Borderline Personalities in Relationships – Wrap Up

Individuals with an impaired and unstable sense of self can present some really interesting challenges in their relationships. And the kinds of difficulties folks are likely experience with any borderline personality is largely dependent upon what traits tend to be the most dominant in their weakly organized character.  Last week’s post addressed some of the problems likely to be experienced with borderline individuals who have prominent dependent, histrionic, or other more “neurotic” features in their makeup (See: Borderline Personalities in Relationships). This week’s post discusses the kinds of problems one can expect to encounter in dealings with borderline personalities whose dominant traits (e.g., antisocial, narcissistic) place them at the more character disturbed end of the neurotic-character disordered spectrum.

Individuals with a unstable sense of self but who also tend to be inordinately self-centered and disregarding of the rights and needs of others (i.e. have narcissistic and antisocial personality traits) are among the most difficult to work with or live with (for more information about narcissistic and antisocial personality traits see Character Disturbance pp. 78-134, In Sheep’s Clothing pp. 37-56 as well as the article: Personality & Character Disorders Pt. 6: Narcissists and Aggressives).  They’re prone to significant violations of reasonable social limits and personal boundaries.  And they’re also prone to various kinds of manipulative behavior. But unlike their more “neurotic” counterparts, these mostly character-impaired borderlines don’t just inadvertently manipulate others out of their neediness and inadequacies. Rather, they more deliberately engage in dramatic, often hostile gestures to keep others both entangled and exploited.

A young man with a very checkered history and a self-described “pathological liar” (Note: as always, details in this vignette have been altered to ensure anonymity) was required by his company’s Employee Assistance Program (EAP) to get an outside psychological assessment. He had many problems both at home and at work and was on the verge of being fired from his job. His main issues were his erratic and episodically explosive behavior with his supervisors, fellow employees, and customers. He had a history of making grandiose claims about his abilities but when tested on the job and then failing to perform would alternately blame others (often verbally unloading on them in language that simply couldn’t be tolerated) or make up excuses and stories. And on more than a few occasions he had verbally berated not only co-workers but also his immediate superiors, lashing out in gross disproportion to the matter at hand, only to express great contrition afterword and give assurances he would never do anything like that again (For more on what genuine contrition looks like see the article: What Real Contrition Looks Like). His company’s EAP had earlier referred him to a physician who diagnosed him with Bipolar Disorder and placed him on mood stabilizing medication (Interestingly, but not atypically, no personality disorder diagnosis was conferred at the time nor was it cited as the “primary” diagnosis). This seemed to help some but his behavior was still erratic and unpredictable. And when anyone brought things to his attention he would readily deny doing them or lie about the circumstances leading up to his behavior. When “cornered” with abundant evidence of his culpability, he was prone to either explode or to brood, call in “sick” for several days, or drop hints to acquaintances that he was seriously thinking of “leaving this sorry $$#ss world for good,” which would simultaneously frighten, enrage, and evoke guilt in those who still had anything to do with him. He’d long been suspected of stealing others’ lunches out of the break room refrigerator, and telling falsehoods about others to get them into trouble. And he had a habit of pitting one employee against another by spreading untrue rumors and falsely claiming victimization at someone’s hands. One day, he was placed on administrative leave. The next day, he stormed into work and threatened a person he thought “responsible” for his dismissal. Two days later, his wife checked him into a hospital after he “threatened” to harm himself.  For the several days he was gone from home and work, folks felt like they could finally breathe.  One co-worker said it was like “being on vacation” to be at work without him there, and everyone dreaded his possible return.

Now, certainly there are similarities in this vignette to the ones in last week’s article (see again:  Borderline Personalities in Relationships). But there are also some very clear differences which make the point that borderline personalities can differ quite a bit based on the dominant traits in their personality.  The man in the above vignette would frequently show the grandiosity, self-centeredness, and readiness to blame others for known personal failures common to narcissistic characters. And his penchant for lying, stealing, manipulating, etc. all bespoke his antisocial attributes. Moreover, while some of his behaviors were impulsive and later regretted to some degree, they were always deliberate and ill-motivated. And there was no self-initiated attempt on the part of this man to seek help. Such things are the very definition of character disturbance.

Borderline personalities like the one above are extremely difficult to work with in therapy, even when the most state-of-the-art techniques are employed. That’s because the features associated with character disturbance are so much more difficult to ameliorate than those associated with neurosis, especially in folks with weakly organized personalities.

Two general types of therapy have been shown to have the greatest potential with borderline personalities: Classic psychoanalysis and specialized forms of Behavioral (especially Applied Behavioral Analysis or ABA) and Cognitive-Behavioral Therapy (CBT), most notably, Dialetical Behavior Therapy (DBT).  Psychoanalysis is a lengthy and costly mode of therapy, often involving sessions 5 days a week for 50 minutes a day (It’s basic objective with borderline personalities is to re-shape personality from the ground up), and its efficacy is highly dependent upon the intellectual and verbal level of the patient as well as their insight capacity. Behavioral and cognitive-behavioral approaches are therefore generally preferred, and most of the time sound medical management is also required to help stabilize mood (at least until internal controls can be developed and solidified) and either prevent or reverse psychotic breaks. 

Great strides have been made within DBT and ABA, especially with a particular form of ABA that focuses on “microbehaviors” and which has demonstrated remarkable results with individuals who have autistic spectrum disorders. In ABA, the patient becomes extremely mindful of all sorts of seemingly insignificant behavioral predispositions, and with the assistance of shaping contingencies gradually acquires the adaptive habits (e.g., how to self-regulate emotion, how to delay the immediate expression of an impulse, how to conduct interpersonal exchanges in a mutually respectful manner, etc.) most folks acquire as a matter of course during their growth and development but which are inherently more difficult for borderline personalities to learn. When seeking help for someone with BPD or even borderline tendencies, it’s important to consider the benefits of securing a professional well-versed in specialized CBT, DBT or ABA.

This Sunday’s Character Matters will be a live program, so I invite everyone to join the discussion.

13 thoughts on “Borderline Personalities in Relationships – Wrap Up

  1. Hi Dr. Simon: It sounds like the journey to rehabilitate a character disordered borderline is a long and arduous one. Most of these narcissistic patients don’t believe they have a problem – everyone else is to blame for their mismanaged lives. So, I am curious to know, how most of these people enter therapy – by a demand through their work or through the legal system or through their spouse? I can surmise that when they feel they have been forced into therapy, their investment in the therapeutic process will be low. As well, you mention that in order for therapy to be successful, the patient needs to have some insight into their condition. Unfortunately, by definition, most character disordered borderlines will not have this insight. Finally, not all mental health centres have professionals who specialize in CBT, DBT or ABA. Bearing all these converging problems in mind, what proportion of borderlines of this type, are successfully treated? It must be very small.

    1. You’re correct here in that most of these folks don’t come into therapy on their own, unless they have a self-serving agenda in mind. And it’s not really “insight” into their “condition” they need. Appreciation for and concern about the impact of one’s characteristics on others is an entirely different matter. And toward that end, all that’s really necessary is that they change behavior and witness the results. This will give them all the “insight” they need.

  2. Dear Dr. Simon,

    I so appreciate all the work you’ve done and continue to do in all directions, including the creating of this site, which I find the most informative out of all I know.
    I have a question. Would you please answer briefly, but as precisely, as your time allows you.
    Q: What are the core features/traits of BPD, that can never be present in Psychopathy? What are the traits/behaviours of Psychopathy, that can never characterise the BPD? (May be apart from BPD type II (Histrionics), that can have compassion sometimes, if I got it right).

    Many Thanks.

    1. Margot, inasmuch as the borderline syndrome, is, as I see it, a failure of the personality to solidify, a person can definitely have psychopathic features and also be to some degree of borderline personality organization. And I have encountered several of such folks. They are among the most dangerous to others as well as self-destructive folks I’ve ever encountered. The key essential component in psychopathy is the lack of conscience stemming from the markedly deficient capacity for empathy which leads to the callous, senseless, and remorseless use and abuse of others. The key element of the borderline syndrome, is, as I mentioned, a failure of the personality to come together and solidify into a stable sense of self.

      1. Hi all — just spotted another possible marker for psychopaths, many seem to have a defective or deficient sense of smell. Google for “psychopaths deficient sense of smell” — of course, if someone has allergies, like me, and the nasal passages are stuffed up, that doesn’t help smell well, either. Has anyone noticed this about the psychopath or sociopath with whom you have personally interacted? Peace and hope from Elva

        1. Hi Elva, what I have noticed and what others I’ve spoken with and reported is a lack of body odor. No, and I mean NO normal male under arm odor. Spathtard did not use deodorant, worked construction and had none of what normally goes along with that. Truthfully, it was a little disapointing because i dont mind a man smelling like a man within reason. All part of that calm, odd, reptilian, quiet, steely, low fear response that I unknowingly mistook as strength…… The predator stare, the cat stocking the mouse.

        2. Okay, I may believe a bit too easily that sociopaths can have no sense of smell or no body odor. Still, if that’s so, perhaps it’s caused by similar biological functions to what help them be so unusually calm and confident.

          1. J, I really do “think”/ believe, without exactly understanding why, that is is all tied together.

    1. J, that is a really REALLY good article. It’s overwhelming actually because it really tells you the serious commitment and effort that have to be intentionally involved if you expect that your life and character is going to change.

  3. It seems that the type of personality addressed in this post: “Individuals with a unstable sense of self but who also tend to be inordinately self-centered and disregarding of the rights and needs of others” are also amongst the most difficult to treat.

    I wonder if it is primarily that psychiatry has used the wrong model, i.e. of a neurotic, or whether it is more that they are cutoff from recognizing that making changes could improve their lives, or that they are cutoff from sbeing able to listen to what others say and take it in?

  4. Thank you for this article. I have been working for the past year with someone who seems to fit this category pretty well. She is emotionally volatile and has been known to act out in strange, aggressive ways during meetings and to send abusive emails to her colleagues. She never displays remorse or even so much as acknowledges that anything has happened after the fact and will deny it if confronted. One time, she tore up a proposal I was presenting in the middle of a meeting (I mean she literally held up the paper and ripped it into pieces to show her contempt) and then immediately denied it when someone addressed the behavior.

    What is unfortunate is that our immediate supervisor goes out of her way to defend this person, largely because she has a neurotic personality herself and is easily manipulated by the abusive colleague. Supervisor feels pity for this woman because her life is pretty much a total shambles and goes out of her way to give this woman responsibility in the hope that it will boost her self-esteem and help correct the problem behavior. And she repeatedly insists that those of us who have had trouble working with this person continue to support “the team” by, essentially, submitting to a bully.

    There are others above this supervisor who appear more canny about the issue, but it remains a significant problem. I’ve managed to successfully avoid this woman for a few months, but I know that she is targeting other people at the moment, and no one seems willing to do anything about it.

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