Borderline Personality Disorder: A Conversation with M. Gerard Fromm, PhD, ABPP
What do people suffering from this condition, look like and talk like? How would a doctor or a family member recognize borderline?
There's a tremendous range, and it partly depends on what defense is in play. In other words, is a person suffering in the moment from their solution or are they suffering from the problem? Often people will develop an eating disorder or harm themselves by cutting or burning. You might say that these behaviors condense the struggle between expressing a strong feeling and controlling it. The behaviors are, in their peculiar way, "solutions." Remember, part of the trouble here is emotional disregulation. And cutting oneself, paradoxically, is an organizing experience. It focuses you in one direction and it distracts you from the more chaotic, emotional pain. Often it punishes you - for some crime you feel you have committed - but it brings both the company and absolution of somebody coming and taking care of you. So it then becomes a tool - sometimes used manipulatively - to get people to stay with you. It solves lots of problems at once. And very often, people who are starving themselves or cutting themselves - they don’t feel it. They’ve managed to develop a kind of psychic numbing capacity, so one of the interesting things you notice when people get better is that the cutting starts to hurt.
Of course, these so-called solutions deepen the problem. We’ve discussed what happens in relationships, when a person gets in the bind of needing another person (say, a romantic partner or parent) and pursuing it to the extent of living in a very false way of being — being “good” or thin enough to make another person like you. We often see a person with borderline chasing after love and using sex to try to get love, so there can be these bouts of promiscuity — and this leads to a vulnerability to sexual abuse and abusive relationships.
Sometimes people’s solutions break down completely. They might enter a phase that looks manic, making frantic efforts to find a new partner or dull the pain through substance abuse or buying things. Sometimes, suicidal behavior occurs as a response to a sense of total breakdown into desperation. I see a close link between what can look like a bipolar
condition and the ups and downs of an underlying sense of chaos, of desperation about being alone in the world and of rage at the person who left you alone. The caricature of this is the Glenn Close character in Fatal Attraction, who will go to whatever extremes necessary to get the attention of her lover; she is determined to vengefully right a wrong and, even more so, to undo a rejection, at the cost of destruction to everyone’s life.
Clearly, BPD can be accompanied by other diagnosable disorders.
Yes, we see a great deal of co-morbidity with things like substance abuse, eating disorders, manic behaviors, major depression. These troubles can be immediately devastating for the patient and the people around them — for family and friends and colleagues. We also see a great deal of post-traumatic stress disorder. It often turns out that in the early history there has been an abusive relationship, perhaps even childhood sexual abuse, and often trouble in the early maternal relationship. There are a variety of ways a bad fit can develop in early attachment relationships, which then have consequences for the child’s development, including the ways emotional events are processed by the mind of the child. One problematic consequence can be turning to male figures, and if it introduces the problem of premature sexuality, it becomes a disaster. So behind “borderline” is often trauma, and empirical data show this.
I don’t mean to blame the parents. People generally do the best they can. One of the things we have seen so regularly here at Riggs is an intergenerational transmission of trauma. So, for instance, our parents’ parents may have survived the Holocaust, which can produce devastating effects on what they can let themselves feel, what they can talk about and how they raise their children.
This six-part series, exploring borderline personality disorder, is taken from an interview, conducted by former Erikson Scholar Joshua Wolf Shenk in 2009, with M. Gerard Fromm, PhD, ABPP, a senior consultant to the Erikson Institute for Education and Research at the Austen Riggs Center.