Brace yourself for borderlines

Brace yourself for borderlines

Borderline personality disorder is “All Of The Above”:  lovely and creative; manipulative and vindictive; tortured and anguished; glowing with energy and joy; self-hating, self-centered, perceptive and gifted, a victim… Without warning, a person can switch from one presentation to another.

Are you ready to bang your head on a wall?  Do you want to abandon your child in the wilderness?  Are you praying for the day they turn 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) bring out the worst in everyone around them.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault.  They are appalled that others mistreat them horribly.  They are insulted and defensive when they detect criticism, even when there isn’t any.  They can never be pleased, and it’s always about them.  Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder

Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something.  They will also turn on the charm in a way to to embarrass you in front of others (e.g. family therapy.  Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child.  People often recommend that you take care of your own issues instead.

Even though their manipulation and upheaval is relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They make a mess of their relationships because of their anger, instability, substance abuse.  Their clingy behavior is annoying.  They drive away good friends, hate them for leaving, and then suffer from loneliness and depression.  They make a mess of their jobs, often fired or forced to resign, and then bounce from one job to another… and they don’t understand why it happens to them.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.

For goodness sakes, why?

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

When playing the teamwork game, the brain of a borderline person showed no activity whatsoever.

Statistics

Another research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems.  (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.

In infants:  the children who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can jump between any behavior: extremely manipulative; more promiscuous; aggressive and impulsive; more likely to use drugs and alcohol; assaultive; and more likely to cut and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

Evidence for hope

Trying to Weather the Storm
Shari Roan, September 07, 2009, Los Angeles Times

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.

“But almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period:  93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent for at least four years. Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.

“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.  “But our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”

Treatment

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832

Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  DBT appears to be the most effective.  It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

There are several appropriate therapies in addition to DBT, and all share common elements:  1. The bond between the patient and therapist is strong.  2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

On DBT:  I recommend this straightforward self-help lesson to get started learning the concepts and skills:  http://www.dbtselfhelp.com/html/dbt_lessons.html.

When to hospitalize

  • In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
  • In long-term residential care – when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
  • Therapy that focuses on trauma and post traumatic issues when an adolescent loses their sense of reality.
  • Reduce stressors in the young person’s environment.  Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

What parents and caregivers can do

With a partner or spouse:  Maintain a united front.  Communicate continually to stay on the same page when managing your child and setting limits.  Have each other’s back even if you’re not in full agreement.  Always take disagreements out of earshot of your child.  Any disagreement they hear will be used against you.

Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive;  and it redirects and ends a negative situation.

Become skilled in DBT and help your child stay in the here and now.  Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior.  Consequently, parents should consider:

  • Tightly limiting cell phone use, email, texting, and access to social networking sites
  • Using technology to track their communications (this is legal), or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room (this is also legal)

A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly.  His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor really does provide relief.
–Margaret

Be patient – You are unlikely to receive the child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

Other characteristics of BPD

Good things:  They can be very financially and publicly successful in many different fields, especially in the creative arts, and especially acting.  They are so perceptive that they can ‘channel’ any character they want.  They can be enchanting, and alluring, easily attracting devoted fans, friends, and lovers.

Bad things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related severe dissociative symptoms or paranoid ideation.

  • Chronic depression: Depression results from ongoing feelings of abandonment.
  • Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the adolescents’ inability to achieve object constancy and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that these adolescents become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
  • Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.

Drawn from:
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville

–Margaret

17 Replies to “Brace yourself for borderlines”

  1. Hello. My son is a 13 year old teen, and he often has extreme anxiety, depression, and/or paranoia. I have always considered him having borderline personality disorder-when I found the description of the disorder, I cried because it sounded so much like him. It seems hard for him to trust anyone-he just doesn’t get people!-and often has really bad mood swings ( like, past normal for a teen-shaking in rage one second, then totally slap-happy, and then exhausted and depressed the next), and he’s always been hypersensitive to a fault, even to just perceived criticism. However, I was under the impression that a diagnose could only be made in people over 18, is that not true?

  2. I think the best step in getting your point across is first recognizing that it is a diagnosis. It is not a borderline child but a child with borderline personality disorder. It’s always the child first. I have a ton of problems with my teen whom I am concerned who will eventually have this diagnosis or bipolar disorder, but she is my child first, she is a person with a possible diagnosis which should not be her label. I think it is only fair to individuals to recognize them as who they are, people, before their diagnosis.

    1. Hello Tara,

      The issue is not about the person-hood of the child superseding the diagnosis. This article isn’t about that–my comment about priorities regarded other children in the household and their needs. Siblings are too often neglected when one child’s needs are too high. This same issue exists in families with a child with a physical or medical disability. Parents often borrow time and attention away from everyone and everything else, even their spouse, their job, and their sleep, and their exhaustion and stress affects everyone. There is a program called Sibshops for the sisters and brothers of a disabled child where they can talk about their feelings and support each other to help them gain understanding and acceptance. It’s a program of the Sibling Support Project (https://www.siblingsupport.org/sibshops). Another post on this blog is “Good messages for siblings (and parents) of a troubled child or teen” which was drawn from NAMI’s article “Coping Tips for Siblings and Adult Children of Persons with Mental Illness.”

      If a family is emotionally healthy and strong, they have the capacity to care for a mentally ill loved one who may need decades of support. A study I read in the Harvard Mental Health Review described a 20-year study of individuals with a diagnosed mental illness, which measured criteria for their quality of life. It found that those with the best long-term prognosis for wellbeing (job, good relationships, self-care, shelter…) had one thing in common: a family who was a loyal and constant source of support through the years. This is the point. One of the best ways to help a troubled child is to ensure all family members are emotionally healthy and accepting.

  3. One of the biggest reasons for my bpd was being neglected as a child. While I agree in most circumstances of this article, you should never put your child last. In fact, your children should come first, borderline or not.

    1. Hello Megan,

      You’ve made a very excellent point. I can see how this section sends a message I really don’t want to send. I’m going to figure out a way to rewrite it to get across the point I’m trying to make instead. I’d appreciate some feedback if you can help. What I want to say is that a borderline child can be mentally and emotionally exhausting, and that a parent also needs to take care of other children and a spouse or partner and other adult responsibilities. This is harder to do than it may seem. Plus, when one child’s needs or demands are so high, siblings get neglected. That is the reason I made the suggestion. Is there a better way to communicate this point? I agree, neglectful parenting is wrong and inexcusable.

      Take good care,

      Margaret

  4. Wow! Thank you! This has been probably the most helpful, and refreshing pieces of guidance that I think I have ever really received in regards to my daughter. Like it’s mentioned and like I agreed with, most people just reply with she is probably just acting like a “normal teen” and do not see or acknowledge that there is more or could be more going on behind closed doors and that can be just as draining as dealing with her ups and downs.

  5. My daughter is everything you explained in the beginning especially the part where she has made everyone else think that she is so sweet and we are the ones with the problems, but as much as we love and adore her our family is constantly walking on egg shells although it feels more like glass! She is not nice, unless she wants something. She is sneaky and untrustworthy and has no real friendships because everyone is fed up of her, or likes her from afar but doesn’t really want to spend too much time with her. It’s always everyone else’s fault, and we’re all out to get her. As I read further I was even more convinced/overwhelmed/relieved that I was on the right track to something when I read about how parents should consider limiting social media and stuff like that. My daughter had the best Apple laptop, and iPhone. First she ended up loosing the laptop because of boundaries and breaking the rules on it. Then she lost her phone because when she was grounded from her phone she was actually using another that her friend had given her and on that one she had all of the the apps and social media things we said “no” to, there was stuff about drugs, sex, lying to us, language.. And so she not only lost that phone she lost the one we boutght her as well. Feeling bad for her, we purchased an der version of an iPod that didn’t get internet, just music, and she couldn’t even handle that because she snuck it after bedtime and stayed up all night listening to it, then she wouldn’t get up in the morning and then she would make everyone late to school. Then when I started putting a time limit on when I was leaving the house in the morning, with or without her, she’d freak out, causing a scene. I would let her (my 15-1/2 y/o) sit in the van with my 5 y/o and 12 y/o while I ran into the gas station and come back out to her her iPod plugged into my band, blaring scream music that was cussing, after I have told her over and over again that I didn’t want the other two to hear that music and that she was not aloud to plug her iPod into the van without asking. Needless to say, she lost that too. So then were down to only our home computers, our personal phones and iPads, and everything has passwords on it, everything! We’ve been being slightly more lax on allowing her some time on the home family computer only to be blindsided with an email that she ordered something through our Amazon Prime account, which when logged onto our family computer has no restrictions and has the credit card info saved to it, and of course she didn’t ask. When confronted, she went down fighting that she didn’t do it, only looked at it. I told her how it takes several steps to make a purchase and then she td me it only takes one click with the ‘buy it now’ option… Busted! So yeh, we have limited all of that, but I am scared for what’s to come. She is suppose to take drivers Ed this summer. I want her to be able to, but it’s like she is incapable of functioning. She checks out of everything and anything if it gets difficult. She is impulsive and will do anything to get what she wants. What is she going to do with real knowledge of how to operate a vehicle?! She was on an antidepressant, which barely if at all helped smooth a little of the ruff edges and she just quite taking them all on her own. I don’t know what to do. Everyone basically says its teenage stuff but there is no way that anyone could willingly behave this way, could get in trouble like her, miss out on things, disappoint her parents about the same thing over and over agin on purpose just to do it just because it teenage stuff, there’s no way. I don’t want there to be something “wrong”, but this isn’t right, and it’s only getting worse.

    1. Hello Tara,

      Thank you for your comment. Walking on eggshells (or glass) is so stressful day after day that everyone in the family can be traumatized over time, affecting health and wellbeing. I hope you can steal time away from your daughter’s demands and spend it on your other two children as often as possible. A sister like their’s can rob them of their childhood, and the sense of safety and play we hope all children get to experience. It’s possible that your daughter will take years to get her life in order, but the siblings shouldn’t have to sacrifice their own wellbeing. Consider speaking with them plainly about their sister’s impact, and share this paradoxical message: your sister’s behavior is intolerable and unacceptable, but that doesn’t mean we won’t love and accept her as family… something like that. Ask them if they need support, or if there’s something they’d like to have happen to bring more calm or ‘normalcy’ in their lives. You too need support and care, and if its not readily available when you need it, practice good self-care. Your children need to observe their mother putting herself first once in a while. It’s something they need to learn to do for themselves.

      Take care,

      Margaret

    2. tara,
      when i read your post it was like listening to mr talk about my daughter! same age as well. i just wanted to thank you for sharing because it made me feel not so alone. this is such a hard disorder to understand and even harder to explain to friends/ family who don’t see the signs.

    3. Tara, we live parallel lives. We had all you did and more. She finally ran away when she turned 18. Lied to anyone n everyone how we kicked her out. Lying persists. It’s been 3 years and she tells people she’s earning a doctorate in neuropsychology even though she never attended school after HS. She says she’s married, she’s not, etc etc. we decided that the five kids remaining counted every bit as much as she. She lives w bio family now and a boyfriend. Promiscuity and drugs resulted in a pregnancy and the cycle continues. She plans many more kids and has become an animal collector. Without being callous, parents cannot fix that. We CAN be present and continue to parent our remaining kids. Our 17 year old son, bio sib to daughter, ran away because he did not want to do chores like load the dishwasher and would not keep drugs out of our home. Called it enslavement. So he left. And he is lying to everyone saying we kicked him out. This is after watching his older sister lie! There is a true break with reality at times. If we didn’t take a step back, we would end up unable to parent the four that are left. I’m sure some kids benefit from unwavering support, but others just need to break free and run crazy wild through their lives. Don’t beat yourself up if you aren’t a pillar of strength. I’m not. I’m human.

  6. Great post/Article; describes my daughter grown, to a tee. Rite down to the suicide attempt! Wow! I haven’t spoken to her for over a year she ruined her health having Charlie, my adorable five yr. Old grandson. He is her only source of income. Last I knew the therapists were forcing her to potty train him. I know, horrible isn’t it. More later when I’m on WiFi.

    1. Hi Debra,
      I hope you will be around for your grandson in the long term. He will need lots of help in his future if he is to develop a healthy lifestyle and social skills. I’ve met many grandparents who’ve ended up raising grandchildren because the parents couldn’t. These folks are saints to set aside their lives for a 2nd time, but they’ve raised wonderful children. I also hope your daughter is able to get the help she needs someday.

      Margaret

  7. A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls. The father also installed cameras in the home, at the front and back doors, in plain sight. Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly. His persistence in the face of obvious monitoring became a great source of amusement for his parents, which softened his emotional impact on their lives.
    –Margaret

    I can not believe that the parents are finding amusement in bulling and hurtful behaviors towards siblings.

    1. Hi M,

      Thank you for your comment.

      My post was not intended to communicate that the parents were amused that their other children were being bullied, and upon rereading it, I understand that it could sound that way. These parents were in no way amused by the bullying! The cameras made it possible to get the facts of what really happened: who was at fault? how did actions lead up to a problem? The parents and siblings had many strategies to prevent bullying and to protect each other from bullying. The camera prevented a he-said-she-said situation. Any of the children could have provoked their brother into bullying. This was a good means of working with all their children.

      As to humor: parents need to find humor in their stressful lives. In high stress professions (emergency rooms, the military), “gallows humor” is tolerated because it helps people cope. I’ve worked with 100’s of parents and discovered that if they could find humor in their situation without guilt, it it helped them cope. Other parents in my support group laughed along with this couple. But amusement like this is not to be shared with any of the children.

      You might be interested in this article: http://www.raisingtroubledkids.com/finding-humor-child/ titled ‎”Finding Humor in your ‘Crazy’ Child.”

      Take care,

      Margaret

  8. Do you have any advice on raising a borderline schizoaffective child, one who experiences resentment and harbors violent urges when corrected? I’m worry that correcting him will result in his harming me while I’m sleeping. He has planned to hurt me before, and was discharged because the insurance stopped paying—not due to remission.

    Just this week he started talking about his “ex-girlfriend” whom he used to stalk before his last psychotic break. He also told me that we don’t catch 1/10th of the inappropriate things he is doing. I get the feeling he can run through the motions, and avoid adult scrutiny, but is harboring some very dark impulses—just hating people to hate them.

    1. Hi Jason, I hope you are taking good care of yourself because your child’s disorder leans toward defiance and violence towards others, criminal violence. This is exceptionally scary. Based on what you wrote, I have a couple of ideas. Can you stop “correcting” him? I don’t know what’s happening, but if you can focus on what he does, rather than what he says or believes, it may stop triggering his anger. That’s the key with schizo people: eliminate anything that causes them stress, even if it doesn’t make sense to you. Worry about his actions, not his rants or strange beliefs (these are a hallmark of schizoaffective disorder).

      His anger can hurt or enrage you, which is why you need to take care of yourself. It will continue until he’s treated, but you will endure. The bad energy he brings in your life is nothing compared to the suffering he will experience, possibly for the rest of his life. My own schizoaffective child finally got help at 30, after years of horrendous experiences.

      If you believe he will harm you while asleep, get a lock on your door. Have a phone in your bedroom and call 911 if he tries to get in. Many parents have had to do both of these. They even got locks for a sibling’s bedroom to keep them safe. Don’t ever be reluctant to call 911 and join the club–for many parents, 911 is a friend.

      You have the legal right to search his room and follow his phone and computer activity. Do not let him know unless you find patently dangerous and unsafe things: weapons, drugs, knives, evidence of criminal plans, or similar. If you find nothing, it’s likely he’s ranting due to psychosis, but always verify.

      Focus on safety above all else. He’s sick, but keep him (and others) safe long enough to eventually get help, like my own child did.

      Margaret

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Parent to Parent Guidance

Parent to Parent Guidance

Margaret Puckette is a Certified Parent Support Provider, and assists parents on how to effectively raise their troubled child. She believes parents need realistic practical guidance for family life and school, not just information about disorders. Margaret has mentored families for over 20 years. She is an author & speaker, and knows from personal experience there is reason for hope.

You Can Handle This.

You Can Handle This.

You are not alone. It's no one's fault. Behavior disorders are disabilities! Troubled children need a very different parenting approach than 'normal' kids.

Care for yourself first, then set new goals:
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2. Acceptance of the way things are
3. Family balance, meet the needs of all
4. One step at a time, one day at a time

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Practical Guide for Parents

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