Sylvia sits with her head in her hands and tears rolling down her cheeks. “Here I am again, all alone. Why can’t I trust anyone? Why does the world hate me so much?” she cries in tearful despair.
Borderline Personality Disorder (BPD): A lifelong pattern of unstable moods, unstable relationships, unpredictable emotions, and impulsive actions.
To live with borderline personality is to live with special pain and extra challenges, far beyond anything that most people ever experience. When you have BPD, you may feel positive and happy one minute, and have that all change the next. You may feel wonderfully loved by someone one day and hated by that person the next. You might put a friend, relative or spouse on a pedestal, only to have them become your most reviled enemy soon after.
Life feels unpredictable. It’s difficult to like yourself, or to have or sustain positive feelings in your life.
Research has shown several major factors to be the causes of BPD, including genetics, unpredictable parenting and abuse.
Childhood Emotional Neglect (CEN): A childhood characterized by the absence of enough emotional attention, emotional validation and emotional responsiveness from one’s parents.
Sylvia doesn’t know it, but she is living with Borderline Personality Disorder. Another important thing that Sylvia doesn’t know: she grew up with an extreme version of Childhood Emotional Neglect (CEN).
Typical (Non-extreme) CEN
CEN children grow up in a household that is essentially blind to emotion. Children whose emotions are not noticed or responded to enough receive the subtle but powerful message that their emotions are invisible and irrelevant. In order to cope in their childhood home, they push their feelings down, so as not to burden themselves or their parents. These children grow into adults who are out of touch with their own feelings. This causes a pattern of adult struggles, including feelings of emptiness, poor self-knowledge, lack of emotional skills, self-directed anger and shame.
The CEN child hears two messages loud and clear:
Your feelings don’t matter.
YOU don’t matter.
Those who develop BPD often (not always because genetics are also a factor) were raised with an exaggerated, more punitive version of CEN, and often in an intensely emotional family. The person with BPD’s parents not only ignored her feelings, but also actively invalidated them. Sylvia’s parents actually rejected and punished the normal feelings that she had as a child. Since her feelings are the most deeply personal, biological part of who she is, Sylvia received these messages loud and clear:
Your feelings are bad and unacceptable.
YOU are bad and unacceptable.
The 5 Effects of Extreme CEN
Your learn that your feelings not only don’t matter; they are bad
You learn that you not only don’t matter; you are bad
You do not learn the emotion skills that other children learn naturally in their childhood home: how to identify, tolerate, manage, express, or use your emotions
You actively reject your emotional self; this leaves you feeling empty, since you’ve rejected the most deeply personal part of who you are.
Your identity, or your sense of self, becomes fragmented because you have rejected important parts of yourself
So Sylvia learned not only to push her emotions away; she also learned to punish herself for having feelings. She has no choice but to actively reject her true self. She feels uncomfortable in her own skin, and doesn’t like herself very much overall. She has not learned how to soothe her own emotional pain. This leaves her far more vulnerable to depression and anxiety.
Only yesterday, Sylvia felt on top of the world. People at work had seemed extra nice to her, which made her feel happy. After work she had run into an old acquaintance she’d had a falling-out with years before, and they’d had a nice chat, almost as if nothing had gone wrong between them.
But today, all of that was turned on its head. It was super busy at work, and her co-worker asked her to hurry in a way that Sylvia felt was rude. This left her feeling raw and vulnerable. Then, as she arrived at her car to drive home, she saw that her tire was flat. At that point Sylvia dissolved into tears. Feeling enraged at other people for being mean, the world for delivering her a flat tire, and herself for it all, she left her car as it was, and impulsively took a taxi home which was far outside her budget.
Now, with her head in her hands, Sylvia is overwhelmed with anger and pain.
“Here I am again, all alone. Why can’t I trust anyone? Why does the world hate me so much?” she cries in tearful despair.
Treatment for Borderline Personality Disorder
Interestingly enough, although CEN is not generally listed as a contributing factor to BPD, the most effective treatment method identified to date by research is one which specifically targets the primary symptoms of CEN. It’s Dialectical Behavior Therapy, or DBT.
DBT teaches you a combination of mindfulness, interpersonal skills, distress tolerance, and emotion regulation. It is a very specific, structured method which helps you begin to intervene between your feelings and your actions so that you can become less emotionally impulsive, and learn to regulate your responses and behaviors in relationships and in your internal world.
Studies show that even though BPD is very painful and challenging, it is possible to lessen the symptoms, and to become more emotionally stable and resilient, with dedicated and persistent work and effective help over time.
So there is hope for Sylvia. She can learn that her emotions are not bad. And that in fact they will enrich and guide her, if she learns the skills she missed in childhood. She can learn that she’s not wrong or bad. She can realize that the world does not hate her.
But for Sylvia to decide to take on the work to change her life, she needs to realize a most vital truth that you and I already know:
Once you figure this out, a whole lot of other things will start to make sense.
To outsiders, your dad is a larger-than-life social magnet who attracts people from all walks of life. Or your mom is the perfect woman, always looking to please and juggling everything with ease.
But behind closed doors, all pretense falls away. Only you, their child, knows what it’s like to endure their cold shoulders for days on end over a minor infraction, or bear the brunt of constant, age-inappropriate demands for perfection and strength. You know what it’s like to be parented by a narcissist.
Narcissistic Personality Disorderis one of 10 personality disorders described in theDiagnostic and Statistical Manual of Mental Disorders, an authoritative psychiatric guide. Narcissists tend to have aninflated sense of self-worthand base their identity on the praise and approval of others. Their intimate relationships are superficial and focused mostly on how other people reflect on them, with little to no empathy for the other person’s experience. They genuinely believe that they’re better than other people, but they are also prone tofeeling intense shameover critiques they receive or mistakes they make.
Researchers estimate that less than one percent of the general population has evidence of “full-blown” NPD, but anywhere fromtwo to 16 percent of people who seek therapy have the disorder. That’s usually because the loved ones in their lives have demanded they seek help or risk losing their relationship, career or other life privileges, explains therapist Wendy Behary, founder of The Cognitive Therapy Center of New Jersey and author of the bookDisarming the Narcissist: Surviving and Thriving with the Self-Absorbed.
But children of narcissists are rarely in a position to demand that their parents seek help. In fact, they may not even realize that their parents were narcissists until they seek professional help for their own struggles, said Behary, who specializes in treating people with NPD and their “survivors.” While narcissists come in all varieties and their symptoms vary across a spectrum, Behary notes that there are a few ways for adult children to tell they may have been raised by a narcissist. In the points below, both she and psychologist Craig Malkin, author of the bookRethinking Narcissism: The Bad — And Surprising Good — About Feeling Special, break down the signs of a narcissistic parent, and what adult children should do to break the cycle of destructive decisions.
1. You’re a complete doormat.
A narcissistic parent will trample all over their family to address their own desires without giving much thought to what anyone else needs. Because of this, some adult children of narcissists will actually overcorrect and bend over backwards to make sure no one could ever possibly perceive them this way. Alternately, they may have grown up all their lives being told that their needs don’t matter. Either way, the result is the same: They let people walk all over them because they’re not in touch with what they need and they don’t know how to express it.
“They’re not able to say, ‘I matter,’ and ‘I have needs’ because that feels narcissistic,” explained Behary. “Someone who’s fighting hard not to be a narcissistic parent ends up being trampled on.”
“I’ve seen clients whose parents made them feel sick, crazy, or selfish for expressing the most basic of needs,” agreed Malkin. “One of my clients felt so worthless and frightened as an adult, he suffered from nightmares and cowered in the face of any authority figures because they reminded him of his abusive father.”
What you can do: Learn as much about narcissism as you can, in order to be able to identify the dysfunctional messages you grew up with and start working against them.
“If I meet someone who has grown up with a narcissistic parent, or if I’m clued in that that might be the case, it’s really important for me to make sure that they understand narcissism in all of its colors,” said Behary. “We figure out together what type of narcissism their parent had, but even more importantly, we have to look for the part of them that got lost along the way.”
2. You’re afraid you might be a narcissist yourself.
Not everyone overcorrects in reaction to seeing narcissism. Some children see that the only way to avoid ridicule and abuse is to be like the narcissistic parent, and over the years, this survival tactic turns into the way they genuinely see the world. Adult children who adopted these coping mechanisms may find themselves putting others down out of a fear — rooted in childhood — that if they don’t show strength first, they could be crushed, just like when they were young, explained Malkin. “Extremely strong-willed children, more extraverted from birth, sometimes become narcissistic themselves in a game of ‘If you can’t beat ‘em, join ‘em,’” he said.
What you can do: Seek the help of a professional to help you break out of abusive behavior patterns, especially if you already have a partner and/or children.
“Children of narcissists who find themselves name-calling and hurling insults aren’t without hope, but they need to roll up their sleeves and work hard emotionally,” said Malkin. “They need to become comfortable feeling — and expressing — vulnerable feelings like sadness, loneliness, fear, and overwhelm with those they love.”
3. You feel relentlessly competitive with, or resentful of, your sibling.
Narcissists have trouble with personal boundaries and view other people as extensions of themselves. In families with several children, one may be chosen to reflect the narcissist’s best qualities. They get the most attention, praise and support, but are also under the most pressure to perform. Another child may be a target for the parent’s blame and shame, and scapegoated as a burden that can never do anything right compared to the chosen child. They may also be blamed as the reason that a narcissistic parent is forced to act in an abusive way. Both projections are two different sides of a narcissist’s personality, but the chosen child and the scapegoat will have two very different childhoods, and this pits them against each other, even into adulthood.
What you can do: Reach out to your sibling with what you’ve learned. If you were the chosen child, you might resent your sibling for the fact that they were under a lot less pressure than you. But if you were the scapegoat, you might resent your sibling for soaking up all the praise and glory and leaving none for you. Understand that the narcissist pits people against each other on purpose, to serve their own needs, and that this dynamic wasn’t your fault.
“Extremely narcissistic people love to put people on pedestals — almost as much as they enjoy knocking them off them,” said Malkin. “Perfect people don’t disappoint, so if you idolize people ― even your kids ― you needn’t ever worry about being disappointed or hurt. Scapegoating accomplishes much the same thing. You never have to worry about expecting too much and being disappointed because none of us really expect anything from people we view as worthless.”
There is hope for siblings who were put in this position as children, said Behary ― even if the only thing that unites them in the end is the shared experience of having a narcissistic parent.
“They can end up feeling extremely bonded to one another,” said Behary. “Common hostages going through different phases of torture, based on how bad the narcissist might be in their life.”
4. At times, you’ve felt you were more your parent’s partner than their child.
Not all narcissists command the spotlight with their bold, brash personalities. Some narcissists demand the attention of the room by playing the victim or describing their problems as greater than anyone else’s problems. They may also try to control other people’s actions by threatening to harm themselves unless a certain outcome goes their way.
People with this kind of narcissistic parent may feel that they spend their entire childhood running to put one fire out after another, or trying to maintain the peace so that no one is hurt. Some of Behary’s clients tell her that they felt more like their mother’s husband than their mother’s son, and this burden meant that they were doing more of the emotional supporting than the parent was. Or they felt their life was all about keeping their father from getting angry at the family.
“It’s the sense of drama that the child feels they have to manage,” said Behary. “In order to do that, they really have to forfeit a lot of their own innate childhood needs.”
What you can do: Take time to acknowledge the young child that’s still inside you, and ask what his or her needs were and still are. Behary advocates using the power of imagination — aided, perhaps, by photos from childhood — to acknowledge the emotional needs that weren’t met and still aren’t being fulfilled by your parents.
“She’s still suffering in there and she needs someone to care about her,” said Behary. “She needs to be able to feel that she’s fine. She needs to know that she has rights too.”
5. You derive self-worth solely from your achievements.
Some children of narcissists figure out that the only way to get along in this world is to do as their parent does and derive their self-worth from production, performance and achievement. While they may not be beset by the perilously low self-esteem and overwhelming sense of shame of a true narcissist, some adult children may take on behaviors like workaholism because their performance is the only way they’ve ever been taught to define themselves.
“The child of the narcissist learns that the only thing that matters is what I can produce in the world, not just my own little being,” said Behary. “[This] is very similar to the way the narcissist can be in the world, except children of narcissists may not have same brash overcoating — they’re more detached, more self-contained.”
What you can do: Try to empathize with your parent, suggests Behary. You don’t have to feel sorry for them, but it can be helpful to emotionally inhabit the feelings and choices of another person, to understand their thoughts and decisions, even if you don’t agree with them. Because of Behary’s work with narcissists, she understand that they are often intensely suffering because the survival tactics they learned in childhood are backfiring on them in adulthood.
While some researchers think that there may be abiological basisthat makes some people more vulnerable to narcissism than others, others agree that the personality disorder stems from acomplex mix of factorsthat include exceptionally harsh criticism and/or praise in childhood, which causes the child to shield their low self-esteem with a strong, perfect persona. It also makes the child especially needy of praise, admiration and flattery in order to feel normal, while leaving themespecially vulnerableto even the slightest criticism, notes the Mayo Clinic.
“I care about the [narcissists] I work with because I know they’re suffering underneath,” said Behary. “People will say, ‘You’re such a softie on them,’ and I say I hold them responsible for their bad behaviors, but I don’t blame them for how they were formed.” Behary emphasizes that while narcissists may have turned out this way through no fault of their own, it is solely their responsibility — not their children’s — to do something about it.
6. You have no sense of yourself, your wants, your needs or your goals.
A telling trait of narcissism is grandiosity: thoughts or feelings that one is superior to others, even if one doesn’t have the achievements to justify it. Narcissistic parents may see themselves as elite, but because they never achieved a certain level of success, they may find meaning in living vicariously through their children, explained Behary.
“Many children of narcissists will say, ‘I’m not sure how I ended up in this career because I never really knew what I wanted,’” said Behary. Or, “I always felt like I was poised to be more of a reflection of my mother rather than be my own person.”
What you can do: Consider going low or no-contact with abusive or manipulative parents. Not all narcissistic parents are abusive, explains Malkin. But parents with extreme forms of narcissism can leave their adult children feeling like shells of themselves, and sometimes the safest thing for adult children to do is to limit their exposure to these toxic relationships, especially if the parents don’t think they have anything to apologize for.
Malkin says there are three signs an adult child should consider going low or no-contact with parents: Abuse, Denial and Psychopathy. No one should ever have to put up with emotional or physical abuse, and if parents can’t acknowledge the fact that there’s a problem in the first place, there’s little chance that anything will change. Psychopathy, which in this case will look like a pattern of easy lies and remorseless manipulation, indicates that the parents aren’t just bad at putting themselves in others’ shoes — they may actually lack the ability to empathize with others, and may even lack a conscience.
“Abusers are 100 percent responsible for their abuse, and only they can stop it,” Malkin concluded. “Until they do, interactions won’t be safe.”
Do you know someone who is struggling with intense emotions, rage or anger, emotional lability, interpersonal conflict, unstable social or family relationships, and poor self-image? If so, perhaps you are dealing with Borderline Personality Disorder (BPD). BPD is a mental health condition that affects all facets of a sufferer’s life. Sadly, although BPD has become less stigmatized over time (especially with Dr. Marsha Linehan and many other experts educating society, families, caregivers, and sufferers to what BPD actually is), it is still hard for people to accept. But as a mental health therapist I have evaluated, talked to, and counseled adolescent girls who stayed in multiple abusive and emotionally unstable relationships for the simple fact that “I cannot live without him. I will die.” These intense emotions led to a cascade of other behaviors that were disturbing such as stalking, obsession, begging, and even sexual immorality. The intensity of the emotions of someone suffering from BPD may be disproportionate to the actual situation. My experience with clients has been that a diagnosis of BPD is like a death sentence due to stigma. This article will explain what a diagnosis of BPD can lead to and how to view the diagnosis in a healthier way.
As a therapist there are times when I have trouble sharing a diagnosis with a client. Why? Because so many of the mental health diagnoses that society talks about (depression, anxiety, bipolar disorder, borderline personality disorder, narcissism, psychotic disorders, and sociopaths) are all stigmatized and confused by hearsay, incorrect information on the Internet or in society, and hidden by those too embarrassed to discuss it. It’s no wonder so many people would rather not see mental health professionals. Receiving a mental health diagnosis or personality disorder diagnosis can change your life forever. Not just change the course of your life due to symptoms, but also change your social, work, and familial relationships in addition to how you view yourself. Self-esteem is often at the core of someone’s difficulty in accepting a mental health diagnosis. It’s bad enough that many of us struggle with self-esteem and incorrect perceptions of ourselves, much less trying to function confidently in the world with a mental health or personality diagnosis.
Over the course of my career I have seen my fair share of clients drop out of therapy after a mental health or personality related diagnosis. Some of the most stigmatized diagnoses included schizophrenia or some other disorder with psychotic features, borderline, antisocial, and narcissistic personality disorder, and oppositional defiant disorder and conduct disorder (which often can develop into sociopathy later in life). In fact, a previous adolescent client ran out of my office when I shared with she and her mother what my case conceptualization was. I informed the young lady and her parents that she was meeting criteria for borderline personality traits and that borderline personality disorder may be a future diagnosis. The young lady bolted out of my office door and ran to the car. She eventually returned after 35 min and shared that she was ashamed that she had “a diagnosis of someone who is really crazy.”
Stigma is a major roadblock for individuals meeting criteria for BPD. After working with multiple adolescent girls and boys including some adults with BPD traits, I have come to recognize that the following considerations can help those diagnosed with BPD accept their diagnosis:
It can open the door for specialized treatment: Individuals diagnosed with BPD should not be so concerned about the label and the stigmatized information found online or spoken in the community. But individuals with BPD should be focused on the fact that treatment can be more tailored to the specific symptoms and challenges that often creates interpersonal, emotional, and psychological barriers. For example, a good therapist will seek to place the individual diagnosed with BPD in a DBT (Dialectical Behavior Therapy) group or program or include DBT work within the therapeutic relationship to help the individual cope and grow in treatment. The label does not have to be a “death sentence” but rather the beginning of a therapeutic plan designed specifically for the problematic symptoms.
Exploration of the diagnosis can lead to greater understanding: Finally receiving a diagnosis of BPD can truly lead to relief, even if that relief is only psychological. Some of my long-term clients have expressed how grateful they were for finally getting the correct diagnosis. Feeling like you are hanging in mid-air just waiting for some kind of understanding of what you are suffering from, can feel like a slow death. Having a label that makes sense, has a specific treatment plan, and has an evidence-based (proven to work) treatment plan can take a load of stress of your shoulders.
BPD can help you identify the “why” of intense emotions & conflict: As stated above, being able to understand what a label means can be a load off. Many individuals who are struggling with BPD symptoms such as: intense emotional reactions, fear of abandonment, poor self-image, and lack of identity are often glad to finally understand “why” they have been suffering within their social and interpersonal relationships for many years. Because of the constant challenges within relationships of all kind, the individual with BPD may begin to attribute the relational difficulties to how they were raised, to the culture they were born into, or a problem with morals, ethics, or values. Having a label disrupts this incorrect view.
BPD is more than a label: Although BPD is just a label, having the label can help those around you including your own therapist understand how to help and support you.
Medication management can begin with a goal to target the right symptoms: Medication management is often important if depression, anxiety, or psychotic symptoms are present. Although medication cannot “cure” BPD, it can reduce symptoms such as depression or anxiety that contribute to self-injurious behaviors, suicidal thoughts, or depressed and anxious mood. If psychotic symptoms are present (paranoia, hallucinations, delusions, etc.), medication can help stabilize the individual so that therapy can be more effective.
The roller coaster relationships can stop: It is a known fact that individuals with BPD struggle within their relationships. A typical case of BPD may include multiple or vicious divorces, multiple partners over time, abusive behaviors and/or domestic violence (male or female), anger management difficulties within the community, obsessive or paranoid behaviors within a romantic relationship, and even stalking if the obsessive relational patterns get worse over time. With a label of BPD and appropriate treatment, the individual can better understand why their relationships tend to be chaotic or unstable. While BPD is not always the reason for stormy relationships, for those with the diagnosis, remaining in therapy to work on relationship stability is an important step toward building healthier relationships.
You can begin researching ways to help yourself: When you don’t know exactly what you are struggling with it can feel almost impossible to figure out how to help yourself. For example, if you don’t know that your symptoms of isolation, anhedonia, lack of motivation, and tearfulness or irritability are signs of depression, you can become very confused if you look your symptoms up online or talk to others you may trust. It can be difficult for mental health professionals and even medical professionals to narrow down your symptoms enough to provide a diagnosis, much less you and those around you. Going to Webmd, Mayo Clinic, or some other website can confuse you more than you were before. Having the label first and then researching it can make all the difference.
Your family/friends/caregivers can better assist you: Being able to share a label with your loved ones can truly awaken them to what you are experiencing. It’s like telling your loved ones you have cancer or heart disease. They will know (or learn) how to help support you and may even begin to educate themselves to how you are affected on a daily basis. Your loved ones may even come up with ways to help you cope.
You will know how to identify your triggers: Having a label can help you not only educate yourself and others to your needs, but also help you identify your triggers. For example, for individuals suffering from BPD, a trigger is often the fear of abandonment within relationships. Knowing that you exhibit symptoms characteristic of BPD can help you identify the things that make you feel vulnerable within your relationships. You can also learn about the things that can lead to relational challenges that completely break you down emotionally.
What has been your experience with BPD or with someone who has BPD? What was the response after getting the diagnosis? Do you think people have a negative view of BPD? Why is it so hard for some individuals to accept the diagnosis?
As always, feel free to share your thoughts below.