Skills, Skills, Skills: The Only Way To Go
Writer’s Reflection
Some years ago a fascinating discovery about the brain was widely reported in the news. Research conducted in England was coming out that appeared to stand previous scientific understandings of the human mind on their head. Stroke victims paralyzed on the right side of their bodies, were regaining use of their previously useless limbs. When their brains were examined with a special kind of xray, doctors found something amazing: the damaged parts of the brain were repairing themselves! And how did this miracle come about? To bring this about, the researchers immobilized the functioning arms of the patients for twelve hours at a time. For these twelve hours patients were expected to feed themselves as well as do all the activities that they would normally do but only with their injured arm. Guess what?! Within hours these previously ‘dead’ arms were back at work! What was previously a permanent disability was no more. Such is the power of determination that it can inspire growth when none was thought possible. And when determination and the skills that you’ll learn about are put together borderline personality won’t stand a chance.
Throughout this book, borderline personality disorder has been described as a group of destructive strategies to deal with very real and highly individual agonies and confusions. Thus in order to leave the most destructive aspects of borderline behind, one must find more effective strategies for dealing with the pain and confusion in living. More than needing a personality transplant, people with borderline personality disorder need ways to cope that respect their sensitivities and celebrate their unique abilities.
And this is what skills training can offer.
This of course was not always the case. For many years well meaning therapists tried to accomplish the worthy goal of healing the person with borderline through reflective therapy. The thinking behind this effort was that a healing supportive relationship could bring about the end of the pain.
Unfortunately, this approach didn’t work. Many patients got worse. They were hospitalized for long periods. Families, mental health professionals, and the patients themselves despaired of ever stopping the cycles of rage, self mutilation, suicidal behaviors and the chaos of borderline personality disorder. In effect, the therapy was undermining patients by making no effort whatsoever at helping them find a way in the world.
In the mid eighties, psychologist Marsha Linehan, bothered by the failure of talk therapy began to reconsider the whole treatment approach. She threw out “the book” so to speak and endeavored to find a new approach that would both help understand the disorder and provide some direction for treatment. Linehan observed that people with borderline personality disorder, more than needing a therapist who passively listened to the horrible complications of their lives, really needed practical assistance in calming their inner turmoil. Due to their exquisite sensitivities they needed real help in making sense of a world that they see as mad. In essence, Dr. Linehan discovered that far from being defective or ‘crazy’, people with borderline personality disorder were deep thinkers, confused by the pain and conflict that exists in the world. While most of us are able to make an uneasy peace such inconsistencies, these people by nature are bothered to no end by them.
Linehan put together a treatment program that taught emotional management skills and offered a sound philosophy for living at peace in their world. This program came to be called dialectical behavioral therapy or DBT. Dialectics refers to a practical philosophical discipline that concretely teaches how to live with the many paradoxes of life. One such paradox includes the desire for change with acceptance of the present moment. Another paradox centers around kindness and personal rights. Without understanding how to thrive in a world of paradox, patients remain stuck in a cloud of confusion that results in impulsive and destructive thinking and action.
Dialectics teaches us that two seemingly two opposed or paradoxical ideas can coexist.
Teaching philosophy however was of course not enough to tame the chaos of borderline personality disorder. Even with a grounded understanding of how the world works, people with borderline still had great difficulties in relationships, solving their problems, and managing their feelings. In response, Dr. Linehan developed a practical curriculum that teaches the skills necessary for positive relationships, solving the real problems of life, and finding joy in life. And because many of the most destructive dimensions of borderline personality disorder become habits with a life of their own such a self mutilation and suicidal behaviors, she developed techniques for creating new alternatives to take the place of the old ones.
The success of Linehan’s program is hard to dispute. People with borderline who have undergone dialectical behavioral therapy engage in far less self mutilation and require less hospitalization than those who receive standard talk therapy. They are more likely to be working and to report satisfaction in their lives.
The skills of DBT focus on the four areas that are the most problematic for people with borderline personality disorder. Without transforming these deficits into strengths, argued Linehan, all of the best intentioned therapies will fail. These skills are designed to empower and guide as people go about the very real business of making a life for themselves.
The skill groups are:
a. Mindfulness Skills
b. Interpersonal Effectiveness Skills
c. Distress Tolerance Skills
d. Emotional Regulation Skills
As detailed in the following chapters, the mastery of these skills will restore control in each of the characteristics of borderline personality disorder.
Monday, December 24, 2007
Focus on: The Difference Between Bipolar Disorder and Borderline Personality Disorder
One of the thorniest issues when it comes to borderline personality disorder is its relationship to depression and bipolar disorder. After all eighty percent of individuals diagnosed with borderline also exhibits symptoms of bipolar disorder. Many people have heard of bipolar disorder, one of the most documented and researched psychiatric disorders. Someone suffering from bipolar disorder is prone to experience frequent, dramatic mood swings. In many ways, it would seem that bipolar disorder and borderline personality disorder are on and the same.
Nothing however could be further from the truth.
Consider these differences:
1. The violent mood swings, rage, hyperactivity, and impulsivity experienced by someone with borderline personality disorder is triggered by inner turmoil. The extreme behaviors are may in fact be strategies to deal with the pain that is felt inside. The moodiness, impulsivity, and hyperactivity of someone suffering from bipolar disorder have a mind of its own. While episodes may be sparked by outside stress, the behaviors of mania and depression have little to do with the inner world.
2. The symptoms of bipolar disorder are usually well controlled with medication. This is usually with some combination of mood stabilizer medication and anti-depressant. The manifestations of borderline personality disorder however are poorly controlled by medication. Some behavioral manifestations of borderline such as depression, impulsivity, self mutilation, and suicidality may be controlled with medication. The inner psychology of the person however remains the same.
3. Whereas dread of abandonment is a hallmark of borderline personality disorder, there is no such parallel among those diagnosed with bipolar disorder.
4. Self mutilatory behaviors are common among those with borderline personality disorder. Similar behaviors are not present among those with bipolar disorder.
Nothing however could be further from the truth.
Consider these differences:
1. The violent mood swings, rage, hyperactivity, and impulsivity experienced by someone with borderline personality disorder is triggered by inner turmoil. The extreme behaviors are may in fact be strategies to deal with the pain that is felt inside. The moodiness, impulsivity, and hyperactivity of someone suffering from bipolar disorder have a mind of its own. While episodes may be sparked by outside stress, the behaviors of mania and depression have little to do with the inner world.
2. The symptoms of bipolar disorder are usually well controlled with medication. This is usually with some combination of mood stabilizer medication and anti-depressant. The manifestations of borderline personality disorder however are poorly controlled by medication. Some behavioral manifestations of borderline such as depression, impulsivity, self mutilation, and suicidality may be controlled with medication. The inner psychology of the person however remains the same.
3. Whereas dread of abandonment is a hallmark of borderline personality disorder, there is no such parallel among those diagnosed with bipolar disorder.
4. Self mutilatory behaviors are common among those with borderline personality disorder. Similar behaviors are not present among those with bipolar disorder.
Saturday, December 8, 2007
Of Lamborghinis and Fords
Of Lamborghinis and Fords
Twenty four year old Brachi and her parents sat with me. Referred by a colleague of mine, they sought guidance on options. Told by a reputable professional that Brachi had borderline personality disorder, they were now focused on the next steps. Which method of treatment would be most appropriate? Should Brachi enter an inpatient program? What about residential treatment?
These were all valid questions. Yet, no matter where Brachi ended up treatment wise, it seemed vital that she and her parents understand some of the vital truths about people borderline personality disorder. A pessimistic outlook of this complex disorder would only mean more and more of the same misery that their beautiful daughter had already been through. So some psychoeducation was in order.
And this education began with Lamborghinis and Fords.
Huh?
Well think of it this way: the Ford Motor Corporation has been making automobiles for many years. Their cars are reliable and not terribly expensive. Ford cars however are not especially flashy or powerful. The rich and famous usually would not be found driving around in a Ford.
In contrast to Ford, the Lamborghini is the opposite. Incredibly expensive, a Lamborghini is extremely powerful. Due to the complexity of its engine it must be serviced quite often. Only special gas may be used. The Lamboghini’s super-powered engined also means that vehicle must be operated with great caution. Otherwise, one may damage the car or, rachama litzlan, injure oneself.
Those who can afford the price and hassle of such a car are in for a unique experience. The price of the Lamborghini however is so high that only few of us can buy one; thus we are limited to driving around in our uninspired, much more affordable Fords.
And this is the same for personalities.
Most of us possess predictable “Ford” type personalities. These personalities serve us adequately when it comes to the day to day work of relationships and accomplishment. While we may rarely consider the deeper meaning of a beautiful blue sky or all the heartbreak in the world, we are content. We don’t think beyond the superficialities of our lives.
And then there are those with a Lamborghini kind of personality. These are people who think beyond the convenient and the superficial. They feel and see in vivid colors and varying intensities. Professor Len Sperry of the University of Wisconsin uses the term Borderline Personality Style to describe this powerful “Lamborghini” person. He lists the following characteristics as the dimensions of such an individual.
He or she tends to experience passionate, focused attachments in all relationships. Nothing in the relationship is taken lightly. He or she usually becomes deeply involved in a romantic relationship with one person.
He or she is emotionally active and reactive. They show their true feelings and put their hearts into everything
He or she tends to be uninhibited, spontaneous, fun loving, and usually undaunted by risk.
He or she is usually creative, lively, busy, and engaging.
He or she usually shows initiative and can stir others to activity with their passion.
He or she is imaginative and curious.
He or she is willing to experience and experiment with other roles, cultures, and value systems.
Such wonderful qualities offer great spiritual advantages. Yet there is great risk that comes with them as well. The sensitivity and deep need for connection can be the cause of great pain. Life after all is difficult. Loved ones leave us. Plans, big and small are frustrated continuously. Whereas the “Ford” types experience the pain with a kind of “nonchalance”, the “Lamborghini” type experiences pain in a most amplified way. And since no one likes to be in pain, such a person, lacking the tools and knowledge specific for their personality, may turn, rachmana litzlan, to quick fixes such as suicidality, drugs and sex that all have long term consequences.
Unfortunately, there is a “no return” policy on the type of personality style that we get. While medical science has figured out how to perform a heart or face transplant and how to generate a new liver from a stem cell, there still is no such thing as a “personality transplant”.
But perhaps that’s just as well. It was after all the pain experienced by Dovid HaMelech and all the other “Lamborghinis” of our people that showed the rest of us what it means to be a Jew.
Twenty four year old Brachi and her parents sat with me. Referred by a colleague of mine, they sought guidance on options. Told by a reputable professional that Brachi had borderline personality disorder, they were now focused on the next steps. Which method of treatment would be most appropriate? Should Brachi enter an inpatient program? What about residential treatment?
These were all valid questions. Yet, no matter where Brachi ended up treatment wise, it seemed vital that she and her parents understand some of the vital truths about people borderline personality disorder. A pessimistic outlook of this complex disorder would only mean more and more of the same misery that their beautiful daughter had already been through. So some psychoeducation was in order.
And this education began with Lamborghinis and Fords.
Huh?
Well think of it this way: the Ford Motor Corporation has been making automobiles for many years. Their cars are reliable and not terribly expensive. Ford cars however are not especially flashy or powerful. The rich and famous usually would not be found driving around in a Ford.
In contrast to Ford, the Lamborghini is the opposite. Incredibly expensive, a Lamborghini is extremely powerful. Due to the complexity of its engine it must be serviced quite often. Only special gas may be used. The Lamboghini’s super-powered engined also means that vehicle must be operated with great caution. Otherwise, one may damage the car or, rachama litzlan, injure oneself.
Those who can afford the price and hassle of such a car are in for a unique experience. The price of the Lamborghini however is so high that only few of us can buy one; thus we are limited to driving around in our uninspired, much more affordable Fords.
And this is the same for personalities.
Most of us possess predictable “Ford” type personalities. These personalities serve us adequately when it comes to the day to day work of relationships and accomplishment. While we may rarely consider the deeper meaning of a beautiful blue sky or all the heartbreak in the world, we are content. We don’t think beyond the superficialities of our lives.
And then there are those with a Lamborghini kind of personality. These are people who think beyond the convenient and the superficial. They feel and see in vivid colors and varying intensities. Professor Len Sperry of the University of Wisconsin uses the term Borderline Personality Style to describe this powerful “Lamborghini” person. He lists the following characteristics as the dimensions of such an individual.
He or she tends to experience passionate, focused attachments in all relationships. Nothing in the relationship is taken lightly. He or she usually becomes deeply involved in a romantic relationship with one person.
He or she is emotionally active and reactive. They show their true feelings and put their hearts into everything
He or she tends to be uninhibited, spontaneous, fun loving, and usually undaunted by risk.
He or she is usually creative, lively, busy, and engaging.
He or she usually shows initiative and can stir others to activity with their passion.
He or she is imaginative and curious.
He or she is willing to experience and experiment with other roles, cultures, and value systems.
Such wonderful qualities offer great spiritual advantages. Yet there is great risk that comes with them as well. The sensitivity and deep need for connection can be the cause of great pain. Life after all is difficult. Loved ones leave us. Plans, big and small are frustrated continuously. Whereas the “Ford” types experience the pain with a kind of “nonchalance”, the “Lamborghini” type experiences pain in a most amplified way. And since no one likes to be in pain, such a person, lacking the tools and knowledge specific for their personality, may turn, rachmana litzlan, to quick fixes such as suicidality, drugs and sex that all have long term consequences.
Unfortunately, there is a “no return” policy on the type of personality style that we get. While medical science has figured out how to perform a heart or face transplant and how to generate a new liver from a stem cell, there still is no such thing as a “personality transplant”.
But perhaps that’s just as well. It was after all the pain experienced by Dovid HaMelech and all the other “Lamborghinis” of our people that showed the rest of us what it means to be a Jew.
What Is Borderline Personality Disorder?
What Is Borderline Personality Disorder?
Consider the following:
Tammy, 19, is calmly sitting in a chair in the exam room of an emergency room. A nurse is putting the final touches on a bandage that covers a three inch long cut on her left forearm. A doctor has already put in eight stitches. The nurse, caring about this young beautiful woman, tries to strike up a dialogue.
“So Tammy. Did you really cut your arm on the door of your apartment?”
“Why? Is that what my dorm counselor said when she brought me in?”
“That’s exactly what she said. Why? Was it something else?”
“Yeah. I was really upset about some problems at school so I cut myself. It feels so good when I do that.”
Seffy closes the door as she leaves Dr. Cohen’s office. Dr Cohen, a psychiatrist, pulls over Seffy’s chart as she begins to write her session notes. She reads over what has been written before. Seffy has been depressed since her fourteenth birthday. She has been expelled from six different schools because of her extreme behaviors. The five psychiatrists and eight psychologists that Seffy has seen have not made any real progress. Seffy has taken over twenty different psychiatric medications in all kinds of combinations. Still, seven years later, at the age of 21, Seffy remains stuck in her misery with no friends and a baffled family. Dr Cohen feels sad and despairing. What can she do to help Seffy?
Thirty year old Meir rocks gently with the subway as it makes its way through the tunnel. Meir however doesn’t really notice it. His mind is rehashing a conversation that he had with his father earlier that afternoon. Actually, it was not much of a conversation since his father did most of the talking. ‘Why aren’t you calling that shadchan back?! What was wrong with that girl?! Haven’t your mother and I tried enough for you? All of your friends are married with kids already! What is wrong with you?!’ As Meir reflected on his father’s words he became confused. What was wrong with him? Even he didn’t understand the thoughts that crisscrossed his mind. Sometimes he got so frustrated with himself, he felt that he and his family would be better off if he were dead.
These three vignettes describe three different experiences of borderline personality disorder. Borderline Personality Disorder is one of the eleven personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). The DSM IV contains a listing of all the psychiatric disorders that have been identified by the American Psychiatric Association. So authoritative is the DSM IV, that only those disorders listed in it are considered official medical conditions by the United States government.
The DSM describes borderline personality disorder as
A pervasive pattern of instability of interpersonal relationships, self-image, and affects , and marked impulsivity beginning by early adulthood and present in a variety of contexts.
In other words, a person with borderline personality disorder has:
Difficulties maintaining positive relationships with others.
Has great difficulty developing an effective sense of identity.
Frequently experiences extreme moods.
Often acts without adequate regard to the consequences.
The DSM offers specific ways that these difficulties are manifest. They are (a separate chapter will be devoted to each of these manifestations):
1. Frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
In order to be diagnosed with borderline personality disorder, an individual must display five out of these nine characteristics. Should he or she manifest less than five, they can be described as having borderline traits. Individuals displaying more characteristics have worse personalities than those with less.
Beyond the level of severity, people with borderline personality disorder are often described as exhibiting one of three subtypes of the disorder. These subtypes are:
Dependent type borderline personality disorder
Histrionic type borderline personality disorder
Narcissistic type personality disorder
Someone with dependent type borderline personality disorder lives in a state of terrible fear of aloneness. Every action and thought is deeply involved in preventing their abandonment by others. They will often undermine their own self interests and future in order to prevent such abandonment. The manifestions of borderline personality disorder are often organized around the feared loss of a relationship.
Tamara, an eighteen year old seminary student, was referred to me by one of her teachers. Over the course of the ninety minute initial consultation a picture of a highly anxious and fragile young person emerges. This is Tamara’s first time away from home and she is adjusting with great difficulty. Her major worried preoccupation is that her best friend, Michal, will abandon her. Because of this worry, Tamara has literally become Michal’s servant and financier. While Tamara recognizes that the relationship is lopsided, she cannot take the risk of abandonment. The anxiety has become so bad that she finds herself feeling more and more desperate. The only thing that seems to relieve the terror is by distracting herself with cutting. Then calmness comes over her.
Someone with histrionic type borderline personality disorder desperately seeks the attention of others. The preoccupation with others’ attention often leads them to act in inappropriate ways so as to become the center of attention. The manifestations of borderline personality disorder are in response to the failures of others to give them the attention so seek.
Menachem was sent for an evaluation by the mashgiach of his yeshiva after a violently angry eruption over a recent in-house Shabbos. From what the mashgiach had shared with me, Menachem had become enraged when his friends had grown tired of his attempts at monopolizing a late night schmooze. Menachem later explained to me that he craved being the center of attention because it was only then that he felt alive. Otherwise, he felt dead. It was at such times that he thought about death.
Someone with narcissistic type borderline personality disorder believe him or herself to be so uniquely special as to deserve to be associated only with others viewed as also uniquely special. The manifestations of borderline personality disorder are in response to the frustration of their attempts to viewed in the manner that they wish.
It was only with great difficulty that Moshe was persuaded to seek treatment. Until the rosh yeshiva intervened, Moshe had rejected the recommendation of both his rebbe and his mashgiach. As he later explained to me, he did not accept the feedback anyone but the rosh yeshiva. His arrogance manner throughout our session belied the emptiness underneath. Moshe was miserably depressed, irritable, and easily enraged. He spoke of feeling empty inside.
Regardless of the exact form that it takes, borderline personality disorder levies a heavy price. The difficult moods and frightening behaviors get in the way of joyful relationships and personal accomplishment. Many people with borderline personality disorder have lives littered with failure and hurt. Feelings of utter despair are not uncommon, rachmana litzlan.
Yet there is good news. Treatment really can help. But first a complete understanding of borderline is needed. The next chapters will explain the concept of personality disorder and the inner psychological world of someone with borderline disorder.
Consider the following:
Tammy, 19, is calmly sitting in a chair in the exam room of an emergency room. A nurse is putting the final touches on a bandage that covers a three inch long cut on her left forearm. A doctor has already put in eight stitches. The nurse, caring about this young beautiful woman, tries to strike up a dialogue.
“So Tammy. Did you really cut your arm on the door of your apartment?”
“Why? Is that what my dorm counselor said when she brought me in?”
“That’s exactly what she said. Why? Was it something else?”
“Yeah. I was really upset about some problems at school so I cut myself. It feels so good when I do that.”
Seffy closes the door as she leaves Dr. Cohen’s office. Dr Cohen, a psychiatrist, pulls over Seffy’s chart as she begins to write her session notes. She reads over what has been written before. Seffy has been depressed since her fourteenth birthday. She has been expelled from six different schools because of her extreme behaviors. The five psychiatrists and eight psychologists that Seffy has seen have not made any real progress. Seffy has taken over twenty different psychiatric medications in all kinds of combinations. Still, seven years later, at the age of 21, Seffy remains stuck in her misery with no friends and a baffled family. Dr Cohen feels sad and despairing. What can she do to help Seffy?
Thirty year old Meir rocks gently with the subway as it makes its way through the tunnel. Meir however doesn’t really notice it. His mind is rehashing a conversation that he had with his father earlier that afternoon. Actually, it was not much of a conversation since his father did most of the talking. ‘Why aren’t you calling that shadchan back?! What was wrong with that girl?! Haven’t your mother and I tried enough for you? All of your friends are married with kids already! What is wrong with you?!’ As Meir reflected on his father’s words he became confused. What was wrong with him? Even he didn’t understand the thoughts that crisscrossed his mind. Sometimes he got so frustrated with himself, he felt that he and his family would be better off if he were dead.
These three vignettes describe three different experiences of borderline personality disorder. Borderline Personality Disorder is one of the eleven personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). The DSM IV contains a listing of all the psychiatric disorders that have been identified by the American Psychiatric Association. So authoritative is the DSM IV, that only those disorders listed in it are considered official medical conditions by the United States government.
The DSM describes borderline personality disorder as
A pervasive pattern of instability of interpersonal relationships, self-image, and affects , and marked impulsivity beginning by early adulthood and present in a variety of contexts.
In other words, a person with borderline personality disorder has:
Difficulties maintaining positive relationships with others.
Has great difficulty developing an effective sense of identity.
Frequently experiences extreme moods.
Often acts without adequate regard to the consequences.
The DSM offers specific ways that these difficulties are manifest. They are (a separate chapter will be devoted to each of these manifestations):
1. Frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
In order to be diagnosed with borderline personality disorder, an individual must display five out of these nine characteristics. Should he or she manifest less than five, they can be described as having borderline traits. Individuals displaying more characteristics have worse personalities than those with less.
Beyond the level of severity, people with borderline personality disorder are often described as exhibiting one of three subtypes of the disorder. These subtypes are:
Dependent type borderline personality disorder
Histrionic type borderline personality disorder
Narcissistic type personality disorder
Someone with dependent type borderline personality disorder lives in a state of terrible fear of aloneness. Every action and thought is deeply involved in preventing their abandonment by others. They will often undermine their own self interests and future in order to prevent such abandonment. The manifestions of borderline personality disorder are often organized around the feared loss of a relationship.
Tamara, an eighteen year old seminary student, was referred to me by one of her teachers. Over the course of the ninety minute initial consultation a picture of a highly anxious and fragile young person emerges. This is Tamara’s first time away from home and she is adjusting with great difficulty. Her major worried preoccupation is that her best friend, Michal, will abandon her. Because of this worry, Tamara has literally become Michal’s servant and financier. While Tamara recognizes that the relationship is lopsided, she cannot take the risk of abandonment. The anxiety has become so bad that she finds herself feeling more and more desperate. The only thing that seems to relieve the terror is by distracting herself with cutting. Then calmness comes over her.
Someone with histrionic type borderline personality disorder desperately seeks the attention of others. The preoccupation with others’ attention often leads them to act in inappropriate ways so as to become the center of attention. The manifestations of borderline personality disorder are in response to the failures of others to give them the attention so seek.
Menachem was sent for an evaluation by the mashgiach of his yeshiva after a violently angry eruption over a recent in-house Shabbos. From what the mashgiach had shared with me, Menachem had become enraged when his friends had grown tired of his attempts at monopolizing a late night schmooze. Menachem later explained to me that he craved being the center of attention because it was only then that he felt alive. Otherwise, he felt dead. It was at such times that he thought about death.
Someone with narcissistic type borderline personality disorder believe him or herself to be so uniquely special as to deserve to be associated only with others viewed as also uniquely special. The manifestations of borderline personality disorder are in response to the frustration of their attempts to viewed in the manner that they wish.
It was only with great difficulty that Moshe was persuaded to seek treatment. Until the rosh yeshiva intervened, Moshe had rejected the recommendation of both his rebbe and his mashgiach. As he later explained to me, he did not accept the feedback anyone but the rosh yeshiva. His arrogance manner throughout our session belied the emptiness underneath. Moshe was miserably depressed, irritable, and easily enraged. He spoke of feeling empty inside.
Regardless of the exact form that it takes, borderline personality disorder levies a heavy price. The difficult moods and frightening behaviors get in the way of joyful relationships and personal accomplishment. Many people with borderline personality disorder have lives littered with failure and hurt. Feelings of utter despair are not uncommon, rachmana litzlan.
Yet there is good news. Treatment really can help. But first a complete understanding of borderline is needed. The next chapters will explain the concept of personality disorder and the inner psychological world of someone with borderline disorder.
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