Borderline Personality Disorder (BPD)

Dr. Ali Khwajapresents a simple but practical understanding of this very troublesome disorder

Lately BPD has been in the news more than before, and many people are being diagnosed with this disorder by psychiatrists.  The following details are meant to help those who are facing possible trauma, and is not a medical analysis.  BPD can be confirmed only by qualified mental health professionals. Though its roots may go back into early years of life, it is often fully identified only in adults who behave very unreasonably causing immense agony and distress to those who are close to them.

Overall indicatorsinclude difficulty in processing or managing emotions, self-image issues, varying moods, and behavioral changes. In addition, it can cause a sense of instability and insecurity.  These symptoms can cause a person to engage in impulsive behaviors and develop strained relationships with family members, significant others, friends, and acquaintances. Other possible symptoms are:

 

1.      Mood swings, including verbally or physically attacking near and dear without or with minimal provocation

2.      Deeply liking or deeply hating individual people

3.      Suspicious nature, irrational fear of others’ behavior or intentions

4.      Low self-image, doubts about oneself, self-pity and loneliness

5.      Thoughts or actual acts of self-harm or anxiety

6.      Often take impulsive decisions or risky behavior, and then back-track

7.      Difficulty in maintaining intimate relationships, with unreal fear of abandonment, at times leading to impulsively forming new relationships

8.      Resorting to unhealthy coping mechanisms such as alcohol or drugs

9.      Anger issues, which can include irrational, intense anger or issues with controlling outbursts or violence.

 

More than half of the above to a reasonable extent and for a period of time exceeding 3-6 months can be fairly good indicator that the person needs professional help.

 

Most of such people have had some bad experiences in life which eventually resulted in BPD.You can check out if the person has:

·         Childhood trauma, abuse, sexual molestation, or growing up in a dysfunctional family

·         Been cheated, abandoned or let down by trusted person(s), particularly in early life

·         Been allowed to freely vent out strong emotions without anyone controlling or guiding

·         Is currently facing high stress, at work or at home

·         Is in a position of authority in office or in family, due to which he does not face much confrontation or resistance

·         Had a family member who also had BPD symptoms

What causes BPD?Exact causes have still not been confirmed, but genetic predisposition combined with environmental factors may be involved. It could also be due to changes in brain chemistry. Confrontation and challenges to his views and behavior can aggravate symptoms.

 

Treatment

If a person is accepting his unreasonable behavior and is willing to change, he can:

·         Learn about borderline personality disorder and accept the above symptoms

·         Focus on your current ability to function and where there are hurdles

·         Learn to manage emotions that feel uncomfortable

·         Reduce impulsiveness by observing and analyzing feelings rather than acting on them

·         Work on improving relationships by being aware of your feelings and those of others

 

Psycho-therapyis the prime and most effective way of healing.  Types of psychotherapy that have been found to be effective include:

·         The most popular one, especially in developed countries isDialectical behavior therapy (DBT), which uses a skills-based approach to teach how to manage emotions, tolerate distress and improve relationships.

·         Cognitive behavioral therapy (CBT), which helps identify and change unhealthy beliefs, behaviors, and inaccurate perceptions the person may have about himself or others. It teaches better ways to react when the individual feels angry, insecure, anxious, or has suicidal thoughts.

·         Schema-focused therapy which helps identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life.

·         Mentalization-based therapy (MBT) which helps identify own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting.

·         Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.

 

Medications

Although no drugs have been approved or specifically identified for treatment of BPD, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics in extreme cases, or mood-stabilizing drugs./

 

Therapy for family members

 

Living with a person with BPD is very traumatic for the immediate family members, and they may require constant emotional support, understanding of the behaviors and abuse by the person, and to cope with the very negative environment that is created by him. In some cases marriages may break up, children may grow up with wrong values and attitudes (resulting in their becoming prone to BPD in adult life). Family members may need to be taught to reduce stress, prevent burnout, insulate themselves emotionally, and work on other relationships.

 

When pushed to the wall, family members may start reacting negatively, and throwing the following accusations to the individual:  “You’re so emotionally unstable.”  “Why can’t you hold down a relationship?”  “You don’t need to get so angry all the time.”  “Pull yourself together!”   “It’s like you have two completely different personalities.”  “Do you ever think first about your actions?”  “I can’t cope with you and your mood swings!”  “Be more positive!”

Such statements, though made after lot of tolerating and in frustration, only aggravate the situation and make the person more defensive and aggressive. Avoiding such confrontations, family members need to practice as much of the following as possible:

·         Carrot and stick policy – be very nice to him when he is calm, and be cold when he starts becoming aggressive.

·         Learn most suitable techniques of stress relief, including meditation, mindfulness, engaging in joyful and distracting activities, music, or even rigorous workout, jogging, punching a bag, tearing newspapers to shreds, etc.

·         Build strong bonds with all other members of the family, if possible connect to extended family, and feel the joy of being bonded, loved and cared.

·         As far as possible, avoid confrontation or even applying logic to the issue on hand, or about his behavior. In fact, remaining aloof and not showing any emotional dependency would help.

·         Do not try to hide his negative behavior from others or give excuses on his behalf.

·         Avoid being alone with him, have people around you and continue with routine regardless of his non-cooperation or criticism.

·         If and when he shows a desire to bring about a change, keep a list of therapists ready and give him the choice which professional he would like to take help from.

Recovery takes time

 

The time required for change and improvement depends a lot on the individual’s acceptance that he has a disorder and his willingness to help himself. As long as he is in denial it is very difficult to bring about a change.  Even when he is willing, learning to manage emotions, thoughts and behavior takes time. Most people who put in sincere efforts doimprove over a period of time, but they may always struggle with some left-over symptoms of borderline personality disorder. There may experience when symptoms are better or worse. But treatment can, with consistency and persistence, make the individual much more functional, feel better about himself, and rebuild close relationships.

 

Note:BPD is not a severe psychotic disorder such as schizophrenia or Bipolar Disorder, though it is often confused with them. There are people with BPD who are productive members of society, sometimes even commanding a respectable and authoritative position, but they lead a form of double life, being very aggressive with selected few. Hence it may be difficult to get support from others who may not agree that he has a disorder. Do not be disheartened if others are unwilling or incapable of understanding the situation, but do work on overcoming extreme symptoms before they lead to a burnout or permanent damage. It is very rare that the symptoms come down by themselves.

 

Hope

His mother was abducted from her tribal village in Africa and brought forcibly along with hundreds of other men and women to America, to be sold as slaves.  She was raped continuously by so many men that when she gave birth to him, she could not say who the father was.  And when he was quite small she was killed by some drunken men who mass-raped her brutally and left her to die in a ditch.

He was passed on from one woman to another in the slaves’ quarters.  The Master had his eye on him and told the women to nurture him as he showed signs of growing up into a strong man who could be useful in the plantation.  He was never really given a name.  Often referred to as ‘forty three’ since that was his roll call number when the slaves were locked up for the night, he was also called by many derogatory and humiliating names, most of which he did not even know the meaning of.

He was never given an upper garment, and was made to wear khaki shorts and nothing else. He did grow up to become a strong man, and could do back-breaking work. But he had a look of arrogance which always annoyed the Master, and hence he received lashings and kicks for no fault of his quite often.  The beatings only served to strengthen him further, and the derogatory names he was called by made no impact on him.

The Mistress had an eye on him because of his big build, well-carved features and his rippling muscles.  When the Master kept getting drunk every evening on a regular basis, obviously she felt lonely and unloved, and craved for a man. She started seducing him, flirting and calling him to her to do chores in the kitchen.

The Master was no fool.  He sensed what was happening, and one day he called out to the slave and in front of the Mistress and many other slaves, started beating him up mercilessly.  When he became exhausted after beating up the man continuously, he was surprised to see the slave still standing and apparently unperturbed. In his confusion and frustration he could not think of what else to do, so he pulled out a one-dollar note from his pocket and asked the slave to run to the town and get him a bottle of liquor – threatening that if he did not return in twenty minutes he would be again beaten up even more.

The slave, like a robot, took the dollar-note, tucked it into the pocket of his shorts, and started running at full speed towards the town.  When he neared the town, he saw that a road branched off, bypassed the town and led to other unknown places.  In fact, he had never noticed that fork and the other road.  But this time he saw it clearly.  He did not have any conscious thought, but he just changed track and started running on the new road.

He was a man without a name, identity, any assets, no family, no professional skills, and no contacts. He was just an anonymous runaway slave.  He did not know where this road would lead him. He did not know what he would be able to buy with one dollar. He did not know how far he would have to run to feel safe from re-capture. But he was running with a steady pace, his head held high, with a sense of freedom.  And he had a great asset – hope. He kept running……

Dr. Ali Khwaja

Just ants

Aab is fascinated with ants.  He has this strong instinctive feeling that they are far superior to human beings.  He loves sitting in a corner and watching the rows of ants walking with so much discipline and team spirit to collect morsels of food and bring them to their den. They even pause for a fraction of a second and touch the ones on the return journey, as though to convey love or salutation, and merrily continue in the path trod by those in front of them. No fights, no groupism, no rebels, and no one trying to assert authority – and the army keeps merrily marching on!

To test them out Aab sometimes puts down a piece of a biscuit or cookie he is eating, and observes what happens.  In no time a single roaming ant turns up.  Aab watches closely as the ant seems to taste a tiny piece of the biscuit, satisfies himself, refuses to gorge on the remainder himself, and quietly disappears. Very soon he sees a row of them making a beeline towards the biscuit.  He cannot recognize whether the scout ant is in the lead or not, but they sure know where they are headed. Not one of them starts eating by himself – they all pick up one morsel and start their return journey in a systematic row. No idling, gossiping, overtaking or wandering off.  There is no visible ‘boss’ supervising their behavior, but they don’t seem to need one.

To test them out Aab sweeps a portion of the row of ants gently.  They tumble over, are scattered, but within seconds they get back into line and continue their task.  Unfortunately Aab cannot see what happens inside the anthill, but he can guess how the tasks are carried out with equal responsibility and commitment. Aab looks around to see if he can find any group of human beings who behave in such exemplary manner – but in years and years of his observation he has never found one.

Aab wonders what it would have been like to be born as an ant. No competition, no jealousies, no worries about who will cheat you, and no striving to get the better of anyone else. No one gets thrown out of his job, no one is promoted or demoted, no one’s rights are trampled upon. He wishes that at least he should have been able to talk to ants.  They would have so much to enlighten him, and he could have made lifelong friends.  But unfortunately Aab is born a human and has to die one.  In the intervening years he has to observe sadly all the cunning, cheating, malice and jealousies of the “superior race.”

Travel to happiness

There is a famous proverb: “Man travels all over the world looking for happiness, only to find it at home.”  The mystic poet Kabir Das had also said something similar about searching everywhere for God and then finding out that He resides in your own home.

I have always been a critical admirer of proverbs and quotes of famous men.  But I do not blindly follow and applaud them.  There are times when I find some very popular proverbs either irrelevant, senseless, or even exactly opposite of what I believe in.  When I identify such a quote, I just ignore it and move on.  But I find so many people who blindly read, repeat, forward and quote to others, without giving a deep thought to their relevance – more so if it is a quote by a “foreigner” with an impressive sounding Western name.

With due respect to many great people (who may often say great pearls of wisdom, but not always so), I think we should introspect and evaluate the relevance or usefulness of a quote.  Going again to the proverb at the top, is it necessary that we come back after our explorations and find happiness at home?  What if we have grouchy family members, or if we are going through stress at home for various reasons?  We can perhaps find happiness when we explore beyond and see how others are dealing with their life situations. 

Travel is a great education in itself and even a source of joy.

Where does Aab belong?

“Where do you belong to ?” People often ask this question to new persons they meet. Whenever someone asks this to Aab, he is puzzled. He would  perhaps be able to answer the “where” if he knew the meaning of “belong”. On the one side, he firmly believes that everyone and everything in this universe is connected. On the other, he wonders who belongs to who. When we cannot even own the air we breathe, how can places own us ?

   Aab sits on a patch of ground and wonders whether he can belong to it. He walks on a road and muses whether he belongs to it.  He walks on a road and muses whether he belongs to the path. He looks up at the sky and clouds and refuses to believe that he can belong even to a tiny patch in it. And as if to prove his point, the clouds move away, change shape, disintegrate – and disappear.

   He listens  with amusement when people talk proudly about their ancestry, their roots, their “native” place, and their possessiveness over it. There is such a strong need to belong as though by ourselves we are incomplete. We need to reassure our fickle minds and appease our insecurity by the reassurance that we are not alone and we need not fend for ourselves. But Aab finds a strange relief in not belonging. He has no home town, no mother tongue, no family tree. Every moment that he is with any friend or stranger, he feels belonged to that person. When someone reaches out to him, he holds the hand, when someone moves back, he moves on.

Where are they headed?

I was invited by Public TV to conduct a Career Guidance session at their Career Fest in Palace Grounds.  Though I was pleasantly surprised to see that there were hundreds in the audience (and I was flattered when some of them told me, “we came only to listen to your talk”), I was once again concerned about the absolute lack of awareness or knowledge about the immense possibilities and options that today’s world offers, and more so with the method they need to use to select their career. 

As adults we force children to go on studying for hours and hours, day after day, completing “portions” and facing innumerable exams. But we do not give them any inputs to actually make them successful and happy human beings.  We do not guide them and teach them how to take the right decisions.  Worse, we not allow them to follow their dreams and aspirations, and wish to make them robots by getting into routine and boring careers just because there is more “scope” in them. It is the responsibility of every adult to ensure that we allow children to blossom out and grow the way they want.

Aside: Western countries were spending more and more money making robots, till they realized that very intelligent third world youngsters are willing to work like robots at much less cost !

compete with yourself

Do I need to put the other person down to show how good I am?

We do have to compete in many areas, we have to win over to move on, and we have to face conflict from those who hold different views.  That is fine. But what I wonder about is…..

When facing any opposition or when there is a need to prove that we are right, why do we focus only on pointing out the negative aspects of the opponent, instead of highlighting where we are right or what we have achieved.  It is done by politicians (listen to election speeches), religious gurus, business competitors and even by family members.  A neutral person listening to such put-downers and criticism is not interested in the unpleasantness and wants to keep away from both parties.

I feel that if I am confident about myself I should stop accusing the other person and emphasize on what I have done or why I deserve better treatment or reward.  Trying to climb over others’ shoulders may make you go higher – but before you know it he or someone else will be climbing over your shoulder and you are back to square one.  Comparing oneself with others, trying to prove I am “better than thou” not only does not get long term results, but makes life a little bitter.

How about ignoring your opponents and detractors, and focusing on yourself, your progress, your skills and your goals?  How about competing with yourself?

Try it out, and make it a habit.