress reactions are part of the
person’s characteristic response set within relationships and a core feature of the
personality” (84, pg. 12).
Dr. Mearesfurther explains that “[an] incident that triggers [an emotional] shift
(e.g., a gesture, word, or tone of voice that suggests devaluation) activates [an]
unconscious traumatic memory system. [When this occurs,] an ill-developed system of
higher-order consciousness relating to self-awareness is overturned by the intruding
traumatic complex. . . A different kind of consciousness [then] prevails, in which
reflection is lost and the person is unaware that he or she is in the grip of memory. The
‘facts’ of an original series of traumata [then] dominate [their] experience, albeit
unconsciously, so that [the individuals with BPD] feels once again in the role of victim
and in a form of relatedness in which the other is sensed as devaluing, critical,
controlling, contemptuous, or whatever part the original other played in the
traumatizing events. This [triggered] state of mind—its structure, its accompanying
affect, and the form of relatedness in which it is experienced—is sharply discontinuous
from that which preceded it. Other social triggers characteristically produce a somewhat
different complex of changes, also discontinuous from a previous state of mind. The
quality of the affect [or emotional expression] alters. The form of relatedness in which it
arises is also changed. . . [Both are] aspects of a particular form of consciousness in
which the lineaments of self are lacking” (85, pg. 216-217).
“There is, [in fact,] a significant overlap in symptoms of Complex PTSD and BPD. .
. Traumatic experiences and/or severe attachment problems underlie both disorders. . .
with unresolved issues related to these experiences paramount in maintaining
symptoms” (65). A significant number of individuals with BPD can also be diagnosed
with PTSD. “[As an example], Zanarini and her colleagues found that 58% of [the
individuals with BPD in their study could also be given a diagnosis of PTSD](Zanarini,
 Frankenburg, & Hennen et al., 2004)” (85, pg. 129).This occurs when both disorders
occur comorbidly.
However, a major difference between BPD and PTSD “may be that PTSD is often
the outcome of a single catastrophic event, whereas the unconscious traumatic memory
system [in BPD] can be the resultant of cumulative traumata taking place in a
developmental atmosphere in which, day after day, the developing individual suffers
small inflictions of harm. Another difference may be the degree to which the reactivated
memory is experienced consciously. PTSD is typically, but not always, accompanied by
intrusive distressing recollections of the event (American Psychiatric Association, 1994,
p. 28)” (85, pg. 129).“The [traumatic] memory system [in BPD] represents an
accumulation of traumata [from childhood] of similar kind, such as emotional abuse,
going on day after day. With the triggering of this system, whether by external events
that resemble certain kinds of its features or by internal associations, the relational
configuration is activated. The attributes of self and other given by [a traumatic ‘script’
then] become present reality” (85, pg. 9). This concept will be further explained in
subsequent sections.

VI. Psychological “defense mechanisms”

According to A.J. Mahari, “In the past most [individuals with BPD] had to protect
against tremendous pain and hurt that [they] experienced and/or perceived in and
through [their] experiences [in childhood]. [As a result, theydeveloped] many
mechanisms to defend [themselves psychologically]. It could be argued that a large part
of BPD in and of itself is a defense mechanism against being hurt any further. Of course
the perpetuation of borderline beliefs and patters does, in reality, cause more pain, but
to those caught up in the patterns of active BPD this is usually the furthest thing from
their understanding” (32).

Because all ‘psychological defense mechanisms’ function subconsciously (i.e., as

a result of processes in the brain that are not due to conscious effort and that an
individual is not normally aware of [e.g., the brain sending signals to the muscles
surrounding the lungs in order to make an individual inhale while breathing, etc. ). In
essence, ‘subconscious processes’ [but not subconscious memories, etc.] refer to those
processes of the brain that do not require effort and normally occur without an
individual’s conscious awareness. As an example, a subconscious process that constantly
occurs in all individuals is the brain sending ‘signals’ to the lungs in order to breath (an
individual does not walk around all day thinking ‘breathe in, breath out.’
 Psychological defense mechanisms are techniques that an individual uses
(subconsciously) to prevent themselves from experiencing uncomfortable feelings (such
as shame, rage, anxiety, andguilt), or to avoid taking responsibility for uncomfortable
thoughts, urges, impulses, or behaviors that risk punishment or retaliation (87, pg. 17).
While all individualssubconsciously implement psychological defense mechanisms from
time to time (e.g., denial, avoidance), individuals with BPD tend to use them more
frequently and in more extreme ways.
Those with BPD have developed various means by which to ‘protect’ themselves
psychologically during childhood (in dangerous, neglectful, and/or abusive
environments), and have carried over their various ‘defense mechanisms’ into
adulthood (because, in a sense, it is ‘all theyknow’), where the environment is
(hopefully) not as dangerous, neglectful, and/or abusive as it was in their childhood, but
where their ‘defense mechanisms’ actually cause them more harm than good (in various
ways such as by hindering communication in relationships and preventing an individual
from getting help). I will briefly summarize some of the main defense mechanisms
commonly associated with BPD (although they are not limited BPD):

o “Splitting”– Splitting is a primitive defense mechanism that is sometimes also

described as ‘black-and-white thinking’ or ‘all-or-nothing thinking’. It is defined
as“[a] failure in a person's thinking to bring together the dichotomy of both
positive and negative qualities of the self and others into a cohesive, realistic
whole” (64). It is, in a sense, forming representations of oneself and others that
are either ‘all good’ or ‘all bad.’
All young children utilize splitting (which occurs at a subconscious level,
so most people are unaware of this). Dr. Masterson explains that “every
toddlerholds two parallel images of his or her mother: a ‘good’ mother-image
(or“the mother who provides pleasure, comfort, warmth, affection, etc.”) and a ‘bad’
mother-image (or “the mother who frustrates, shows displeasure, punishes, etc.),”
which in normal development are eventually fused into one (86, pg. 34).
Dr. Masterson also explains that this fusion, which is, essentially, the
‘outgrowth’ of the use of splitting, occurs during the first few years of life and is
dependent upon a child’s ability to repress negative aspects of themselves and
others into the unconscious for sublimation [(which I speculate might be the
basis for forgiveness)] (86, pg. 35). As we will see in a subsequent section,
individuals with BPD were, for the most part, unable to develop the ability to
repress (instead, their main line of defense is a temporal splitting of the ‘self’
[and others], which will be explained later). In any case, individuals with BPD
were never able to ‘outgrow’ the use of splitting, which became a deeply-rooted,
overly-developed (and maladaptive) coping strategy for them.
Interestingly, Dr. Mastersonstates that“the splitting defense mechanism,
which usually recedes as the real self emerges(which, according to a research
articlethat he published, is hypothesized to occur when a child is approximately
four years old[CITE]), persists as a principal defense against the abandonment
depression” (CITE). He also writes that the development of a normal personality
is dependent upon the use of repression (86, pg. 35). Furthermore, he explains
that for those with BPD, “The conflicting images of the good mother and the bad
mother, the good child and the bad one, and the feeling states associated with
them (being loved or being rejected) remain conscious but are kept apart so they
do not influence one another. It is as if they were closed off in two separate
closets. . .In psychodynamic terms, [these children fail] to achieve ‘object
constancy,’ and will go through life relating to people as parts-either positive or
negative-rather than whole entities. [Thus, they] will be unable to maintain
consistent commitment in relationships when [they are] frustrated or angry” (86,
pg. 78-79).
According to Patricia Judd, Ph.D. and Thomas McGlashan, M.D., “When
BPD patients feel deprived, betrayed, or victimized [in their adult relationships
(which, for those with BPD, can actually result from relatively trivial matters or
misinterpretations of interpersonal situations)]. . . the significant other who is
apparently triggering [these states] is viewed, at worst, as an enemy and, at best,
as withholding. [This is the result of] ‘splitting,’ which is a manifestation of
preoperational thinking. It reflects an inability to think dichotomously—that is, to
entertain opposing feelings and thoughts about a person and understand that he
or she has complex motivations. At this preoperational level of cognitive and
emotional development, [an individual with BPD] uses attributes of the other
idiosyncratically to represent the whole person and reacts to these with one-
dimensional and pervasive emotions that have an either-or quality (Lane and
Schwartz 1987)” (84, pg. 189).In essence, individuals with BPD tend to view the
world (meaning themselves and others) as either ‘all-good’ or ‘all-bad,’failing to
see the true colors:
 “There are very few gray areas, if any [for individuals with BPD]. [For
example], it is difficult for [an individual with BPD] to be angry at a loved one and
recognize that - while [they are] angry at [them]–[they] still love [them].
Conversely, if a loved one is angry at [the individual with BPD,] then the
[individual with BPD] will view either themselves or the loved one as ‘bad,’
because for them, someone who is ‘good’ would never criticize [them] or make
them feel sad” (CITATION NEEDED).
“Splitting[does not occur against everyone. It occurs primarily against
those [who an individual with BPD] feels ‘they cannot live without’” (CITE).
Therefore, “the people who are most likely to be idealized and devalued [(or split
as ‘all-good’ or ‘all-bad’)] are the partners of [individuals] with borderline
personality disorder, and the doctors or therapists who treat them” (68). In a
subsequent section, I will provide an example that demonstrates how truly
‘deeply-rooted’ the utilization of splitting is for individuals with BPD. Splitting is
central to BPD and I speculate that it is the main reason why BPD relationships
are “characterized byalternating between extremes of idealization and
devaluation.”
o “Projection” –Projection is a fairly common defense mechanism used by many, if
not all, individuals from time to time (subconsciously)—although those with BPD
may use it more frequently (and in more extreme ways). Projection is when an
individual subconsciously (without their own
awareness)attributestheiruncomfortable feelings, urges, or even behaviors to
others (35). For example, an individual who is sad might look around and think
that others are sad (which they perceive consciously). An individual with BPD
might project their own anger onto their partner and believe that their partner is
 angry at them (and they may even avoid talking to their partner because of it).

Because individuals with BPD tend to experience more negative emotions

than most people (and tend to have poor introspective abilities), they tend to
utilize projection more frequently. Furthermore, someone who is a cheater
themselves might begin to feel paranoid that their partner is cheating on them
(i.e., because they subconsciously ‘project’ their own behavior onto their partner
to avoid feeling guily) (this is actually an example that I learned that applies to all
individuals—not only those with BPD [i.e., cheaters sometimes become paranoid
that others are cheating on them]).
o “Projective identification” –Projective identification involves projection, but
takes it a step further by actually influencing the other person to carry out the
precise projection (CITE Wiki projective identification), creating what is known as
a self-fulfilling prophecy. “Kernberg, in a series of publications (e.g., 1967, 1984),
has described [projective identification] as a principal feature of BPD” (85, pg.
183-184).
Projective identification begins when an individual with BPD has a certain
part of themselves (or has a certain trait) thatthey feel they cannot ‘identify’
with as a part of themselves (as this would produce great emotional pain for
them), so they ‘project’ this part (or trait) onto another (usually within the
context of a relationship). This occurs subconsciously and only in the mind of the
individual with BPD. Then they perceive the projected part (or trait) as belonging
to the other person (e.g., if the projected trait was aggression, they would
believe that their partner is aggressive [or angry at them]). At this point it is
simple ‘projection.’ (CITE ‘Projective Identifiecation’ video by Rune Fardal). Then,
the individual with BPD behaves in ways that entice or coerce the other to
behave in accordance with the projection (e.g., the individual with BPD might
verbally tell the other person that they are being aggressive [when they are
actually not], causing them to become angry at the false accusation and
aggressively responding, ‘I’m not being aggressive!,’ which has now become a
behavioral manifestation of the projected trait that the individual with BPD can
identify with in the other (safely outside of themselves [i.e., thinking ‘see, I am
not the aggressive one, you are—and the fact that you are yelling at me proves
it]). The important thing to realize is that, in the example above, the individual
who the trait was projected upon was not actually angry or aggressive (or
showing any real signs of anger or aggression) until the trait was ‘projected’ onto
them and they were coerced into becoming aggressive by the individual with
BPD.
The aforementioned example is a rather trivial (but good) example of
projective identification. It can be much more extreme.Dr. Moskovitz goes so far
as to say, “When she [(meaning the individual with BPD)] casts you as a villain,
you may feel and even act villainous. At worst, you may participate in recreating
her victimization by becoming physically, sexually, or emotionally abusive. At
best you may feel yourself a victim, an object of rage held hostage by self-
destructive acts for which she holds you to blame” (87, pg. 152). The reason why
projective identification is a principle feature of BPD (which tend to occur only in
the context of intimate relationships [i.e., when attachment plays a role]) is
because of the childhood trauma associated with BPD (i.e., the individual with
BPD internalized the abusive behavior, aggression, etc., in early childhood [when
brain development is highly dependent on interactions with the environment]
which was also in the context of a close relationship [that with ones parents],
which they then project onto others).
Dr. Mearesprovides an explanation of how projective identification
operates in BPD:“The disintegrated forms of relatedness [(which will be
explained in a subsequent section]) seen in those with BPD are essentially
traumatic. The nature of this kind of relationship in which the higher-order
systems controlling and modulating limbic activity may be hypofunctional, create
a peculiar interpersonal effect that I call the expectational field (Meares, 2005,
pp. 114-125). This field is produced by what Bowlby (1973) would have called an
internal working model (IWM). This term refers to the representation in memory
of a particular relationship, which necessarily includes the attributes given to
both partners in the relationship and their roles in relation to each other. When
a particular IWM is triggered, the individual feels him- or herself to be in relation
 to the other in accordance with the ‘script’ of the IWM (Meares, 1998). If for
example, the person has been the victim of relentless criticism and devaluation
[(during childhood)], he or she will expect, unconsciously, the other to behave in
this way. With this expectation comes his or her assumption of the role of one
devalued. This person is rarely aware of either the expectation or the role he or
she plays in it.
He goes on to explain, “The other person in the dyad, when this
traumatic memory system is activated, tends to become influenced by the
expectation of the subject. The other, without being aware of the influence of
this expectation, comes to play out, or at least tends to play out, the role the
subject has cast for him or her. The therapist, for example, may make remarks
which are implicitly critical of the individual in a way which is uncharacteristic of
him or her. . . In the traumatic relationship, there may be sensed a subtle
coercion to behave, or not to behave, in a particular way, in accordance with the
expectation. This feeling and tendency are the clinical bases of the conception of
projection identification (Ogden, 1982)” (85, pg. 183-184).
Interestingly, this is probably one of the reasons why so many people
state that individuals with BPD are manipulative (while individuals with BPD
typically have no idea why people call them manipulative [since this operates at
a subconscious level]). In essence, it is not conscious manipulation but it is
coercion through projective identification (which operates subconsciously).
o “Transference” – Transference is defined as “any re-experiencing or re-
enactment of a childhood situation [that occurs] in psychoanalysis or
psychotherapy”
(https://www.tandfonline.com/doi/abs/10.1080/00107530.1994.10746874?jour
nalCode=uucp20). It is similar to projective identification in that aspects of
childhood trauma are ‘re-experienced’ in the present, although transference, by
definition, occurs only in a therapeutic setting (where the therapist has been
trained to help the client identify the connection to childhood trau
 The figure above illustrates a trivial example of transference. In this
example, transference is a psychological defense mechanism in that the client’s
expectation that the therapist will laugh at their feelings might lead them to
avoid their therapist in an effort to avoid being laughed at (i.e., it is a defense
against experiencing an uncomfortable feeling or emotion by being laughed at).
This also illustrates how defense mechanisms (especially in BPD) can be harmful
in the long-run (i.e., the client might quit therapy completely in order to not be
laughed at). Transference is not always a defense mechanism, though.A very
powerful example of transference (in which transference is not a defense
mechanism) comes from a research article: INSERT RAPE EXAMPLE.
In a sense, transference (usually) involves at least three people (two in
the present and at least one from the past): (1) the individual with BPD [whose
behavior in transference is related to the past], (2) the therapist [who helps the
client identify the connection between their behavior in the present and what
occurred in the past], (3) the caregiver [or someone] from the client’s past who’s
influence (in the past) is manifested in the transference (in the present).
“The focus in psychodynamic psychotherapy is, in large part, the
therapist and patient recognizing the transference relationship and exploring the
relationship’s meaning. Since the transference between patient and therapist
happens on an unconscious level, psychodynamic therapists who are largely
concerned with a patient’s unconscious material use the transference to reveal
unresolved conflicts patients have with childhood figures” (CITE).
Interestingly, transference is the basis for a type of therapydesigned
specifically for BPD (called transference-focused psychotherapy [TFP]), although,
 as we will see in a subsequent section, it may not be the best type of therapy for
BPD.
o Dissociation – Dissociation can be considered a defense mechanism as well
(albeit not always).
Dissociation is a powerful defense used by the brain (the most fascinating
structure in the entire universe) during childhood sexual abuse, although it leads
to long-term damage. Individuals who were sexually abused during childhood
often experience dissociative symptoms under stress when they are adults.
Like with the other defense mechanisms, individuals who dissociated in
childhood continue to dissociate when they are adults (i.e., they bring the
‘defense mechanisms’ that were developed against childhood traumas with
them into adulthood, where they are no longer useful and become pathological).
One form of dissociation [that individuals with BPD might use] is the ‘sorting’ of
experiences [(i.e., memories, feelings, thoughts] into compartments that are
disconnected from one another. In this extreme form of discontinuity of
experience, memories of feelings or events occurring during one feeling-state
may be inaccessible in another” (87, pg. 21-22). Dissociation will be discussed
further in a subsequent section.
o Emotional inhibition (check to see if this is considered a defense mechanism).
Check on a link between emotional inhibition and dissociation.

There are other defense mechanisms but the significant ones for BPD have been
covered. It should be easy to imagine how they can negatively impact relationships.

VII. “Borderline provocations”

In the context of intimate relationships, individuals with BPD are known for
provoking their partners into conflict (which may or may not be their intention). Paul J.
Hannig, Ph.D, MFCC, CCMHC, NCC, writes, “Borderlines [are known to] test their
partner's level of frustration-tolerance and anger. Borderlines can push partners to the
limits of their rage and reactivity” (8).
David M. Allen, M.D., explains that “[borderline] provocations are meant to
elicitone of three reactions: anxious helplessness, anxious guilt, and/or overt hostility. . .
[People with BPD] make herculean efforts to induce these reactions and are very good
at finding [their partner’s] vulnerabilities in order to do so” (106). Hewrote a series of
articles explaining how not to respond to these provocations:
Responding to “Borderline” Provocations—Part I
Responding to “Borderline” Provocations—Part II
Responding to “Borderline” Provocations—Part III
Responding to “Borderline” Provocations—Part IV
In some cases, the provocations may not be intentional (and may be behaviors
driven by the subconscious in an effort to help the individual deal with their difficult
emotions). For instance, Dr. Masterson explains that, “[in relationships, individuals with
BPD subconsciously]project the withdrawing, disapproving parental image onto [their
partners] so that they do not have to feel and be aware of the associated depression. As
long as they are angry at their partners, they do not have to feel depressed. For them
interpersonal conflict is preferable to feeling intrapsychic depression.” (86, pg. 111). In
essence, they may instigate conflict because it helps them deal with their emotions.
Other times, their provocationsmight be intentional (for example,to ‘get
revenge’ on their partners for past transgressions, since individuals with BPD have a
hard time forgiving others).
In any case, people with BPD (in their intimate relationships) are known for their
subtle (but highly effective) provocations towards their partner. NAME states, “you
might be brilliantly accomplished in your chosen field, but the Borderline is exquisitely
adept at discovering where your deficits and vulnerabilities are buried”
(http://gettinbetter.com/key.html). They then use these vulnerabilities to provoke a
reaction out of their partner. Their provocations are not limited to romantic
relationships, as Dr. Moskovitz admits, “[In the therapeutic setting, patients with BPD]
test our limits and probe deeply at our inadequacies. . . During my years of teaching
medical and psychiatry students, I have seen powerful emotional reactions to people
with BPD” (87, pg. xi-1).
An article that I read a while back (but cannot find again in order to cite)
provided an excellent example that illustrated an interesting point. It described a couple
(consisting of one person with BPD and their non-BPD partner) on a dinner date at a
restaurant. During the entire dinner, the partner with BPD (who knew exactly what
highly-sensitive and personal things to say in order to “get” to their partner) relentlessly
went on and on with these comments (presumably because they felt wronged and
therefore wanted a reaction out of their partner) until, finally, their partner angrily
stood up and slammed his hands on the table, yelling, “That’s enough!” As soon as he
did this, all of the heads in the restaurant turned towards him. The point of this example
is that the only part of the conflict that the people in the restaurant witnessed is the
non-borderline partner’s angry (but short-lived) reaction to the borderline’s high conflict
 behavior, likely assuming that the non-borderline is the “troublemaker” in the
relationship (as the borderline’s abuse towards their partner, which went on for an
entire half hour, was too subtle and quite for anybody to notice). If the other people in
surroundings know the person with BPD (as often happens in similar situations in real
life), they are even likely to contribute to the borderline’s blaming of the other person
for their relationship problems since the borderline’s high conflict behavior (which is at
the heart of the problems) may go unnoticed by other people in their lives.
VIII. High conflict personality (HCP)
Many individuals with BPD also have characteristics of a ‘high conflict
personality’ (HCP), the main facet of which is the tendency to act in ways that
actuallyescalateor maintain conflict(once it begins) rather than working towards
resolving it, which is what most people do (CITE).Not all people with BPD have an HCP,
and having an HCP is not limited to people with BPD (it is, however, frequently
associated with cluster B personality disorders) (CITE). Individuals with BPD may not
even intend to behave in ways that maintain or escalate conflict and, in fact, may not
always be aware of how their behaviors contribute to doing so.
Conflict is, of course,is a normal part of intimate relationships (CITE), but it is the
ways in which the conflict is handled by both partners that is crucial to maintaining a
healthy relationship.Individuals with BPD tend to avoid fixing problems in a relationship
by becoming preoccupied with blame (80), which underlies many of the high conflict
behaviors, such as:
o Stonewalling (AKA the ‘silent treatment’): Individuals with BPD may ‘stonewall’
their partner, or give them the ‘silent treatment,’ which is a high conflict
behavior (CITE). Mental health professionals seem to agree that this is an unfair
way to behave in relationships and is emotionally abusive towards a partner
(CITE). By doing this, they avoid fixing problemsin the relationship (thus,
maintaining conflict) and may provoke their partners into getting angrier with
them as a result of the unfair treatment (thus, escalating conflict).
o Yelling or using a loud voice: Individuals with BPD may use a loud voice or yell
during arguments in order to gain control, which is also a high conflict
behavior(CITE). Oftentimes, their yelling serves no real purpose other than to
offend or provoke the other individual. In an online post, someone provided an
example: INSERT EXAMPLE FROM ONLINE FORUM RE: “You’re not a man”, etc.
Clearly, this serves no real purpose and can only escalate conflict.
o LOOK UP MORE INFO ON HCP AND INSERT THIRD EXAMPLE
 “High-conflict people (HCPs) have a pattern of high-conflict behavior that
increases conflict rather than reducing or resolving it. This pattern usually happens over
and over again in many different situations with many different people. The issue that
seems in conflict at the time is not what is increasing the conflict. The “issue” is not the
issue. With HCPs the high-conflict pattern of behavior is the issue, including a lot of: All-
or-nothing thinking Unmanaged emotions Extreme behaviors Blaming others (77) and
Stonewalling” (78)
During my relationship with Patient X, it felt to me as if she was constantly
working against me—probably because she constantly would find fault in me (and
blame me) for conflict and did not realize that she could have worked with me to fix the
problems that she was constantly blaming me for in the first place. At the time, this
would only make me more mad at her, but looking back at the three years that I spent
with her, I can now tell that she was simply incapable of working with me to fix the
problems as blaming was her default (it was if it was all that she knew).
It is worth mentioning that in addition to resulting from a diminished capacity for
introspection due to an impaired sense of self, a borderline’s tendency to blame might
also serve as a psychological defense mechanism against feeling shame or guilt for one’s
own mistakes and shortcomings—but as I will discuss in a subsequent section, the
defense mechanisms used by people with BPD (which they developed during childhood)
are pathologic in nature and only lead to more suffering in the present (in this case, by
perpetuating conflict and the problems that the borderline found problematic in the
first place).
I believe that the defense mechanism of blame (in order to avoid feeling guilty or
shameful as a result of finding fault in self) may be related to being unreasonably and
cruelly punished in childhood. As I mentioned in a previous section, Patient X was
beaten severely for making a minor, innocent mistake when she was a child (which was
forgetting to take down an article of clothing from a clothing line). She never learned
the lesson that it is okay to make mistakes as long as you try your hardest not to (and
that everybody makes mistakes). Instead, she likely associated the idea of making a
mistake (or doing something wrong) with the concept of being unreasonably punished
and experiencing pain—and as a result, her psyche may have built a defense mechanism
against having to feel that she did something wrong (or finding fault in herself) in order
to avoid experiencing the pain that she associated with it. However, this association
(and the defense mechanism that goes along with it) is unreasonable and only leads to
problems in the present day. If she had only been able to realize (and admit to—to
herself) what she was doing wrong that contributed to our relationship problems, she
would have been able to work with me to fix the problems that caused her grief in the
 first place (as the reason that the problems never got fixed was that she was unable to
work with me to fix them in a way that worked for both of us—again, probably because
she kept blaming me for the problems and as a result, working against me (as if to
punish me for my wrongdoing).
IX. Other traits associated with BPD that negatively impact intimate relationships
In addition to what has already been described, individuals with BPD tend to
possess several other traits which can be very problematic in relationships. While non-
borderlines can have some of these traits as well, they tend to be much more common
(and more extreme) in individuals with BPD.
According to Patricia Judd, Ph.D. and Thomas McGlashan, M.D.,“[Individuals with
BPD] operate at a latency-age level of moral development, where right and wrong are
absolutes and moral rectitude carries special power. They are strict judges and set high
standards for others, especially those in caregiving and authoritarian positions. Similarly,
they work hard themselves to be right and are inordinately sensitive to perceived unjust
criticism and blame, many having been raised in a blaming and shaming environment.
This makes it difficult for them to see their own role in social situations. They apply a
morally dichotomous ‘right or wrong’ analysis to many interpersonal dilemmas” (84, pg.
202). In fact, I once heard BPD described as ‘moral insanity,’ due to the abnormal (and
problematic) moral/value systems thatindividuals with BPD tend to have. Many of the
problematic traits (which are, for the most part, associated with an individual’s moral
values) that individuals with BPD tend to have are deeply-rooted in their personalities
and cannot simply be changed by deciding to do so (and can only be changed in therapy,
where the individual’s intrapsychic structure is modified over time). Some of the
problematic traits associated with BPD are:
o Difficulty with forgiveness– Individuals with BPD tend to find it difficult (if not
impossible) to forgive others, especially those they feel closest to. I first noticed
this when Patient X told me that she simply ‘cannot’ forgive. This makes sense
when considering the horrible transgressions that have been committed
towards them during childhood.
o Abnormal empathy – Many individuals with BPD claim that they are empathetic
and can strongly sense the moods and feelings of others, while others claim that
individuals with BPD have “[difficulties with] feeling empathy for others” (12).
Even research on this topic may appear contradictory at times (with borderlines
showing what appears to be diminished empathic capacity in some studies and
equal or even superior empathic capacity compared to non-borderlines in other
studies). This is due, at least in part, to their empathic capacities being state-
 dependent, as well as dependent upon interpersonal contexts, and the fact that
there are two kinds of empathy (affective and cognitive?, with borderlines
typically showing diminished cognitive? empathic capacities). While I will not
attempt to explain the findings in detail, the point remains that individuals with
BPD have ‘abnormal’ empathic capacities, which can negatively impact
interpersonal relationships.
o Inability to experience guilt – “It is important to make a distinction between
guilt and blame. Guilt implies remorse over one’s action and presupposes the
capacity for empathy and a full acceptance of responsibility for what one has
done to another. Blame carries a connotation of censure and shaming from one
person to another and is developmentally an earlier emotion and interpersonal
experience. [Individuals with BPD] have not developed the capacity to
experience guilt fully. Instead, they struggle with an overwhelming fear of the
shame and humiliation that they experienced as children. Parents struggling
with similar issues often verbally or physically humiliated them for acts of no
consequence. The harsh overreaction of caregivers is etched in their mind, and
they anticipate it from others” (84, pg. 202). Dr. Moskovitz explains that (INSERT
QUOTE RE: survivors of childhood [and/or sexual] abuse oftentimes experience
[irrational] shame). In essence, individuals with BPD lack an ability to fully
experience guilt when it would be appropriate to do so (which is important for
being able to function successfully in a relationship) and instead, experience
irrational shame.
o Tendency to seek revenge – Probably related to their inability to repress (and
forgive), individuals with BPD are known to ‘seek revenge’ on others who they
deem ‘did them wrong.’ Combined with their abnormal empathic capacities, this
can cause them to hurt others (physically or emotionally, especially in the
context of relationships).
o Difficulties with introspection – Finally, individuals with BPD tend to have a
difficult time with introspection. Introspection is defined as INSERT DEFINITION.
As Dr. INSERT NAME explains, (INSERT EXPLANATION RE: lack of self – ‘nothing
to look into’).During our relationship, I noticed that Patient X had almost never
apologized for anything she did and I took blame for almost everything. In fact,
she would actually blame me for things that I never did and that she was guilty
of herself!
o Tendency to blame –There are several reasons why individuals with BPD have a
tendency to blame. This tendency is related to their diminished capacities for
introspection and their difficulties with forgiveness (as well as other
 characteristics and traits). The tendency to blame tends to lead to turmoil in
relationships.“From the center of the shame suffered as the result of the core
wound of abandonment in BPD, those with BPD experience the drama, chaos,
pain, and even toxic relationship rupture as being caused by the non-borderline.
This can be crazy-making for the non-borderline because the borderline living
actively with and from the shame of the core wound of abandonment steeped
in polarized cognitively-distorted ways of thinking experiences life in a
fragmented way that compromises or obliterates his or her capacity to engage
in shared reality” (66). Sadly, “those with BPD, more often than not, without
being consciously aware of it, end up blaming the person or people in their lives
that actually do care the most” (CITE).
X. Fear of engulfment
Finally, as was mentioned previously, individuals with BPD also have a fear of
engulfment, which is also sometimes described as a fear of attachment or intimacy.
INSERT QUOTE RE: once that need for intimacy and affection has been satisfied, their
fears of engulfment kick in, and their interest towards you disappears). EXPLAIN
FURTHER.
As an example, in her memoirThe Buddha and the Borderline, author Kiera Van
Gelder (a woman suffering from BPD) gets engaged to her long-term boyfriend Taylor,
but then she starts to feel anxious about the commitment. She writes,
I’ve read that, for some borderlines, the flip side of abandonment fear is the fear
of engulfment. It’s another one of those “screwed if you do, screwed if you don’t”
situations. All you want is love and belonging, and your very existence depends on
it. But when you get it, you have no existence except that love: there’s still no you.
And in relinquishing the last little holdouts where I was separate, I’m now covered
with Taylor—and cat hair. I just might be feeling engulfed (93, pg. 191).
Later in the book, she writes,
A horrible pit in my stomach develops whenever Taylor and I discuss our plans.
And the house itself feels toxic. One night, when we’re in bed and the cat hair had
driven my allergic reactions to a height, I tell Taylor, “I’m going crazy in this house. I
don’t know if this will work.” He hugs me closer and says, “Don’t worry. . . You get
panicked. Everything is okay.”
But it’s not okay. It’s like I’m giving birth to a monster. Taylor can’t see it yet, but
he will eventually; there’s only so much time it can stay inside (93, pg. 193). Later,
she tells him that she has to cancel the engagement and move out.
 Now that I have outlined the various ways in which BPD can make relationships difficult,
there is one final concept to discuss. Dr. Moskovitz writes, “Despite the pain [that individuals
with BPD] experience in relationships, [they] continue to search for the one that will be
different. And each new love will shine for a time. The passion of [their] encounters with others
serves as a momentary distraction from the profound feelings of loneliness that constantly
haunt [them]. [They] seek someone who will fill the emptiness insiderather than an equal
partner with whom to share life’s experiences and responsibilities” (87, pg. 144).
There is an ongoing debate on the subject of whether individuals with BPD are even
capable of true love (or, capable of truly loving someone). Some individuals with BPD claim that
‘they love so much that it hurts’ (CITE). But many people who have dated someone with BPD
claim that borderlines cannot love (CITE). So, then, what is the explanation for this discrepancy?
Certainly, individuals with BPD are not “faking it,” and those who claim that they cannot love do
not claim this about other individuals they have been in relationships with. Interestingly,
Patient X was the first person who brought this to my attention when she once asked me, ‘How
do you know if it’s true love?”
INSERT NAME writes, “Many people ask if borderlines have the capacity to love. . .
Borderlines felt anguish in relation to yearning and striving for their parent's affection
throughout childhood--and learned to interpret these difficult, dramatic feelings as ‘Love’. . . To
the point, when you satisfy a Borderline's cravings for love, those painfully intense sensations
associated with ‘loving,’ instantly evaporate for them, and so does their desire for you” (39).She
goes on to say that “Borderline Personality Disorder clients cannot sustain emotional
commitment. They change emotions in midstream and have difficulty holding on to feelings of
‘love’. [For them,] ‘love’ turns to indifference, estrangement, and perhaps back [to ‘love’
again]” (CITE). However,“real love is a totally different matter, as it is a sustainable emotion”
(39).
Dr. Moskovitz explains that, in normal development, “as a child learns that people and
things can last from moment to moment, the images of the ‘good mother’ and the ‘bad mother’
slowly merge into a consistent figure who can fundamentally be trusted to protect and provide.
[And] this image can stand up to occasional barrages of disappointment and rage, and as love
forms, splitting is left behind” (87, pg. 14). He says that borderlines “may never have acquired
[a] basic trust in a loving caretaker. Or, once having learned to trust, [they] may have been so
betrayed that [they] have had to retreat to a world of discontinuity, peopled by caricatures.
[Their] world is split into good and evil” (87, pg. 14). As a result, people with BPD are “either ‘in
love’ or ‘in hate.’ [Their] involvement with the other person is sustained by the passion of either
feeling. Once the passion subsides, at the point in a relationship when true intimacy usually
begins to form, [they] become bored and move on to a new object of passion” (87, pg. 144).
 Dr. Masterson explains that “the emerging of the real self is of vital importance to the
capacity to love another person successfully in a sustained, mutually satisfying relationship. . .
Particularly necessary are the ability to perceive the loved one as a complete human being with
both good and bad traits; the capacity to be alone and feel genuine concern for—as opposed to
a neediness for—others; the capacity to tolerate anxiety and depression; and the capacity to
commit oneself emotionally to another without the fear of engulfment or abandonment” (86,
pg. 107-108).
He also writes, “We can say that true love is a union of two people, each for the good of
the other, where the other’s best interests become at least equal to one’s own” (86, pg. 110).
“Only love based on honest self-expression and an acceptance of the other can sustain a
healthy relationship” (86, pg. 81) (as this capacity is exactly what allows one to solve problems
in a relationship together). Borderlines, however, “have lived [far] too long on deception,
fantasy, and the myths of the false self” (86, pg. 81), to which ‘proof’ of being loved is essential
for feeling good” (86, pg. 80). In her memoir The Buddha and the Borderline, Kiera (a woman
with BPD) writes, ““It’s like I’m constantly searching for confirmation of his love for me, and
each of his gestures and words, no matter how trivial, can either prove or disprove it. I wish I
could just ease up and feel secure. On the other hand, I wish he’d stop doing things that trigger
my insecurities. It’s a vicious cycle of sorts” (93, pg. 129)
True love is supposed to be “for better or worse” (as is marriage). This separates the
concept of love from infatuation or idealization. Individuals with BPD utilize splitting as a
defense and identifysolely with their present state of affect. This means that at any moment in
time they view their partner either as all-good (or, essentially, someone worth their love) or all-
bad (someone not worthy of their love). They alternate between the two and, in essence, are
incapable of loving “for worse,” since they cannot integrate the positive and negative aspects of
their partner into a coherent image.
The following video is an animation that demonstrates what a conversation between a wife
(who has BPD) and a husband (who does not have BPD) can be like (notice that she blames him
for what she does herself [and he does not do], etc.):Borderline "Discussion" (Animation)

Criterion #3(Identity disturbance: markedly and persistently unstable self-image or sense of

self)
Identity disturbance is a core feature of BPD (which is present in 90% of cases [CITE]). It
is an outcome of secondary structural dissociation of the personality duringchildhood (which is
a defense(INSERT EXPLANATION). In essence, parts of‘self’ (including memories, thoughts and
feelings) that areassociated with traumatic experiences getcompartmentalized (or placed into
separate ‘compartments’ that are dissociated from so that they can no longer be accessed),
only to re-emerge later in life(81; 85, pg. 152;89).
As adults, individualswith BPD experience “identity diffusion,”which means that their
sense of self(and others) isfragmented and disintegrated(34).This also means that their sense of
self and others is superficial and distorted (CITE). Individuals with BPD live much of their lives
through an ‘apparently normal personality’ (ANP), which resembles the ‘as if’ mode of relating
to others (as described by NAME in YEAR) (85, pg. 152). While in this state,individuals with BPD
are disconnected from their own emotions and do not experience the emotions that generate
links between interpersonal events and models of attachment (84, pg. 195).
Psychoanalyst Helene Deutsch, PhD, explains, “We have a person who acts ‘as if’ they
are this or that, but never really occupies a place of depth or substance. With borderline, you
see people who may try to be one sort of person, but it doesn't fit as a true identity, and so
they look for another, and on and on. They identify with certain roles and environments. And
they can be, at times, competent in those contexts. Their adaptation seems solid, but also
brittle, because real identity is a deeper process than performance or behavior, where our daily
actions and roles flow from a consolidated and durable sense of self” (49).
 Many individuals with BPD explain that they do not know who they really are (45). “Even
trying to grasp what ‘knowing who you are’ [might actually mean can be] difficult for someone
with BPD” (CITE). Many individuals with BPD refer to their ‘apparently normal (part of their)
personality as their ‘false self’ (107),which is a sort of façade that “was created when, as young
children, [they] were overwhelmed with pain” (10). Psychoanalyst Donald Winnicott “thought
that this. . . extreme kind of false self began to develop in infancy, as a defense against an
environment that felt unsafe or overwhelming because of a lack of reasonably attuned
caregiving. [He explained] that the false self is a defense, a kind of mask of behavior that
complies with others’ expectations” (108).
A.J. Mahari states that some individuals with BPD may be unaware of their false self
(although I believe he is referring more to the term ‘false self,’ as I imagine that individuals with
BPD feel something strange about themselves (which other people cannot see) [which is
demonstrated in the following video: Youtube – “I don’t know who I am…”]).Dr. Masterson
explains that “the purpose of the false self is not adaptive but defensive: it protects against
painful feelings. In other words, the false self does not set out to master reality but to avoid
painful feelings” (86, pg. 23). Some individuals with BPD consider their ‘apparently normal
personality’ (ANP) to be their ‘false self,’ while they refer to the ‘emotional (parts of their)
personality’ (EPs) (which will be explained later) as their ‘true,’ or ‘real’ self (CITE) (which can be
problematic for several reasons that I will explain in a subsequent section). In any case, (INSERT
QUOTE RE: The ANP [which some refer to as the ‘false self’] is for daily functioning).It is a sort of
‘trancelike’ state in which individuals with BPD are disconnected from their own emotions (or in
which they inhibit, or suppress, their own emotions) and live much of their lives.This part of
their personality is a false self. A façade. A false identity. Individuals with BPD lack a truly stable,
or durable, sense of self. They lack their own identity.
 Because they lack their own identity (or stable sense of self), they adopt different
identities at different times and change themselves for other people. Dr. ?Robert? Chessick
explained that individuals with BPD “[tend] to ‘borrow’ identities from others” (CITE) (such as
by ‘mirroring’ the identity of whoever they are dating [CITE]).Thus, some individuals with BPD
might fear losing their identity if a close relationship were to come to an end (CITE).Their
personalitymight change dramatically periodically or depending on who they are with (or what
they think others want from them [CITE]) (81). This tendency to change who they are based on
external cues is known as the chameleon effect:
 Most people tend to adapt their behaviorsto match their environments (e.g., a man
might be more polite and quite in church than at a party with his friends) and also
(subconsciously) mimic the mannerisms of others around them, butindividuals with BPD tend to
also experience far greater changes from time to time (e.g. changes in their forms of
relatedness[e.g., victim vs. victimizer],personal preferences,value systems, goals, and
evenmemories of other people [CITE]).Individuals with BPD are adaptive not because they want
to be, but because they need to be (because they lack a ‘real self,’ which is the consistent and
stable sense of self at the center of one’s identity that remains the same from one experience or crisis to
another [86, pg. 50])

Interestingly, Dr. Richard Moskovitz goes so far as to say that a man who has been in a
romantic relationship with a woman with BPD “[was] attracted to her, not because of who she
was, but because of her uncanny ability to be whomever [he] needed her to be. Without a clear
identity of her own, she locked in her radar on [his], and. . . became a mirror for those qualities
[that he had] yearned for in [himself]. . . [He] fell in love with the person [that he was] when [he
was] with her” (CITE).
Patricia Judd, Ph.D. and Thomas McGlashan, M.D., write, “[The] ‘good’ functioning or
‘apparent competence’ (Linehan 1993a, 1995) [of an individual with BPD] crumbles dramatically
under interpersonal stress” (84, pg. 190). Dr. Meares explains that “from time to time, [their]
‘apparently normal’ personality (ANP), which acts like a protective shield, fails [them,] and [an]
‘emotional personality’ (EP) emerges, often in [an] explosive way” (85, pg. 152).Interestingly,
several laboratory studies (Kuo& Linehan, 2009; Jacob et al., 2009; Herpertz&Koetting, 2005;
Herpertz et al., 2000) have not been able to demonstrate this sort of hyper-reactivity in
individuals with BPD, which is due to their inability to replicate interpersonal situations
(particularly ones in which attachment plays a role) in the lab setting (85, pg. 216).
Individuals with BPD have multiple dissociated ‘emotional personalities’ (EPs) (or
‘emotional parts’ of their personality), which represent the compartmentalized self-states that
are associated with childhood trauma. It is important to highlight that these are not actual
separate ‘personalities,’ but dissociated parts of one personality (which is disintegrated, or
fragmented). “These dissociative parts, also known as dissociated self-states, are
dysfunctionally stable (rigid) in their functions and actions, and overly separated from one
another. . . As EPs, [individuals with BPD] are fixated in reenactments of traumatic experiences”
[but in ways that they may not be aware of] (99). As EPs, “[individuals with BPD are] unaware
that [they are] in the grip of memory. . . [while they ‘play out a role’] decreed by a ‘script’
(Meares, 1998) derived from [traumatic childhood experiences]” (85, pg. 9).
“In a patient with BPD, there is likely to be a number of traumatic memory systems
derived from different caregivers, and from individual caregivers in different traumatic modes. .
. All of these various traumatic systems are as if sequestered from each other and from the
consciousness of self. . .The individual [with] BPD switches from state to state, dependent upon
his or her relationship with the environment. Each of these states involves not only different
forms of relatedness but also differences in emotional expression.” (85, pg. 9-11).
Patricia Hoffman Judd, Ph.D. and Thomas H. McGlashan, M.D., explain that “what is
critical to an understanding of [individuals] with BPD is that they are dimly, if at all, conscious of
the dramatic shifts in states of mind regarding relationships that are so obvious but puzzling to
others. They are, in a sense, surprised by their suddenly shifting emotions and states. Of
importance clinically is an understanding of what may trigger these different states of mind and
why these [individuals], unlike others, often cannot remember their behaviors” (84, pg. 35).
Note: My speculation is that they do not actually have memory lapses in adulthood (as
individuals with DID do), but rather, that they remember experiences differently (i.e., they do
not remember their behaviors). Dr. Judd and Dr. McGlashan propose that “their behaviors are
activated by fear in response to an experience of maltreatment that triggers the original but
now generalized traumatic sensorimotor memories. Each state of mind represents a form of
mood state-dependent memory and cannot be retrieved when the person’s mood changes”
(84, pg. 35).
Dr. Meares goes on to explain that individuals with BPD have “multiple and shifting
states of personal [existence, each one correlating] with a particular form of relatedness (85,
pg. 186). “[The] disintegrated forms of relatedness. . . are essentially traumatic [and create] a
peculiar interpersonal effect [called] the expectational field (Meares, 2005, pp.114—125). This
field is produced by what Bowlby (1973) would have called an internal working model (IWM).
This term refers to the representation in memory of a particular relationship, which necessarily
includes the attributes given to both partners in the relationship and their roles in relation to
each other. When a particular IWM is triggered, the individual feels him- or herself to be in
relation to the other in accordance with the ‘script’ of the IWM (Meares, 1998). . . [However,
the] person is rarely aware of either the expectation or the role he or she plays in it” (85, pg.
183). “With the triggering of [a traumatic memory] system, whether by external events that
resemble certain kinds of its features or by internal associations, the relational configuration is
activated. The attributes of self and other given by the script [then] become present reality”
(85, pg. 9).“[One example of this] unconscious traumatic relatedness. . . [is the] effect of the
‘expectational field,’ in which the individual’s script-driven expectations of the other are often
fulfilled. . . A second kind of traumatic relatedness. . . [is when] the roles of the traumatic script
are switched and, in a ‘reversal’ (Meares, 1993a, pp. 87-100; 1993b, 2005, pp. 104-113), [the
individual with BPD takes on the role of their own] abusive father, as if inhabited by him.
Patients, in describing this experience, talk of being demonized, of having something alien, an
‘it,’ active within them” (85, pg. 9-11).
In 2003, Dr. Young and his colleagues developed a schema mode model of BPD. “In
Young’s view,[individuals with BPD]are characterized by various pathogenic schema modes.
They are assumed to suddenly flip from one mode into an-other, especially in reaction to
environmental changes caused by important events” (CITE). Schema modes can be thought of
as different personalities (although, of course, they are actually disintegrated and dissociated
parts of one personality, in technical terms). These different ‘personalities’ take over in order to
‘protect’a borderline whenever she is hurt or threatened in some way [or, perceives to be hurt
or threatened] (54).Individuals with BPD are characterized by the following five maladaptive
schema modes: (NOTE: GO TO THE ACTUAL RESEARCH LITERATURE TO ENSURE THAT THE
‘ABANDONED CHILD’ AND VC MODE ARE NOT IN FACT DIFFERENT MODES):

1. The Abandoned and Abused Child mode, which has a direct link with their abuse
history.
2. The Impulsive Child mode, which acts on non-core desires or impulses from moment to
moment in a selfish or uncontrolled manner to get his or her needs met, with little
regard to possible consequences for the self or others.
3. The Angry Child mode, which parallels the central place of excessive and misplaced
anger in the DSM-IV BPD criteria and the angry protect against perceived or past abuse.
4. The Punitive Parent mode, which originates from the harshly punishing and rejecting
family environment BPD patients often experienced.
5. The Detached Protector mode, which allows them to emotionally disconnect from the
negative emotions caused by the other dysfunctional modes.
 (Source: Schema Modes – “Lost in Fragmentation”)

“There isone more mode [that] must be discussed; this is the vulnerable child mode.
This is the mode that is being protected by the other, more destructive modes. The vulnerable
child is the inner child [of individuals with BPD] that was not nurtured or protected in
childhood” (109). In schema therapy, the vulnerable child mode plays a central role. This will be
discussed in a subsequent section.
In any case, “modes can be seen as different aspects of one’s personality. These
different parts of the self can cause a patient to feel fragmented in that some facets of identity
have not been fully integrated with the self. This does not imply that modes are entirely
separated; although modes can operate independently of each other, a person does have
access to several modes at a certain moment in time. Thus, they do not operate without
awareness of each other [and cannot be seen as completely separate entities from one
another] (Young et al., 2003)” (http://www.tijdschriftdepsycholoog.nl/assets/sites/6/Shedding-
light-on-schema-modes-a-clarification-of-the-mode-concept-and-its-current-research-
status.pdf).
The maladaptive child modes that characterize BPD “reflect a sort of regression into
intense emotional states experienced as a child,” (56) so when they are activated, individuals
with BPD can appear very child-like (in their styles of emotional expression, behaviors,
mannerisms, and even reasoning). The punitive parent mode represents the internalization and
copying of behaviors displayed towards them by their parents during childhood (56). In this
mode, individuals with BPD may bully or abuse others (mainly, their significant others and their
therapists). “Most of the time. . . BPD patients find themselves in the Detached Protector mode
[which I believe is what others describe as the ‘apparently normal’ personality], [which
provides] them with the opportunity to emotionally shut off from the negative emotions
caused by the other dysfunctional modes, and [gives] them a safe hiding place. Since patients
seem quite at ease in this mode, therapists often confuse this Detached Protector mode state
with the Healthy Adult mode, while in fact they are shutting off their emotions and avoid
dealing with them” (56).The detached protector is reflective of an overdeveloped coping
method, which was ‘created’ during childhood.
The video below shows what these maladaptive schema modes might look like in real
life (acted out by someone who, I assume, does not have BPD). Individuals with BPD, however,
can become much more reactive and intense (as, in the video he is calmly talking, but schema
modes are typically accompanied by intense
emotions):https://www.youtube.com/watch?v=Do6owMR1hSY.
I find it interesting that an individual with BPD states, “Friends, family and people who
have crossed my path along the way will have no idea to a certain extent that these different
identities exist within me or at different times in my life. The ones who remember are those
who I have split, those who got to meet the protective identity, the no empathy, unforgiving,
hateful identity—who has kept me alive in times of pure distress. These people have gone from
being idealized to then being devalued and thrown away” (CITE).
At times, BPD can actually resemble dissociative identity disorder (DID) (formerly known
as ‘multiple personality disorder’ [MPD]). Dr. Meares explains that “[individuals] with BPD may
switch between a condition or state when dissociative identity disorder could be diagnosed and
those states [when] the ‘alters’ are much less salient [and] dissociative identity disorder would
not be diagnosed” (85, pg. 152). Of course, the ‘alters’ in BPD are not truly alters (or alternative
identities), as is the case for DID. It is important to realize that even in the case of DID, most of
the people in an individual’s life will never even know that they have a disorder (or multiple
‘personalities’ [i.e., identity disturbance is much more subtle than most people would think—
although I do not watch TV, I heard that borderlines on TV even change physical appearance
during an ‘identity disturbance,’ but it does not work that way in real life]).
As was already mentioned, BPD is a result of secondary structural dissociation of the
personality, which leads to one ‘apparently normal personality’ with multiple dissociated
‘emotional personalities’ (EPs)(41, pg. 97). DID, on the other hand, is a result of tertiary
structural dissociation that leads to a personality dissociated into multiple ANPs as well as
multiple EPs (41, pg. 97). This concept is illustrated in the figure below, which has been
modified slightly (in terms of removing other diagnoses, which are irrelevant to this discussion)
from its original version in order to highlight this difference:

Image source: INSERT SOURCE

 There are, of course, many differences between BPD and DID (in fact, there are more
differences than similarities). Fragmentation in BPD “is nowhere near as dominating or as
persistent as in DID” (38). Individuals with DID can have as many as hundreds of distinct alters
(CITE) (although this is typically not the case). Furthermore, individuals with DID tend to have
complete amnesic barriers between their alters (i.e., no conscious awareness of their
existence,with no control over their emergence) (41, pg. 97;
https://www.taylorfrancis.com/books/9781135845834). Thus, individuals with DID usually have
long lapses in their memories(which is what usually brings them into therapy) in which they
cannot remember what they did andthat cannot be explained in any other ways (such as
normal forgetfulness) (CITE).Individuals with BPD have onlypartial amnesic barriers between
their different modes and tend to remember their experiences (albeit in distorted ways,
although they might not even realize this). The fragmentation in BPD can be disturbing for
those with BPD as it can affect their memories and association to other people, or separate
what is (INSERT QUOTE RE: dear to one ‘self’ from another [38]).
Approximately 30% of individuals with BPDreport hearing voices in their heads (85, pg.
136), which actually “stem from [the]dissociated parts of [their personality]” (CITE “Complex
Trauma… article).The voices may “[utter] the same or similar derogations, humiliations, [or]
abuse as [those of their] originalabuser [from childhood], often in the voice of the original
abuser)(85, pg. 136).The voices might“tell [them] how to act or think” (87, pg. 7)(85, pg. 136) or
manifest as a conversation in the individual’s head (CITE).Some individuals with BPD might feel
uncomfortable sharing information about hearing voices with their therapists or doctors (due
to an irrational fear that they will be looked down upon or unaccepted, which is not true).
Furthermore, individuals with BPD who hear voices and do share this information with doctors
who do not know much about BPD specifically sometimes (unfortunately) get misdiagnosed
with schizophrenia (which sounds strange to me because these two disorders are not similar—
even the characteristics of the voices that each one might hear are different [in this case
individuals with BPD should find different doctors or share with their doctors the information
about BPD and hearing voices]).
As had already been mentioned, as EPs individuals with BPD are, essentially, fixated on
‘re-enacting’ childhood traumas. In essence, the EPs’ unresolved traumatic experiences are re-
experienced or re-lived in present-day relationships as symptoms that are observable by others
(although, unless the others know about BPD [and possibly the individual’s history], the
connection to childhood trauma would not be apparent to them). As ANP, individuals with BPD
are “fixated in avoidance of traumatic memories and often of inner experience in general. [The
ANP is] mediated by action systems for functioning in daily life. . . [Although the] ANP’s
normality is only apparent, and manifests in negative symptoms of detachment, numbing, and
partial or, in some cases, complete amnesia for the traumatic experience. As ANP, EP’s
traumatic memories are experienced as ego-dystonic and intrusive symptoms such as voices,
disowned thoughts, feelings or sensations, or acts that do not belong to their own sense of self”
(99).
In a sense, individuals with BPD are ‘doomed if they do, doomed if they don’t,’ They are
‘doomed,’ or plagued, by symptoms that stem from unresolved childhood traumas and unmet
developmental needs. So what can they do? Do they try to ‘avoid’ the problems and live with
it? Or do they continue their cycle of ‘pain and abandonment’ by re-experiencing their trauma
in present-day relationships? Or, is there a better way? There is, but I will save the answer for
the end.
I found the following question posted online by an individual with BPD. Personally, I find
this heartbreaking—and it really makes me want to somehow help these individuals, as their
struggle is real:
https://www.reddit.com/r/BPD/comments/26we8k/anyone_figured_out_how_to_form_an_identity/

Criterion #4 (Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, reckless driving, binge eating)
“Impulsiveness, defined as unpremeditated action, characterizes the behaviors of BPD
patients when they are surprised by intense emotions such as anger or fear. Action follows
emotion without mediation through thought and language. These patients are often driven
toward an immediate behavioral solution because they cannot tolerate emotional intensity and
require immediate relief” (84, pg. 206). In other words,the potentiallyself-damaging impulsive
behavior in BPD is a means by which these individuals deal with difficult feelings and emotions
(i.e., it is one example of “behavioral solutions to intolerably painful emotions” (Linehan 1993b,
84) in BPD).

It is worth noting that not everybody who is impulsive is impulsive because of difficult
feelings or emotions (but the potentially self-damaging behavior associated with BPD is a
means by which individuals with BPD cope with difficult feelings, mediated through impulsivity
[at least this is the way I see it]). Similarly, not everyone who engages in potentially self-
damaging behavior does it to alleviate negative feelings (but this is often the reason why
individuals with BPD may engage in potentially self-damaging behavior). In essence, individuals
with BPD experience difficult emotions more frequently than others (and with greater
intensity), which means that they have a greater need for coping strategies that provide
‘immediate relief’ (despite how harmful it might be in the long run).

While some experts have proposed that impulsivity is one of the core features of BPD, it
seems (to me, at least) to be an ‘outcome’of other core features (such as emotional
dysregulation and disturbance in ‘self’ [or identity disturbance]) (at least in terms of the
potentially-damaging behavior associated with the impulsivity in BPD). Impulsivity is not
necessarily a bad thing on its own, but when paired with emotional dysregulation and identity
disturbance (as in BPD), it becomes harmful. Dr. Judd and Dr. McGlashan write, “Impulsitivity
originates from a probable genetic and biological vulnerability and an environmentally
mediated impaired ability to identify and modulate feeling states” (84, pg. 206). Since
impulsivity is not a main focus of this article, I will leave it at that.

Criterion #5 (Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.)

“Between 50 and 90% of individuals with BPD engage in [self-injurious behavior] [71,72].
By far the most common reason individuals with BPD give when asked why they engage in [self-
injurious behavior] is that it reduces feelings of negative affect and helps regulate their mood
[73]” (82).Self-harm is commonly inflicted by cutting, burning, or by intentional overdosing. It is
important to highlight the fact that many individuals with BPD do not self-mutilate. It is, of
course, a common feature of the disorder, but it is worth mentioning again that only five
diagnostic criteria must be met for a diagnosis (i.e., self-mutilation does not have to be one of
them). I believe that there are many individuals with BPD who are ‘forgotten’ (or go
‘unrecognized’), thus never getting the help that they need—simply because they distance
themselves from this diagnosis because they lack this ‘symptom,’ and because others do not
see their pain (as is often the case for those who do self-mutilate). The ones who self-mutilate
may represent more severe cases, but in either case, BPD is BPD (i.e., self mutilation is a
solution (to them) to their problem, which says a lot about the severity of this disorder).
In essence, self-mutilating behavior is another example of “behavioral solutions to
intolerably painful emotions” (Linehan 1993b, 84) in BPD). There is evidence that self-injurious
behavior “serves as a method of emotion regulation in BPD. [Similar to the potentially-
damaging behaviors listed in Criterion 4, self-mutilation is a ‘coping strategy’ that some
individuals with BPD utilize as a means for providing ‘immediate relief’ to their difficult and
intense emotions. ‘Immediate gratification,’ however, comes at the cost of long-term harm.
While the concept of utilizing self-mutilation (as a means to deal with negative emotions)
seems ‘unthinkable’to most people, it is a tribute to the intensity of the emotions experienced
by those with BPD (i.e., self-mutilation, to them, is a ‘reasonable’ strategy because their
emotions are that intense—it is important to realize that most individuals with BPD are as
smart [if not smarter] than most other people). However, these individuals likely havenot yet
realized that there is actually a ‘better way’ for them (i.e., therapy).

Unfortunately, as many as 80% of individuals with BPD attempt suicide at some point in
their lives, and up to 10% die by suicide (75).Dr. Judd and Dr. McGlashan write, “[In therapy, an
individual with BPD] often talks about suicide without fully realizing the impact it has on the
therapist. The patient is dissociated from her own emotions. . . During these times the patient
does not feel she is in a relationship with someone who cares about her. . . To address this
dissociation, the therapist must help the patient to experience the therapist in the room as a
caring concerned person who will feel terrible if the patient dies. Further, the therapist conveys
that the patient’s life is valuable and worth living. Through this interchange the therapist points
out the patient’s dissociation and supplies the missing emotion for the patient. The therapist
mirrors empathy the patient should be feeling toward herself. One way of accomplishing this is
for the therapist to ask the patient in the session to envision herself as a young child alone with
intolerable sadness and hurt and no one to comfort her. The patient usually can find it easier to
have empathy from a distance for herself as this small child” (84, pg. 204-205).

Criterion #6 (Affective [emotional] instabilitydue to a marked reactivity of mood)

The termaffect refers tothe expression of feelings and emotions (so affective instability
is another way of saying ‘emotional instability’).“Affective instability [is] a key aspect of
emotional dysregulation [in BPD]” (84, pg. 31). Dr. Linehan (and other experts) considered
emotional dysregulation the core symptom of BPD. However, other experts consider it a core
symptom but not the core symptom (secondary to a disturbance in ‘self’ [LOOK IT UP]. INSERT
INFO RE: 2-factor model (identity disturbance and emotional dysregulation).
The symptoms of affective instability become apparent in close relationship (especially
intimate relationships and relationships between individuals with BPD and their therapists).
However, individuals with BPD “often appear impervious to emotion [at other times]” (84, pg.
31) (or at least their emotions do not appear to be intense). Affective instabilityis related to
their emotional vulnerability (characterized by an unusual sensitivity to personally significant
emotional stimuli coupled with abnormally strong reactions to those stimuli with slower return
to baseline)” (84, pg. 31). In essence, they are sensitive to emotional stimuli (e.g., offensive
words) and experience their emotions with greater intensity and longer duration that most
people—which is because they were emotionally invalidated during childhood and thus, never
developed normal strategies for regulating their emotions (and developed maladaptive
strategies [such as emotional inhibition [or suppression] instead).
 Image Source: Healthyplace.com - BPD Quotes

“Emotions are designed from an evolutionary and developmental perspective to

organize and motivate behavior. Basic emotional responses and expressions, such as interest,
joy, sadness, anger, and fear, appear during infancy before the development of thought and
language. They appear to be preadapted to the environment and require no cognitive
construction for activation or expression (Izard 1989). For those with BPD, emotional
invalidation during childhood lead to a sort of arrest in their emotional development in this
stage of life. Thus, “[individuals with BPD] face adult situations [(i.e., relationships)] with a child’s
emotional repertoire” (84, pg. 30) “[and recover] slowly from an aroused emotional state, as do
young children” (84, pg. 30).
Because emotional development is arrested during childhood (in people who go on to
develop BPD), “the intense emotions [that they feel and/or exhibit as adults] often mimic those
experienced by children” (63).
Carpenter RW and his colleagues (2013) defined emotional dysregulation in BPD as
consisting of four components: emotion sensitivity, heightened and labile negative effect, a
deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies”
(82).The first component(emotional sensitivity) “[has] biological origins and [is] present from
early life. It consists of a heightened emotional reactivity to environmental stimuli, including
emotions of others. Emotion sensitivity in BPD has primarily been associated with negative
mood states (e.g., anger, fear, sadness).” Other studies suggest that individuals with BPD may
have a bias toward processing negatively-valanced stimuli and toward identifying negative
emotions in others (82).
The second component of emotional dysregulation is heightened and labile negative
effect (or experiencing high levels of negative affect), which“is theorized to be a direct
consequence of emotion sensitivity, which, as stated above, has been primarily demonstrated
to be specific to sensitivity toward negative mood states” (82). Dr. Mearesexplains that
individuals with BPD might “suffer [from] not one, but two or more, kinds of depression, each
having a characteristic affective state or mood” (85, pg. 204).
The third component of emotion dysregulation in this model is a deficit in appropriate
emotion regulation strategies. “As emotionally-sensitive children experiencing heightened
negative affect, [individuals with BPD] did not learn the necessary skills to regulate emotion”
(82). “The ability to identify what emotions one is experiencing is an important part of emotion
regulation” (82). Normative research in child development suggests that parents who often
discuss the cause and consequences of emotion and encourage emotional expression have
children who express higher levels of emotional understanding (Denham and Grout 1992;
Denham et al. 1994). We know that as children,[individuals with BPD] did not have this
experience. Instead, the parents of [children who develop BPD] rarely discuss emotions, often
discourage or punish emotional expression [(which is, essentially, emotional invalidation)], and
repeatedly misidentify emotional cues and acts toward the child based on this
misunderstanding” (84, pg. 33).

As adults, individuals with BPD have lower emotional awareness. Similar to emotional
awareness is the ability to distinguish among emotional states, called emotional granularity.
Those high in emotional granularity are able to reliably and accurately differentiate their
emotional states (e.g., distinguish sadness from anger). In contrast, those low in emotion
granularity (such as individuals with BPD) tend to describe emotional states in more global
terms (e.g., feeling good or feeling bad)” (82). Recent research findings “are consistent with
clinical observations that those with BPD have more difficulty identifying, differentiating, and
labeling emotions (especially if they are of the same valence)” (82). Since individuals with BPD
have difficulties with understanding what they are feeling, it is no wonder that it is difficult for
them to regulate these feelings.
In her memoir The Buddha and the Borderline, when Kiera first begins DBT group
therapy, she states, “We [people with BPD] have to understand what emotions are and
investigate the myths we’ve believed about them. We have to understand that some of our
core beliefs increase the intensity of our inner pain: beliefs that our inner experiences are evil
or meaningless or not worthy of being understood, that emotions are bad, that there are right
and wrong ways to feel. In my sessions with Ethan, I’ve discovered that I view all negative
emotions as enemies, and changing that perception isn’t easy” (pg. 104).
 The fourth and final component of emotion dysregulationis a surplus of maladaptive
emotion regulation strategies (or the behavior that may occur instead of appropriate emotion
regulation strategies). “There is a great deal of evidence that BPD individuals engage in
maladaptive regulation strategies in an attempt to reduce their negative affect. BPD has been
linked to maladaptive cognitive strategies such as rumination, thought suppression, [and
emotional inhibition/suppression [CITE}], which often increase, instead of decrease, negative
affect. Research also suggests that BPD is associated with experiential avoidance, defined as
behavior engaged in to escape an unwanted experience, such as negative affect [65, 66]” (82).

“Emotional sensitivity is not a problem in itself, in fact it has many benefits, such as
increased intensity of love, passion, empathy and connection. However, when a person does
not know how to take care of their sensitivity they may learn to dull the pain through escaping
or avoiding emotions” (62). In The Buddha and the Borderline, Kiera explains, “as everyone with
BPD knows, the charges so often leveled against us include being overly sensitive, overly
reactive, and emotionally intense and unpredictable” (CITE BUDDHA BOOK, pg. 23). She
explains that these are not pathologies, but biological vulnerabilities (i.e., they are not
symptoms to be cured but qualities that individuals with BPD have not learned to manage (pg.
23). As Patient X had told me, “just because I don’t show it, doesn’t mean that I don’t feel it.”
 Image Source: Healthyplace.com - BPD Quotes
Individuals with BPD “are often workaholics and can be successful in their careers,
particularly in environments that follow rigid rules (it fits in with their black and white method
of thinking). A demanding workload aids to distract from negative emotions” (16). While work is
not a ‘maladaptive’ strategy for dealing with emotions on its own, some individuals with BPD
can actually ‘overwork’ themselves (which Dr. Masterson explains is another way that someone
with BPD might ‘abuse’ themselves [CITE]). Furthermore, work, for them, might be a substitute
for avoidance, which is a maladaptive emotion regulation strategy. Interestingly, an individual
online states, “A borderline may get caught up in a busy workaholic schedule and thus passively
neglect the important emotional work necessary for recovering the real self” (9).

Criterion #7 (Chronic feelings of emptiness)

Dr. Judd and Dr. McGlashan write, “It is difficult to describe “emptiness,” but we liken it
to a feeling of the presence of absence. It is accompanied by an awareness that something is
missing. We speculate at these times [an individual with BPD] feels disconnected from
significant others and that this state is experienced as numbness” (84, pg. 31).

Although I did not research this criterion extensively, I speculate that it is related to
what Dr. Masterson describes as a lack of ‘real self,’ as well as ‘intolerance of aloneness.’When
mentally healthy individuals are alone, in a sense,they feel as if they are with someone else
(i.e., they are with themselves). Furthermore, I once read a book by a psychologist who said
that a mentally healthy individual’s ‘inner voice’ should, in a sense, feel like a companion who is
always with them (i.e., a mentally healthy individual typically does not mind being alone—
although they enjoy others company as well. My speculation is that individuals with BPD need
others in order to fill the emptiness inside (which in mentally healthy individuals is filled with a
core ‘real self’ that isalways present and remains the same from one moment to the next—an
inner companion who an individual can always count on to be there).

Criterion #8(Inappropriate, intense anger or difficulty controlling anger (e.g. frequent

displays of temper, constant anger, recurrent physical fights)
Individuals with BPDhave particular difficulties with modulating their own anger. Anger
itself is not a bad thing (at least for mentally healthy individuals [or individuals with BPD who
learn to modulate their anger in therapy]). “[Normally,] anger functions to alert us to frustrating
events or obstacles blocking goal-oriented behavior. Anger also triggers assertive thought and
energizes action to ameliorate frustration (Cicchetti et al. 1995)” (84, pg. 31). Dr. Masterson
explains that "contemporary life is filled with plenty of frustrations that breed justifiable anger
and resentment. In fact, not to be angry at something in today’s society would seem a bit
strange. This brand of anger is quite normal; and with a little reflection, the specific causes are
soon discovered. . . [Mentally healthy adults] can recognize these and control the angry
response in those situations where it would not be appropriate to indulge it” (86, pg. 65).

Individuals with BPD, however, can experience anger that becomes so intense that they
cannot control it (which typically only occurs in interpersonal relationships). The anger in BPD is
sometimes referred to as ‘borderline rage’ because of its intensity.Of course, individuals with
BPD can become angry without losing control, but their anger can build to the point that they
become ‘afraid of what they might do’ (CITE).It is worth mentioning that individuals with BPD
actuallyare afraid of what they might do (they typically do not share this information with
others—meaning that most peoplein that individual’s life wouldnever even know this about
them). Someone with BPD would typically leave (or avoid) a situation before reaching the point
of ‘losing control’ (knowing that they actually can).

A mentally healthy individual never actually loses control (despite how angry they
become—and despite what they actually do as a result of that anger [if they do anything]). A
mentally healthy individual is also never actually afraid of what they might do (because they
know that they are always in control, despite what they might say to others). Sometimes
people who are mentally healthy say things such as “I’m afraid of what I might do to you” to
someone as a joke or an empty threat (knowing that they themselves are mentally healthy and
cannot reach the point of losing control), but individuals with BPD actually feel that way (and
typically do not say this information with others). It is worth considering the fact that such
statements can be misinterpreted (especially by those with BPD, who may assume that others
feel like them and thus, take the message more seriously than it was intended]) and that such
statements should be avoided (although individuals with BPD should have a serious
conversation about how they feel with their partners or therapists).
 Individuals with BPD are sometimes confused by their own anger(e.g., they might refer
to their own anger as ‘something inside of me that I cannot control). This is related to their
difficulties with identifying and labeling their own emotions (which is, in a sense, the first step
in learning to modulate and control their own emotions [which individuals with BPD can do in
therapy]). Interestingly, it is not as easy as it seems for an individual with BPD to learn how to
actually regulate their anger in therapy (i.e., it can take them some time, as they did not learn
this skill naturally during childhood like most people did).

“[An individual with BPD] may be high functioning, efficient, and display socially
acceptable conduct most of the time, [but] the inevitable outbreak of a regressed or childlike
state of helpless anger—observed clinically by Knight (1953) and, later, Kernberg, (1975) --
devastates interpersonal interactions (Clarkin, Yeomans, &Kernberg, 2006; Gabbard, 2001,
2005; Grinker et al., 1968)” (3). “At times, inappropriate anger can escalate into physical
confrontations, explosive rages, and violence” (3).

Furthermore, Dr. Judd and Dr. McGlashan explain that “[individuals with BPD] usually
become dissociated in response to rage and enact their feelings in a seemingly detached and
calculated fashion [(which is not referring to the aforementioned type of anger[or rage], in
which individuals with BPD ‘lose control’)]. The plan to hurt and avenge the perceived
perpetrator of injustice falls along a continuum from malicious mischief to lawsuits to murder
[(in the most extreme of cases)]. . . The person to be harmed represents the original abuser
[from childhood]. The patient acts as a means to gain mastery over intolerable feelings of
helplessness and to right the perceived wrong” (84, pg. 216).

Criterion #9 (Transient, stress-related paranoid ideation or severe dissociative symptoms)

“Dissociation has been traditionally understood as a defensive coping strategy that
protects one from the overwhelming emotion and intolerable information induced by traumatic
events. . . [As was explained in the section on identity disturbance, the personality of an
individual with BPD is disintegrated into an ‘apparently normal (part of their) personality’ (ANP)
and multiple ‘emotional (parts of their) personality’ (EPs) as a result of secondary structural
dissociationin response to childhood trauma.]The clinical description of dissociation refers to
disruptions in the normal integration of memories, perception, and identity associated with
trauma (American Psychiatric Association 1994). Dissociation can also be understood as a
failure of information processing (Bower and Sivers 1998), possibly related to release of large
quantities of stress hormones and neurotransmitters during traumatic or highly emotionally
arousing situations. This would lead to high levels of activation of the sympathetic nervous
system that could interfere with the processing of information” (84, pg. 17).
 As adults, individuals with BPD experience a variety of dissociative symptoms that are
transient and stress-related. The definition of the term dissociation is actually not well defined
or agreed upon, so I will simply summarize the pathological dissociative symptoms that are
commonly associated with BPD:
 Identity alteration: INSERT DEFINITION
 Amnesia: “The loss of memory for aspects of personal history [(which cannot be
explained by normal forgetfulness)]” (84, pg. 161).
 Depersonalization: The perception of being detached or disconnected from one’s own
body, feelings, or mental activities” (84, pg. 161)(Roth, 2004, p. 247) (85, pg. 132).
INSERT INFO RE: limb
o Out-of-body experience (OBE): An extreme form of depersonalization in which
an individual experiences themselves as floating out of their body, which they
watch, typically from above. OBE is commonly reported by sufferers of sexual
abuse (85, pg. 132). It can be understood as a disintegration of the bodily basis of
self (85, pg. 133).
 Derealization: INSERT DEFINITION
 Flashbacks: Another form of dissociation in which (INSERT DEFINITION). Flashbacks may
occur to terrifying experiences from early childhood” (87, pg. 22).
 Absorption: “Becoming so engrossed in an activity that one is completely unaware of
their surroundings” (84, pg. 161).

When stressed, individuals with BPD can also become paranoid or develop other brief
psychotic states (84, pg. xi).“Paranoid ideas are conceived as the manifestation of a reactivation
of the traumatic memory system, which involves ‘malignant internalization’ (Meares, 1999b).
Certain figures in the social environment are experienced as the original traumatizer. Paranoid
ideation is accompanied bya paranoid stance that is determined by the expectation of the
damaged individual that he or she will be harmed once again” (85, pg. 286).

“Patient X’s Negative Narrative” (Distortion Campaign)

My relationship with Patient X ended ina series of peculiar eventsthat I refer
to,collectively, as “Patient X’s negative narrative,” (or ‘distortion campaign’).During
her“negative narrative,”Patient X re-experienced or re-enacted several of her childhood
traumas in the context of our relationship(although she may not be consciously aware of this).
In essence, unresolvedtraumatic experiencesfrom her past were superimposed on
eventsoccurring inthe (then) present and re-lived in real life (which commonly occurs in
BPD).While it is unquestionablethat she re-experienced some of her past (childhood) traumas, I
propose that the events are actually related to one another in such a way that they form a
complete representation of a series of events from her childhood, with a happier overall ending
(as will be explained).Many experts do believe that‘repetition compulsions,’ or the
psychological phenomena in which a person repeats traumatic experiences from their past, are
the brain’s attempts at resolving these experiences (or, in a sense, attempts to create happier
endings for the trauma) (theactual efficacy ofwhich will be touched upon later). My particular
hypothesis that the events that comprise “Patient X’s negative narrative” represent a complete
series of traumatic experiences from Patient X’s childhood, all culminating in one overall
happier ending (than what actually occurred in her childhood), could, of course, be wrong.
[Disclaimer: Individuals who are not familiar with BPD might find this section strange. My
intention was to write this section in a slightly lighter tone (with some comedic aspects),
although the events are described accurately]
To begin, I should mention that Patient X and I argued frequentlythroughout the course
of our three-year-long relationship, but our arguments became more frequent as time went on.
During this time,I did not know much, if anything, about BPD. However, I began noticing that
Patient X seemed toforget (or simply ignore) what we would talk about while on good terms(in
terms of how we would handle future conflicts) every time that we would argue. Then, she
behaved in ways that she knew would either maintain or escalate conflict(almost as if doing it
on purpose).One day, I decided to ask her about it.
I began by askingher whether she actually enjoys arguing (since her behavior made it
appear that way). She replied with aconfident and seemingly sincere, “No.” Assuming that she
was telling me the truth, Iasked her why, then, does she behave in ways that she knows will
either maintain or escalate conflictevery time that we argue (and almost never works towards
resolving conflict). She looked atmein a very innocent, “child-like”manner,and told me, “I don’t
know.” It was at this moment that it first occurred to me that she might actually not remember
her own behavior during the course of arguments (or that she remembers it in a somewhat
distorted manner). Furthermore, it struck me that her reasoning (as well as her behavioral
mannerisms) during this conversation resembled that of a young child.In fact, her facial
expression andmannerismsresembled what is depicted in the image below (although, of course,
she was an adult):
 After researching BPD extensively, I learned that my initial presumption (that Patient X
might actually not remember[or remember in a distorted way] her own behavior during the
course of conflict)is a feasible explanation.Patricia Judd, Ph.D. and Thomas McGlashan, M.D.
explain,“[Wheneveran individual with BPD feels that they were mistreated, they begin to feel]
helpless, demoralized, and victimized. These feelings [then] activate [their] generalized early
experiences of mistreatment and how [they] learned to respond. The anger and outrage that
ensue can trigger a mode of relating characterized by bullying and intimidation. . . [Once the
individual gets what they want by coercion and feels] secure, this mode of relating disappears
and cannot be recalled. Thus, when confronted with her or his behavior, [the individual with
BPD] does not accept responsibility for the behavior or explains it as a necessary response to
the situation” (84, pg. 35).

Dr. Judd and Dr. McGlashan further explain thatindividuals with BPDare “dimly, if at all,
conscious of [their] dramatic shifts in states of mind, which areso obvious but puzzling to others
[(in the context of relationships)](84, pg. 35).They explain that individuals with BPD, “unlike
others, often cannot remember their behaviors [(i.e., they cannot remember their behaviors
which occur during dramatic shifts in states of mind, such as those during conflict)]” (84, pg.
35). Dr. Judd and Dr. McGlashan propose that “each state of mind represents a form of mood
state-dependent memory and cannot be retrieved when the person’s mood changes” (84, pg.
35) (although, I assume, that individuals with BPD do not have lapses [or at least do not have
many lapses] in their memoriesrelated to these events [for several reasons that I will not get
into]). This would explain why Patient X seemed to forget what we talked about while on good
terms (i.e., while she was calm) every time that we would argue (i.e., when she would have a
dramatic shift in state of mind and state-dependent memory), as well as why she could not give
me feedback on her own behavior during the course of arguments (which was sometimes
violent and aggressive) when we would talk about the arguments (i.e., when she was calm and
in a different state of mind with a different state dependent memory).
[Note: It is important to point out, for those who might be less aware, that these dramatic shifts
in state of mind do not occur when an individual does not have BPD [or certain other mental
illnesses], even when an individual uses drugs, especially stimulants]

Patient X and I then promised to each other that we would never again break each
other’s possessionswhenever we argue.However, within the next few days we got into an
argument (probably because I said something that she did not like) in which she got angry and
purposely knocked something of mine off my desk,thus breaking it. I got angry at her for
breaking her promise (as well as breaking my stuff) and I got up to confront herabout it (i.e., to
express my frustration to her).I had a red pen in my hand at the time(sinceI was gradingpapers
at the time [I believe]), and as immature and wrong of me as it was, I attempted to ‘get
revenge’ by leaving a pen mark on her jacket (which I was unable to do).Skipping the irrelevant
details, we ended up on the floor (and no, no one hit each other), where I continued my
attempt to leave a pen mark on her jacket (and again, I was unable to do it). She ended up
grabbing the pen out of my hand, slamming it against the floor(thus breaking it), and then
stabbing me in the chest with it (although it only ended up scratching me, which can be seen in
the photo below). At this point I could see that Patient X wasvery upset,and so I got up and told
her to leave, which she did (I had already learned that attempting to console her would have
only made things worse).The relatively more peculiar part (at least for me), however, came
next.

Photo original date: February 26, 2017

I forgave Patient X for breaking her promise, breaking my stuff, and for stabbing me in
the chest with the pen, and so I went to her job during the next couple of days in order to make
up with her.We ended up talking and getting back on good terms, although sheended up
passively telling me that the reason why she was upset with me was becauseI was trying to stab
her with a knife (referring back to the incident with the pen). I found this a bit strange (since I
did no such thing), but I figured it was no big deal (since I did not think that she actually
believed it herself).
After about a week she brought up the knife again(i.e., she told me that the reason why
she was upset with me during the past week was because I was trying to stab her with a knife
[again referring back to the same incident with the pen]). I asked her if she actually believes
that I was trying to stab her with a knife, and she said that she does. I figured that she was
simply using it as an excuse for having been distant from me during the past week, so I did not
think to question her about it any further. I simply told her that no such thing happened and
left it at that.
At some point later,she ended up bringing it up again(although this time she said that I
was‘threatening [her] with a knife’rather than ‘trying to stab [her]’ with it). It only occurred to
me much later that she must have really seen me trying to stab her with a knife (when I was
actually trying to leave a pen mark on her jacket with the pen) as a result of a visual
hallucination (which is a stress-related, transient psychotic symptomin BPD [which occur in20 –
50% of cases of BPD [100]]).
Because “childhood trauma may play a role in the development of hallucinations in
BPD” (100), and because“BPD [(although not every case of BPD)] is a function ofhaving been
chronically terrified during one’s early development. . . [with] the superimposition of childhood
terror upon adult situations ” (51), it is reasonable to suspect that her visual hallucination was
not only a visual hallucination but a‘reliving’ of an event from her childhood (i.e., it is possible,
although not necessary, that someone threatened Patient X with a knife during her
childhood).It would be helpful for Patient X to bring thisup in therapyin order to explore the
possibility further (as traumatic memories can be repressed from conscious awareness, which
typically maintains an individual’s symptoms [although this is not the only way that traumatic
memories can lead to symptoms]).
Approximately a month later, Patient X and I went to Mexico for her sister’s wedding,
which was when I first met her dad. Interestingly, he had a knife on him (which he seems to
carry on him regularly). Jokingly,hetold me something along the lines of, “If you ever do
anything to my daughter…,” as he brandished his knife [WARNING: FOR THOSE WHO WOULD
PREFER TO NOT KNOW MY OPINION, PLEASE SKIP THE FOLLOWING THREE LINES OF TEXT]:
(which, from my perspective, was acoward of a manpretending to protect his daughter when in
reality, his own abusive and violent behavior towards his daughter [and towards her mother]
during childhood contributed to the development of her serious mental illness).
Prior to leaving Mexico, Patient X told me that when I would curse at her [i.e., use profanity
towards her],it would“bring up memories” (i.e., intrusive recalls or flashbacks, depending on
how she experienced them)of her father beating her mother in front of her (as she watched)
when she was a child. She told me that he used to yell and curse at her whilebeating her (which
is why my cursing, which was thecommon stimulus between the past and present, brought up
these memories and triggered her other symptoms [which she is less likely to be aware of]).
When we got back from Mexico is when I first started noticing something “out of the
ordinary” about Patient X.Withoutgetting into details, I will simply say that it started out slowly,
came without warning, and that I did not think much of it at first—butsomething about Patient
Xwas not quite right…

I found out much later (from Patient X) that what she did around this time was that she
secretly “put me on [her] list of people who hurt [her]” (which seems to me to be a sort of
‘permanent devaluation’ [which is not actually permanent but seems to be different from the
splitting that she utilized throughout our relationship [unless she put me on her list many times
before without me knowing about it]). “At the exact moment of devaluation, people with
borderline personality disorder may start planning and implementing their exit strategy from
the relationship (since they now hate/dislike the other person). This can take the form of an
unconscious distortion campaign that creates a false and negative narrative regarding the
former loved one, justifying any actions the person with BPD takes. Typically, the distortion
campaign involves a lot of rationalization as well as the elaborate manipulation and
gaslighting of the former loved one” (CITE). (It is important to note that the manipulative
behavior [from the perspective of the non-borderline individual] and the “gaslighting”
mentioned above are not intentional on the part of the individual with BPD (but rather, these
are outcomes of their symptoms, as will become more apparent later in this section).
While this next event is rather trivial, I will briefly describe it since helps demonstrate a
point. On a late morning (or early afternoon) after returning from Mexico, I went to Patient X’s
house so we could talk.I parked my car next to a curb near her house and she came out to talk
to me. She stood outside (by my passenger-side door) as we began talking. She was calm and
appeared completely normal at first.Then, however, I must have said something that she did
not like—asshe suddenly reached through the passenger-side windowof my car and attempted
to grabsomething out of my hands(I believe it was money). Startled by her response, I dropped
whatever I was holding on the floor and banged my knee on the steering wheel. After picking it
up off the floor, I looked up at Patient X. She was standing outside of my car (still next to my
passenger-side window) and staring back at me with a sinister smile on her face. I found it odd,
to say the least (as she appeared as though she wanted to destroy me). It was almost as if a sort
of ‘demonic’ influence came over her for an instant. In fact, her facial expression was similar to
what is depicted in the image below (except, of course, she wasnot a red cartoon):

Interestingly, a similar facial expression is described in the paragraphs below (which are
in reference to women with BPD):
“In the midst of mending from these intoxicating but dangerous relationships, hundreds
of men have described a terrifying ‘demonic’ influence that appears to inhabit their beloved
when she's confronted with her lying, manipulations and betrayals—or some sort of (minor)
infraction on their part has catalyzed the most horrifying change in her facial expression. Many
have reported,‘it's like sparks flew out of her eyes,’ or ‘there's such a cold and hideous mask’
that showed up, they couldn't recognize the woman they've loved so deeply. If looks could kill,
they believe they'd be dead after one of these episodes!(continued below…)
But how does this facet of "pure evil" manifest in somebody we've felt so close and
loving with, just minutes or hours earlier? Would they recognize themselves, if we held up a
mirror when this vile darkness descends on them? Might they see the distorted face of their
rageful/punitive parent, instead of their own?Could it be that's what you have seen in them?”
(39).
This was a trivial example of the emergence of Patient X’sschema mode in which she
would bully, abuse, criticize, and degrade me (and appeared to enjoy it most of the time). At
first, I thought that this is called the‘punitive parent’ schema mode (although it may be a
different mode instead [I am not an expert in schema therapy so I will simply call it Patient X’s
‘bullying’ mode). In any case, this mode began to appear more often after Patient X had put me
on her list of people who hurt her. Dr. Judd and Dr. McGlashandescribe a similar phenomenon, “[a]
patient [with BPD] in a bullying and coercive state of mind often surprises the therapist. It is difficult to
extend understanding of the immaturity of the BPD patients when they appear otherwise of reasonable
intelligence and competence” (84, pg. 190).This

Another morning Patient X told me that I could borrow her laptop for school (which I
had let her do for months at a time when she did not have a laptop). Then, however, she must
have been offended by something that I said because she ended up leaving my house without
giving me her laptop. Since I needed to use it and she already said that I could, I had to go to
her house in order to get it—butI was met by her in her‘bullying’ mode, in which she seemed to
get a rise out of seeing me suffer. I was there for serious business (to get her laptop and go to
the lab that I worked in while in school, still assuming that the relationship that I was in was a
serious one), but shecame out of her house and threatenedto spray me with pepper spray (or
mace). She seemed to enjoy chasing me around with a stream of spray as I attempted to avoid
it (which I managed to do successfully). She had a sinister smile on her face as she abused me,
as she often did in her ‘bullying’ mode.
To begin making connections between the events that comprise Patient X’s‘negative
narrative,’ I should point out the distinct ‘roles’ that she played in the events thus far. During
the “knife” incident (which was, in a sense, ‘created’ in her ownhead [as there was no knife in
realityin the first place, and I did not threaten her as another individual with BPD
suggested]),she played the role of herself as a child (i.e., the abused child, which is a schema
she developed during childhood as a result of her father’s violent and abusive behavior towards
her).I believe that this is called the ‘abused child’ schema mode (although I could be wrong
about the terminology, as I am not an expert in schema therapy). In this mode her form of
relatedness (in relation to me) was that of one abused (and I was, therefore, the ‘abuser’
[although not in reality]). This ‘role’ represents the suffering (andprobably fear for her safety
and/or life) she had experienced in her childhood (as a result of, at the minimum, her father).
The “knife” incident (which was a significant event that seemed to ‘snowball’ into the other
events) marked the beginning of what I describe as “Patient X’s negative narrative.”
Next, while we were in Mexico, she told me about hermemories (which she may have
experienced as intrusive recalls or flashbacks) of her father beating her mother in front of her
during childhood. In a way, this can be considered the ‘re-experiencing’ of her father’s violent
and abusive behavior towards her mother? (or stepmother?) during childhood. This represents
the sadness, torment, fear, and concern she felt in her childhood, again as a result of her father.
Next, Patient X ‘permanently devalued’ me (by putting me on her list of people who
hurt her). This is an overly-developed [and in adulthood, maladaptive] coping strategy, which
Patient X probably relied on in her painful and abusive childhood. I believe that this is a
manifestation of ‘splitting,’ which children who are abused by caretaker(s) rely on in order to be
able to continue relating to their parents as providers of needed support even though they
abuse them (and it manifests later life as a symptom of their mental illness). Patient X probably
put her father on her ‘list of people who hurt her’ (but I could be wrong]) during her childhood
as a result of his abuse towards Patient X and her mother.
My observation was that once Patient Xhad put me on her ‘list of people who hurt her’
(i.e., ‘permanently devalued’ me), she began to exhibit more frequent (and more salient)
manifestations of her ‘bullying’ mode. In “Patient X’s negative narrative,” the point at which she
put me on her list represents the transition from being abused [although not in really, but the
way that she probably perceives it] to becoming the abuser [actually in reality, which she could
not become during childhood since shewas too young).(INSERT QUOTE FROM DR. MEARES RE:
TRAUMATIC SCRIPT REVERSAL). At this point, as I mentioned earlier, it appeared as though she
wanted to ‘destroy’ (or get revenge on me by bullying and abusing me).Dr. Judd and Dr.
McGlashan explain that, “the person to be harmed represents the original abuser [from
childhood [although in a subconscious way so that Patient X would not be aware of it]]. The
[individual with BPD] acts as a means to gain mastery over intolerable feelings of helplessness
and to right the perceived wrong” (84, pg. 216). In a sense, one can think of it as Patient X
getting revenge on her father for abusing her during childhood by ‘becoming’ her father and
getting revenge on me(by abusing and bullying me).
The next event in Patient X’s ‘negative narrative’ demonstrates one example of how an
individual with BPD can manipulate their partneras a means to getting revenge on them. On
this day Patient X and I were sitting in my car, parked outside of her house. She brought me a
plate of food that I began eating as we talked. I must have said something to offend her (note:
she was constantly offending me as well, but I did not react to her words as she did to mine
[which I realize now is not necessarily her fault, as her extreme reactions were, in large, due to
her mental illness), which lead her to push the plate of food into my face. This was, in a sense, a
provocation (which may be a manifestation of projective identification).Dr. Moskovitz explains
that individuals with BPD can “have powerful effects on other people’s feelings and behavior.
[Their] tumultuous emotions and dramatic, often provocative behaviors are sure to elicit strong
reactions in others. [Their] environment often becomes a theater for playing out inner
conflicts” (87, pg. INSERT PAGE). I got angry at her for pushing the plate of food into my face
and, as immature and wrong of me as it was (and knowing that it could not physically hurt her),
I threw the (paper) plate of food at her, creating a big mess. Then she got out of my car, walked
over to her own car, and got in the back seat (where she stayed for up to a minute while I could
not see what she was doing). At the time I thought that she was going to get her baseball bat
(which may have been herintention until she thought of a better plan for revenge [unless this
was her plan the entire time], which I will explain).
 Dr. Judd and Dr. McGlashan explain that “[individuals with BPD] usually become
dissociated in response to rage and enact their feelings in a seemingly detached and calculated
fashion. The plan to hurt and avenge the perceived perpetrator of injustice falls along a
continuum from malicious mischief to lawsuits to murder” (84, pg. 216). In a sense, Patient X
took her usual means of revenge (malicious mischief [as with her baseball bat]) up a notch [not
necessarily a lawsuit, but a somewhat similar concept]).She stayed in the back seat of her car
for up to a minute, while I waited to see what she was doing. Once she got out, she ended up
walking towards me (without a bat, which made me think that things were going to be okay),
but then she ended up charging into my car and aggressively slapping me in the face multiple
times as I put my arms up in front of my face to block her. She then grabbed my hair and began
pulling it as she got out of my car, causing me to grab onto her shirt (in order to minimize the
tension in my hair).
When she let go, she said, “look what you did to my lip” (which was bloody). Since I
know that I did not punch or hit her, I suppose it might be possible that I accidently elbowed
her in the face while putting my arms up to protect myself from her violent attack on me, but
what I think happened was that she gave herself a bloody lip in the back seat of her car in order
to get revenge (which she had already learned how to do from before). When some individuals
with BPD are dissociated, they cut themselves with knives and razor blades in order to alleviate
their difficult feelings (so it is reasonable to believe that Patient X could [and would][and
probably did] give herself a bloody lip in order to get revenge on me). In that case she probably
charged at me and slapped me repeatedly in order to ‘cover up’ for giving herself a bloody lip
and making it appear as though I did it.
She then got revenge on me by calling the police and claiming that I punched her in the
face. I was looking into her eyes as she was talking to the police operator and I literally thought
that she was pretending to be (or acting) ‘crazy’ (as she had a strange, blank and ‘disconnected’
look in her eyes while she was talking on the phone to the police operator). Later, I learned that
she was not acting crazy but that she was dissociated (during the phone call and the incident
just prior to it). The fact that she was dissociated is evident in the fact that she later changed
her story (claiming in court that I elbowed her, probably because she does not
actuallyremember what happened [because she was in a different dissociated state of mind at
the time, with a partial amnesic barrier preventing her from remembering it clearly [although
she used what I told her in an email [that I elbowed her] to, in a sense, ‘fill in’ her own memory
of the experience], whereas I am not sure exactly how she got a bloody lip because I know that
I did not do it on purpose and I remember everything that happened clearly.
Interestingly, Dr. Moskovitz (in describing women with BPD) writes, “She is director of
the piece. When she casts you as a villain, you may feel and even act villainous” (87, pg. 152).
Since she was calling the cops on me (for something that I did not really do [i.e., she was
‘directing’ her negative narrative [or distortion campaign]), I decided to leave the scene and
started driving away (i.e., acting villainous because she was ‘casting’ me as a ‘villain’). I was
stopped by the police and arrested (which can be thought of a me feeling villainous).
I ended up forgiving her again, thinking that things would go back to being normal (as
she still had not yet told me that she put me on her list of people who hurt her). Patient X acted
in very contradictory ways during this period of time. She would ‘get revenge’ on me, but then
go back to being her usual self. At other times she would confide in me. While it may be
tempting to believe that she was going back to her usual self (and confiding in me) as a means
to get more revenge on me, I do not believe that she was doing that on purpose (although this
is a complex discussion, so I will not get into it).
One of the days she met up with me at a bar and told me that somebody in her
childhood taught her that “displaying [her] emotions is a sign of weakness” (i.e., they
emotionally invalidated her). She told me that she began hiding her emotions so as not to
appear weak. Since I did not know much, if anything, about BPD at the time, I did not realize
how significant this was and therefore did not have much to say about it. During this
conversation, Patient X was her ‘normal’ self (and not re-experiencing, but simply
remembering, her own troubled childhood). I believe that this represents the ‘apparently
normal(part of her) personality’ (which she lives the majority of her life through). This fits into
her ‘negative narrative’ in the sense that her childhood experiences, which she shared with me
verbally when we were on good terms, were heavily on her mind at the time.(Note that the
‘dramatic shifts in state of mind that are so obvious but puzzling to others’ [as described in a
previous section] represent her dissociated parts of her personality [or ‘emotional (parts of her)
personality,’ in which she “re-experiences” her childhood traumas [in a complex way and
outside of her conscious awareness [as she almost certainly experiences it simply as strong
emotions]. The connection to childhood trauma is very evident in the fact that—[I will not get
into it here])
Dr. Masterson writes, “[When an individual with BPD is in therapy (whichPatient X was
not)], the more depressed [they get, the angrier they become], and eventually the real seeds of
the anger are uncovered: incidents in the first years of life when the real self [(which I will
explain later)] was trying to emerge and failed to do so” (86, pg. 64).Patient X was obviously not
in therapy, but she seemed to go through a similar sequence during the course of her ‘negative
narrative.’ When, at first, she visualized me trying to stab her with a knife, she began to
distance herself from me and appeared to become more and more depressed. When she put
me on her list of people who hurt her, she transitioned into anger as she began to seek revenge
on me. What happened next is quite interesting from my perspective (and is not
inconsequential). The real seeds of the anger were uncovered: incidents in the first years of life
when the real self was trying to emerge and failed to do so (which I will explain next).
 Patient X met up with me at the same bar as before on another occasion (since she no
longer wanted to meet me at my house). On this day I was a bit angry at her for the way that
she had been treating me recently, so I kept a bit on a distance from her and did not talk much.
When we went to smoke a cigarette outside on this gloomy evening, she spontaneously began
to tell me about the day when her mother left. Because this will help me demonstrate a point in
this section (as well as the following section), I will share her story here again:
On the day that her mother left, Patient X did not want to let her mother see her crying
(so she kept it all inside). She kept it all inside as everyone was saying their goodbyes and
getting ready to escort her mother to the car that was taking her away. First, her mother went
to Patient X’s sister so she could give her a hug and say goodbye. Her sister was crying, but
Patient X kept it all inside. Next, her mother went to give Patient X a hug and tell her goodbye.
She asked her why she was not crying, but Patient X kept it all inside. She kept it inside even as
she watched her mother get into the car that was taking her away. She kept it all inside as she
watched the car drive off and everyone was waving her away. She kept it inside all the way to
the exact point when she could no longer see her mother’s car in the distance, and then she ran
to where she could be all alone and hid where nobody would be able to see her, and then she
let it all out. She cried.
After telling me her story, Patient X said, “She [(meaning her mother)] thought that [not
crying] meant that I didn’t care as much.But just because I don’t show it, doesn’t mean that I
don’t feel it.” And as she said this, it was as if she was that part of herself that remained a
young child who isupset about her mother leaving her and confused as to why she did not
understand that Patient X really does care (even though she does not show it). At the time I did
not know what this meant or why she told me this story at such a seemingly peculiar time, so I
had nothing to say to her in response.
It is significant that Patient X did not cry in front of her mother(i.e., Patient X inhibited,
or suppressed, her emotions).A.J. Mahari (who suffered from BPD and recovered after years of
therapy) claims that “the core wound of abandonment arrests the emotional development of a
young child” (CITE). She also claims that “the core wound of abandonment [(or the loss of the
primary relationship [the relationships between a child and their primary caretaker, which is,
more often than not, their mother], which form(ed/s) the basis of coping, the development of
relationships, and the formation of personality)] leads directly to the loss of self – a loss of
authentic self that creates the false self organization of Borderline Personality Disorder” (CITE).
Since children perceive things differently than adults (i.e., children are their emotions [CITE]),
the loss of the primary relationship can be highlytraumatizing to a child. A.J. Mahariexplains,
“[The] intolerable nature of this pain leaves the very young child traumatized by his/her
primary relationship, experiencing the creation of a protective false self” ().It is worth noting
that individuals with BPD, as ANP, are actually disconnected from their own emotions (and do
not experience the emotions that generate links between interpersonal events and models of
attachment [84, pg. 195]). As mentioned previously, some individuals with BPD consider their
ANP a ‘false self,’ while they consider their EPs their true, or real self (which is how I think
Patient X thinks about it [but this is problematic for reasons that will become apparent later]).
What happened next (in Patient X’s “negative narrative”) is quite interesting.A.J. Mahari
explains that individuals with BPD unconsciously ‘doom a relationship to failure,’ as they cast
the other person into the role of their original primary caregiver (which is typically the mother),
and re-enact (or re-live) their core wound of abandonment (and the feelings of depression and
helplessness that accompanied the loss of their primary relationship) (1). I realized later that
Patient X (subconsciously) ‘doomed our relationship to failure’ and then told me that I was the
one who kept “pushing [her] away” (when in reality she was the one who was pushing me
away). She began acting helpless in preventing our relationship from ending (it was very bond-
boggling) and told me, “you ruined my life” (which, interestingly, is a phrase that I repeated
myself some time later), which did not make sense to me at the time because I did not actually
do anything to ruin her life.

Although I did not make the connection at the time (between the story [about her
mother leaving] and what happened next in the context of our relationship), I did notice that
her overall level of emotional expressivity became so flat (so flat that I became very concerned
for her [I even started thinking that someone might be poisoning her or something]). I tried to
voice my concerns about her emotions to her over the phone, but all she had to say in response
was a flat and emotionless, “yeah” (i.e., she could not explain to me what was happening to
her). I realized later that she must have inhibited (or suppressed) her emotions, which is what,
in a sense, she did when her mother left. I have never seen her do that before during the entire
three years that I knew her (and, in fact, I have never seen anybody’s emotions [especially ones
as intense as hers] seemingly “disappear.” It wasn’t until much later that I learned that
emotional inhibition/suppression is associated with BPD.

As was explained in the section on affective instability (and emotional dysregulation),

emotional inhibition, or suppression, is a maladaptive coping strategy (which individuals who
develop BPD begin using in early childhood), which is one aspect of emotional dysregulation. It
is interesting to point out that Patient X told me the story about her mother leaving her during
childhood (and how she hid her emotions in front of her mother on the day that she left), but
shortly after, she began re-living this experience in the present (with me). In essence, she knew
that a close relationship (our relationship) would soon come to an end, and felt helpless to do
anything about it (although in reality, she could have), and like in her childhood, she inhibited
her emotions in response (thus re-enacting another one of her traumatic experiences from her
childhood[with me now ‘playing’ the role of her mother, and her ‘playing’ herself as a child]).
“[As adults, individuals with] borderline personality disorder, when in the active throes of the
disorder, [are] reliving the past (what happened in childhood), at the core wound of
abandonment.” (22)
What stands out to me the most is that she seemed to transition from what is described
in Dr. Young’s model of BPD as the ‘vulnerable child’ schema mode (which, I believe, she was in
when she was telling me the story about the day when her mother left [INSERT CITATION RE: in
the vulnerable child mode, the individual feels…]) to what is obviously (at least to me) her
‘detached protector’ schema mode (which is when individuals with BPD are disconnected form
their own emotions). She did this in her childhood (i.e., creating the ‘false self’ organization of
borderline personality disorder), and she did it again with me (when she was re-enacting the
traumatic experience of losing her primary relationship, which, it is reasonable to believe,
contributed to the development of BPD [which is the particular trauma that I will focus on when
recommending a treatment for Patient X [which my personal physician recommended that I do
in this article]]).
Dr. Masterson writes, “After [an individual with BPD] psychically [projects] the conflict
into the environment so that [they do] not feel it internally, [they] literally ‘act it out’ in
behavior. Typically, the individual, due to [their] hypersensitivity to rejection, will avoid facing
up to and dealing with the abandonment depression by playing out the painful parental
relationship with another person cast as the parent. In this way, what was internalized and
caused pain in the past is externalized and dealt with as if it were an external problem in the
present. The illusion is created that the person is ‘managing it’ in the here and now” (86, pg.
78). (ADD NOTE RE: It is possible that Patient X telling me, “you ruined my life” was her illusion
of ‘managing it’ [i.e., she said to me what she felt/feels towards her mom?])
On one of the days during this period of time, I went to talk to Patient X so that I could
figure out what was going on with her (since I was worried about her). We met in the parking
lotoutside of her work, and all of a sudden, seemingly out of nowhere (as nothing in reality had
happened to precipitate this particular event), she began “running away” from me. There was
absolutely no reason for her to run, although knowing what I know now, I can explain this
seemingly bizarre behavior. In essence, it is what was mentioned earlier in this section—
manipulation (although it is subconsciously-driven [i.e., it was unlikely that it was her conscious
intention to manipulate]). She knew me well, she knew that I cared a lot about her a lot, and
she ran knowing instinctually that I would want to follow her to make sure that she’s
alright(thus, she, again, was “creating” another part of her negative narrative [essentially, using
me as part of her “story”]). She got into her car and started driving.
(ADD NOTE RE: Manipulating others is generally considered wrong [although the ‘manipulation’
associated with BPD is usually a symptom of their disorder and is not due to conscious effort].
As an example of manipulative behavior that is not necessarily associated with a disorder [and
is due to conscious effort], imagine the following hypothetical scenario (which sounds like
something out of a movie): If someone wanted to distract a police officer [or security guard]
while others committed a crime, they might start running in front of the police officer, likely
causing them to run after them [and thus, distracting them]. In this scenario, the officer’s
behavior was manipulated [out of conscious effort]).
With Patient X, her behavior was driven by subconscious drives (possibly through
emotions that she experienced consciously) in an attempt to resolve (or create a happier
ending for) her traumatic experiences from her past (from her childhood), which is a
phenomenon that commonly occurs in BPD (in various ways). Dr. Moskovitz writes, “[If you are
borderline,] Your environment often becomes a theater for playing out inner conflicts. . .
Sometimes the other people in your world fit into the roles that you have scripted for them”
(87, pg. 16). I fit into the role that she had scripted for me because…
Surprised by her bizarre behavior (i.e., surprised by her running away), and curious to
know what was going on with her (in addition to wanting to make sure that everything was
alright with her), I got into my car and began following her. Her brain (or the subconscious part
of her brain), in an attempt to “create” her perfect “negative narrative” (or story), very keenly
manipulated my behavior. She kept driving and I followed her all the way to her “mom’s” house
(i.e., the house of a woman who is not her real mom, but whom she calls “mom”). Patient X
parked her car in front of the house and went inside, and I, still bewildered by her behavior,
knocked on the door, and her “mom” let me in. While I talked withPatient X’s “mom,” I noticed
that Patient X was hiding behind her, acting like a “little girl” (i.e., she was silently standing
behind her, in a dissociated state and sort of ‘taunting’ me), thus continuing her “negative
narrative.” I assume that in her “story,” her “mom” played the “mom who Patient X never had
in real life (one who stayed to protect her),” and I was someone from her childhood who
abused her (who her “mom” finally got to protect her from).
Dr. Moskovitz explains that “[the] compulsion to repeat earlier traumatic events. . . may
represent an unconscious attempt to create a new, happier ending to a painful memory” (87).
As an interesting point of reference, studies suggest that absence of maternal protection
(during childhood) (https://bpded.biomedcentral.com/articles/10.1186/s40479-017-0075-
3#CR11), as perceived by individuals with BPD, is one factor that is associated with the
development of BPD pathology (which is why Patient X may have re-enacted this).
In reality, I was simply standing there, calmly talking to her “mom,” who never actually
sawwhat Patient X was doing behind her back (who was sort of‘taunting’ me [as if she knew
that I couldn’t do anything to her because her mom would protect her [although, of course, I
wasn’t actually trying to do anything to her in the first place]). While Patient X was “hiding”
behind her “mom” (and being what I described [in this example] as a “little girl”), it was an
example of a schema mode, which occur through the process of dissociation (55). While I did
not point out Patient X’s behavior to her “mom,” the interesting part, to me, is that the one
moment when her “mom” turned her head towards Patient X, Patient X instantly “dropped the
act” (or, in a sense, seemed to “snap out” of her dissociative state, regaining her composure),
but the moment when her “mom” turned her head towards me again, Patient X went right back
into behaving like a “little girl” hiding behind her mom).
While this event marked the end of what I consider “Patient X’s negative narrative,” as it
created a happier ending to her story (i.e., it created a ‘happier ending’ to a series of repetition
compulsions), and no events that I can easily identify as repetition compulsion followed it,
Patient X continued to have severe dissociative symptoms, identity disturbances, and other BPD
symptoms after this (some of which I will describe below). During this time, although I had
already realized that her behavior was a result of BPD, I did not know much about BPD and was
very puzzled by her behavior. She still had told me about putting me on her list (of people who
hurt her), so I continued my attempts at resolving things with her. Our encounters after this
event were brief, but I managed to get Patient X to tell me some key pieces of information
(which are related to BPD), some of which I will describe towards the end of this section.
(INSERT INFO RE: conclusion to negative narrative/what it means… Explain that each
trauma that she ‘re-experienced’ can be considered a repetition compulsion. Explain why I
believe that they are not simply multiple unrelated repetition compulsions but rather that they
represent an actual series of events in her childhood, but with a happier ending)
First, I should further explain repetition compulsions. “These behavioral reenactments
are rarely consciously understood to be related to earlier life experiences. This ‘repetition
compulsion’ has received surprisingly little systematic exploration during the 70 years since its
discovery, though it is regularly described in the clinical literature. Freud thought that the aim
of repetition was to gain mastery, but clinical experience has shown that this rarely happens;
instead, repetition causes further suffering for the victims or for people in their surroundings”
(33).
“Projective identification, [which is (INSERT INFO RE: CENTRAL TO BPD), is one
mechanism that can be involved in repetition compulsions. Projective identification, which was
explained in a previous section, is when someone] provokes a reaction similar to the original
abuse in another person, such as a therapist or partner [although no real abuse, at least in most
cases, actually ends up occurring—except for, maybe, in the person’s own head]” (41). In
certain types of therapy (e.g., transference focused psychotherapy [TFP], which was designed
for BPD specifically [although extended to also treat other specific conditions since then]), an
individual with BPD may (subconsciously) attempt to provoke a reaction out of their therapist
(e.g., throwing their coffee at the therapist), or re-experience their childhood traumas in other
ways (i.e., those in which they do not attempt to provoke a reaction out of their therapist). The
therapist then helps the client find connections between their present day behaviors and their
past trauma (REWORD). “Addressing the present moment experience with the client can
provide new insight and safety, which in turn can help the person begin to change the pattern
of projective identification and re-enactment” (41).”
 At least one of the reasons why repetition compulsions (such as those involving Patient
X) are ineffective at actually resolving an individual’s past trauma, is because they are typically
rarely consciously understood (by the individual experiencing them) to be related to earlier life
experiences. ADD INFO RE: (One of the goals of treatment is to actually integrate the traumatic
experiences from the past into conscious awareness/One type of therapy for BPD actually helps
the client obtain a resolution to these experiences… Treatment for those with BPD will be
explained further in a subsequent section.).

Because repetition compulsions occur as a result of subconscious drives and are rarely
consciously understood (by the individual experiencing them) to be related to earlier life
experiences, I am not quite certain how Patient X remembers the events that comprise her
“negative narrative” (although I have a general idea). It is likely that she remembers these
events, as individuals with BPD, unlike those with DID (who ‘dissociate completely and don't
remember becoming [another alter identity])(54), do remember their experiences (although
they remain ‘controlled’ [as was explained in the section on identity disturbance] by a particular
mode while experiencing them (54)). Schema modes occur through the process of dissociation,
and episodic memory deficits are most often seen when BPD is accompanied by dissociative
symptoms (Fonagy et al., 1996). Memory in BPD is a complex subject on its own, so I will not
attempt to explain it further.

I always find it interesting to understand things from different perspectives. The

following is a description from the perspective of someone with BPD (although it is unlikely that
Patient X would think of it this way (as this individual is probably actually further in their
progress towards recovery than Patient X [who may not even be consciously aware of how her
own behaviors can affect relationships]): “What most people with BPD don’t realize is that we
have an amazing power. We have the power to create these relationships. As, we are the
creators of this play - this drama we so frequently find ourselves in. We are like silent
directors.. playing the other people in our lives for roles that they never signed up for” (40).
I should point out that in the example above, in which the person with BPD describes
their own perspective, their perspective is very interesting to consider, and sounds like a
pathological way of thinking that is indicative of a serious mental health condition (but is not
pathological if the individual is working towards recovering from their serious mental health
condition in therapy).
The following describes basically the same concept but from a scientific perspective
(although there are various ways in which individuals with BPD can ‘re-experience’ their past
traumas in the context of their relationships): “For many borderline clients, the connection
between early trauma and current problems in close relationships often remains out of
awareness. These clients may repetitively re-enact scenarios in which they feel threatened,
attacked, or abused, and then become enraged. The characteristic self-destructive and stormy
interpersonal behaviors that follow are an attempt to cope with unbearable feelings of rage,
shame, guilt, and terror associated with the symbolic re-experiencing of the trauma” (41).
 In any case, following the events that comprise what I described as “Patient X’s negative
narrative,” Patient Xmet up with me at a bar and appeared to me to be consciously attempting
to ‘act normal.’ She was clearly having severe dissociative symptoms around this time (which I
will not get into explaining). On this day she ended up telling me, “I already forgot all of the
good memories” (or “I can’t remember any of the good memories anymore”) (referring to good
memories of our relationship).When she told me this, it seemed as though she was unaware
that there is anything abnormal about this. I find it interesting that she was (or seemed to
be)consciously aware of having forgotten the good memories (i.e., it is interesting that she
remembered that she forgot [or at least said she forgot] the good memories).
An individual (who I believe has BPD, as it came from a website where the topic of
discussion was BPD) writes the following [although their statement may be an exaggerated
version of what really occurs]: “[Whenever an individual with BPD suspects] real or imagined
abandonment, suddenly (overnight), the loved one will be viewed as ‘all bad,’ and all their
behaviors become suspect with malevolent ulterior motives. The entire relationship is
completely forgotten and replaced with an alternate reality where the former loved one was
always ‘all bad’ and the two were never enmeshed in an intense, loving, and personal
relationship. This phase is called ‘Devaluation’” (CITATION NEEDED). This is obviously not
something that occurs when an individual does not have BPD (or possibly some other serious
mental illness [although Patient X has BPD]).
Individuals with BPD doactually experience distortions in their episodic memory
involvingthose who they devalue, or ‘paint black,’ (i.e., their memories of those individuals
become negatively ‘tainted’) (CITE).This distortion in their episodic memory does not, of course,
occur due to conscious effort (so it seems a bit strange, to me at least, that Patient X would be
consciously aware thatshe forgot the good memories).It is possible that Patient X’s statement
was instead a reflection of thought suppression(which isthe conscious effort to forget
something, which she may have been attempting to do at the time). Thought suppression is
also associated with BPD (and is not typically something that normal individuals do [i.e., most
people do not consciously try to forget something]). Thought suppression, like emotional
suppression,in typically causes more harm than good in the long run. While I could write an
entire book solely on the topic of memory in BPD, I will end my discussion of memory with the
following excerpt from a research article: “[Individuals with BPD have difficult with] integrating
multiple representations of their ‘selves’, a lack of a coherent life narrative, and a lack of
continuity of relationships that leaves significant parts of the borderline’s past ‘deposited’ with
people who are no longer part of their lives, and hence the loss of shared memories that help
define the self over time” (47). [Note for those who may be extremely ignorant, to say the least,
this does not imply that I am interested in being in a relationship with BPD and does not imply
anything other than what it states]
 On another occasion following the events that comprise Patient X’s “negative
narrative,” Patient X and I met outside of a bar (since she no longer wanted to meet at my
house) again. In an attempt to figure out what was going on with her (and since I was still trying
to make it work with her at the time), I questioned her about no longer wanting to stay at my
house (since she seemed much happier while she was staying with me). She brushed off the
question and told me, “well at least with you I could be myself.”It is interesting (to me) that she
inhibited, or suppressed, her emotions around this same time (during the weeks prior to telling
me this). This indicates to me that she thinks of her EPs as herself (or her ‘real self’), while she
thinks of her ANP (in which she is disconnected from her own emotions) as her false self. This is
problematic for a variety of reasons.
This was also around the time when, after telling Patient X that everything can still be
fixed, she told me, “It’s too late. I already put you on my list of people who hurt me.” I was
taken aback by her statement (as it is not something one would expect someone else to say). I
searched for this online and could not find one example of an individual with BPD describing it
in exactly the same way, but it is clearlyan example of a list of ‘devalued’ individuals.
Hearing this made me more concerned (for her, because I wanted to help her). I was still
trying to make it work with Patient X at the time (since I actually did not do anything to hurt her
on purpose), although by this time my focus shifted more towards trying to help her with BPD
(by talking to her about it and convincing her to go to therapy [since I realized how mentally
unhealthy she really is]). I decided to ask Patient X about her list. I pointed out to her that her
list is indicative of BPD and she replied, “it’s not like I have an actual list of people in my head.”
(She was obviously trying to rationalize it, or trying to “cover it up,” without realizing the point).
It is possible that she rationalized it so as not to seem ‘abnormal’ (as individuals with BPD feel a
need to fit in and be ‘normal’ [as do many other people, but that is beside the point]). In any
case, her list did not make me think of her as any less—it made me realize that she is not as
mentally healthy as I thoughtthat she was (and therefore, it made me really want to help her).I
believe this is also a prime example of BPD being ego-syntonic.
 The rigid, “black and white” nature of BPD thinking is apparent in her statement, “it’s
too late. I already put you on my list of people who hurt me.” It reveals a lot about her way of
thinking (which she must have developed during childhood—when she began making her ‘list’
[or began devaluing people]). [NOTE: This is not her fault and she would never be expected to
stop using her list if she went to therapy, which would be the equivalent of asking a person to
start walking on their arms instead of their legs]. Interestingly, when I saw her briefly after this
and tried to tell her solely about BPD, she was, you could say, in the active throes of her
symptoms and did not seem to pay attention to anything that I was saying (i.e., she was
frantically trying to avoid me at this point), until I said, “what about your list? Is it possible for
somebody to come off your list? When I said this, Patient X suddenly looked right at me—and
her eyes lit up as if she heard me say something that she never even considered could be
possible (as ifI said something unheard of!).This shows how deeply-rooted her BPD thinking is
(which is not her fault).It is, in a sense, all that she ever knew since childhood. (INSERT QUOTE
RE: The masks of the borderline keep…)
Around this time I also asked her to take an online ‘personality disorder assessment’ (to
prove to her that she has BPD, which is a serious and severe mental illness, although it is ego-
syntonic), which showed that she has a relatively ‘high’ probability of having several personality
disordersincluding BPD [although there are various reasons for this and she almost certainly
only has BPD]. After she got her results, she told me to take the same assessment—and my
results showed almost no probability of having any personality disorder. When I showed her
this, she told me, “that’s because you know what to put” (but I answered the questions
honestly). BPD is incredibly complex (which is why I am so interested in studying it), and
individuals with BPD (INSERT QUOTE RE: Neurotic fear of being found out.). However,
 Towards the end of our relationship, I managed to convince Patient X to go to a
psychologist (who specializes in BPD) with me. I suggested that we both ask to be evaluated for
BPD (although I knew that it was actually her who needs the help). She agreed to go and told
me to make an appointment(and even gave me her insurance information)—but later she
“disappeared” on me(in that she ended up not going to the appointment with me and never
told me that she no longer wanted to go—leaving me hanging). Interestingly, I was trying to
take her to see Dr. Patricia Judd (who co-wrote‘A DevelopmentalModel of Borderline
Personality Disorder’ with Dr. McGlashan [a source that I have referenced throughout this
article]).
To conclude this section I would like to include my interpretation of the image below (in
reference to Patient X), which is from HealthyPlace.com? and represents BPD.
The beginning of ourrelationship was good (i.e., the ‘honeymoon phase’).In the end,
however, Patient X ‘permanently devalued’ me (by putting me on her list of people who hurt
her), thereby ripping me off the pedestal that she had created for me and, since individuals
with BPD tend to ‘borrow’ their identity from others (such as by mirroring the identity of
whoever they are dating), losing the identity that she was mirroring (and thereby losing her
own identity [or, in a sense, ‘destroying herself’). And by doing that, she destroyed. . .
 Image Source: Healthyplace.com - BPD Quotes

[Interestingly, I was arrested several times, with police reports claiming that I ‘battered
her at least 10 times’, etc., when I have never actually hit her, etc., and she actually battered
me at least 10 times [and that barely even begins to tell the whole story], but it is not her fault,
as she is severely mentally ill].

Treatment
Towards the beginning of her memoirThe Buddha and the Borderline, Kiera Van Gelder
describes her own struggles with BPD and how she began her journey towards recovery. She
explains, “The whole concept of recovery brings up some painful questions. What do I recover?
With drug addiction, you hear that you can recover and reclaim your former self, the person
you were before you started using. With other psychiatric illnesses, getting rid of symptoms
means you’re more or less back to ‘yourself.’ But what if you simply don’t have a solid self to
return to—if the way you are is seen as basically broken?” (93, pg. 22).
Author and life coach A.J. Mahari (who recovered from BPD after several years of
therapy), writes,“[Most people with BPD,] without really being consciously aware of it. . . are
living in and from a false self. A pseudo-self that exists only to express in what are known as
‘repetition compulsions.’ A loss that sits outside of the borderline's conscious awareness and a
loss that has left them without the self that they were meant to be. . . It takes having a self, and
then a connection to that self, to be able to form an identity that can be authentic. Borderline
Personality Disorder exists in the space of that evacuated authentic self—where it would have
otherwise been. It rises up from the ashes of the core wound of abandonment and it is the very
definition, in so many ways, of a brokenness that is this loss of self along with one's identity”
(97).

Maharialso states that “the central battle for change and recovery when one [has
BPD]revolves around the degree to which [they] can become increasingly aware of [their] false
self” (53). She also explains that “It is not possible to [even] know, let alone be, your ‘real’ or
true self [when you have BPD]” (42).“When [an individual is first] diagnosed with [BPD,] and/or
[before they reach a certain level] of recovery—the truth about who [they] really are is often
dissociated or fragmented from [their] authentic self. [The] authentic self is buried underneath
the pain [and the] fear, and has been left behind at the developmental stage at which [they]
were last able to be, for the most part, [themselves]”(25).

So, what does this mean? What is the real self? Could an individual with BPD believe
that they are (or were) their ‘real self,’ but be wrong? How would they know? Well, they can
start by taking an online personality disorder assessment and/or seek professional help to get
diagnosed.“The good news [for those with BPD] is that they can, in treatment, find [their] lost
authentic self” (42).

Does this mean that individuals with BPD will suddenly ‘turn into’ someone else and lose
everything about who they are now if they choose to go to treatment? Of course not.Could
someone with BPD believe that they are (or were) their real self when in fact they are (or were)
not (such as with Patient X)? Yes. Dr. Masterson states that “[a] person with a false deflated self
[(which is the case for those with BPD [as opposed to a false inflated self in NPD, which is very
different])] remains perplexed and cannot see through the defensive structures of [their] life, [their]
thinking, [their] ways of perceiving reality. [They sense], but cannot understand, the hollow core at the
center of [their] life. [They have] lived too long on [self] deception, fantasy, and the myths of [their own]
false self” (86, pg. 81).

Any individual who scores high (or relatively high) on a personality disorder assessment
would live a happier life if they took their results to a therapist (and anybody who feels unsure
[e.g., has questions about life, etc.] would also benefit greatly from going to therapy. There are
no negative consequences to seeking help (or obtaining a diagnosis) for a mental health issue.

For those with BPD, “The presence of The Chameleon is often one of the main obstacles
to effective initial treatment and diagnosis. . .[because] it effects the interaction between
patient and doctor, and can mask the disorder itself” (95).
 Image Source:BPD – “The Art of Pretending”

Until fairly recently, BPDwasconsidered incurable. This was due, at least in part, to an
incomplete understanding of the disorder among researchers and clinicians(as well as the fact
that individuals with BPD seemed resistant to common forms of treatment) (CITE). In past
decades, BPD was [even] a diagnosis that hospital staff and mental health professionals kept
secret from their patients (which further complicated treatment). Dr. Moskovitz explains that
“for years, [BPD was a diagnosis that was kept] secret from [the patients] for fear that [they]
would be wounded and flee” (87, pg. 2).However, this is no longer the case.
“There is no drug specifically for BPD. [In some cases,] drugs may sometimes be helpful
for treating specific symptoms of BPD or to address other illnesses that may occur during the
course of BPD. Drugs can help to regulate mood, to reduce anxiety to control impulses—
including the urge to self-mutilate—to reduce the frequency of dissociative symptoms, and to
correct misperceptions of reality such as hallucinations or feelings of persecution” (87, pg. 111).

The first type of therapy designed specifically for BPD was developed in the late 1980s
(and early 1990s) byDr. Marsha Linehan. It is calleddialectical behavioral therapy (DBT) and is
highly effective at treating a specific symptom of BPD (emotional dysregulation) and those who
are at a particularly high risk for suicide.
 Dr. Marsha Linehan, known worldwide as a top-
notch clinician and researcher (and as developer
of dialectical behavioral therapy[DBT] disclosed
in a New York Times article that she herself has
been a long-term sufferer of borderline
personality disorder (BPD).

American singer, actress, and producer Selena

Gomez, who has been suffering from mental
illness (depression and anxiety) for years, is a
passionate advocate for DBT, which she stated
has “completely changed [her] life.” (DBT has
been extended to treat conditions other than
BPD, which it was originally designed for).

DBT might be the best first step in treatment for many individuals with BPD, as it allows
for the acquisition of skills to regulateone’semotions (instead of inhibiting or suppressing one’s
emotions) and in a sense, stabilizesthem. These days, there are several types of therapies that
are commonly used fortreating BPD, including:

 Dialectical behavioral therapy (DBT)

 Transference-focused psychotherapy (TFP)
 Schema therapy (ST)
 Internal family structures(IFS)
 Eye movement desensitization and reprocessing (EMDR)
 Mentalization-based therapy (MBT)
 Cognitive analytic therapy (CAT)

While DBT may be great at alleviating certain symptoms of BPD, it is considered a ‘here
and now’ intervention and cannot fix the underlying causes of the symptoms of BPD.
Researchers write:
“While focusing on here and now issues and managing triggers can be useful to stabilize
and as a preparation to work with traumatic issues (Mueser et al., 2008; Harned, Jackson,
&Comtois, 2010; Mosquera, Leeds, & Gonzalez, 2014), it is not sufficient to help clients resolve
their symptoms. Many approaches for BPD are focused on here and now interventions.
Although these approaches have shown efficacy in symptom reduction, they do not seem to
achieve a complete integration of the personality. The individual has to make an ongoing
strenuous effort to stay stable and not resort to familiar but maladaptive coping strategies.
Triggers remain a problem. We believe that working with the here and now and avoiding
unresolved issues is exactly what the client has learned to do in order to avoid dealing with the
past. Far too often, they are experts at diverting attention from memories or intrusions that are
too painful by using alcohol, drugs, self-harm, sex, bingeing, and so on. All of these ‘strategies’
tend to numb their emotional pain from the original traumatization (Mosquera, 2013, 2016).
Trauma resolution is in many cases essential to achieve comprehensive symptom resolution.
Thus, once the client is stable, a focus on understanding and processing traumatic memories
is essential, so they can be resolved. At that point, triggers lessen and even disappear
completely, so the client can focus on the present without having to ignore or suppress the
past” (72).
Prior to recommending the best type of treatment for Patient X (which my own personal
physician suggested that I do in this article), I would like to demonstrate a key point.Throughout
my three-year-long relationship with Patient X, she wouldspontaneously tell me stories about
her childhood. In a sense, she seemed to be preoccupied with her childhood. While I learned in
one of my psychology courses that childhood trauma can affect an individual psychologically for
the rest of their lives (if not treated), I did not understand how until late in my relationship with
Patient X (when I began to understand the connections between the symptoms that she
exhibited in the context of our relationship and her past traumas).
After our relationship ended, I began reading about BPD and speaking to individuals
with BPD online in order to learn more about their experiences. Whatstood out the most to me
is that individuals with BPD have a part (or parts) of them that is (or are) ‘stuck’in childhood
(although it may not always be apparent).I first realized this when I thought back to Patient X
telling me about her mother leaving her. When she told me this, it was as if a certain part of her
was telling me the story (a part of her that is stuck in childhood and is still upset about her
mother leaving her and confused as to why her mother was not able to understand that Patient
X really does care [even though she does not show it]).
The different parts of an individual with BPD represent dissociated states of self that are
related to childhood trauma. In her memoirThe Buddha and the Borderline,author Kiera writes,
“The parts that are most inaccessible and fearful are known as exiles [(which is a term used in
IFS therapy)]. These frozen and traumatized parts of ourselves hide and feel theneed to be
protected at all costs” (93, pg. 150). She goes on to say, “[My] deepest exile is the part I call ‘the
little dark one.’ She’s primal in her rage, her love, and her need. I can barely get her to raise her
head from her knees. She’s the one hiding in that small, secret room” (93, pg. 160). “Of all my
parts, she is the most desperate for comfort and connection, and she’s also the most angry and
fearful. So she’s usually locked up, because when she emerges her pain overshadows
everything else” (93, pg. 196).
Another individual with BPDdescribes the following[note: minor grammatical
corrections have been made to the original post]:
“There is a terrified inner-child within me that fears deeply that she will be left alone to
die [note: In other words, this inner child fearsabandonment?]. . . Normally the child hibernates
but once in a while someone awakes hope in it. When that happens, along comes the
insecurity, because now the vulnerable child is again vulnerable, the very emotional core of us
becomes vulnerable, which normally isn’t… It’s probably like undressing a live wound… We,
however, we may suppress it, [but] deep inside [we] want to heal it, make the child ok again…
Let it deeply trust someone and then it’s kind of [like],‘oh its happening all over again!’. The
trauma is re-experienced and the reaction is frantic. [Continued in next paragraph]

Actually, the imperative to protect this child is so strong that I could not care less about
other peoples’ feelings in that moment… As Lila put it poignantly, it is experienced as matter of
life and death, literally, you must act or THE CHILD WILL DIE. As you would understand…
imagine you would have to save your child from a burning building… you would not think twice
about pushing a few people aside to get there and hurting their feelings, would you?”
(https://www.quora.com/Why-do-people-with-BPD-fear-abandonment).
 It is important to realize that this is not simply something that these individuals are
making up. While the terminology used to describe it may differ, they are describing the same
phenomenon (i.e., which is a result of secondary structural dissociation of the personality, in
which memories, thoughts, and feelings associated with painful childhood experiences become
compartmentalized and dissociated from conscious awareness [which does not occur in
individuals who are not suffering from BPD or certain other disorders [which do not include
other personality disorders, as far as I know]] as a means of ‘defense’ that the brain uses during
these traumatic experiences, which later maintains their symptoms). Brain studies (e.g., fMRI
studies) reveal that certain neural network that normally function together are actually
disconnected [at least partially] in individuals with BPD (CITE DR. MEARES, ETC.). The good thing
is that, as DR. INSERT NAME explains, (INSERT QUOTE RE: Since this process is experience
based, it can be reversed). In essence, when individuals ‘break,’ they break in very predictable
ways (which is why we can classify them into distinct disorders), which also means that there is
a systemic way to ‘put them back together.’

In 2003, Dr. Jeffrey Young and his colleagues developed schema therapy (ST) (which was
designed specifically for treating personality disorders, and later ‘customized’ to BPD
specifically (REWORD)). ADD INFO RE: BPD specific modes.
“Schema therapy (ST), like DBT, [aims to help individuals with BPD] deal with emotional
dysregulation [(as well as other symptoms)]. . .A core difference of the two approaches is that
DBT focuses directly on the acquisition of emotion regulation skills and assumes that improved
skills will result in better emotion regulation. In [schema therapy, however,] problems in
emotion regulation are seen as a consequence of adverse early experiences (e.g., lack of safe
attachment, childhood abuse or emotional neglect). These negative experiences have led to
unprocessed psychological traumas and fear of emotions and result in attempts to avoid
emotions and dysfunctional meta-cognitive schemas about the meaning of emotions. ST
assumes that when these underlying problems are addressed, emotion regulation
improves.Major ST techniques for trauma processing, emotional avoidance and dysregulation
are [empathic confrontation, limited reparenting] and experiential techniques like chair dialogs
and imagery re-scripting” (CITE).
INSERT INFO RE: Maladaptive schema modes in BPD (angry child, abandoned child,
punitive parent, etc.)
“There is one more mode which must be discussed; this y the vulnerable child mode. This is the
mode that is being protected by the other, more destructive modes. The vulnerable child is the
inner child that was not nurtured or protected in childhood. The therapist must help the patient
find this vulnerable inner child and help him heal by limited re-parenting” (109).
 (INSERT EXPLANATION: An example of a technique used in schema therapy to resolve
past traumas is called a two-char dialogue. (INSERT DESCRIPTION OF 2 CHAIR DIALOGUE)
(MENTION THAT IT CAN EVEN HELP AN INDIVIDUAL RESOLVE CONFLICT/TRAUMA WITH
INDIVIDUALS WHO ARE ALREADY DEAD IN REAL LIFE) (INSERT EXPLANATION RE: For an
individual with BPD, making amends with the actual individuals involved in their past traumas in
adulthood (whether it is a good or bad thing) will not help resolve past traumas (when the
individual with BPD was a child, which is where the origins of secondary structural dissociation
lie)) (INSERT EXPLANATION RE: In schema therapy, these modes are accessed from a first
person perspective). (INSERT EXAMPLE OF 2 chair dialogue: Vulnerable child confronts punitive
parent). (INSERT EXPLANATION RE: Integration of the personality involves slowly bringing these
dissociated parts together, by first becoming more consciously aware of them and gradually
resolving their trauma [in therapy]).
“What sets Schema Therapy apart from all the other major treatments for personality
disorders, including treatments like Dialectical Behavioral Therapy, is its use of limited
reparenting. This involves the therapist doing more to directly meet the early core emotional
needs of the patient. Limited reparenting is organized around modes, or parts of the self. The
therapist works to get past modes like the Detached Protector and Punitive Parent Mode to
reach the Vulnerable Child Mode. Direct access to the Vulnerable Child is the key to the
therapist being able to meet these needs and is the cornerstone of treatment. All the major
alternatives involve the therapist talking to the adult patient about their vulnerabilities and thus
are more focused on adult to adult interactions. Schema therapy focuses on direct contact
between the therapist and this vulnerable or child part of the self. This sets a very different
tone to the treatment; one that patients respond readily to and that is believed to be the
reason for the unusually low drop-out rate. The adult side of the patient is gradually brought in
as it becomes healthy enough to take over for the therapist” (96).
I believe that Patient X was her ‘vulnerable child’ mode when she told me about the day
when her mother left her. This seemed to be a sort of ‘core wound of abandonment’ for her.
(INSERT HER STORY). When Patient X told me this story, she appeared sad and a bit confused as
to why her mother could not tell that she really does care (even though she doesn’t show it).
Patient X would benefit from utilizing the two-chair dialogue technique in schema therapy to
‘re-create’ this interaction between her and her mother (on the day when her mom left her).
(INSERT INFO RE: Instead of hiding her emotions in front of her mom, tell her how she felt [even
if it is ‘you ruined my life’]). Patient X would be able to learn that displaying her emotions is
actually not a sign of weakness (limited reparenting) and be able to express to her mother,
through words and emotions, how it is that she felt about her leaving (thus helping to resolve
this emotional trauma, while learning to identify and label emotions [which is a key aspect in
emotional regulation] and learning to feel accepted and ‘appreciated for who she really was
[supposed to be],’ thereby beginning to integrate the various parts of her personality that
underly and maintain her symptoms when they remain dissociated as a result of unresolved
conflicts).

Image Source: Healthyplace.com - BPD Quotes

This is one example of how Patient X would benefit from schema therapy. This is one of
Patient X’s unresolved (emotional) traumas, which she (like other individuals with BPD) would
continue to hone in on as she explores the various troubling experiences in her childhood.

Such techniques allow the patient to, essentially, resolve traumatic experiences from
the past and meet their unmet developmental needs from childhood. As an example, I believe
that a two-chair dialogue between Patient X (in her VC mode) and her mother (from her
childhood) would allow her to finally express to her how it is that she did feel (learning how to
express and label her emotions), have her emotions validated and possibly mirrored back to her
(learning to accept and understand her own feelings, learning how to mentalize?, and possibly
how to modulate her own emotions), and finally obtain a resolution to this experience so that
she can fully integrate it into her personality structure?
Obviously, most individuals with BPD have multiple severely traumatizing experiences
that they would have to attain resolution for. This sort of exercise would also allow an
individual to finally obtain a resolution to other traumatic experiences, such as being sexually,
physically, or emotionally abused. (INSERT EXPLANATION RE: SCHEMA THERAPY CAN HELP AN
INDIVIDUAL OBTAIN RESOLUTION TO EXPERIENCES INVOLVING PEOPLE WHO ARE NO LONGER
ALIVE).
INSERT INFO RE: Since attachment is involved in schema modes, establishing a
therapeutic relationship is, in essence, a key prerequisite to being able to work with modes
(meaning that an individual with BPD cannot simply go to a therapy session and begin with
chair work [at least that is what I think, but I could be wrong] (LOOK INTO THIS FURTHER)). In
essence, chair work (and other techniques in schema therapy) are not simply activities where
an individual ‘pretends’ to do something. This is a serious type of therapy designed by very
intelligent and smart human beings who developed an effective way to treat a serious mental
illness (although their method actually sounds like it might be a lot more fun [and is more
effective] than other methods, which is probably one of the reasons why schema therapy has a
low drop out rate). All in all, it is not as easy as it sounds and it can take several years of schema
therapy to fully integrate the personality. ADD NOTE RE: It is typically only one or two sessions a
week (each session lasting only an hour or so).
ADD INFO RE: Schema therapy (ST) provides opportunities for identity formation.
“Unstable identity is a core deficit in patients of BPD that underlies feelings of emptiness,
abandonment fears and difficulties with interpersonal relationships. We develop our identities
by internalizing feedback (reactions to us, labels, descriptions, positive and negative defining
experiences with others including acceptance or rejection, etc.) from important caretaking
figures in early life and from our peer group in adolescence. ST addresses this BPD deficit
through schema mode work in which disconnected aspects of self are healed or transformed
and ultimately integrated into a strengthened Healthy Adult Mode. Early identity work for the
young Vulnerable-Abandoned Child can be effectively accomplished in individual or group ST.
The therapist can provide information about normal childhood needs against which patients
can reevaluate their childhood experiences and the expectations and reactions of their
parent/caretaker” (110).
INSERT INFO RE: “Most of the time. . . BPD patients find themselves in the Detached
Protector mode [which I believe is what others describe as the ‘apparently normal’ personality],
[which provides] them with the opportunity to emotionally shut off from the negative emotions
caused by the other dysfunctional modes, and [gives] them a safe hiding place. Since patients
seem quite at ease in this mode, therapists often confuse this Detached Protector mode state
with the Healthy Adult mode, while in fact they are [disconnected from their own emotions]
and avoid dealing with them” (56).

[Disclaimer: An individual with BPD cannot do this on their own, and anyone who is not a mental health
professional (i.e., psychologist, psychiatrist, or licensed therapist) that is trained in schema therapy
should not attempt to conduct schema therapy [or any type of therapy] with an individual with BPD [or
any mental health problem] on their own].
More info on schema therapy:
https://www.researchgate.net/publication/312779535_Working_with_Modes_in_Schema_The
rapy
So, is schema therapy truly effective? “A large scale randomized control trial (INSERT
NAME OF STUDY) shows Schema Therapy to be significantly more effective than two major
alternative approaches to the treatment of a broad range of personality disorders [(including
BPD)]. Schema Therapy resulted in a higher rate of recovery, greater declines in depression,
greater increases in general and social functioning and had a lower drop-out rate. The results
indicated that Schema Therapy is also more cost-effective” (CITE).“This is an important
extension of Schema Therapy's unprecedented outcomes in the treatment of borderline
personality disorder. Three major outcome studies (Farrell et al., 2009; Nadort et al., 2009;
Giesn-Bloo et al., 2006) have shown that many patients with Borderline Personality Disorder
can achieve full recovery across the complete range of symptoms and that it is twice as
effective as a popular alternative, Transference Focused Psychotherapy. This study extends
these impressive findings by including a broad range of understudied personality disorders and
suggests that Schema Therapy is the most effective means currently available to alleviate the
high societal and personal costs of these prevalent disorders. While rapidly gaining popularity in
Europe, Schema Therapy is virtually unknown in the United States [(although it has become
more popular in the United States since this article was written several years ago)]” (96).
“Three years of [schema therapy (SFT)] or [transference-focused psychotherapy (TFP)]
proved to bring about a significant change in patients’ personality, shown by reductions in all
BPD symptoms and general psychopathologic dysfunction, increases in quality of life, and
changes in associated personality features. Using intention-to-treat analysis with adjustments
for baseline assessments, SFT and TFP effectiveness became apparent at 12 months of
treatment and was further extended at 3 years of treatment. Schema-focused therapy was
superior to TFP with respect to reduction in BPD manifestations, general psychopathologic
dysfunction, and change in SFT/TFP personality concepts. All in all, it seems that changes in
manifest (BPD) psychopathologic dysfunction go hand in hand with changes in pathologic
personality features. An explanation may be that both treatments address the level of
personality, not merely the “surface” symptom level” (CITE).
The duration of treatment varies case by case, but is often in the range of two to five
years and typically involves only one [or two] hour-long session(s) per week. Most individuals
with BPD do not require hospitalization (although this is often the case when patients are
suicidal). BPD does vary in severity and impairment (and the more severely impaired and/or
suicidal individuals typically want hospitalization). In any case, BPD is always a serious mental
illness (even though many, if not most, individuals with BPD are high functioning). INSERT
QUOTE RE: “highly-functional individuals with BPD.”
 Patricia Judd, Ph.D. and Thomas McGlashan, M.D. write, “Patients who have mild forms
of the disorder may benefit from a 2- to 5-year course of psychotherapy. . . However, they too
may return for treatment during life crises and to further rework developmental issues, as do
many patients. Those with moderate forms of the disorder may benefit from “intermittent
continuous” therapy over the life cycle. . . Patients who have severe forms of the disorder will
require a combination of ongoing case management, supportive psychotherapy, and
medication maintenance” (84, pg. 177).According to Dr. Moskovitz, “The length of treatment
depends upon your goals. Crisis intervention might take just a few sessions. Resolving
underlying emotional issues might take four or five years” (87, pg. 171).Personally, I encourage
all individuals with BPD to seek treatment to resolve their underlying emotional issues.
INSERT INFO RE: I have not been able to find any studies comparing schema therapy to
DBT directly (most likely because these studies take many years to complete [as the therapy
itself takes many years to complete, and this is only a part of a study])… As was stated earlier,
DBT may be the best option for indiviudals with BPD who are less stable and/or are suicidal. As
Dr. Linehan stated, after completing ‘stage one’ of DBT (which is focused on learning skills
that…..), an individual with BPD can transition into a different type of therapy. INSERT INFO RE:
Once an individual with BPD is stable, they can move on to stage 2 (which is trauma resolution).
At this point they can transition into schema therapy. Individuals with BPD who are relatively
stable (compared to the more severe cases of BPD) and not at a particularly high risk for suicide
(such as Patient X) can (and should, in my opinion) begin treatment in schema therapy.
INSERT TIPS RE: If an individual with BPD wants to attend schema therapy but it is not
offered in their proximityschema therapy online, possibly ask therapists to learn about it,
etc.)
A.J. Mahari states, “It is not possible to [even]know, let alone be your ‘real’ or true self,
when one has BPD. . . The good news is that those with BPD, in treatment, can heal and find
that lost authentic self. Recovery and knowing oneself is possible as anyone with BPD
perseveres in therapy to healing the core abandonment/attachment trauma which paves the
way to really knowing who one authentically is” (42).“It is important to confront and work
through the past [what happened in childhood] to be fully alive and present to the here-and-
now. That is the way for anyone with BPD to find his or her lost self and begin to address
working toward solving his or her legacy of abandonment – a legacy that is re-experienced and
re-lived until it is faced” (67).
“It is the finding of this lost authentic self that will enable the borderline to come to
know and have his/her own identity. A place to feel, think, and exist from that is all his or her
own. A place to be inside that doesn't require the living through someone else. An emotional
reconnection to one's dissociated from inner child is also at the heart of this reclamation of
authentic self - the authentic self that holds within him or her, if you have BPD, your identity”
(97). “Finding one's identity from Borderline Personality Disorder is the gateway to recovery. It
is difficult and often painful work. It is worth it though. It will, in time and over time, bring
with it such relief from suffering and lead to the reclamation of the lost authentic self” (97).

“You have to get another person, a therapist, to foster your true self…
It’s about correcting what went wrong.
It’s about facing your own difficulties, your inability to accept help, your trust in another
person.
It’s about talking; talking about you. Yep, honestly, the world will be interested in what you
have to say.
It’s about losing that false self; the thinking, the over-thinking, the impulsivity, the running
away, the pretending, the acting, the sleeping around.
It’s about accepting you have Borderline Personality Disorder. Stop looking away. You have it
and you have to deal with it.
It’s easy, really (the concept, anyway). Someone else has to love you and show you that you’re
worth a hell of a lot. They have to show you that you have a great side, and sometimes a bad
side; but all of you is okay.
You’re meant to start feeling all of your feelings; to start to regulate, not to be empty and dead
inside anymore. You’re meant to feel accepted by completely accepting yourself.
All of this has to be done by someone else showing you how to do these things. You need a
teacher to guide you and show you the way.
The result is freedom. It’s not running anymore. It’s independence to fulfill who you are.
Then you can pass this feeling to other people.
The best part for someone with BPD is that there’s a person who can love them
unconditionally—and that’s themselves, and they have a person to meet, a great person(which
also means that they will never feel empty or alone again).
By the way, it takes about 5 - 10 years in total [note: it may take as short as 3 years] for this to
happen through therapy and self-help. (The devil is in the details).”
(Source: https://www.quora.com/Is-it-possible-to-be-your-real-self-if-you-have-BPD)

Image Source: Healthyplace.com - BPD Quotes

Extra material
[NOTE: Since this is not written for any professional or scholarly purpose, I am including this
section simply for entertainment [although the material in it is not written to be entertaining]]
This section includes excerpts from research articles and websites that are intended to
provide advice for therapists working with clients withBPD. I included these excerpts simply
because they have some aspect to them which I, personally, found a bit funny (although they
are, actually, serious). Since, it seems to me, most people with BPD have a good sense of
humor, they would likely find it comedic as well)…

“In our view, the most constructive way to view borderline patients is as vulnerable
children. They may look like adults, but psychologically they are abandoned children searching
for a parent. They behave inappropriately because they are desperate, not because they are
selfish: they are “needy, not greedy.” They are doing what all young children do when they
have no one who takes care of them and makes sure they are safe. Most borderline patients
were lonely and mistreated as children. There was no one who comforted or protected them.
Often they had no one to turn to except the very people who were hurting them. Lacking a
Healthy Adult they could internalize, as adults they lack the internal resources to sustain them
when they are alone. Alone, they feel panicked.
When therapists become confused in their treatment of borderline patients, we
sometimes find that mentally superimposing the image of a small child or infant over the
patient can help the therapist understand the patient better and know what to do. Whether
the borderline patient is angry or detached or punitive, underneath she is a forlorn child” (70).

“Let us say a therapist is working with a patient who has been severely sexually abused,
and that the patient is able to describe the ‘facts’ of what has happened, but without attendant
feelings, and that the therapist finds herself experiencing disgust and rage and being on the
point of offering to accompany the patient to confront her abuser. To do so would, I suggest,
simply evoke the typical D response in the patient: panic, embarrassment, disempoweredness
and a wish to regain control. Instead, the sensitive therapist might say something like: ‘It
sounds like these are feelings that it is very difficult for you to face on your own, but that to do
so with another person brings up huge feelings of shame, so you are damned if you do, and
damned if you don’t’. The therapist takes her own responses as reflecting, representing, or
symbolizing the emotional state of the patient. By introducing a conversation about
conversation the therapist is initiating the BPD sufferer to the possibility of ‘sense 3’ meaning –
the possibility of a shared language of intimacy” (CITATION NEEDED).

[NOTE ON FOLLOWING: INSERT NOTE]

“I'm occasionally contacted by psychotherapists needing help with a particularly difficult BPD
patient or client. These clinicians have given over control of their therapeutic relationship to
the client who is borderline-disordered—and there's intense drama, chaos and abuse that
comes their way within these sessions.
During our consultations, I coach them on setting very firm limits and boundaries, and
taking back their power. A rageful, abusive borderline is literally screaming for containment.
The therapist must be willing to treat these patients differently than others, and protect
themselves during the entire process--even if it means leaving his/her office for a few
minutes throughout the session” (http://gettinbetter.com/BPDlove.html).

The excerpt below comes from an online forum and was not intended to be advice for
therapists. Rather, psychotherapist Mike Leary answers the question, “If you strongly suspected
that someone you care about has Borderline Personality Disorder, and that they are not aware
of it, should you tell them of your suspicion?”:

“The borderline is a professional victim. They can take any, and I mean any, situation
and figure out a way it wasn't fair and they were had. . .
Borderlines usually, not always, have been abandoned emotionally by both parents. . .
They need reassurance all the time that they are desirable. . .
Borderlines believe if they feel it, it is true. The problem with them though is; feelings
can change with mood, at any moment and because it is tied in with their security system, one
mistake and you are with all the other bastards who have hurt them. Once again, they've
been proved, they can't trust anyone . . .
1. The first part tends to be medication if they act-out. . .
2. Next, they need to heal that empty abandonment inside. Therapeutically, they need
to be acknowledged from some higher power. The little, abandoned, girl didn't do
anything to deserve this. She needs acknowledgement and some form of higher-
power to trump the original Parent-Gods. That little girl part of her needs to know, it
wasn't her fault. There isn't anything wrong with her and never was. She needs the
blessing: you're unique, wanted, have purpose, are lovable, and you are not alone.
You are safe here.
3. Now the problem is, There have been a lot of habits made over the years and those
are difficult to break. This is where life hacks come in, as the person needs to learn
what are typical triggers and then how to reroute them to not run havoc though
their life.
I've had to literally throw my body between a borderline, (45 years old) who had
absolutely trusted me, and her dad. She then broke all the rules and agreements. She was
justified because of a one-word-statement from her Dad. . .
So yes, I believe they need to know, however it is one thing to have me say it, and quite
another to have someone else say it. . .
With friends and especially family members, telling the person they have BPD is
tantamount to name-calling. It will not be tolerated. Not only that, when they do find out later
what it is, the oppositional part of them may fight the truth. . . Whatever is said by you, will
have a comeback instantly from them. . .
The biggest thing to remember; it will be your fault and you will never be able to fix
them, but you better try”(71).

Extra material, Part 2

[NOTE: Since this is not written for any professional or scholarly purpose, I am including this
section simply for entertainment [although the material in it is not written to be entertaining]]
In this final section, I wanted to include a few short excerpts on a particular topic that I
happened to stumble upon several different times while researching BPD that I thought was
interesting. The topic is the connection that seems to exist between individuals with BPD and
one other cluster B personality disorder (which is narcissistic personality disorder [NPD]).
The majority of individuals diagnosed with BPD are women (~75%), while the majority of
individuals diagnosed with NPD are men (ADD STATISTIC, CITATION). I will not go into the
details of explaining NPD nor why this connection might exist—I will simply include a few
excerpts that are, at least to me, thought provoking:

The following is from an interview with Dr. Aaron Kipnis, a clinical psychologist and
professor of psychology at Pacifica Graduate Institute:
“I had a graduate student years ago that was an admitted, self-diagnosed person with
NPD. He did his graduate research with me on his disorder. Some years later I ran into him and
asked him how he was doing. He told me he was very well, with a full practice of clients who
were mostly people with BPD.
This is somewhat unheard of—in fact, I was shocked, initially. We advise our therapists
in training not to take on more than one or two clients with BPD in their practice because they
can be so overwhelming to work with. Clients with BPD might over-idealize their therapist then
vehemently demean them—sometimes in the same session. There may be the potentially
unnerving suicidality and phone calls at all hours. But my former student had about thirty
clients with BPD! He was enjoying the work and most important, his colleagues at the clinic felt
his clients were benefiting from their work with him.
Some therapists say people with personality disorders just can’t be helped so they won’t
have to feel so ineffectual for not being able to help them. But my former student, unlike the
majority of therapists, was able to tolerate their intense and erratic affects by virtue of his
thick-skinned NPD. In fact, he actually enjoyed being with them. And his clients’ felt safe and
contained because they could not freak him out, push him away or get abandoned by him” (83).

References
(1) http://www.borderlinecentral.com/articles/primaryrelationship.php
[from here, also use this quote: “The here and now for people with Borderline Personality
Disorder, especially when trying to relate to other people, is lost to their past, over and over
again, and in ways that just continue to increase their own suffering and the pain and
suffering of those around them as well.” When talking about the knife incident.
(2) https://blog.cognifit.com/fear-of-abandonment-and-borderline-personality-disorder/
(3) https://patch.com/california/carlsbad/the-stable-instability-of-patients-with-borderline-
personality-disorder-and-the-difficulty-clinicians-face-trying-to-treat-them
(4) https://organizationalchangesolutions.wordpress.com/2011/03/11/deception-and-the-
borderline-personality-what-could-have-been/
(5) https://bpded.biomedcentral.com/articles/10.1186/s40479-017-0075-3
(6) https://www.verywellmind.com/borderline-personality-disorder-statistics-425481
(7) http://unresolvedabandonment.com/2010/03/abandonmentinborderlinepersonalityaudioaj
mahari/
(8) http://www.primals.org/articles/hannig03.html
(9) http://www.primals.org/articles/hannig03.html
(10) http://www.toddlertime.com/dx/borderline/when.htm
(11) Kaplan MCAT Behavioral Sciences Review 2018-2019 (Book) [pg. 271]
(12) https://www.psycom.net/depression.central.borderline.html
(13) https://www.medicalnewstoday.com/articles/9670.php
(14) https://en.wikipedia.org/wiki/Neurosis
(15) https://www.verywellmind.com/borderline-personality-disorder-meaning-425191
(16) https://www.dbtselfhelp.com/html/bpd_criteria.html
(17) https://www.psychologytoday.com/us/blog/traversing-the-inner-terrain/201609/when-is-
it-emotional-abuse
(18) https://www.cliffsidemalibu.com/dual-diagnosis/borderline-personality-disorder/
(19) http://www.sakkyndig.com/psykologi/artvit/crawford2009.pdf
(20) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819472/
(21) http://www.borderlinecentral.com/articles/primaryrelationship.php
(22) https://www.verywellmind.com/emotional-invalidation-425156
(23) https://en.wikipedia.org/wiki/Identity_disturbance
(24) http://www.borderlinepersonality.ca/bordertruthbehindmasks.htm
(25) https://www.verywellmind.com/emotionally-invalidating-environment-425303
(26) https://www.google.com/search?ei=nYE2W7XSLpOr8AO6uJSwDA&q=emotional+inhibition+
in+children+npd&oq=emotional+inhibition+in+children+npd&gs_l=psy-
ab.3...8621.9492.0.9699.4.4.0.0.0.0.84.311.4.4.0....0...1.1.64.psy-
ab..0.0.0....0.CmWau2EOzVw
(27) https://core.eqi.org/invalid.htm
(28) https://www.ncbi.nlm.nih.gov/books/NBK195987/)
(29) https://medium.com/@KevinRedmayne/its-all-in-your-head-borderline-personality-
disorder-and-the-brain-c14b66eb0966
(30) http://www.bpddemystified.com/overview/
(31) https://mental-health-matters.com/bpd-when-will-i-ever-know-who-i-am/
(32) http://www.cirp.org/library/psych/vanderkolk/
(33) https://www.elementsbehavioralhealth.com/personality-disorders-2/borderline-
personality-and-identity-understanding-yourself-in-order-to-heal/
(34) https://www.frankyeomans.com/assets/WebsiteTFP.ppt
(35) https://www.ncbi.nlm.nih.gov/pubmed/17652950
(36) http://www.swapassessment.org/wp-
content/uploads/2013/01/SWAP_13._psychodynamics_of_bpd_Bradley_dev_and_psychopa
thology_2006.pdf
(37) https://charlottefarhanartactivism.com/2017/05/16/the-looking-glass-identity-on-the-
borderline/
(38) http://gettinbetter.com/anatomy.html
(39) https://www.quora.com/Why-do-people-with-BPD-fear-abandonment/answer/Tatiana-
Reeder?share=893eeb4c&srid=hY1DF
(40) http://www.hakomiinstitute.com/Forum/Issue19-
21/4Linda%20Baird,%20Childhood%20Trauma2.pdf
(41) https://www.quora.com/Is-it-possible-to-be-your-real-self-if-you-have-BPD
(42) https://www.quora.com/Is-it-possible-to-be-your-real-self-if-you-have-BPD/answer/Aj-
Mahari?share=6a7b698a&srid=hY1DF
(43) https://www.quora.com/Is-it-possible-to-be-your-real-self-if-you-have-BPD/answer/Aj-
Mahari?share=6a7b698a&srid=hY1DF
(44) https://www.verywellmind.com/borderline-personality-disorder-identity-issues-425488
(45) http://oxfordmedicine.com/view/10.1093/med/9780198530213.001.0001/med-
9780198530213-chapter-001
(46) https://thebernardbert.wordpress.com/2013/11/14/identity-disturbance/
(47) https://thebernardbert.wordpress.com/2013/11/14/identity-disturbance/
(48) https://www.austenriggs.org/blog-post/how-does-bpd-manifest
(49) http://www.hakomiinstitute.com/Forum/Issue19-
21/4Linda%20Baird,%20Childhood%20Trauma2.pdf
(50) http://www.hakomiinstitute.com/Forum/Issue19-
21/4Linda%20Baird,%20Childhood%20Trauma2.pdf
(51) https://www.quora.com/Can-someone-with-BPD-if-they-know-and-accept-that-they-have-
BPD-learn-to-recognize-when-their-thinking-and-reactions-are-becoming-counterproductive-
and-step-back-before-they-harm-themselves-and-others-How-can-I-help-my-partner-learn-
to-do-this/answer/Laura-Hurt?share=6de69485&srid=hY1DF
(52) https://mental-health-matters.com/the-false-self-in-borderline-personality-disorder-and-
pathological-narcicssism/
(53) https://www.healthyplace.com/blogs/borderline/2015/04/schema-modes-help-in-
understanding-borderline-personality-disorder
(54) https://www.ncbi.nlm.nih.gov/pubmed/29272751
(55) http://www.tijdschriftdepsycholoog.nl/assets/sites/6/Shedding-light-on-schema-modes-a-
clarification-of-the-mode-concept-and-its-current-research-status.pdf
(56) https://childhoodtraumarecovery.com/2017/07/03/trauma-triggers-definition-examples/
(57) https://www.ncbi.nlm.nih.gov/pubmed/19685950
(58) http://www.nicolamethodforhighconflict.com/ex-girlfriend-bpd-projection/
(59) https://mental-health-matters.com/acceptance-of-paradox-is-the-epicenter-of-recovery/
(60) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696274/
(61) http://dbtsydney.com.au/
(62) https://www.healthyplace.com/blogs/borderline/2016/04/soothing-the-inner-child-in-
borderline-personality-disorder
(63) https://en.wikipedia.org/wiki/Splitting_(psychology)
(64) https://static1.squarespace.com/static/54616986e4b085cc73aaffcf/t/59ada08c46c3c480db
36fae1/1504551053472/Complex+trauma+and+BPD+Working+with+integrative+failures+EJT
D+2017.pdf
(65) http://nonborderline.blogspot.com/2008/07/black-hole-of-borderline-personality.html
(66) https://mental-health-matters.com/past-vs-present-in-borderline-personality-disorder/
(67) https://www.quora.com/Why-is-it-inevitable-that-people-with-borderline-personality-
disorder-will-devalue-those-they-idealized/answer/Alexander-van-Hattem-
1?share=ebe50218&srid=hY1DF
(68) https://www.helpguide.org/articles/mental-disorders/borderline-personality-disorder.htm
(69) https://sites.google.com/site/cognitivetherapycenterofli/self-help-materials/borderline-
personality-disorder
(70) https://www.quora.com/If-you-strongly-suspected-that-someone-you-care-about-has-
Borderline-Personality-Disorder-and-that-they-are-not-aware-of-it-should-you-tell-them-of-
your-suspicion/answer/Mike-Leary?share=6c72cf77&srid=hY1DF
(71) https://static1.squarespace.com/static/54616986e4b085cc73aaffcf/t/59ada08c46c3c480db
36fae1/1504551053472/Complex+trauma+and+BPD+Working+with+integrative+failures+EJT
D+2017.pdf
(72) https://www.drugs.com/health-guide/borderline-personality-disorder.html
(73) https://mental-health-matters.com/borderline-personality-and-abuse/
(74) https://www.psychologytoday.com/us/blog/where-science-meets-the-steps/201512/the-
destructive-power-borderline-personality-disorder
(75) A Dissociation Model of Borderline Personality Disorder by Dr. Russell Meares (book, pg.
63)
(76) https://www.highconflictinstitute.com/who-are-high-conflict-people/
(77) https://www.psychologytoday.com/us/blog/here-there-and-everywhere/201611/the-5-
types-high-conflict-people-what-do
(78) https://books.google.com/books?id=Ez1VGRmaXPIC&pg=PA25&lpg=PA25&dq=HCP+person
ality+police&source=bl&ots=sG6kDOkfJ4&sig=s4dYy-e9h-
P086cxw5irWF2vjDU&hl=en&sa=X&ved=2ahUKEwiZtabdtO3dAhXKh1QKHUD0Cx8Q6AEwDn
oECAIQAQ#v=onepage&q=HCP%20personality%20police&f=false
(79) https://www.linkedin.com/pulse/its-all-your-fault-12-tips-managing-high-conflict-people-
bill-eddy
(80) https://www.klinikum.uni-heidelberg.de/fileadmin/zpm/psychatrie/fuchs/Fragmented-
Selves.pdf
(81) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423/
(82) https://blogs.psychcentral.com/therapy-soup/2014/03/narcissistic-and-borderline-
attraction/
(83) A Developmental Model of Borderline Personality Disorder by Patricia Hoffman Judd, Ph.D.
and Thomas H. McGlashan, M.D. (book)
(84) A Dissociation Model of Borderline Personality Disorder by Dr. Russell Meares (book)
(85) Search for the Real Self: Unmasking the Personality Disorders of Our Age by James F.
Masterson, M.D. (book)
(86) Lost in the Mirror: An Inside Look at Borderline Personality Disorder by Richard Moskovitz,
M.D. (book)
(87) **FIND ONLINE VERSION: Wilkinson-Ryan, Tess, A.B. and Westen, Drew, Ph.D.. Identity
Disturbance in Borderline Personality Disorder: An Empirical Investigation. Am J Psychiatry
2000; 157: 528-541.
(88) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579511/
(89) **FIND ONLINE VERSION: Mosquera, Dolores and Steele, Kathy. Complex Trauma,
Dissociation and Borderline Personality Disorder: Working with Integration Failures.
European Journal of Trauma & Dissociation 1 (2017) 63-71.
(90) https://www.healthyplace.com/blogs/borderline/2014/06/if-you-really-loved-me-bpd-and-
romantic-relationships/
(91) https://www.healthyplace.com/personality-disorders/borderline-personality-
disorder/borderline-personality-disorder-relationships
(92) The Buddha & the Borderline by Kiera Van Gelder (book)
(93) https://pdfs.semanticscholar.org/b7ae/da3aedce3b757bca57522a733d793c0f7302.pdf
(94) https://sjmyles79.wordpress.com/2013/07/22/borderline-personality-disorder-and-the-
chameleon-effect/
(95) https://www.sciencedaily.com/releases/2014/02/140210101955.htm
(96) http://borderlinepersonality.typepad.com/my_weblog/2009/01/bpdandidentity.html
(97) https://books.google.com/books?id=otOhCgZTWGYC&printsec=frontcover#v=onepage&q
&f=false
(98) FIND ONLINE: Early Experience, Structural Dissociation, and Emotional Dysregulation in
Borderline Personality Disorder: The Role of Insecure and Disorganized Attachment paper
(99) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579511/
(100) scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632015000200002
(101) https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0939-x
(102) https://www.ncbi.nlm.nih.gov/pubmed/14686459
(103) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by American
Psychiatric Association
(104) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743691/
(105) https://ceufast.com/course/borderline-personality-disorder
(106) https://www.psychologytoday.com/us/blog/matter-personality/201312/borderline-
provocations-how-not-respond
(107) https://janinafisher.com/pdfs/structural-dissociation.pdf
(108) https://en.wikipedia.org/wiki/Donald_Winnicott
(109) https://www.therecoveryexpert.com/HowtotreatBorderlinePersonalityDisorder.en.html
(110) http://bpd-home-
base.org/yahoo_site_admin/assets/docs/BK_CHAPTTO_USE_MANUAL.1663028.doc
(111)