This article is the second in that series. Like the first post, this article records my dialogue with H.O., a very insightful physician who herself has been diagnosed with borderline personality disorder. Like many borderline personality disorder sufferers, she has been determined to find routes to recovery.

I have written earlier PT articles on borderline personality disorder from the point of view of people who suffer from having to deal with an individual with difficult-to-deal-with bpd behaviors such as adult children of mothers with borderline personality disorder. This current series of posts, by contrast, clarifies the painful inner experience of someone who struggles with a borderline personality disorder him/herself.

Warmest thanks to H.O. for sharing her insights with us.

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To Dr. Heitler,

I wrote to you after reading three of your articles published in the Psychology Today website: “Evil Genes? An Unconventional Perspective On borderline personality disorder,” “From Cute Little Girl To Boderline Personality” and “You Can End Your Borderline Personality Style.”

I have to say I disagree with a fundamental tenet especially of the first article which refers to “manipulative” or even “sadistic” behaviours of borderline personality disorder sufferers. The choice of the term “manipulative” suggests some kind of Machiavellian scheming and cunning to reach objectives which are not immediately obvious.

I think Dr. Linehan was the closest to the truth in interpreting the so-called “manipulative” behaviours of borderline personality disorder patients when she declared they were blunt, clumsy and ineffective efforts to have the borderline personality disorder’s needs met.

To all concerned the objective of these behaviours is also blatantly obvious thus removing any element of manipulation.

I would strongly recommend avoiding the use of term “manipulative” in reference to any clumsy efforts of borderline personality disorder patients to achieve anything, because these efforts are anything but. At best these behaviours (eg threatening suicide is case of abandonment by a loved one) are somewhat pathetic efforts, when a borderline personality disorder patient actually begs and humiliates herself in inevitably unsuccessful attempt to avoid abandonment.

The use of the term “sadistic” in my humble opinion is a misinterpretation of motives behind borderline personality disorder’s “bad” behaviours, achieving nothing but greater stigmatization.

In my work with very poorly functioning patients with borderline personality disorder what I commonly saw was that these girls were victims of sadistic, inhuman abuse as kids. They themselves however never intentionally upset or harmed anyone for the pure evil joy of it. The arguments and even physical acts of violence never involved any gratification from inflicting pain, ever. They were solely vents for frustration and anger at having borderline personality disorder’s needs and demands not met yet again.

The source of these common misconceptions about the intentions and motives of borderline personality disorder patients lies in fundamental misunderstanding. Please believe me, borderline personality disorder makes it impossible to function in the world as it is, where most people are indifferent and don’t care at all and others are trying hard, but rarely succeeding in getting the needs of borderline personality disorders met. This is because these needs are so immense!

A person with borderline personality disorder could function, when symptomatic, only in the world where everybody loves her like her own mother, unconditionally and patiently. Of course such world will never exist and thus borderline personality disorders with their enormous, unfulfilled needs of love and affection will forever remain frustrated and angry, and resort to behaviours which are misunderstood as “manipulation.”

A normal person derives strength in daily functioning in the indifferent or occasionally hostile world from their own healthy ego. A borderline personality disorder has no healthy ego to base their survival on. A borderline personality disorder can only survive on constant stream of love and affection, and if it dries out the borderline personality disorder’s world collapses. This is where the frantic efforts to avoid abandonment come from–because  borderline personality disorders know painfully well that they are unable to function without it.

The fact that terms such as “bad”, “sadistic,” and “manipulative” are used to describe how the “normal” world perceives and judges borderline personality disorder’s desperate attempts to have their needs met is a sad testimony to the fact that the world is, in fact, more often than not hostile to these patients.

The only way to understand these patients is to assume their needs in terms of affection, support, understanding and human warmth are infinitely larger than the needs that can reasonably be met in the world as it is. This is why these needs will inevitably remain unmet and result in a borderline personality disorder person feeling frustration, anger and hostility.

As “bad” as these patients are it is much worse to be in their shoes. I would argue that in terms of quality of life borderline personality disorder is in the same league as terminal cancer. The irony is, of course, that while everybody is compassionate to patients with cancer, few, if any have genuine compassion for patients with borderline personality disorder because these patients through their utter lack of social skills and use of behaviours which are considered inappropriate at best, and “sadistic” at worst are absolute masters in antagonizing everyone around them.

This is the vicious circle of borderline personality disorder—while these patients’ need for human compassion is infinitely greater than that of functioning individuals, their clumsiness in getting this need met results in even less, if any compassion at all.

I really appreciate your lending an ear to the perspective of a borderline personality disorder sufferer.

With regards,

H.O.

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To H.O.

As a result of what I have been learning from our correspondence, and consonant with Marsha Linehan’s observations, I find myself increasingly limiting my use of the term borderline personality disorder to refering only to  pervasive patterns of emotional hyper-reactivity.

There may well be some individuals with borderline personality disorder who are genuinely manipulative or sadistic.

These habits now would suggest to me comorbid diagnoses, that is, a combination of borderline personality emotional hyper-reactivity with narcissistic and/or psychopathic (conning) patterns.

In the Journal of Personality Disorders a 2006 an excellent article by Nancy Nyquist Potter, PhD entitled “What is Manipulative Behavior Anyway?” looked to define the term manipulative.  “In the HarePsychopathy Checklist (cited in Bowers, 2002) … manipulation is defined as deception used for personal gain, without concern for victims.”

Interestingly, the point of Dr. Potter’s article, like the point of your writing, H.O., in this post, is that many clinicians too readily utilize the termmanipulative with clients who have a bpd diagnosis.  Bpd sufferers get further stigmitized this way, that is, when clinicians label behaviors that stem from hyperemotional responsivity with the perjorative termmanipulative.

Again, thanks so much to you H.O. for sharing your insights.

With warmest appreciation,

Dr. Heitler

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Denver clinical psychologist Susan Heitler, Ph.D, a graduate of Harvard and NYU, is author of Power of Two, a book, a workbook, and a website that teach the communication skills that sustain positive relationships.

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