May 2004: Comfort Zone ONLINE
I am asked this question frequently and have heard this disorder equated with sensitivity by some professionals, so it seems to be time to clear this up. It’s an important issue. “Borderline” is a term that strikes a deep nerve for anyone in the health and mental health professions. It means trouble. Get rid of the person if you can. This patient will be impulsive, suicidal, explosive, attached to the point of stalking you, then turn on you the moment you show the slightest flaw, and will be impossible to heal. It is a damning diagnosis to receive, it is difficult to be taken seriously after you receive it, and it is one diagnosis you generally won’t know was given to you. And women, and probably sensitive men, are the ones who most often receive it. Clearly we HSPs do not want to be equated with this disorder, even if, alas, some of us have it.
The Underlying Cause
Too frequently professionals speak of “a borderline” as if the person and the disorder are synonymous. In part this is because to receive the diagnosis of any personality disorder one must have had it all of their adult life. (You can have the same problems in adolescence, but teenagers considered to be naturally so mixed up that it is unfair to diagnosis them at that age!) And these problems have to be significantly impairing your life. What’s worse, these diagnoses are part of an overall category that includes mental retardation because these are seen as almost untreatable, in that they do not improve with medication alone. Still, to equate a person with this diagnosis, stubborn as the disorder may be, is truly unfair--even more so because lately treatments have improved and after enough years of good psychotherapy, those diagnosed often cease to fit the criteria. These formal criteria, published in the Diagnostic and Statistical Manual of the American Psychiatric Association, can be found online--for example, at http://www.behavenet.com/capsules/disorders/borderlinepd.htm.
Besides stigmatizing a person and ignoring the potential for recovery, what makes it triply unfair to equate person and diagnosis is that it makes no mention, as Post Traumatic Stress Disorder does, of the cause. And the cause is never the person’s fault or even purely the fault of genetics. I have never found a person with this diagnosis who did not have a very troubled childhood. Parents of these patients do not like to hear this, but they should understand that the problem may have been subtle and beyond their control. For sensitive children especially, parents fill the essential role of providing emotional regulation at first and teaching it through example and techniques later. If parents happen to have been under so much stress that they could not regulate their own emotions, their child experiences an almost catastrophic sense of everything being out of control and they also do not learn how to regulate their own emotions. More often, or along with this, there was physical or sexual abuse or years of living with serious reasons for chronic fear. Often the problem was a mother who would have been diagnosed with BPD.
Sadly, when children do not receive what they need in childhood, there seems to be something automatic that registers this as “there’s something deeply wrong with me.” Maybe this mechanism was wired into children so that they would be highly motivated to adapt their behavior to whatever the parents needed. Who knows. It certainly leaves scars in adulthood. Persons said to be borderlines are very insecure and desperately need validation and nurturing, not only because of what happened to them, but also because they are so easily reminded of this deep “something wrong” that must be there. Add to that a stigmatizing diagnosis and they are deep in the hole.
An Insidious, Deepening Pattern
The tragedy is that what those with this diagnosis need most, true caring, is what they rarely receive. Even in psychotherapy it is rare, unless the therapist is well trained in treating this condition and also truly likes the patient. The problems simply make the person too difficult to live or work with, must less love. This is not their fault, but of course each time this happens it makes the precise problem so much worse by causing them to feel even less worthy of another’s affection and respect. In fact, what one notices most about those labeled with BPD is that relationships hurt them, over and over. There is a regular pattern to it. Because of their great need for what they never had, they come on strong with people. They fall in love hard. They idealize the other, hoping to finally receive the love and recognition they need. They find it very difficult to regulate or control these emotions so that they do not “leak” out and be noticeable to others. Their overwhelming emotional approach causes the other person to pull back because of this “too muchness.” It feels “off,” weird. “Why is this person telling me all of this? “...giving me this expensive gift?” “...writing a long email in response to my simple question?” Or worse, the other person takes advantage of all of this openness and generosity.
But even if the other person sincerely tries to provide a little or a lot of what is needed, these troubled people will feel so certain of eventually being abandoned that they can never relax into it, or hear caring without distorting it as more or less than what it is. Instead their emotions leap ahead of them and they bring on a crisis through their need to test the other’s caring. Others may say that those with BPD are manipulative, but they rarely get what they want. Or people say they are overly dramatic, but when you can’t regulate your emotions, life really is overly dramatic.
So finally the rebuff or rejection comes. Naturally, after their hopes were raised so high and then dashed so low, they feel either furious or a deep shame and hopelessness. “Something must be terribly wrong with me. This happens every time.” Or, “Something is terribly wrong with the person who did this to me. Something is wrong with the whole world.”
In short, this sense that one is a horrible, unlovable person, this shame, is an unbearable emotion. To deal with it, these individuals are forced to get rid of it in some drastic way. One way to get rid of it is to blame the other person instead, and they may imagine elaborate plots that the person always intended to use them or hurt them, or simply be aware of the efforts someone is making to get out of the relationship, see the dishonesty in it, and be furious. Another way to get rid of these emotions is to kill themselves, take drugs until they are unconscious, cut themselves, or behave in other self-destructive ways that will blot out the awful feeling. Seen in this way, it is an understandable and miserable place to be, and something very difficult to heal.
HSPs And Borderline Disorder
While the impulsivity and rages associated with BPD are far from the behavior of most sensitive persons, there are HSPs who do have this disorder. This is because HSPs are more affected than others by having a troubled childhood. But there are also many non-HSPs who receive this diagnosis. The trait itself and the disorder itself are very, very different. This is a fact as important for HSPs with the diagnosis as it is for HSPs without it. Those with the diagnosis have to keep in mind what might be normal for an HSP among all of their intense thoughts and emotions, and what is not.
Confusion has arisen because of course many times professionals meet HSPs who do also fit the BPD diagnosis. But sometimes mistakes are made, especially because all HSPs tend to be more emotional, and to those professionals who are non-HSPs and less emotional, this can seem abnormal. Since any abnormality that has been present throughout one’s adulthood and has impaired one’s life can be classified as a personality disorder, the next step is only deciding which personality disorder. Since those with BPD are often said to be “hypersensitive” to nonverbal communication, when professionals hear of “high sensitivity” they may think it is the same thing.
Adding to the confusion, some psychiatrists (e.g., Stone, Grotstein) say that “hyper irritability” is typical of BPD and can be either inherent or traumatically induced. If it really is inherent, that might seem to be the same as being an HSP. But I don’t see the evidence for BPD being inherited. They make an analogy to physical systems, arguing that the borderline’s sensitivity leads to a lowered threshold, exaggerated response, and chaotic oscillations. But if this over reactivity is inherited–which, again, I doubt--it does not seem likely to be the same innate trait as we are familiar with, which predominately involves a preference for reflection before action, is found in twenty percent of the population, and has persisted throughout the long course of evolution.
It is true that theoretically, at least, sensitive patients could feel “forced to the wall” sooner than others, becoming hostile or suicidal, simply because emotions can reach these levels more easily in them. But more often sensitive persons assiduously avoid behaving in a way that is risky or that would disturb others. In my own experience, even those with a severe personality disorder produce little of the aggressive or thoughtless behaviors typical of BPD. When they do express anger, rather than raging, they usually became depressed and concerned about the harm they may have done to the relationship. If freed of their shame over what they see as a highly inappropriate response, they can usually begin to reflect on their situation in a constructive way, as one would expect of those who specialize in processing before acting.
In other words, a lowered threshold in a living system can as easily lead to more accurate, orderly responses rather than to chaos. Or as one expert on the disorder, van der Kolk, observed, “Exquisitely sensitive children may interpret normative growth experiences as terrifying. However, our study suggested that shyness and biological vulnerability are not the pre-dominant factors leading people to develop Borderline Personality Disorder; the superimposition of childhood terror upon adult situations is most likely to be the key.”
Don’t Worry, We All Are Borderlines Just a Little Bit
Upon hearing about BPD, many HSPs think they have it. Well, you do, in the sense that almost everyone has a “borderline part” inside (except those who project it onto others), and HSPs will notice it in themselves even more, I am sure. This part is very needy. It yearns for care and attention, more so if there was not enough of it in our childhood. And if we let that yearning show, and then sense some sign of rejection, real or not, or just feel we were “too much,” we can be plunged into shame and self-loathing. But the difference is that this spiral does not happen often or ruin every relationship. If it seems to you that it is present too much, then psychotherapy with the right person is the only treatment that I know of.
There is another treatment specifically for those diagnosed with BPD, and that is Dialectical Behavior Therapy. It requires at least two years of going to group sessions along with individual therapy. When it is well done, it can be very helpful. But it would not be appropriate unless you truly fit the diagnosis as described in DSM and your life and relationships are going very poorly. Furthermore, individual psychodynamic psychotherapy–again, with the right person--has proven to be just as effective, although sometimes more expensive. And it will help with whatever is the matter, without having to label it.
Why Are We More Vulnerable?
Returning to the subject of HSPs and this condition, let’s just list some of the reasons HSPs are more vulnerable to problems like BPD and major depression when they have had a painful childhood.
I’m sure some of you can add to this list. The point is, do not blame yourself or them, but do understand what happened to you and get the healing you need. This will require a good, long-term relationship with someone. There are no short cuts, as far as I can see, and I have looked for them. Meanwhile, all of you should not be better able to refute the claim that high sensitivity is the same as BPD, while still appreciating that they can coexist. Further, now you know the borderline part of yourself and others, so that you can take better care of it rather than see it spiral into blame or shame.