- Overview of BPD
- Living with BPD
- Special BPD Topics
Individuals with Borderline Personality Disorder (BPD) can experience many symptoms of their disorder that can lead to serious social consequences. These consequences commonly occur following acting out behavior due to high levels of impulsivity, poor judgment, anxiety, fear of abandonment and overall sensitivity to relationships and changes in intimacy. As a Personality Disorder, BPD related problems are often evident in patterns of interaction with others and in dysfunctional attempts to cope with the impact of relationships. BPD predisposes one to hypersensitivity in social interactions and this dramatically increases in relationships that are more intimate. There is particularly a high risk for problems and acting out behaviors in romantic relationships, but this risk is also present for many in other ‘intimate’ relationships such as friendships and relationships with co-workers that continue over time.
Individuals with BPD are likely to also have a history of traumatic experiences particularly in childhood. These typically include victimization such as by physical or sexual abuse. Such experiences damage the ability to trust others and to establish and maintain appropriate and healthy boundaries with others. For many, there is an inability to understand what is ‘normal’ in relationships. Situations in which there are multiple relationship dynamics such as families and the work place can be confusing and difficult to manage.
Cognitive distortions or thinking mistakes occur in BPD and are frequently the basis for hypersensitivity in relationships and difficulty understanding the social cues of others. These errors in thinking are patterns or beliefs that misinterpret how others, self, the world and relationships operate. The tendency to personalize the behavior of others, for example, is a characteristic of BPD that can lead to many social consequences such as conflict, alienation, embarrassment, guilt, remorse, feelings of inadequacy, social awkwardness, insecurity and poor self-esteem and self-worth. In personalization the social cues of others are interpreted as “all about me” and trigger emotional distress that can lead to acting out behaviors in response.
Many problems can arise for those with BPD due to misinterpreting the behavior, intentions and motivations of others. Due to the tendency to personalize the behavior of others, for example, individuals with BPD often mistakenly believe that they are somehow the cause of the behavior of others or that the behavior of others is directed toward them. This is a result of hypersensitivity to others and relationships. It is also reflects the feelings of insecurity, desire for approval and closeness and the belief that others will reject and abandon them that are characteristic of BPD. Previous traumatic experiences can greatly intensify the tendency to personalize the behavior of others and lead individuals with BPD to believe that others intend them harm, are abusive, are betraying them or otherwise trying to dupe or mislead them. Such beliefs may have been formed during actual experiences in which these dynamics did occur. It becomes problematic when the previous real events begin to affect other situations that are not abusive.
Other cognitive distortions that can greatly affect relationships and lead to negative social consequences are:
• ‘Black and white thinking’ or ‘all or nothing’ thinking (splitting)
• Jumping to Conclusions or assuming
• Seeing self as victim
• Emotional reasoning
• Using power plays
• Overlooking the positive
• Seeing others as villains
• Using should statements
Splitting is a characteristic of BPD which occurs internally in the way events and situations are interpreted and in patterns of thinking. Splitting involves the use of all or nothing, black and white thinking and is done in terms of simplistic value judgments such as pro/con, good/bad, love/hate. There is no ‘gray area’ in this type of thinking and splitting is considered a developmentally immature level of thought more appropriate for children who do not have the capacity for making complex value judgments. Splitting also occurs in social situations when, for example, some people are seen as allies, positive, friendly, well-intentioned and supportive and others are viewed as of little value, villains, nonsupportive and hostile.
Splitting can involve negative social consequences when dynamics such as the following occur:
• Having splintered relationships—having trouble negotiating situations in which one’s friends have associations with others
• Creating conflict in systems where cooperation and support of several people is the norm
• Using gossip to devalue or alienate others
• Using efforts to control the social interactions of others
• Forming inappropriate alliances
• Overstepping usual social boundaries
This cognitive distortion involves making conclusions with very little information and is sometimes called ‘mindreading’ or ‘fortune telling’. It foregoes the usual communication skills used in conducting successful and healthy relationships such as actively listening to what others are saying and asking for clarification to be certain one understands what is being communicated. Individuals with BPD frequently jump to the conclusion that others are unhappy with them, disapprove of them and wish not to associate with them. Reacting to false conclusions about the intentions, feelings and motivations of others can lead to much problematic behavior in family, occupational and social relationships.
Overgeneralization occurs when an isolated fact or incident is used to make sweeping conclusions about other situations. Individuals with BPD, especially those with trauma histories, are predisposed to using overgeneralization in their perceptions of others. An incident of healthy disagreement or conflict, for example, may be viewed as evidence that another person wishes to reject or harm. Usual life occurrences such as being late for appointments or missing telephone calls may likewise be overgeneralized to mean that one is being devalued, abandoned or rejected.
Making dramatic statements, drawing dramatic conclusions or engaging in dramatic behavior can result from the intense emotional response that individuals with BPD can have due to symptoms of mood swings and impulsivity that are not well controlled. Hypersensitivity to others and fear of rejection and abandonment can increase the tendency to dramatize. Dramatic behavior can involve angry outbursts, attempts to control others, attempts to reject or abandon before getting rejected or abandoned and aggression, shaming and blaming of others. One of the most serious forms of dramatization is the use of self-harming behavior. The social consequences of dramatization can involve alienation, loss of credibility and social standing, loss of employment, loss of relationships and mental health crisis.
Individuals with BPD are prone to view themselves as victims and others as intending to do them harm particularly through rejection and abandonment. As a result, many are reluctant to enter into relationships and must struggle with trust issues throughout becoming involved and while maintaining relationships. Situations in which there are natural differences in power and authority such as in work environments and in dealings within community settings can trigger the feelings and beliefs that one is being victimized or is at risk for victimization. Academic and professional dealings can be sabotaged by seeing self as a victim and prevent success. In more intimate relationships healthy alliances can also be sabotaged by these dynamics.
‘Crying wolf’ or making false allegations about victimization can eventually lead to the loss of credibility and even to the unwillingness of others to risk involvement for fear of being falsely accused of wrongdoing or abuse.
Additionally, individuals with BPD who see themselves as victims may enter into relationships with abusive people. In these cases, the sense of self as victim can be ‘normal’ and familiar and put such individuals at risk for accepting and tolerating typically unacceptable behavior from others.
Emotional reasoning is a cognitive distortion in which feelings are considered fact. Decisions and judgments are made using emotions and can discount and dismiss facts that substantially contradict one’s decisions and opinions. Using emotion as the primary tool for decision-making is unreliable particularly when one’s moods shift and negative feelings are easily triggered by situations and events in daily life. Emotional reasoning can create serious consequences socially due to ‘snap judgments’, ‘knee-jerk reactions’, impulsive decisions and the disregard of other information such as knowledge of risks and potential for harm when making important decisions. Interpersonal conflict and loss of relationships can also easily arise when reasoning is based upon emotions since those with BPD are apt to have intense and fluctuating emotions in relationships.
Hypersensitivity and fear of rejection and abandonment can lead those with BPD to attempt to control the behavior of others. Attempts to exert power and control over others are usually in reaction to intense, often frantic efforts to ward off rejection or abandonment and to maintain a relationship. The result of exerting power over others can alienate others, be abusive and cause lost relationships.
People with BPD are prone overlook the positive in situations (and at times, others) and to deal with inconveniences, obstacles and the set-backs of usual life by viewing them as indications of how bad self, others and the world are. Problems are apt to be seen as indications of more problems to come and are frequently viewed as the beginning of an inevitable and future catastrophe. These patterns of thinking sabotage relationships and create undue delays in solving problems. These cognitive distortions also can set up ‘self-fulfilling prophecies’ in which more problems are created by the negative reactions to an initial set-back or obstacle.
Idealizing is the opposite of having a pessimistic attitude and seeing only the negative in situations and others. The idealization of others and situations can have serious social consequences when relationships are formed despite evidence that others cannot be trusted or are dangerous. In less extreme cases idealizing another sets up unreasonable and unrealistic expectations of others that lead to conflict in relationships when others are not viewed as they truly are.
Fragmenting is the tendency for those with BPD to change their behavior and attitudes in various social situations. This is the ‘chameleon effect’ in which people who are motivated by intense desires for approval and security in relationships attempt to please others at all costs. This results socially in others viewing the ‘chameleon’ as unreliable and undependable. For the person who using fragmentation in an attempt to be accepted, there can be a sense of not knowing who one is and what one’s authentic desires, hopes, dreams, values and motivations are.
Should statements include firm opinions about what self and others should do and how the world should work. This cognitive distortion sets up rigid and often unrealistic expectations and ‘rules’ that are not flexible enough to accommodate everyday changes, obstacles and occurrences. Using should statements is often an attempt by those with BPD to have a false sense of security and predictability in relationships, however, the result can be chronic dissatisfaction, upset, disappointment and conflict when others do not abide by the ‘rules’ established.
Addressing cognitive distortions is very frequently a key goal in treating BPD. Identifying the thinking patterns and beliefs that trigger increased symptoms of BPD is the first step in replacing these with more realistic and healthier patterns of thinking and more functional beliefs about self, others and the world. Working to combat the use of cognitive distortions can help reduce symptoms such as mood swings, impulsivity, fear of abandonment, compulsive and self-destructive behaviors and sabotage of relationships. Individual and group therapies that use Cognitive Behavioral Therapy (CBT) techniques utilize structured exercises to identify dysfunctional patterns of thinking and to replace them with healthier ones. Use of such techniques leads to decreased sensitivity to triggers, more emotional stability and more stable relationships. Typically care providers of all disciplines will incorporate such work into therapy for individuals with BPD. The targeting of cognitive distortions is a clinical best practice and helps those with BPD successfully correct the negative social consequences of their condition and have greater social success.