Understanding Borderline Personality Disorder with Compassion; “Manipulation” Reconsidered

If you are a family member or friend of someone who is diagnosed with Borderline Personality Disorder, you may or may not have some understanding of what this label means.  You also may or may not have overheard or participated in discussion, readings, or media about this very diagnostic label, and possibly gleaned from these discussions or readings an idea that the diagnosis implies that your friend or loved one is somehow burdened with intractable behaviors and symptoms.  Typical examples of this might be: “manipulative,” “self-harming,” “unpredictable,” “impulsive,” or “childlike.”  Among mental health labels, the Borderline Personality Disorder label has taken on a highly negative connotation.  Understandably, trying to help or live with an individual who may be volatile and possibly suicidal can be frightening or even exhausting.  Similarly, if you are in a relationship with an individual with the diagnosis of Borderline PD, you may not understand what drives your loved one’s behaviors and may feel confused and upset at times. In this article, I would like to address the idea of “manipulation” because often it is the perception of the other non-diagnosed person in the relationship that they are the victim of manipulation.  What is manipulation and why does this behavior occur?  Patients and family members of patients often describe feeling manipulated by their loved ones’ acts of self-harm; such as cutting, threats of suicide, dramatic or volatile emotional upset, use of guilt, neediness, or rejection, for example.  Often these family  members will describe feeling drawn in and then rejected or pushed out of their loved ones’ realm of focus or attention and do not understand why or what causes this person’s inconsistent behaviors. To understand this with more clarity, I like to use the “mommy /baby analogy.”  All of our relationships, whether we want to admit it or not, are reflections of our own experiences with our own caregivers.  If you have had a baby,  you will also be able to use that experience to help you understand this analogy.   Let’s pretend that we have a crying baby.  Babies can’t talk, so whether they want to play, eat, cuddle, get out of the crib or change diapers, they cry.  If a baby cries and they get picked up and cared for, they (hopefully) will stop crying.  (I understand that this may depend on the baby in question.)  If they don’t get picked up, they will cry more.  Depending upon the caregiver, they may then get picked up, but if the caregiver does not respond, they may cry even louder and more forcefully.  Let’s presume that at times,  the crying may work, but that sometimes it may not.  If the baby learns that to get it’s needs met it needs to cry really, really loudly, then it may just jump immediately to that.  I mean, why waste your breath going through the other less effective levels of cry?  If this baby learns to cry super loud but still the caregiver responds inconsistently (sometimes they pick it up, sometimes not) the baby learns exactly that; “sometimes my very forceful cries get my needs met, but sometimes they don’t.   I don’t know when to cry super loud or when to cry softly or when not to cry at all.” This baby is now probably going to make a lot of mistakes such as crying loudly for something that’s not critical, or not cry for something really important. If you are following me, you might be putting some of the pieces together by now about why manipulation occurs. My mommy/baby analogy is really too simple because lots of other factors contribute to the situation such as other ways that the caregiver might react (do they act angry or annoyed? Do they act pleasantly?    Are they distracted by something in the environment?)  But let me ask this: is the baby manipulating the caregiver?  No. Babies are only trying to get their needs met.  So, too, is the individual with the diagnosis of Borderline Personality Disorder. Your loved one is not a baby.  In fact, they have many areas of significant skill, competence, and sophistication. They are likely intelligent,  and  at times may be able to live life without any burdensome symptoms of the diagnosis. Individuals diagnosed with Borderline PD often describe living in a type of hell.   Marsha Linehan, PhD,  creator of Dialectical Behavioral Therapy says, “The only way out of hell is acceptance.”  Individuals with the BPD diagnosis usually have great difficulty accepting themselves, and make many mistakes involving their abilities to accurately evaluate themselves as well as others. People with this diagnosis often make the false assumption that because they have problems in one or more skill area of life, that they are therefore entirely worthless.  Because they  have a tendency to see themselves in this way, they also forget to realize that others may not.  Because this person has had many, many invalidating experiences and likely trauma ( over 60% of individuals with this diagnosis have been sexually traumatized), it is very painful and difficult for this individual to trust that others will be able to accurately evaluate them and treat them as a whole person with full rights and needs.  This is why it may seem that your friend or loved one sometimes appears very assertive or aggressive in their attempts to get their wants or needs met, but at others times may appear utterly unable to assert their rights from others or ask for help appropriately.  It’s just too difficult for this person to understand and accurately anticipate when and how their attempts may or may not be successful. If you are in a relationship with someone with a BPD diagnosis, it is important for you to learn how to communicate using a common language that helps both of you understand each other’s needs and how to meet them, as well as learn how to meet your own needs and take care of yourself.  It is possible to have balance without accusing the person with BPD of  “manipulation.”  Using the term manipulation to describe someone with BPD is not fair,  and in my experience, using it creates unhelpful barriers to treatment and self-acceptance.   The behaviors that feel like manipulation are this person’s attempts to feel relief, feel connected, avoid pain, get help, or assert his/her rights.  And whether we have the diagnostic label of BPD attached to us or not, we can all understand those needs.   Dina Berdy, LMSW, has a psychotherapy practice at Birmingham Maple Clinic where she specializes in treating Borderline Personality Disorder, substance abuse /chemical dependency,  parent-child relational issues, and behavioral disorders in children and adolescents.

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