Can People With Borderline Personalities Succeed In Life?
A letter from a medical professional with BPD who has seen both sides.
Posted Nov 01, 2017
As in my several earlier posts on borderline personality disorder, my understanding of BPD has grown significantly from discussions with a physician whom I refer to as H.O., who suffers from borderline personality disorder. Whereas my clinical practice mainly consists of clients from the middle and upper reaches of the economic spectrum seeking help with relationship issues, depression and anxiety, H.O. has worked professionally treating young women from the lower rungs of the economic ladder who suffer from borderline issues. In her comments below, she draws our attention to the plight of these sufferers.
Our discussions, accomplished via email exchanges, focus on the tragic challenges faced by women, and men as well, with borderline disorders. My heart goes out to all who struggle with BPD, as the intense emotions that rise up within them can be terrifyingly painful.
I share here, with her permission, H.O's most recent observations. She has been writing to me about the impact of borderline personality disorder on the sufferer and also on family members:
It is really heartbreaking how much hurt and unhappiness mental illness creates every day, is it not?
I have seen the illness of borderline personality from both sides—from the point of view of a sufferer (myself), and from the perspective of those who live with and have been injured by them (including my husband). I see how both sides are deeply hurt—those affected directly from living the hellish realities of suffering from BPD and the non-BPDs who may feel terrified, abused, scared and who can be even criminally hurt by those with the disorder.
Overall, people with borderline personality disorder are extremely unhappy people.
With their hyper-reactive amygdala and other dysfunctional brain aspects that cause super-intense emotional reactivity—often triggered initially by maltreatment from borderline personality-disordered parents—women and men with BPD live lives characterized by great challenges. In their younger years, many of them have suffered abuse. As they grow into adulthood, and especially if they are on the lower rungs of the economic ladder, they may experience little opportunity, great anguish, sadness, loneliness, and a troubled adolescence. They may enter adulthood with broken educational and career pursuits, plus desperate attempts at self-medication with drugs and alcohol. Their dysfunctional hyper-reactive emotional reactivity may sabotage even their most determined positive efforts to establish lives of well-being. Overly intense emotional reactions potentially can eventually wreak destruction of virtually everything they attempt to do. BPD sufferers definitely can become victims of their illness.
Women and men with significant borderline personality disorders, and especially those who simultaneously suffer from economic limitations, can experience such extreme emotions that they commit felonies. They can stalk, abuse, terrorize, steal, destroy property, set fire to and even, extremely rarely, may hit or kill someone in a fit of rage. Economic struggles make life more stressful. And lower-income folks have less access to effective psychological treatment.
At the same time, BPD sufferers of any income level are at risk for wreaking horrible chaos in the lives of others who surround them, chaos first and foremost of the emotional kind. Their quick eruptions of anger and quickness even to rage, often based on misinterpretations of situations, can lead them to treat others poorly, including and especially family members.
Anger induces a belief that what I want is holy and what you want is irrelevant—that is, profound narcissism. This temporary narcissism, in turn, can cause people with BPD to become blind and deaf to the suffering they induce in close-by others. Enormous personal strength, plus insight and determination, may be necessary to prevent emotional outbursts from erupting.
In sum, people who suffer from a borderline personality disorder may victimize others and at the same time are themselves victims, tortured by their too-intense emotional reactions. The challenges they face are major and real—yet hope is on the horizon.
What can be done with this conundrum?
One way to make progress may be to look at BPD as what it really is—unequivocally proven by empirical research—a severe disability. It can be a disability that affects sufferers' quality of life, how far they will get in their career, and their ability to sustain close relationships. The disability can interfere with their intimate relationships, hindering their attempts to find a spouse increasing the likelihood that if they do marry the union will end up with a divorce. The emotional storms caused by BPD's overly reactive emotional system also increases the likelihood they will be challenged with regard to raising emotionally healthy children.
With understanding of their disorder and especially with effective therapy help, these challenges can be overcome. Unfortunately, however, therapists generally deal with only the top and highest functioning of the iceberg of borderline personality sufferers. With fees of upwards of $100-plus per hour, therapists generally work primarily with the professionals and upper-level business folks who somehow, despite their brains having become wired problematically, have made it in life enough to be able to pay for treatment.
In addition, BPD sufferers from higher income groups generally have enough education to buy and learn from self-help books that teach how to cope with the depression and anxiety, as well as the anger, induced by BPD. Lower-income BPD sufferers may have less access to these self-help options, especially if they grew up with negative school experiences and a negative attitude toward reading.
In my work as a physician in a public health service, I have realized that the more fortunate BPD sufferers—the ones who receive intensive enough help to reduce the ravages of the illness—represent a tiny fraction of folks with a BPD diagnosis.
The silent majority are hidden in the shadows of our society. Often in dire economic straits from under- and un-employment, these sufferers either become profoundly lonely or endure repeated abusive relationships. Too many subsist on disability checks or end up homeless, institutionalized, or imprisoned.
Destitution, institutionalization or imprisonment can be unfortunate outcomes for women with severe BPD. Men who have been diagnosed with anti-social disorder may, in fact, be showing the male version of what in women we call BPD. The typical outcome for these low-income "personality disorder" men is also very sad. With little to no treatment options, their road of life too often leads to imprisonment. How sad that our society so inadequately understands the nature of their problems, responding with punishment when nurturing, teaching and psychological help are so desperately needed.
Less economically advantaged people with borderline personality disorders, through no fault of their own—the women and also the men—have been dealt a genuinely harsh hand in life. Who will help them?
Maybe they could have played better the poor hand they have been dealt if someone had taught them to understand their emotional disability. This is what Marsha Linehan has been trying to do. Her programs teach people with BPD first how to stop digging an even deeper hole for themselves if they want to get out of it. Strong mental health services could go a long way toward giving these sufferers a chance to enjoy more satisfying lives.
Meanwhile, on a brighter note, in spite of my own abusive upbringing and my still-tyrannical emotional upheavals, I am doing well. While I struggle, I do prevail.
For instance, I have found ways to practice my medical profession in ways that enable me to minimize my interactions with patients. With work that requires me to face only very few interpersonal situations and therefore emotional demands, I have succeeded in becoming a highly respected contributor in my field.
In addition, I feel profoundly thankful for my exceptionally understanding husband. His active participation in raising our children helps in a major way. My understanding of situations that I need to avoid plus skills for handling situations that otherwise would have overwhelmed me also have contributed to protecting our family from the ravages of my illness. My children are growing and developing amazingly robustly every day. Together, my husband and I as a team are breaking the chain of generational transmission of BPD that goes way back in my family.
For my current good fortune, in addition to my husband, I profoundly thank both my own studies of BPD and the several mental health professionals who have helped me to learn to manage my emotional disability.
Yet who will help the many other women and men with borderline personality disorders who have fewer resources to support them? I do encourage all with BPD tendencies to seek out help. Community mental health, as well as private mental health care options, do exist. Seek them out!