BPD is a complex diagnosis often given to people who present at hospital with suicidal ideation, aggressive behaviour or chaotic social situations; or a combination of all three. People who receive this diagnosis often have poor emotional regulation and tend to see situations in black and white. This is about might drive the BPD Experience.
In Part 1 [Link] we looked at what BPD isn’t, and some of the many names that BPD is also known by.
In Part 2 [Link] we looked at some of the diagnostic criteria that is used when giving someone a diagnosis, including a list of aspects that I look for when determining if BPD is an appropriate label for someone’s experience.
In Part 3 (this article) we will look at what is probably going on behind the scenes that leads to the experience and behaviours that meet the criteria in Part 2.
In Part 4 (yet to come) we will look at how to tell if something needs to be done about your experience of BPD, and if so, what that might be.
The JDT List
This is a quick refresher on the list that we use when considering BPD as a good descriptor for someone’s experience. For a more full write up, please go and take a look at the bottom third of Part 2.
* A Loss of Self – a chameleon like ability to adapt to the person they are with.
* Dysregulated Mood – all moods are at extremes and calm is a foreign concept.
* Perception Distortion – always looking for the threat in the situation, but more in the people they interact with. This includes looking for betrayal, looking for the fight and looking for the threat.
* Black and White Thinking – things are either black, or white, never grey, and certainly not coloured.
* Boundary Confusion – a focus on “how it should be” and low ability to adapt to “this is how it is”. Uncertainty about what is “good enough”, and what “Reasonable” means.
* Chaos – people around them are often thrown into chaos dealing with the persons inner chaos, life and relationship chaos, self harm and or suicide attempts, emotional dysregulation and so on.
Each of these are strong characteristic presentations of a few common underlying thought mechanisms. A thought mechanism is a method by which you solve a problem, which when working properly allows you to function alone, in a group of people and in society in general. When a thought mechanism is not up to the task maladaptive behaviours present, which either harm the individual or those around the individual.
So what are the underlying mechanisms?
Many things look deceptively simple until something goes wrong with it. Let us consider driving your car. When everything works, you get into your car, drive it car and then get to your destination. Now think of everything that could go wrong in that process and you start to realise how complex driving actually is. You could fail to drive properly for a number of reasons, someone else on the road might create an accident, your car might fail in hundreds of different ways, the road itself might have road works, traffic jams or a bushfire covering it. Only once you start to look at what can go wrong with a “simple” process do you realise how complex it is.
When we look at decision making, it is very similar. It seems easy until something goes wrong.
An important component of decision making is assessing the components of the decision and the outcome of that decision. This relies on how we feel about each of these aspects. For example, if I want to take an object I found on the couch outside, how I feel about the object will change how I tackle the task. Let us say the object is a spider. If I have a phobia about spiders, I will overestimate the danger level of the spider, which may either prompt me to take extreme caution when picking the spider up, or disable my ability to act at all. Even if that spider is made of plastic. A balanced level of feeling will accurately determine that the plastic spider poses no risk, enabling me to pick up the toy and take it outside.
A quick side note here – feeling is what the experience feels like, while an emotion is what you show the world about the feeling you have. Often people use them interchangeably.
The stronger a feeling is that you experience, the more your hind-brain (the limbic system – amygdala, hippocampus, thalamus, hypothalamus, basal ganglia) is warning you of an extreme situation, and thus the less time your brain thinks that you have to solve it. Because of this, people who are erroneously feeling too much about a thing think they have no time to solve it, so everything becomes black and white – safe, or not safe; good, or evil; do, or do not – there is no try. This illusion is created by the sense of immediacy from the extreme emotion, because hind-brain logic tells us that strong emotions must be significant and very now.
Hopefully it is clear how this dysregulation of emotions (feelings) can lead to black and white thinking, and perceptual distortions in assessing a situation. What is less obvious is that if your hind-brain is constantly reporting to you that you are in danger, it can change the way you manage social interactions – you need to be safe, so you alter yourself to be the person that is safe. This contributes to the Loss of Self above. Another aspect that is fed by this dysregulation is Chaos. Because you have no time, you make snap or automatic decisions that will keep you alive in this perceived emergency situation.So far it has worked as you are still alive, but that doesn’t make them good solutions – just good enough solutions. This often leads to very chaotic solutions to situations that seem like emergencies, which in hindsight aren’t.
To take this a bit further, often then chaos is exacerbated by having to now fix the thing that an impulse decision made in perceived danger has mucked up. That fix isn’t well thought out either, as there just simply isn’t time, so that leads to yet another situation that now needs repair. Often when listening to someone with BPD describe the mess they are in, each decision seems understandable in isolation, but often in a series of well meaning but disastrous outcomes, mostly because the person thought things were wrong and needed to be fixed.
Emotion is contagious. It is one of the traits that helped humans survive against stronger predators. When I see something scary, I feel scared and emote that to you. When you see my fear, you are ready for the danger I see but haven’t pointed to. When a person’s emotions are dysregulated, it can prompt those around them to become caught up in the sense of urgency, danger, confusion and chaos. It is important to watch your own feelings and reality check all drivers of strong emotion that you are picking up from the person with BPD, exercising the calm and logic needed to navigate the circumstances. It is important to remember that a person with BPD is not delusional – there is a source to most things being felt and reacted to, however the interpretation is suspect and bares checking.
Two out of three people diagnosed with BPD are able to identify with a traumatic past. The vast majority of the traumatic pasts experienced are focused around one or more abusive people. The abusive person may have been accidentally abusive (ignorant of the effect they are having, abusive as a side effect of their own trauma/mental health) or maliciously abusive (people diagnosed with BPD often have a narcissistic person in their lives). The perpetrator of abuse’s reasons for abuse are somewhat irrelevant to the outcome of this section, however it does help when learning how to not be a target to abusive people and how to identify them better in the future. We aren’t going into that here.
The perpetrator of abuse (I’ll just call them the perp) doesn’t want a strong person who will stand up to them, who will call them on their abusiveness, or recognise when the perp is fouling up reality to make their story believable. They need you to be confused, uncertain and vulnerable. As such, these perpetrators will gaslight you, commit moving goal post fallacies, commit emotional and cognitive abuse, trigger strong emotional states and frequently use various charismatic attacks to undermine your sense of reality. This confusion keeps you pliant with their whims.
One out of three people diagnosed with BPD don’t have a significant trauma in their past, thus no single person or series of people who have accidentally or purposefully blurred the social lines of reasonable. In my experience this one in three frequently have stronger rule compliance issues, characterised by a strong sense of completion and confusion when patterns are unfulfilled or people don’t stick to the roles assigned to them to simplify the social equation.
Children are born as tabula rasa – blank slates. They are open to a number of different ways of being human, which allows babies born in various cultures to pick up those cultural norms. If babies couldn’t do this, all humans would either be the same, or chaotically different. A few biological traits underlie this ability to absorb culture, hence why my brother and I are so different – we got different traits from our biology underlying and shaping a similar upbringing.
As children grow, they first learn the rules of the house they are born into. As they age the child learns the rules of friends places, then rules of school, then rules of bigger schools, then rules of work and so on. Each set of rules is somewhat similar to previous rules, but also significantly different (you can hopefully see here how a perp can mess with this rule acquisition by changing rules arbitrarily – however we are focusing on the lives of people who didn’t have this). A part of growing up is recognising that rules vary from location to location and from group to group. Every time a person is added to a group, the rules subtly shift. Every time a person leaves, the rules subtly shift. We are supposed to automatically pick up that shift and adjust our rule set to manage. People with BPD struggle with this (not the only people to do so).
Signs that this is true for you is that you find one on one easiest. A few people in a group is harder, but ok. Groups of about 6 or more are difficult. You’d rather avoid crowds unless you have a clearly defined role, such as acting, the class clown or the teacher. You can find yourself easily overwhelmed when certain people join the crowd and that overwhelmed takes the form of one of the three following – you shut down, you run away or you become aggressive.
You may recall the bit above about wanting clearly defined roles in a crowd and the bit where you might assign roles to others. These are two tools frequently used to simplify the social calculation – the series of internal processes that we all use to work out what the group is doing, what our part in it is, what we can expect everyone to do, and thus how we stay safe in the group. In BPD this is often defined as the chameleon nature – where the person with BPD will shift their presentation based on how they perceive the group or other person – the-role you take. The flip side is the simplification of other people – the role you assign to them. This is often based on the most dominant personality trait you see in the person. When the person fails to live up to (or down to) the role you have assigned them, it is likely to bewilder you, which can frequently result in panic, anger or disillusionment.
When combined, this feeling of social confusion and danger can someone with BPD to look for clues about social interactions based on the people who are present. Whoever has the strongest personality, or seems the biggest threat, defines the interaction. Their trait defines what the role of the the person with BPD needs to fulfil in order to be safe. If the target person strays too far out of the personality trait, this can leave the person with BPD feeling lost and in danger, which can have strong reactions. The person with BPD can try to guide the target person back to the trait they need them to be, or become angered that the person has failed them, feeling abandoned or betrayed by the person’s failure; frequently redefining the person’s role to an opposite role – Angels become demons as they fall off the impossible pillar they have been awkwardly perched on, or demons become angels when they fail to be bad. Another common pathway for the person with BPD is to lash out in anger – aggression and damage to the environment around them, or self harm and suicide attempts when that aggression is turned inwards.
These traits can also create the look and feel of chaos in the list above.
A quick note about DBT
It is not surprising that the world recognised standard for helping people with BPD is DBT, which mostly focuses on helping people to regulate their emotions, and once a bit more stable, to understand the complexities of social interaction and help create a smoother heuristic (set of malleable rules) for social interaction.
Next time – When something needs to be done about BPD, and what that something can be.