346 SelfWork: Borderline Personality Disorder, Guilt, and Building Boundaries

I wouldn’t wish borderline personality disorder on anyone – it’s a truly difficult and chaotic way to live life. Yet it’s just as difficult to be in relationship with someone who lives their life on an emotional roller coaster. Today we’re going to focus on how you can set boundaries with folks who have borderline traits (I’ll also go over the traits themselves). We’ll focus specifically on having a parent with borderline PD – but these suggestions could also help if your friend or cousin or sibling suffers from the disorder. I’m pulling from some extremely well-written articles as well as my own experience with patients – and those links you’ll be able to find in the show notes..

The listener voicemail is tough to listen to and involves murder – so please realize this may be a trigger for you. It’s from a woman who’s deeply grieving her daughter’s actions as well as the deaths of grandchildren - and blames herself – or feels guilt – for not knowing how to help. I’ll do my best to answer…

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Mayo Clinic’s list of signs and symptoms

Psychology Today article, Matthew Hutson

Article by Megan Glosson from The Mighty

Books on Borderline Personality Disorder: Understanding the Borderline Mother, Stop Walking on Eggshells, and I Hate You Don't Leave Me. 

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Episode Transcript

This is SelfWork. And I'm Dr. Margaret Rutherford. At SelfWork. We'll discuss psychological and emotional issues common in today's world and what to do about them. I'm Dr. Margaret and SelfWork is a podcast dedicated to you taking just a few minutes today for your own selfwork.

Hello and welcome or welcome back to SelfWork. I'm Dr. Margaret Rutherford. I'm a clinical psychologist and I started SelfWork almost seven years ago in order to extend the walls of my practice to those of you who might already be very interested in psychological and emotional issues, maybe you're even in therapy, would would appreciate the comments from another therapist or thoughts or to those of you who might be looking for answers. Maybe you've just been diagnosed with a mental illness or you have a loved one that you're concerned about. But also to those of you who are bit skeptical about the whole mental health thing, this is for you and I so appreciate every one of you being here.

You know, I wouldn't wish borderline personality disorder on anyone. It's a truly difficult and chaotic way to live life, but it's just as difficult to be in relationship with someone who lives their life on this kind of emotional rollercoaster.

Today we're gonna focus on how you can set boundaries with people who have borderline traits. And I'll also go over the traits themselves. We'll focus specifically on having a parent with borderline personality, but these suggestions would also help if your loved one is a friend or a cousin or a sibling that suffers from the disorder. I'm pulling from some extremely well written articles as well as my own experience with patients and those links you'll be able to find in the show notes.

I discovered a wonderful article on the Mighty written by someone with borderline who offered what I thought were creative and very helpful tips on how the individual themselves can set boundaries with themselves that allow them to slow down, be less reactive, and thus create less chaos.

The listener voicemail is tough to listen to and involves murder. So please realize this may be a trigger for you. It's from a woman who's deeply grieving her daughter's actions as well as the deaths of grandchildren and blames herself or feels guilt for not knowing how to help. I'll do my best to answer. I wanna announce that for a few weeks now, self self-work has offered transcripts for episodes which we hope will offer the hearing impaired or anyone who might wanna read the actual transcript. What I hope is that those folks who wanna do their selfwork will now be able to read it.

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So let's answer the most obvious question first, what are borderline traits? Here's the Mayo Clinic's list of signs and symptoms, and I'm adding my own comments about what that might look like in real life.

So here's number one, an intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection. Now when they say extreme, it can be very extreme. I once worked with a man, happened to be a doctor who'd been so emotionally abused by a wife with borderline that he was divorcing her. He drove from another city to see me because she'd follow him, threaten him with bizarre threats and leave frightening troubled notes or dead animals to try to prevent the divorce from happening. This was very serious. Now obviously she had severe borderline and borderline is on a spectrum just like everything else in mental health, but this fear of abandonment is really, really strong.

Number two is a pattern of unstable, intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn't care or is cruel. So you can go from the best friend ever, the best child ever, if it's your parent, the best therapist ever to the worst, just imagine what it might be like to truly feel that way, the way the borderline feels. And of course when you're on the receiving end, and if you are a child, it's highly confusing and can feel very manipulative.

Number three is rapid changes in self-identity and self-image. That includes shifting goals and values and seeing yourself as bad or as you don't exist at all. What I've found is that questions will be asked like, do I matter at all? For example, years ago I had a client who'd leave this message on my voicemail, "Call me back if you want to."

So if I called back, I obviously wanted to reflecting that it was soothing to her that it wasn't my job to call her back, but cause I cared about her. And of course the opposite of that would be if I didn't call her back, at least not immediately, it would mean to her I didn't care and the client could even feel that she didn't exist for me. And so they can set themselves up by this need for reassurance. And also when they don't get it in the way they want it, they can feel as if they don't exist. They're not important, they're bad, whatever.

Number four is periods of stress-related paranoia and loss of contact with reality lasting from a few minutes to a few hours. Now this is the case for truly severe cases of borderline. I'd say what happens more often is that the person with borderline personality disorder frequently disassociate likely due to previous abuse.And so it's become a way for them to de-stress.

Dissociating means that your minds sort of goes someplace else and you feel like you're not really in your body. Daydreaming is a mild form of dissociating. But people with a lot of abuse in their histories, their minds have dissociated from the abuse when the abuse was happening as a way to protect themselves.

Here's the next one, impulsive and risky behavior such as gambling, reckless driving, unsafe sex spending, sprees, binge eating or drug abuse or sabotaging success by suddenly quitting a good job or ending a positive relationship. Now this trait can be confused with bipolar disorder and does have quite a few similarities, but when the mania is over, someone with bipolar disorder will see the damage as damage. Someone with borderline personality disorder may not. Most of this is due of course, to the fact that they are governed by their emotions.

So if they wanna do it, if they feel like it's an impulse at the time that they wanna do or they'll spend the money or they'll drive recklessly it's sex they wanna have, then they'll do it no matter what the impact on them is or other people.

Actually. The next one is suicidal threats or behavior or self-injury, often in response to fear of separation or rejection. This is very, very common. Cutting is often a part of this or burning yourself. Another is hitting their heads against something repeatedly. And of course what someone with borderline personality disorder might tell you is that when they cut, they're actually trying to distract themselves from their deep emotional pain. It relieves the depth of their emotional pain by feeling physical pain. Other borderlines have told me that they don't feel anything when they cut. So it is truly a dissociative, like we were talking before, it's a dissociative behavior.

Here's the next. Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame, or anxiety. Again, this really mimics bipolar disorder.

Here's a very important one, ongoing feelings of emptiness. I had the same, "call me if you want to" client tell me her soul felt like it was a black hole. In my work with borderline personality, I often used the image of creating a safe sponge in your soul. So when something positive comes your way, you can absorb it instead of being lost in that black hole and you lose the existence of whatever positivity there was. But of course, someone with borderline may also or more often absorbed the negative. That's why the sponge idea has to be linked with positive feedback.

And then the last is inappropriate intense anger such as frequently losing your temper, being sarcastic or bitter or having physical fights.

So those are the major signs and symptoms of borderline personality disorder. Now your next question could easily be how does someone develop B P D? The only answer is that its cause seems to have multiple levels, multiple facets because we don't know. It may be from early trauma, very poor attachment, never feeling safe. There are many in fact who feel that dissociative identity disorder or what used to be called multiple personality disorder is really a severe borderline disorder where in your past your safety was so compromised that you literally had to break into another sense of self or another persona to handle the stress of no safety. Think of it as something getting heavier and heavier to hold. So you have to use both hands. As the stress increases with the horror in this case, increases, your mind creates another self to help with the weight of that horror.

And so doing your mind stays more stable, although you are now "broken" into two personas. Much less severe is the person who may feel as if they morph into different aspects of themselves. Not two different names or identities, but again, those symptoms we discussed of changing values or identities is tied into dissociation so early trauma can cause it. Then there's genetic inheritance, although genetic factors are being ruled out in other areas. So I'm not sure on this one. Now these behaviors can also be learned if you had a parent with borderline, you can absorb and mimic those beliefs and behaviors. But what I really wanna say is that it's a miserable way to live. And obviously if you are a child of someone with borderline, it's very confusing and very complicated. But let's move on to trying to love and relate to someone with borderline personality disorder. We'll talk about that right after we hear from AG1.

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Okay, let's get down to setting those boundaries. Many of the authors and researchers who write about borderline personality say it's helpful to see the different kinds of people with borderline traits. If you've listened to SelfWork a lot, I did an episode a while back on the different categories of narcissism. So this is similar we should say here, and in fact I probably should have said it in the beginning. There do seem to be more females with borderline than males. The reason for that is unknown.

So let's talk about those types or categories of borderline. Christine Lawson, author of Understanding the Borderline Mother has a taxonomy of the troubled parent. There are four of them, the waif, the hermit, the queen and the witch. In a Psychology Today article, a man named Matthew Hudson writes, "The queen is controlling, the witch is sadistic, the hermit is fearful and the wave is helpless."

Why is this important? Because the way they may have of interacting with you is going to look and feel different from one another. And so each requires a different approach. Again, I'm still quoting Matthew Hudson. "Don't let the queen get the upper hand. Be wary even of accepting gifts because it engenders expectations. Don't internalize the hermit spheres or you'll become limited by them. Don't allow yourself to be alone with a witch. Maintain distance for your own emotional and physical safety. The witch is probably the most sadistic and even sociologically pathological kind of personality, and the wife don't get pulled into her crises and sense of victimization". Lawson says, "Pay attention to your own tendencies to want to rescue her, which just feeds the dynamic."

But all that said, what does loving someone with borderline personality feel like and what can you do? Often the chief of motion you have to deal with and learn how to confront is guilt.

Let's say your phone rings, you look down and her name appears on your screen. Sadly, you dread clicking over and then comes the guilt you history with her rushes into your mind as you wait for one more ring, you're reminded of all the times that you've rushed her aside, comforted her and told her you'd be there for her while realizing over time that your caring would never be enough to shore up her fragile self-worth. Or you think of how you've watched as she's made one impulsive choice after another, while blaming others, including you. For the chaos of her life, you've had to set boundaries against which she constantly pushes, ultimately accusing you of not caring when she senses your fatigue. Perhaps you've heard thinly veiled hints of self-harm followed by admonitions that she doesn't know how long she could continue like this. Maybe there are sudden unexplainable times when you felt that your love for her was reciprocated in an intense, almost intoxicating way, yet almost as quickly as it arrives, that warm glow that you feel disappears in a cloud of sudden anger or irrational disappointment that's coming at you.

Even more confusing is that others who know her in the community may adore her. They have a clue about how draining this relationship can be for you and would find your reality nearly unbelievable as she can often be quite popular and well loved by coworkers, neighbors, and even strangers. You see, structure offers her a scaffolding, a role to play, and if she's the teacher or the supervisor, she can shine, but she lacks the empathy needed for closer, more intimate relationships. What this means, again, is that with structure, someone with borderline personality disorder, when that structure is provided for her, when she knows what her role is, what her duties are, what her responsibilities are, she can follow those rules exactly and be beloved, be kind, be enthusiastic. But when she leaves that structure and has to build her own, that's where she can fall apart.

And so she's not a good mother or she's not a good friend. In fact, she could be an awful friend or an awful mother no matter who she is, whether she's your mom, your sister, your partner, your friend, you can become exhausted and your own guilt can be unrelenting. And guess what? She'll encourage that.

So what does guilt sound like inside your head? "She's my mother. She raised me the best way she could. I owe her and she's getting older and isn't able to care for herself." Or, "She's my daughter. I'll never forget the day I saw her for the first time. So tiny, so trusting, she deserves the same kind of relationship I have with the other kids", but she's not like your other kids. "Even though she's my ex, I don't know how she'd treat the kids if she felt like I wasn't there for her.She flipped out when we got divorced. I can't totally abandon her ever. It's wreaking havoc between me and my now wife who of course she detests" And one more. "She was my best friend when no one else would talk to me in the eighth grade. She was there always. So why do I shudder at the thought of simply talking with her?"

Now you can hear it. Guilt. Guilt and more guilt, In

I hate you. Don't leave me the classic book on borderline personality disorder. The author state, "The borderline shifts her personality like a rotating kaleidoscope, rearranging the fragmented glass of her being into different formations". That's what we were talking about before, right? Like a chameleon, she transforms herself into any shape that she imagines will please the viewer. That's why you can think you know her, but then when you try to develop an intimate or emotionally intimate relationship with her, all of these other traits that we talked about begin to come out.

In fact, it could actually be uncanny how well someone with borderline traits can assess your own internal struggles and use those very issues to manipulate you. For example, if you're someone who takes responsibility for your actions very seriously, she may subtly or not so subtly insinuate you're falling down on the job or question whether you know what you're doing. A lot of times if I had a borderline client, maybe I hadn't slept the night before and I was a little fatigued, and she would look at me and she'd say, "Oh, you know what? We don't have to meet today. You look kind of tired." You could hear that she's zoned in on my fatigue already and she's trying to see if I'm going to tell her, "You're right, you're not important to me. Let's call off this session". Or "Of course you're important to me even though my fatigue is showing." It's a setup, but they don't realize it's a setup.

That's what's important to know. As someone who's lived and tried to love someone with this struggle, you can only be responsible for that which you can control. I wanna say that sentence again. You may be someone who's lived and tried to love someone with this borderline struggle, but you must remember you can only be responsible for that which you can control. You've probably tried multiple times to get your loved one help. And what does she do? She stops taking her meds, she gets involved with another bad relationship, or she doesn't return your text after she's threatened suicide one more time. Perhaps she even denies that she has a problem at all pointing the finger at you and stating you're not, not trying hard enough at the relationship. So here are some steps to minimize that guilt and establish those boundaries we talked about in the title of this episode.

What you need to do is one, face the fear of your own helplessness in this relationship by predicting the most feared outcome, most likely suicide or some kind of highly dramatic action and decide how you would handle it. This sort of anticipatory grief or anticipation of the worst helps you develop some kind of armor to it. I know what's probably going to happen and I won't be as hurt by it. Number two, assess whether or not she's capable of physically hurting you. Is that a rational fear on your part? If it is, seek advice from a lawyer or in an emergency, the mental health emergency services in your area if you have any. Number three, try to objectively see the damage caused to you and to other family members because someone with borderline is not going to understand the impact of her actions. You need to journal about it and see how your acknowledgement of that may influence your future actions.

But you have to claim, yes, I've been hurt, my children have been hurt, whatever it is. Here's number four. Give her back the responsibility for her own life. For example, when she calls with another crisis, say, I know you'll find a way to cope with this and get off the phone. Again, that's giving her back the responsibility for her own life and likely she'll do okay. Now, she may call you back in 20 seconds or 20 minutes, but you just have to keep reassuring her, you know you've got what it takes to handle this. Knowing that she may respond by doing some dramatic action. That's what we talked about at the very beginning. Number five is you wanna provide empathy but not sympathy. You wanna set up strict boundaries for communication, especially around hot topic issues, and then be available. If she does indeed, follow those guidelines.

Give her feedback about the positives in the relationship and what you appreciate about her. You want to know and to remember that she's probably in many ways not realizing her impact again, but you don't wanna feel sorry for her, but you can have empathy for what that must feel like. Number six, you wanna grieve the relationship that could have been acknowledge and feel the pain of that loss. Again, journaling can be very helpful here. Number seven, realize she may never have the capacity of understanding the impact she's having on you. She's not withholding something from you, she's likely not capable of giving it. So if you stop expecting that from her, perhaps she won't get hurt. Number eight is get support from others who understand or have walked the same walk. Again, books like Understanding the borderline mother, stop walking on eggshells and I hate you Don't leave me provide great strategies.

And number nine, and perhaps the most important, have compassion for yourself.

But now quickly, I want to add in some advice from an author who has borderline personality disorder herself and offer some steps for the borderline to set their own boundaries. It's a woman named Megan Glosson, and I found this on The Mighty. So this is boundary setting for the borderline herself. You wanna maintain a two-sided conversation where you listen as well as talk. So focus on listening. You want to ask people if they have the emotional bandwidth to talk to you before you start divulging something serious or telling them how dysregulated you're coming, how upset you are. Don't answer phone calls and don't text messages during your work or sleep hours. You want to pause before you respond in conversations. When you feel yourself growing what she calls dysregulated again, upset, unstable, angry, whatever it is, you wanna take certain situations to your therapist for coaching before you simply react emotionally.

You get to practice with your therapist. I loved this idea. You wanna create a list with your family members of off limit topics or friends who don't agree with your perspective and you know you're just gonna argue about it. So there's a list of topics that you agree not to talk about. You can say no to requests that feel uncomfortable or may lead to poor decisions on your part. And then this last one I really liked. You could ask people to not use your diagnosis of borderline as a weapon or an excuse to treat you poorly. And that's exactly right. Now again, some of that may be things you're perceiving erroneously, but that's not fair for someone to say, you know, you've got borderline personality disorder, you're crazy. That's gonna go nowhere. So I thought this was wonderful advice. And from someone who knows how hard it is to live with borderline personality disorder, you can hear the pragmatism in her suggestions.

Stop, wait, think, then act. I'll end with this. When I have someone as a client with borderline personality, I'll suggest they ask themselves the question, will this likely create chaos? Now, the definition of chaos might need a little work, but overall, you want to help someone stop and wait and think through things, and that's vital to healing. And if you're trying to love someone with borderline personality disorder and if they have any sense of how their behavior is impacting you and their relationships, perhaps this is a list you want to share with them. And then perhaps you could apply the stop, wait, think, and then act to yourself.

Speak pipe message from dr margaret rutherford.com.

Let's hear from the listener voicemail for today. Again, a warning is about a murder of two children. Please don't listen if that will act as a trigger for you.

Good morning. I woke up feeling guilty this morning because I wasn't able to or didn't know how to help my daughter. At her darkest moments. She wanted to kill herself and I didn't know how to help. She ended up killing her two kids and she attempted to kill herself as well. Her relationship with the kids' father was terrible. She never asked for help. She really put up a front that everything was really good. I live in California, she lived in Las Vegas, but she never said anything and I feel really, really guilty about that. I'm very sad. So the past two years I had my two grandkids pass away, and this year my mother passed away.

I've worked with parents and even grandparents who've lost children to murder, but for the mom to kill these children, that's obviously a deep, deep illness or pathology. I could guess that maybe she was hearing voices that told her to kill. That's called psychosis and the proper term is auditory hallucinations. But there's another term for killing your children. It's called philide. The most common factors are depression, including postpartum depression, psychosis, prior mental health treatment, and suicidal thoughts. Sometimes it can happen because a mother believes death is in the child's best interest or she can have delusions. And again, she may be hearing these command hallucinations that tell her to kill. This can occur as a result of cumulative child abuse, neglect, or what's called Munchhausen syndrome by proxy. We won't go into that today. It's too long . Maybe I'll do an episode on it.

And actually sometimes it's a very selfish mother who believes her kid as a hindrance. We've recently heard about a woman who killed children because they weren't following her particular religious views where she saw them as filled with the devil. And this is the rarest, a mother who kills as an act of revenge against the child's father. But whatever the reason or the pathology behind it, it's horrific for those who've loved all of them. And this mama also tried to kill herself or it looked like she did this kind of grief that's also accompanied by absolute horror.

To use that word again, is so very complicated. I'm certainly going to recommend that this listener gets someone to talk to about the guilt she carries since her daughter didn't look sick. Then it's likely that she kept secret whatever was really going on with her. It could have been postpartum depression or some kind of depression that she hid. Perhaps more will be discovered. But until then, the guilt that you didn't see, this is something that I've seen as a part of many types of grief that occur from sudden loss. The fact is, your daughter didn't want you to see it. She didn't want anyone, it sounds like to see it or to see her. I'm so sorry for your loss and sad for all involved, but please turn to a therapist who knows how to work through this kind of trauma with you.

Thank you all for being here today. I know there are many ways you can spend your time and having you here at self-work means so very much. Don't forget my Facebook group at facebook.com/groups/ selfwork, and please leave me a rating, a review wherever you listen. I cannot tell you how important that is and how absolutely grateful I feel when I see a new review. Thank you again for being here. Please take very good care of yourself, your family, and your community. I'm Dr. Margaret and this has been SelfWork.

 

 

 

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