BPD  from a sufferer’s perspective

Borderline’ is Code for ‘Difficult’ is the title of an article by Bruce Bower in Science News. The article reports on a major challenge faced by women, and men as well, who suffer from borderline personality disorder and the relationship struggles that syndrome tends to bring.  The article quotes Sandra Sulzer of the University of North Carolina at Chapel Hill who conducted extensive interviews with psychologists and psychiatrists.  Her research clarified that the diagnosis of borderline, for all too many therapists, connotes needy, manipulative people, drama queens who do not need or benefit from treatment. “Clinicians,” Sulzer said, “frequently view borderline personality disorder symptoms as signs of badness, not sickness…”

The attitude toward borderline personality disorder that equates borderline with difficult merits challenging.  This blogpost is the first in a series of five posts that aim to offer an alternative, more empathetic, view.

The seeds of this post were planted by a reader who wrote an email to me complaining of what she had interpreted in my earlier blog posts on this syndrome as a pejorative attitude toward folks with bpd. Often, emails and comments that I receive from bpd folks are overtly hostile and clearly misconstrue what I have written.  By contrast, H.O.’s restrained way of expressing her concerns and apparently knowledgeable perspective piqued my interest.

So I wrote back.  And H.O. responded further.

The resulting informative dialogue about borderline personality disorder has influenced me greatly. I am pleased therefore to be able, having received H.O.’s permission, to share our dialogue with you.


Dear Dr. Heitler,

I am astounded and shocked by your articles in PsychologyToday.com which strongly judge and stigmatize people with BPD. They don’t want to be treated like royalty. They just want to be loved, an emotion which many never experienced. Please do not contribute personally to yet more stigma which BP sufferers have to struggle with, in their already barely livable lives. There is stong biological vulnerability and often horrific abuse which results in this devastating condition. It is blatantly clear to anyone who interviewed BPD sufferers. Their dysphoria, or mental pain, which is their baseline mood is unbearable. Their lives are hellish. They do not need yet more patronizing and contemptuous articles like I am very sad to observe, your articles in PsychologyToday.



Dear H.O.,

Thank you for sharing your concerns with me.

I apologize if I wrote in a way that came across to you as judging and stigmatizing.  That certainly was not my intent.

Actually, I have become increasingly interested in finding new treatment methods for bpd, so I very much appreciate your feedback.  Meanwhile your email has encouraged me to re-think my stance to be sure that I have sufficient sympathy for individuals with this difficult disorder.

Thank you again for taking the time to communicate to me your legitimate concerns.

Dr. Heitler


Dear Dr Heitler,

As a physician who has worked with borderline personality disorder patients herself, and a BPD sufferer personally, I really appreciate your reply.

What I see as the most complex issue with BPD is that these patients provoke very intense “counter transference” reactions in their doctors and anger, or even hate in “normal” people. This emotional burden is not conducive to resolution of their problems and results in declaring borderline as impossible to deal with and frankly “bad.”

As a borderline personality disorder sufferer myself I want you to know that we are not manipulative. We are desperate.

We don’t know how to live with others, how to have friends and get our needs met the normal way. We simply are ignorant in this respect.

If you read Freud’s classic works he points out that intense affect brings about “abaissement de niveau mentale” which means it clouds judgement to the point of insanity. Our uncontrollable and horrible emotions deprive us of ability to think and control our behaviour. Our behaviours are not meant to harm, at least not mine.  Rather they are an expression of desperation.

We do not manipulate by cutting ourselves. We cut because pain of being borderline is so intense and so unbearable that the little kick of endogenous endorphins in reaction to acute physical pain is the only thing that brings relief from this horrific mental pain. How bad would you have to feel to want to kill yourself? We feel like it most of the time.

Please understand. Having a borderline personality disorder means suffering which I can only compare to terminal cancer.

If you saw a cancer patient howling with pain you would have compassion. The world does not have compassion toward us, even though we howl with pain, because our effort to escape unbearable pain cause behaviours which antagonize people.

Please believe me, if our pain went away we would not do any of the ‘bad’ things that the world finds inappropriate or harmful. We commit suicide because our pain is sometimes simply impossible to bear.

Please believe me, the depression and dysphoria of BPD is the most horrible feeling. Sometimes I prefer I had cancer instead. At least then the whole world would not blame me for desperate efforts to blunt the pain brought about by my biological vulnerability and abuse I suffered as a child.

Pain is the core and the essence of borderline personality disorder.

BPD behaviours are nothing but inefficient ways to escape the pain. It is a vicious circle because these behaviours bring even more pain.

Pain distorts reality and results in what traditionally was called “borderline” psychosis. It is not true that we are not psychotic when symptomatic.  Our perception of reality is so distorted by intense affect we do not think straight. Only after recovery do we realize how we were wrong and how our perceptions were distorted by the illness.

When symptomatic, a Borderline is in living hell, surrounded by perceived universal hostility.

I wish you all the best in your efforts to help alleviate this horrible condition and damage it brings both to the sufferers and those who have to deal with them.

With regards,

H. O.


Part II of this series on borderline personality disorder deals with patterns that might be labeled manipulative or sadistic.


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Susan Heitler, Ph.D., is a Denver clinical psychologist who specializes in treatment of anxiety, depression, anger, narcissism, parenting challenges, and marital difficulties. An author of multiple books, articles, audio cd’s and videos, Dr. Heitler is best known in the therapy community for having brought understandings of conflict resolution from the legal and business mediation world to the professional literature on psychotherapy. David Decides About Thumbsucking, Dr. Heitler’s first book, has been recommended for over twenty years by children’s dentists to help young children end detrimental sucking habits. From Conflict to Resolution, an innovative conflict-resolution theory of psychopathology and treatment, has strongly influenced the work of many therapists. The Power of Two and , and also Dr. Heitler’s  website for couples called PowerOfTwoMarriage.com, teach the skills for marriage success. In addition to her clinical work, Dr. Heitler coaches boards of directors in skills for collaboarative decision-making and, in the world of professional sports, Dr. Heitler serves as mental coach for a men’s doubles tennis team. Education Dr. Heitler graduated from Harvard  University in 1967, and earned her Ph.D. in clinical psychology from NYU in 1975. Awards and Accomplishments The editors of the master therapist video series Assessment and Treatment of Psychological Disorders selected Dr. Heitler from all the marriage and family therapists in the US to demonstrate the theory and techniques of couple treatment.  Her video from this series, The Angry Couple: Conflict Focused Treatment has become a staple in psychologist and marriage counseling training programs. The editors of the Psychologist Desk Reference, a compendium of therapeutic interventions, selected Dr. Heitler to write the chapter onTreating High Conflict Couples. Other editors of books on counseling theory and techniques have similarly invited her to contribute chapters on her conflict resolution treatment methods. Dr. Heitler’s 1997 book The Power of Two (New Harbinger), which clarifies the communication and conflict resolution skills that sustain healthy marriages, has been translated for publication in six foreign language editions–in China, Taiwan, Israel, Turkey, Brazil and Poland. Dr. Heitler has been invited to present workshops on her conflict resolution methods for mediators and lawyers, psychologists, and marriage and family therapists throughout the country.  She has been a popular presenter at national professional conferences including AAMFT, APA, SmartMarriages, and SEPI and has lectured internationally in Austria, Australia, Canada, China, Israel, Lebanon, Spain, and the United Arab Emirates. Dr. Heitler is frequently interviewed in magazines such as FitnessMen’s HealthWomen’s World, and Parenting.  Her cases have appeared often in the Ladies Home Journal column “Can This Marriage Be Saved?”  She is often interviewed by Denver TV newscasters for her perspectives on psychological aspects of current events. In May, 2004 Dr. Heitler appeared on the CBS Early Show where anchor Harry Smith introduced her as “the most influential person in my life—my therapist.”  He encouraged his viewers similarly to seek therapy when they are emotionally distressed and pre-marital counseling when they are contemplating marriage. Most recently, Dr. Heitler, three of her adult children and one of their friends were awarded a U.S. government Healthy Marriages Initiative grant to produce interactive games for teaching marriage communication and conflict resolution skills over the internet.  Seehttp://poweroftwomarriage.com to experience their fun, low-cost, high-impact methods of teaching the skills for a strong and loving marriage. Personal Dr.  Heitler and her husband of almost 40 years are proud parents of four happily married adult children and are grandparents, thus far, of a a baker’s dozen grandchildren.