Markham's Behavioral Health

When the borderline mother's motto is "Life is too hard"

Borderline Personality Disorder can manifest itself in mutliple ways. In her book, Understanding The Borderline Mother, Dr. Christine Lawson describes four role types which BPD is exemplified by: the Waif, the Hermit, the Queen, and the Witch. These role types are not mutually exclusive and characteristics of these types over overlap and inter mix.

The Waif seems to want soothing and often leaves others feeling helpless because she is often inconsolable. As Dr. Lawson writes that the Waif might say, "I can't allow myself to need your help and be in control at the same time."  The irony is that the Waif feels that in accepting help she is loosing control.

The Waif can self soothe with the compulsive use of alcohol, drugs, money, food, sex, work, and likes to play the role of the martyr. She can often become hysterical to get attention.

Unfortunately, nothing others do for the Waif seems to be quite good enough. She could be described as a bottomless pit in that if you give an inch, she will want a foot, and if you give a foot, she will want a yard, etc. Others usually wind up feeling "used" and burned out and then will avoid her only compounding her fears of abandonment and rejection which leads to the dysphoria and anxiety which are the beginning of the self reinforcing cycle all over again.

The Waif rarely has insight into her own behavior and is more likely to play the victim than to take any responsibility. If challenged to take responsibility she will either further sink into helplessness or flip and accuse others of persecuting her.

Dr. Lawson writes:

"Loss or abandonment can trigger psychotic reactions. Abandonment or rejection by her partner arouses rage in the Waif, as she seeks to annihilate the one who failed to love her perfectly." p. 72

I worked in Psychiatric Emergency Rooms for over 18 years and estimate that over that period of time I peformed over 14,500 suicide assessments. The only patient I lost was a woman in her 30s who had had several admissions to the psychiatric floor for suicide attempts. Her problems had been diagnosed as borderline personality disorder. When I interviewed her at 3:00 AM in the morning she attributed her suicidality to her break up from the tumultuous relationship which she had with her boyfriend. We worked out arrangements for her to spend the next few days with her father and for her to see her therapist later in the day. Apparently, in the morning, instead of keeping her appointment with her therapist she sought out her estranged boyfriend where a further argument occured. She reportedly grabbed his rifle from his house and went into the front yard where she proceeded to shoot herself as he watched from the front door. Unfortunately, she died.

Doing a psychological autopsy after the incident it was determined that there was no way to predict her impulsive and deadly act. Had she not had contact with the ex-boyfriend she would never have killed herself that day.

Dr. Lawson writes that the Waif Mother's motto is "Life is too hard" to which I would add, "Nobody loves me", "you'll be better off without me", and "you'll be sorry when I'm gone."

Children of Waifs often become excellent caregivers and often enter the helping professions as nurses, social workers, psychologists, EMTs and other crisis workers. These adult children of Waifs have spent their whole lives making order out of chaos, managing other people's emotions for them, and consoling the inconsolable in situations where there is a high level of subjective distress. These are skills which are invaluable in situations where most people would fear to tread and become paralyzed. For the Adult Child of a Waif, they, many times, have "been there and done that".

This is post # 14 in a series based on Dr. Christine Lawson's book, Understanding The Borderline Mother.

Treatment can help in the borderline family and it begins with information

Dr. Christine Lawson writes in her book, Understanding The Borderline Mother:

"Knowing the proper diagnosisis is the first step to treatment. Some therapists are reluctant to inform the patient or family of the diagnosis of BPD. Yet growth cannot occur without understanding. Patients wih BPD have a right to the truth just as much as patients who suffer from other incurable, life-threatening conditions, especially since over 10 percent of individuals with BPD commit suicide. Just as the diabetic must learn to manage sugar intake and output, the individual with BPD must learn to manage emotional input and output. Psychotherapy, combined with antianxiety and antidepressant medications, can significantly enhance the borderline's quality of life." p.51

The diagnosis of Borderline Personality Disorder is one of the most controversial in the field of psychiatry. Many mental health professionals avoid, and prefer not to work, with people diagnosed with Borderline Personality Disorder because of the dramatic presentations, sometimes seemingly ongoing drama and crises, the emotional lability, and the "spitting", that is the idealization and the demonization of the same person in often instantaneous flips, and the playing of one person off another.

The borderlines ability to "split" staff on inpatient psychiatric units and in community residences is legendary. In my experience, working with people with borderline disorder on an outpatient basis is very difficult if they require inpatient hospitalization unless staff have the time and are willing to make the effort to coordinate the care and treatment. When one client of mine was hospitalized for depression and suicidal ideas, the client assumed the role that Dr. Lawson describes as the Waif and plaintiffully asked me what was wrong with her. When I responded that she may have Borderline Personality Disorder and brought some information, the inpatient psychiatrist was irrate with me saying that the patient was not in any condition to understand the information and recommended that the patient's care be transferred to another therapist upon her discharge. Over the next few years the patient's condition  continued to deteriorate with more hospitalizations, and I continue to wonder if things could have stabilized and maybe even improved, if she had been given and helped to process the information.

This is post # 13 in a series based on Dr. Christine Lawson's book, Understanding The Borderline Mother.

Communicating with people with Borderline Personality Disorder sometimes feels like being in the Twilight Zone

Today, June 21, 2007, on the blog, Borderline Crazy, the author has a great article on borderline thinking processes which at times can be quite delusional. The writer likens the process as communications going through the borderline's black box which become misinterpreted and take on a delusional quality that leaves the communicator as feeling like he/she is in the twilight zone.

Today on my mind has been on the translations that communication goes through (I think of it as “the black box”) before it reaches the mind of a person with BPD. This may be a diagnostic feature not to be found in the DSM; if you find yourself often thinking you’re in the Twilight Zone (OR often wishing you had a tape recorder to replay what was actually said) when conversing with someone, I think chances are good you’ve got yourself a borderline. When I was growing up, I often thought, “Where did she get that?” I was always saying, “I didn’t say that” or “I didn’t do that,” but once her mind was set on something, then that’s what had happened.

The whole article is well worth reading which can be accessed by clicking on the link below.

Link: Borderline translations: the black box « Borderline Crazy.

Emotional abuse in borderline families is the worse abuse of all

Christine Lawson writes in her book, Understanding The Borderline Mother, that children have four needs:

1. To be held (to be enveloped by safe, loving arms)
2. To be mirrored (to se a positive reflection of themselves in their parent's eyes)
3. To be soothed ( to be comforted, reassured, and protected)
4. To be given some control ( to elicit predictable responses to expressed needs)

Lawson writes a little further:

"Like a broken record, the borderline's behavior seems compulsively driven, with the aim of eliciting what she lacked as a child. The Waif needed to be held, the Hermit needed to be soothed, the Queen needed to be mirrored, and the Witch needed control." p.45

In addition to physical and sexual abuse, emotional abuse in the form of denigration put children at high risk of developing Borderline Personality Disorder. Denigration can take the form of teasing, ridicule, mockery, humiliation, embarassment, and harassment. Dr. Lawson writes:

"Chronic denigration can destroy even an emotionally heathy adult's self-esteem. Denigration of a child can destroy the soul before self-esteem has a chance to develop." p. 46

One client told me how he was constantly referred to as "fat butt" as a child growing up. He also said that he was often told sarcastically that he was "dumb as a stone", and that the dog was smarter than he was.

What is even more damaging is when the parent is held accountable for this emotional abuse and it is denied as "I was only kidding." or the victim gets blamed as "not being able to take a joke" or further denigrated as "there you go whining again."

Some might argue that physical and sexual abuse are less psychologically damaging to children because the nature of the abuse and the perpetrator is clear, but emotional abuse is more confusing or "mystifying' as R.D. Laing, a British psychiatrist called it. Dr. Laing thought it was the "mystification" that was the most damaging aspect of emotional abuse because as the abuse is being perpetrated, it is also being denied.

It was this invalidation that Lawson refers to when she writes:

"Linehan explains that invalidating environments do not allow the expression of painful or negative emotions. Invalidating families teach children that pretending to be happy is more important than being happy, and that talking about how you really feel only makes things worse."p.46

The "no-good child" often has it worse. As Lawson says,

"Unjustly accused, the no-good child is sentenced without trial, held without bond, and may feel imprisoned for life. Therapists sometimes warn family members not to depend on the person with BPD to validate their self-worth, yet young children have no choice." p. 47

One client, a very capable competent nurse in her early 30s, told me that it took her years to overcome her anxiety about whether she was competent and good enough.

Lawson writes:

"Children raised by borderlines may spend their childhood balanced on the edge of disaster and may suffer anxiety for the rest of their lives." p. 48

The old child's nursery rhyme, "Sticks and stones may break my bones but words can never hurt me." is wrong. Words often hurt worse than sticks and stones because sticks and stones only injure the body, but words can injure the soul. A broken leg is one thing, but a broken spirit is quite another.

This is post # 12 in a series based on Dr. Christine Lawson's book, Understanding The Borderline Mother.

Destructive parenting often justfied in borderline families and enlightened witnesses can be soul saving

Christine Lawson in her book, Understanding the Borderline Mother, writes,

"Studies indicate that the single most important factor affecting resiliency in children is the conviction of being loved. The effects of parental abandonment, abuse, neglect can be mitigated if children have access to a relationship with a loving adult such as a teacher, a minister, a neighbor, or a relative who is empathically attuned to the child's feelings." p.43

This person is what Alice Miller calls "an enlightened witness." The enlightened witness is a person whom the child trusts and feels understood by whom the child believes knows what is going on and who validates the child so that the child is reassured that the problems being experienced are not generated by them but by the other.

The symptoms and interpersonal dynamics of borderline disorder are subtle and often not recognizable by the casual observer. When symptomatic behavior appears it often is easily dismissed as an aberration by a non-intimate observer. The Dr. Jeckle/Mr. Hyde phenomenon is very prevalent in borderline families where there is concentrated effort to hide the dysfunction and a breach of the secrecy is judged to be a huge betrayal and is severely punished. Therefore, repeat disclosures are unlikely, and children repress and deny their experience knowing it is unlikely their stories would be believed by outsiders, and would be punished by insiders. Even when symptomatic behavior is recognized and acknowledged, it is hard to believe that a supposedly loving parent would treat their child in such ways. Even the parent herself often does not seem to be aware of the destructive impact of her behavior and so dysfunctional behaviors are denied or rationalized, or even justified as being necessary for the benefit of the child.

This is post #11 on a series based on Christine Lawson's book, Understanding the Borderline Mother.

Long-Term Data Document Course of BPD Symptoms

There is an interesting article in the June 1, 2007 issue of The Psychiatric News about a study in the June, 2007 issue of the American Journal of Psychiatry which found that over 10 years 12 of the 24 symptoms of Borderline Personality disorder which deal with impulsivity and suicidality seemed to improve while the remaining 12 symptoms which deal with affect and interpersonal relationships seemed to be more stable.

Twelve of the 24 symptoms studied showed patterns of sharp decline over time and were reported at 10-year follow-up by less than 15 percent of the patients who reported them at baseline. The other 12 symptoms showed patterns of substantial but less dramatic decline over the follow-up period.

Symptoms reflecting core areas of impulsivity (such as self-mutilation and suicide efforts), and active attempts to manage interpersonal difficulties (such as problems with demandingness/entitlement and serious treatment regressions) seemed to resolve the most quickly.

In contrast, affective symptoms reflecting areas of chronic dysphoria (such as anger, loneliness, or emptiness) and interpersonal symptoms reflecting abandonment and dependency issues (such as intolerance of aloneness and problems with dependency) seemed to be the most enduring.

It seems to be somewhat seredipity for me to find this study because I just raised this question with my psychotherapy supervisor last week about whether people with Borderline Personality Disorder, "mellow" as they get older and the symptoms subside or whether the symptoms persist and functioning slowly deteriorates. Neither one of us seemed to know the answer, but in my professional and practical experience it seemed to me that without treatment, the symptoms seem to get worse and functioning deteriorates.

I tend to tend to think of the symptoms of Borderline Personality Disorder on a continuum from mild to severe. People with mild to moderate symptoms often either do not seek treatment, or do not stick with it if they seek treatment briefly for immediate symptomatic relief or to manage a crisis. Once the immediate problems subside, treatment is rejected and the underlying difficulties are never adequately addressed. Over time the symptoms seem to take their toll and functioning deteriorates as time goes on.

Link: Long-Term Data Document Course of BPD Symptoms -- Moran 42 (11): 13 -- Psychiatr News.

Relationships borderline mothers have with their children

Dr. Christine Lawson writes in her book, Understanding The Borderline Mother, about the relationships that borderline mothers have with their children.

"The dependency of the newborn can be intensely satisfying to the borderline mother, but as the child becomes increasingly independent, conflict erupts." p. 40

I had a client who told me that she never felt better than when she was pregnant. She stated that she enjoyed the nursing and caretaking of the infants until they reached about 2 years of age and then she wanted another child. She had nine children altogether and she became increasingly unhappy when she came to the age when she could no longer have children in her mid-40s.

As the child grows and becomes more independent having been weaned, talking, walking, and toilet trained, the borderline mother feels increasing distress at the separation and the diminishment of the symbiotic tie the toddler has with her.

"The mother's anxiety intensifies because the child is no longer totally dependent and cannot be completly controlled. When the borderline mother recognizes the child's separateness, separation anxiety is triggered and different parts of her personality are split off and projected onto the child." p.40 - p.41

When the borderline mother has several children, some of them can be treated as the "good child" and some of them as the "no-good" child. As a result children in the family can have quite different experiences of the same mother.

"Adult children of borderlines may experience conflict with siblings who have different perceptions of the same mother." p 41

A little further down on the same page, Dr. Lawson writes further:

"Loyalty is richly rewarded whereas the price of betrayal is symbolic beheading - the child is completely cut off." p. 41

The differential treatment is often confusing to children and sometimes they are played one off the other. The good child may feel guilty and upset about how the no-good child is treated but is afraid to say anything less she/he loose their favored position and become the object of the wrath, scorn, and denigration as well. Dr. Lawson writes:

"The consequences of betrayal so frighten children that they may have difficulty speaking about their mother. Upon entering therapy, adult children of borderlines are initially reluctant to discuss their childhood experiences." P. 41

Children learn not to speak of their experiences out of fear of upsetting the mother and precipitating some sort of abuse. Dr. Lawson writes:

"Because borderline mothers can misperceive a child's normal need to separate as betrayal, children learn to deny, disavow, or repress their feelings in order to survive. All good children may stay merged and unable to separate from mother. No-good children may distance themselves completely, although they are more likely to continue a conflicted relationship. It is rare for adult children to abandon their mother, regardless of how many times their mother has abandoned them." p . 42

I had an adult child of a borderline mother in counseling who came from a large family who said "Mom could be very good when she was good, or very bad when she was bad." She told me she has phone contact with her mother on holidays but is leary about physical visits.

This is post # 10 based on Christine Lawson's book, Understanding The Borderline Mother.

Mourning the breach in the relationship between parent and adult child in the borderline family

On June 14, 2007 there is a wonderful article posted on the Borderline Crazy web site entitled "What if I'm wrong" in which the author expresses "guilt" and distress over not having seen her mother with Borderline Personality Disorder.

So basically I keep these boundaries but feel horribly guilty about them. I hate living this way. I wish, OH how I wish, that she were a regular person, a regular mother. I could call her and we could hash this out and each acknowledge our parts in it and then resume our relationship. But she isn’t. My heart aches for her with a soul-sucking vehemence, but I have no words or actions to repair the damage in her or even to get her to see it. Miracles do happen, but without one she will never hear me, and she will never see me, even if she is looking at me and listening to me. So I stay silent.

One client told me that he had nightmares that his mother died and he never got to talk to her again. Often time the children of borderline mothers experience a breach in the relationship and years can go by with no contact leading to sense of guilt, shame, fear, and most of all grief. There is a mourning and grieving process which involves many of the stages which Dr. Elizabeth Kubler Ross described of anger and denial, bargaining and guilt, sadness and despair, and then hope. How do you grieve for someone still alive but with whom no relationship is possible without abuse and pain?

Link: What if I’m wrong? « Borderline Crazy.

Growing up in the borderline family leaves children not knowing what is normal.

Christine Lawson writes in her book, Understanding The Borderline Mother,

"Children with borderline mothers adjust to the chaos of their lives by learning to expect the unexpected. They associate love with fear and kindness with danger. Craziness becomes normal, and life without chaos may seem boring. They may grow up without recognizing healthy love." p.28 -29.

A little further down on page 29 Dr. Lawson writes further, "Children of borderlines may tune out by dissociating and disconnecting from their environment." p.29

It is a comon experience for people in relationship with a person with borderline disorder to wonder who is crazy "me or them?" Attempts to please, placate, clarify, correct are often met with an escalation of conflict not resolution. The person in relationship with the person with borderline disorder then attempts to mollify or submit which sometimes brings resolution or at least a subsiding of the intense emotion in the charged situation. The constantly changing emotional climate, seemingly unconnected from external events, brings about the sense of a surreal environment fraught with tenuousness, danger, and a lack of predictability. After a while, a child, or partner living in this situation comes to expect the unexpected and when the person with borderline disorder is absent for awhile life seems boring and too plain.

Children who grow up with borderline parents are often attracted to people who "have problems", who tend to be eccentric in some ways, or volatile. They have learned since they were small children how to manage the emotions of others, how to bring order from chaos, how to stabilize crises, how to act "normal" when things are out of control or on the brink of "going over the edge."

I have been quite struck with how the adult children of borderline parents often come for counseling because they are confused by some conflicted situation at work, in their neighborhood, in their church or some other sort of club or organization they are in, or in a friendship, and they are using the counseling as a sounding board to determine "what's normal and what's not normal" because they genuinely do not know. They have no reference point. They didn't grow up in a "normal" situation so deciphering and understanding situations is experienced as "flying blind."

This is post #9 in a series based on Christine Lawson's book, Understanding The Borderline Mother.

Tirades in the borderline family

Christine Lawson writes in her book, Understanding The Borderline Mother,

"Laura explained that her mother 'went on tirades.' Something could set her off and she would whirl around the house like a cyclone. The warning signal was 'the look.' The look was a piercing, threatening glare to mean, 'I could kill you.' When Laura was a child, her mother actually said it, with no awareness of the power of her words. Children of borderlines and survivors of hurricanes have much in common. Survival is dependent on finding a safe place, staying low, and not being fooled by they eye of the storm." p.27

A little further down the page, Dr. Lawson writes, "When Laura was young the tirades terrified her, but as she grew older, she became immune to them." p. 27

It is interesting how children of borderlines become hypervigilant and learn how to "read" people very well. These children "smell" danger at 1,000 yards.They often are chronically anxious because they don't know what to expect next. One client told me, "I was especially wary when she was nice to me. If I got home from school and she had baked cookies and was warm and affectionate I knew that trouble was not far away.

It seems sad to me that  children of borderlines can never relax. They either are dealing with the fury of high winds to use Dr. Lawson's metaphor of the huricane, or they are nervous as they enjoy the lull before the storm.

"The look" that Dr. Lawson refers to in her quote above makes family, friends, and therapists anxious alike. I know the look of which she speaks having seen it in many of my clients. It can be overly charming and effusive as well as testy and passive aggressively quiet with monosyllabic responses to questions and defensive withdrawal with no apparent reason given what has occured in the immediate situation. Continuing to press often is met with a hurtful sarcastic remark or some other sort of attack.

The emotionally lability of the Borderline is legendary wherein on the one hand they can idealize the other person and then flip and demonize the same person. There seems to be an incapacity to hold both good and bad in the mind at the same time in a grey area. Things are seen as either black or white.

People with borderline disorder are capable of perpetrating destruction on others and themselves, verbally and physically. Often times the emotional and mental scarring is the worse and by far more prevalent than the physical.

This is post #8 in a series based on Christine Lawson's book, Understanding The Borderline Mother.