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Section 3
Self-criticism and Dependency in Borderline Personality Disorder

Question 3 | Test | Table of Contents

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In the last section, we discussed three sources of anger in BPD clients. These three sources are  learned responses in the amygdala; stress; and trigger thoughts.

In this section, we will examine aspects that contribute to an angry BPD client’s sense of helplessness. These aspects are thought process; low self-esteem; and isolation.

Three Aspects Contributing to Sense of Helplessness

♦ Aspect #1 - Thought Process
The first aspect of helplessness in relation to anger is the thought process leading to helplessness. I have found that when an angry BPD client expresses feelings of helplessness, he or she has gone through a four-step thought process that brought them to that point. The process includes the following

  1. Client tells him or herself, "I’m in pain, something is wrong or lacking."
  2. Client tells him or herself, "Others should fix or provide it."
  3. Client expresses his or her anger with aggression.  Often, in BPD clients, this aggression is impulsive and misunderstood by the receiver.
  4. Client’s anger is met with resistance and withdrawal.

As you well know, borderline personality clients create a quick and overzealous attachment to loved ones, thus, their fear of abandonment becomes much greater. Unfortunately, unable to control his or her impulsive anger, the BPD client will eventually and unintentionally push their loved one away. This will also feed the client’s conviction that he or she is an evil or unworthy person. Obviously, this type of self-loathing is extremely dangerous and could be the cause for the high rate of attempted suicide among BPD clients. 

Lindsey was a 23 year old BPD client.  She stated, "I always needed a guy to hang on to.  Whenever I had one date, or he kissed me, or he and I had a good time, I seemed to fall in love with him. I didn’t understand why other girls didn’t get this rush of feelings and emotions as often as I did. Yet somehow, something in the relationship was missing. I’d always find something wrong with the guy: he wasn’t being attentive enough, he didn’t call me whenever he got off of work. I accused a lot of my boyfriends of cheating. I should have called a lot of the relationships off, but I couldn’t. I’d just demand more and more from them, and I’d get angry that they weren’t changing. Eventually, they all broke up with me. Can’t say I blame them, I mean, I’m just such a bitch to everyone ." 

As you can see, Lindsey wished for an undeniable sense of control over her relationships, a level of control she could never truly achieve. Once the relationship deteriorated, Lindsey was left feeling alone and even worse about herself than before.

♦ Aspect #2 - Loss of Self-Esteem
The second aspect of helplessness is the loss of self-esteem. For the BPD client, self-esteem affects a great deal of their emotional life. If the client’s sense of pride is insulted, or they assume it’s being insulted, they react with anger, towards a common threat. However, the client also feels a significant blow to their self-esteem through his or her own actions. 

Amanda was a 28 year old BPD client of mine, who stated, "Whenever I get mad and hit something, I have this strange feeling of ‘I can’t control myself’, but it’s still happening. I’m still throwing the plate against the wall or smashing a mirror, or yelling at someone. When it’s over and done with, I feel ashamed, but I can’t tell the other people that, that’s weakness. Only hippies and new age assholes apologize. I know people tell me that apologizing isn’t weakness, but if I do tell them I’m sorry, I know they’ll think I was wrong in getting angry. So when they confront me, I act sarcastically, and I think I make them feel bad for making me apologize. And I wonder why I’m alone."

In a strange and inevitable cycle, Amanda loses her self-esteem because she is helpless to control her anger, but once Amanda loses her sense of self-worth, she also decreases her likelihood of controlling her impulsive anger. Think of your Amanda. Is he or she feeling helpless because of a loss of self-esteem?

♦ Technique:  List of Attributes
To help Borderline clients like Amanda regain their self-esteem, I ask them to make a "List of Attributes". I ask Amanda to create a list of fifteen characteristics that she feels positive about.  I ask her to include physical, emotional, and mental attributes as well.  Some of the items that Amanda listed included the following:

  1. I take care of my hygiene.
  2. I’m diligent in my house up-keep, but not anal.
  3. My hair is healthy and shiny.
  4. I have a good sense of humor.
  5. I eat well
  6. I’m a great cook.
  7. I’m not lazy. 
  8. I keep my mind occupied.

I then asked Amanda to put the list in an area of her house where she would most frequently see it.  By reminding Amanda of her positive attributes, she could more willfully deny her sense of self-loathing.

♦ Aspect #3 - Isolation
In addition to thought processes and lack of self-esteem, a third aspect that contributes to a feeling of helplessness is isolation. As you know, BPD clients require an established support structure consisting of family members and friends. Without this structure, the BPD client cannot begin to override his or her feeling of self-loathing. This not only applies to spouses, but also family members and long-time friends.

Unable to understand the client’s emotional outbursts, they become guarded around the client and cannot give the client the support he or she needs. Without support and encouragement, the client will, obviously, feel helpless when faced with dealing with his or her disorder. Amanda stated, "I don’t feel like anyone is there for me. Even though people call and talk to me, I don’t feel it’s the same kind of support I should have. Maybe that’s why I seem to push everyone away:  they don’t give me the emotional support I need. I just know, if I don’t get something more, that I won’t be able to beat this thing." 

As you can see, not only did the isolation from friends and family cause her to drive away Amanda’s loved ones even further, but also created in her a defeatist attitude. We will discuss empowerment in a later section.

In this section, we discussed aspects that contribute to an angry BPD client’s sense of helplessness. These aspects are  thought process; low self-esteem; and isolation.

In the next section, we will examine ways for BPD clients to reflect on their anger in order to understand and prepare for outbursts using the "Anger Journal". These ways are  basic entry; four questions; and specific incidents.

Peer-Reviewed Journal Article References:
Kopala-Sibley, D. C., Zuroff, D. C., Russell, J. J., Moskowitz, D. S., & Paris, J. (2012). Understanding heterogeneity in borderline personality disorder: Differences in affective reactivity explained by the traits of dependency and self-criticism. Journal of Abnormal Psychology, 121(3), 680–691.

Samuel, D. B., Miller, J. D., Widiger, T. A., Lynam, D. R., Pilkonis, P. A., & Ball, S. A. (2012). Conceptual changes to the definition of borderline personality disorder proposed for DSM-5. Journal of Abnormal Psychology, 121(2), 467–476.

Vansteelandt, K., Houben, M., Claes, L., Berens, A., Sleuwaegen, E., & Kuppens, P. (2020). Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study. Personality Disorders: Theory, Research, and Treatment, 11(4), 270–279.

What are three aspects that contribute to an angry BPD client’s sense of helplessness?
To select and enter your answer go to Test.

Section 4
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