The main victim of the borderline patient is herself.
Yes, yes, or himself.
Gender pronouns are interchangeable. When I say she, simply replace it with he. When I say he, guess what? You can replace it with she. I'm going to use she throughout this text, throughout this video.
So the greatest victim of the borderline patient is herself. She torments herself. She hates herself. She loathes herself. She considers herself a bad object. She tries to keep people away from finding who she truly is.
She has a very negative self-image, is unworthy, bad, corrupt, hopeless, and very often helpless. Her aggression is compensatory.
And this is the topic of today's lecture.
My name, by the way, is Sam Vaknin. Yes, still. And I'm the author of Malignant Self-Love: Narcissism Revisited, and a bazillion other books about personality disorders, economics, philosophy, and so on and so forth. I'm also a former visiting professor of psychology. Yes.
And today we're going to discuss secondary issues in dialectical behavioral therapy, issues that elucidate, throw light on the borderline dynamic.
When I say borderline, I mean, of course, borderline personality disorder or BPD.
Our borderlines abuse first and foremost themselves.
In dialectical behavioral therapy, there's something called secondary targets. And what I want to do, I want to read to you something that Linehan has written, Marjot Linehan has written. She's the one who developed, who developed a DBT, dialectical behavioral therapy, the main therapy used in borderline personality disorder.
So she identified basically several dimensions of behavior that are problematic in borderline.
Active passivity.
And I'm quoting Marshall Linehan, active passivity, the tendency to approach problems passively and helplessly, rather than actively and eternally.
And this results in a compensatory mechanism known as apparent competence, the tendency to appear able to cope with everyday life and resistance to seeking help or accepting it when it will be effective and wise to do so.
The second dimension is emotional vulnerability and self invalidation. Emotional vulnerability, high sensitivity to emotional cues, emotional intensity, and slow return to emotional baseline.
Self invalidation, adopting characteristics of the invalidating environment as fact, not acknowledging true thoughts and feelings about self, others or the situation.
And the third diet is unrelenting crisis and inhibited grieving. Unrelated crisis, repetitive, stressful events, coupled with an inability to recover fully from any one stressful event. Inhibited grieving has to do with not inability to fully experience and or resolve these aforementioned traumatic or painful events.
These are the three diets we're gonna I'm going to expand a bit on each and every one.
One of them, these are patterns, extreme patterns experienced by the way, both by clients and sometimes by therapists via transference. And both the clients and the therapists remain stuck in these patterns, makes it very hard for therapy to be effectuated and for clients to reach their goals.
These are known as secondary targets.
Let's start with inhibited grieving.
In the next edition of the Diagnostic and Statistical Manual, edition six, we're going to have a diagnosis known as prolonged grief disorder. It's an encapsulation of what Linehan called inhibited grieving.
Inhibited grieving is active or passive ways that people avoid or escape their emotions, particularly emotions related to loss or grief.
And so when do we grieve? When do we experience loss? When do we mourn? When we lose something, we lose someone who or which are significant to us.
So it's not always the loss of the person. It's not always the loss of an object, inanimate object. It's not always the loss of a position, replication, place, language, you name it. It's sometimes the perception of the loss. Sometimes the grief is sometimes not over the loss itself, but over the experience of the loss, the perception of the loss.
It's an attempt to avoid the emotions attendant upon the loss, upon the grief, upon the mourning.
The grief is prolonged precisely because we don't confront these emotions. We don't process them. We don't leave with them. We don't get habituated by avoiding them, actually end up perpetuating them.
And so loss and grief are very dominant in cluster B personality disorders, especially narcissistic and borderline.
I've suggested many times that NPD and BPD, these personality disorders, actually types of prolonged grief, grief reactions, grief over what could have been, grief over loss potential.
When we lose something, when we lose someone, when we think of tragic, regrettable things, our past, when we're nostalgic, and even when we live a life that we disown, that we feel estranged from, a life that is not our own, a life that we hate, a life that we never wanted, we feel sad, we feel grief because there is a loss there.
And it is a loss of a hypothetical. It's a loss of a future, a counterfactual future that has never happened, but could have.
In short, prolonged grief is about lost potentials, much more than about lost actualities. We grieve what could have been, and we grieve the idealized image of the past.
These losses are all in our minds. And this is especially true in borderline personality disorder.
Borderline personality disorder is a form of solipsism, an escape from reality by handing over important internal processes and their regulation to an outside agent, outsourcing them, for example, to an intimate partner.
So grief and sadness and mourning, they're painful, they're overwhelming. In the case of the borderline, they're intolerable.
And so the inhibited grieving comes in to prevent the borderline from decompensating, disintegrating and acting out. It's a defense against the ocean of sorrow and suffering that constitutes the borderline's experience of herself.
Escaping such feelings is understandable. Avoiding them is a reasonable strategy.
And so the borderline actively tries to distract herself. She becomes an alcoholic. She develops obsessive compulsive rituals like cleaning the house all the time, trying to get work done. She keeps her mind busy all day.
And many, many borderlines abuse alcohol and drugs. They develop addictions and all these things are intended to prevent the borderline from having an internal experience or shall I say experience of an interior.
It's as if the borderline lives on the surface. On the one hand, the borderline has no skin separating her from reality. Reality impinges upon her, touches her directly and super painfully. On the other hand, it is there on the interface of reality that the borderline exists. She has no depth because she's empty. There's nobody there exactly like the narcissist.
But the narcissist solution is to pretend that reality is a figment of his own fantasy.
Reality in the narcissist case is always internalized and introjected.
The borderline solution is very different. It's to say I'm going to avoid reality by keeping busy. I am going to avoid reality by demolishing and eradicating my mind with drugs and alcohol. I'm going to divorce my own body via depersonalization, derealization, amnesia, dissociative defenses. I'm going to divorce my own body so that anything and everything that happens to me is not happening to me actually. I'm not there.
This is the borderline solution. The narcissist solution, the world is me. The borderline solution, I am not in the world.
So the borderline spends an inordinate amount of time suppressing her thoughts and feelings, not expressing how she really emotes, hiding the true extent of other people's impact on her.
Some of this avoidance is actually very functional and necessary. It gets her through the day. It allows her to function at work or some other activities.
But over time, she gets addicted to avoidance, to escape. She develops a phobia, a fear of being engulfed and enmeshed in reality, not only with the intimate partner. She loses the opportunity to experience things. And so she's devoid of an internal experience. It's as if her life, the borderline's life was some kind of dream, a dreamscape, very often nightmarish, but not necessarily. It's very surrealistic in the neutral way. It's as if she, everything that's happening to her could have happened otherwise. It's just a narrative choice, a script, a movie.
And so the prolonged grief, the inhibited grieving, the experience of loss of the borderline is there, but it's very superficial. It's mediated via numerous defense mechanisms, cognitive distortions, self-deceptions, and so on and so forth.
The borderline mourns potentialities. Her losses are possibilities. It's as if she lives, she inhabits the past and the future, but never the present. And so this is inhibited, inhibited grieving.
What about unrelenting crisis? This is the flip side of inhibited grieving.
Inhibited grieving involves avoiding reality, escaping emotions. Unrelenting crisis is actually inhabiting the chaos, the internal chaos of the borderline. It's as if you immersing, the borderline immerses herself, immerses herself in her own dysregulated, overwhelming, drowning emotions. It's as if she is a puppet, a mindless marionette driven by her emotions.
Emotions dictate to her what to do. And she ends up in very difficult, stressful, dangerous situations. She ends up being in these situations because she abrogates personal responsibility, choice, and decision making. She says, "I can't help it. My emotions have driven me to do this." And so most borderlines go through an unusual, crazy number of stressful eventsin a single week.
The borderline can use drugs and alcohol, then get raped, then get evicted because she hadn't paid the rent, then break up with her partner, then get into a car accident, get arrested for an assault of the other driver, and all this in five days. The avalanche of tsunami of stressful events in the borderline's life is what Leinhem called the unrelenting crisis, a prolonged and repeated crisis state that engulfs the borderline, is intense and provokes a dysregulation of emotions.
Another reason for the unrelenting crisis is the fact that borderlines misperceive reality. They have very poor reality testing. Their judgment is impaired, but they have like a weak radar for dangerous situations, risky people, and so on and so forth.
And sometimes they do realize that some people are predators, some situations are bad for them, but they get into the situation anyway. Why? Because it's exciting. It's risky. It's thrilling.
Borderlines are reckless and defiant when they are in a secondary psychopathic state. So sometimes it's a lack of discernment, a lack of judgment, gallibility, naivete, or whatever. And sometimes it's just the FU factor. What the hell with it? I'm going to go along with it because it sounds fun. It sounds exciting. It sounds irresistible. Let's go to the next dyad.
Active passivity. Active passivity is the opposite of apparent competence, which we're going to discuss momentarily. Apparent competence is when the borderline appears more competent and capable than she is. So people don't recognize that she's suffering. They don't recognize that she's falling apart and needs help because she displays amazing competence. We'll come to it a bit later.
Active passivity is what is called in other schools of psychology, land helplessness.
In active passivity, the borderline actively seeks help from other people, but she's passive in helping herself. She doesn't take care of herself. She ignores her own emotional needs. She neglects things that need to be done. She procrastinates, but not because she's a perfectionist, but because she is needy and clinging, similar to a codependent.
So she has a hard time managing her life and she fully expects other people to do it for her. She relies on them. She's entitled exactly like the narcissist. She doesn't have the confidence or the skills she believes. She's afraid. She's anxious. She feels more comfortable and less alone when people around her do everything for her, help her in her lingo.
So people help her. And in the borderline's mind, anyone who helps her loves her, cares for her.
There is an over-perception similar to the histrionic. So it's a kind of test or testing. The borderline pushes people around her to serve her, to cater to her needs, to take care of her, of her life, to manage her life for her, because this is the only way she could ascertain that these people love her, that they're there for her, that they care about her, that they want her well-being.
So it's not only over-dependency. It's also a form of testing. The borderline doesn't do things for herself, even if she could do them. Instead, she actively recruits other people to help her. And this is active passivity. It's like sitting on your hands while asking someone to help you to stand up.
Active passivity is very problematic. Over time, the borderline develops a self-perception, which is essentially helpless. The borderline develops learned helplessness. She becomes anxious, incapable of helping herself. She starts to view herself as defective, deformed, impaired, disabled, unable to accomplish anything. And the more she relies on other people to do things for her, the more she sends the message to herself that she is doomed, finished, hopeless.
Over time, she begins to believe this. She takes this message to heart and she thinks, "I'm incapable. I'm inadequate. I'm unworthy. I'm a failure. I'm a loser. Sounds familiar? That's the bad object.
Active passivity encourages the expression of the bad object and its dominance over all other internal psychological processes. It puts a lot of pressure on the borderline, on the one hand, and on other people who are expected to do things for her, expected to conform, into a beggar, friends, lovers, I don't know, therapists.
They find themselves doing way more for the borderline than they would for other people.
In short, it's an unboundary situation.
Both the borderline and everyone around her lose their boundaries. And over time, this leads, of course, to resentment and burnout. Everyone around the borderline gets exhausted. Don't want her around anymore.
People become reluctant to help the borderline. They find themselves rejecting her and shunning her.
And she, on the other hand, escalates. She ups the ante. She demands things more intensely. She begins to threaten, to stonewall, passive aggressively, manipulate people to do what she wants them to do.
Active passivity is bad for self-esteem, but also detrimental when it comes to relationships. This is why many borderlines choose the solution of active, apparent competence. Apparent competence is when the borderline pretends to be more capable, more emotionally put together, more stable, and more competent than she actually is. She fakes it. Fake it till you make it.
She seems to be okay. She seems to be reasonably competent, so people say, you know, she doesn't need help. People don't realize how much she's suffering, how much she needs succor and assistance.
People don't understand or don't grasp how near the verge she is on the verge of falling apart and disintegrating.
So she ends up being alone, having to deal with her problems in a solitary fashion, feeling disconnected or alienated from other people.
Some people suffering from mental head problems, they use apparent competence because they're incredibly smart and they're very capable in certain situations. So these people are good at work, or I don't know, in their jobs, or hobbies, or volunteer activities.
But when they're back at home in intimate situations or alone, they fall apart. They can't cope with loved ones and intimacy and so on and so forth. This is called contextual competence.
Contextual competence is when you're good in some situations, capable and competent in some environments, but a disaster in others.
People are more competent than they are because there's a disconnect between how they present to others and how they're feeling or functioning. It's a lie, it's a facade, it's a deception.
But you know, other people have their own problems. They're happy to pretend together with a borderline that everything is fine.
And so borderlines sometimes avoid presenting the real case, avoid being truthful about how suffering and how disintegrating they are because they don't want to be a downer. They don't want to express how they really feel because it makes other people miserable. Nobody would want to spend time with them.
So they put on a cheerful facade. I'm happy go lucky. I'm joyful. I joke around. I make people smile and laugh. I'm jovial. I'm companionate. I'm sociable.
And all this is fake. All this is intended. It's a desperate attempt to avoid abandonment and rejection by other people. It's deep inside.
The borderline is a shambles, is a ruin. There's nothing there. It's like some ancient archaeological site of trauma and pain and suffering. Putting on a happy face is exhausting. Spending time with others starts to seem like a major chore and they start to avoid people.
And this compounds, of course, the depression.
Let's go to the last diet, which is emotional vulnerability versus self-invalidation.
Emotional vulnerability is a core characteristic of borderline personality disorder and it has three different aspects.
Emotional sensitivity, emotional reactivity and slow return to emotional baseline.
Let me enlighten you about each one of these.
People with borderline personality disorder have a low threshold for emotional responses. They have a hurt/rigor response. It doesn't take much to bring a BPD person to extremes of emotional response, an emotional storm.
A borderline can look at someone, listen to something or someone, watch a sad movie, be frustrated in a minor way and all this can throw the borderline into a complete emotional tantrum. She just is all over the place, often aggressive and violent and so on and so forth.
While other people who are not borderline, they would seem completely oblivious to these triggers and this is emotional sensitivity.
Emotional reactivity is a tendency to experience very strong emotional responses.
Research suggests that people with borderline, they tend to have overpowering emotional reactions, particularly when the emotional triggers are interpersonal or related to rejection, both intimate rejection and personal, social rejection.
Borderlines do abandonment and they do rejection very badly. People with borderline, when they have these strong emotions, these emotions consume everything. There are no resources left. The entire energy economy of the borderline is consumed and subsumed by these emotional hurricanes and tsunamis. It's very hard and takes a huge effort and skill to manage these emotions.
And so most borderlines fail into this. Intense emotions interfere with the borderline's ability to think, to plan, to problem solve, to see reality for what it is, to compromise, to consider other people's perspectives, in short to do anything. It's as if the borderline becomes the emotion. It's transformed into this tidal wave of feelings. It's hard to control behavior when we experience strong emotions. It's doubly so for the borderline.
There were quite a few studies that demonstrated that when emotions are intense, the main priority, even in healthy people, is to escape these emotions, even through behaviors which might cause us problems. So for example, overeating, drug abuse, substance abuse, becoming aggressive or violent, there's always, there's always ways to avoid emotions that threaten to kill us, literally.
And then the third element in borderline is slow return to emotional baseline.
People with borderline often have difficulty to get back to what is called physiological baseline arousal.
Physiological baseline arousal is like a rest or a resting emotional state.
Rest, emotional state at rest. Think of it as zero.
So that's the emotional baseline.
Most people, all people actually, go from the emotional baseline to emotional arousal.
Emotional arousal can be 10 out of 100, 20 out of 100 and so on. The borderline goes from the emotional baseline of zero to 80 and 90.
There are no stations in between. It's from zero to hero, from zero to 160 seconds and cannot return to zero. She remains stuck at 60 or 70.
Baseline is how you feel when nothing emotionally is happening. You go to a walk, for a walk. I don't know. When you sit quietly reading a non-fiction book, financial statements, that's baseline.
Borderlines are never at baseline. Never. And they always find it very difficult to even get close to baseline. Probably there are biological reasons for this. I don't want to go into this. There's a physiological stress response system, differences in parasympathetic and sympathetic nervous system, brain differences, which have to do with emotions, self-regulation. We'll leave it some other time.
But it's a fact that people with borderline personality disorder not only depart from the baseline very often and are not able to get back to it, they also ruminate about emotional events and this amplifies emotions, make it impossible literally to get back to baseline.
People with borderline don't have the skills. They don't know how to regulate emotions. They don't know even how to self-soothe them in order to get themselves back to baseline.
And there is a strong element of displacement. The slow return to baseline renders the borderline chronically vulnerable to emotional situations.
So a borderline can have an emotional response at work. She shoots up from baseline to 90, zero to 90. Then she goes back home and she's still at 60 or 70 because she can't get back to zero. She's still at 60 or 70.
And then a tiny problem, tiny frustration, cause her to erupt and aggress against her intimate partner who has done nothing to her. But she's still at 60. She is not overreacting to the frustration. She's just unable to get back to baseline after the incident at work. So she takes it out on her intimate partner, aka displacement.
Emotional vulnerability leaves the borderline, renders her, makes her feel helpless, out of control of her own emotions, thoughts and actions. And she despises herself. She loathes herself for this. She's very self-critical. She is a harsh inner critic and she feels consumed by her own emotions and unable to see a way out.
Marshall Linehan described people with high emotional vulnerability as emotional burn victims, sensitive to the slightest touch.
And the other side of this is self-invalidation.
Self-invalidation is when the borderline rejects or invalidates her own emotions. When she's stuck in emotional vulnerability, she's caught up in her emotions and then she moves on to self-invalidation, judging herself, rejecting herself for having had these emotions in the first place.
She goes from being sad and devastated and depressed and anxious and unhappy and so on so forth because she has been rejected. She's been abandoned. I know what.
She goes from this, telling herself that it's stupid to feel this way. Something's wrong with her. She's mentally ill. She's acting out. She needs to get a hold of herself. She needs to snap out of it.
And so she learns to invalidate herself because she's grown up in an invalidating environment. She was surrounded by people who invalidated her emotions in early childhood.
Parents, caregivers, society itself, sometimes therapists, can be invalidated, outright rejecting.
People struggle with mental health problems and other people around them, their friends, their neighbors, their colleagues, their spouses, their children, their therapists, church, you it. Other people around them tell them, you know, it's nothing serious. Manyserious.
Many people go through this.
Why can't you just snap out of it? Why don't you just move on?
And this is very invalidating.
And it adds to the borderline's internal self-invalidation. She internalizes these voices. She introjects them, and they become a way of coping with her emotional dysregulation because she devalues the emotional dysregulation. And she devalues the emotions. She says, "It's nothing bad. It's nothing big. It's nothing serious." Why are you reacting like this? Shame on you. There's a vulnerability which seems to be even genetic, maybe.
But to tell you right, the borderline constantly self-criticizes, constantly self-invalidates.
And if the borderline gets caught in this dialectic between emotional vulnerability and self-invalidation, she's swept away by this.
She feels like a victim of the storm of her own emotions. She self-victimizes. She's engulfed by self-criticism, self-judgment, shame about her emotions.
If the borderline is comorbid with psychopathy or with narcissism, she would then project these feelings. She would develop alloplastic defenses.
And rather than self-victimize, she would accuse other people of victimizing her. She's harshly invalidating, harshly self-critical.
And this sometimes works. Sometimes it jolts her out of unwanted emotional experiences.
But the cause, especially in the long term, are huge. Personal suffering, shame, guilt, self-hate, inwardly directed anger.
And so one of the main solutions of the borderline is to transition from the self-state of a borderline to the self-state of a psychopath, secondary psychopath.
And then grandiose, narcissistic, reckless, reactant and defiant, she blames everyone around her for her own self-victimization.