Under the Microscope with Dr. Robert Jacobs: Borderline Personality Disorder
In our October issue, Richard Helms’s "Cradle of Criminality," gave us a look at the inner workings of the criminal mind. For you crime and mystery writers out there, a basic understanding of the criminal psyche is pivotal to crafting believable, authentic characters. But not every criminal, or antagonist, for that matter, possesses those specific markers laid out in Helms’s article.
In keeping with February’s Romantic Suspense theme, we’ve elected to take a look at a common trope among literature and film alike, i.e., the obsessive significant other. In this installment of Under the Microscope, Dr. Robert Jacobs, psychologist, explores the tendencies of someone suffering from Borderline Personality Disorder.
Borderline Personality Disorder and Romantic Relationships
By Dr. Robert Jacobs
Adam met Liz by chance in the aisle of a department store, and the two began a playful banter right away. Her laugh was airy and carefree, and she touched his arm while they talked. Before they parted ways, she said to him, “I know you want to text me, so why don’t you give me your phone and I’ll put my number in.” He placed his phone in her hand. Her candor was thrilling. Liz seemed so open and familiar.
They arranged to meet for a drink the following day. When Adam arrived at the bar, he spotted Liz easily despite the crowd; she was wearing a short, tight dress. She stirred her drink and kissed his cheek as he sat beside her. Her touch felt electric. Her eyes never seemed to leave him. Hardly an hour passed before they were at his apartment, turning off the lights.
The first three weeks of the relationship were invigorating; Adam felt energized and constantly turned on. He’d never had such great sex. Work seemed unimportant, and he often left early to spend time with Liz. He felt unusually protective when she mentioned her ex-boyfriend; thinking the guy sounded vain, even abusive. Fleetingly, Adam marveled at how quickly he and Liz had connected—in moments. The pace was dizzying. She texted a lot, and he noticed that when he didn’t respond immediately, she often asked if everything was okay. Or if he was mad at her. He found himself having to reassure her that he felt fine, and that the relationship was “great.”
“How great?” She would ask flirtatiously.
Something inside Adam began to tighten.
The next time he picked Liz up for a date, she seemed irritated at his being s a few minutes late. Adam noticed several magazines related to his hobbies on the coffee table in her living room, and that she’d stocked the refrigerator with his favorite type of beer. Over dinner, Liz wanted to decide on a vacation destination for the following summer, and had several ideas. When he told her he would need to check his work calendar, and that it was too early to decide, she bristled.
The following week, Adam realized he was woefully behind at work and needed to catch up. When he called Liz to suggest they postpone their date, she screamed and hung up. Startled, he immediately called back and when Liz answered, her voice sounded completely different. Sobbing, she explained that her doctor had phoned earlier to tell her that she had a rare form of cancer. “I’m sorry,” Adam offered. “What can I do?”
“Can you just come over so we can talk? I don’t want to be alone.”
An hour later, Adam arrived, and found Liz to be in a mysteriously positive mood. In fact, she didn’t seem to want to talk about her health at all. She wanted to have sex. The change seemed odd, and when Adam pressed for details, Liz was vague and annoyed. The tightening inside Adam continued. Her cancer diagnosis was never mentioned again.
A week later, Adam decided he decided he needed some space from the relationship, and explained to Liz, in the kindest way he knew, that he wanted to slow their pace and take time for himself. Liz turned over her chair as she stormed away. Five minutes later, Adam’s phone lit up with a text message from her. “I have something I need to talk about, too,” it said. Below was a picture of a positive pregnancy test.
Human behavior is inherently fascinating. Most of us have puzzled over the motivations of our friends and loved-ones, and, at times, been curious about the intent of our own actions. We want to be more effective participants in our relationships, but at times we’re at a loss for how they work. We ask questions like, “Why would (s)he do that?” and often in hindsight wonder, “What was I thinking?”
Certain diagnoses in particular are especially intriguing. Any time the subject of Borderline Personality Disorder comes up, curiosity and questions follow, and it’s easy to understand why. People with this diagnosis have an easy time capturing the attention and igniting the frustrations of people around them; they engage others and act out in ways that are intense and often destructive. They show a pervasive pattern of instability in interpersonal relationships, self-image, affective states, and marked impulsivity. The pattern typically begins by early adulthood and is present in a variety of contexts (DSM-V, 2015). They are frequent characters in fiction. About seventy-five percent of those diagnosed are female, though research on males with Borderline Personality Disorder continues to come forth.
Patients with Borderline Personality Disorder, or BPD, lack emotional regulation and exhibit strong, sometimes wild, behavioral extremes in their relationships. Many times the goal of this behavior is to elicit the concern of a caretaker, but nowhere is the pattern more acutely observed than in their romantic connections.
In therapy, when patients characterize their exes as “crazy,” what do they mean? What is a romantic relationship like with someone who has BPD? Many people describe them as childlike and manipulative, constantly testing a relationship, often showing wild emotional swings when they sense real or perceived abandonment. Having little emotional regulation, they’re prone to tantrums. It can feel to people around them that “something” is missing, or didn't develop; a critical sense of stability, of being fundamentally okay despite normal relational fluctuations, is distinctly absent. Their impulsive, acting-out behaviors are even more notorious for being self-damaging: recurrent suicidal behavior, self-mutilation, substance abuse, reckless driving, overspending, promiscuity, and intense and inappropriate anger are common.
What Borderline patients excel at is eliciting an emotional response. The clinical folklore among some therapists is, that if in the first session the therapist wants a romantic, inappropriate connection with the patient, he or she is probably Borderline. If that sounds circular and patronizing, it’s because it probably is. Even if the idea offends some, (I do think that a therapist’s awareness of his or her emotional response to a patient can help diagnosis and guide treatment. For example, our own reactions likely resemble the reactions of others around them, as well.) it does raise an important truth: Borderline patients are skillful at provoking.
Borderline Personality Disorder is fueled by emptiness and insecurity, and the misguided goal of all of this self-destructive and manipulative behavior, after all, is to gain stability and feeling cared for. One cruel paradox of Borderline behavior is that the backing-away response elicited from relationship partners is precisely the reverse of what the person desires: more love, assurance, and intimacy. The conventional thinking among many psychologists is, that when it comes to having a relationship with someone suffering from BPD, the best strategy is avoidance altogether. Or, as one friend suggested, “Run, don’t walk.” And most of the time, this self-protective drive comes from a very understandable source: frustration and fear. We sense right away that we want no part of the toxic behavior at hand, or worse, worry that we’ll reinforce it, making it more likely to recur.
Theatricality may distract us in other ways as well. It’s tempting to marvel at the foreignness of Borderline behavior, and in doing so, we may be miss the universality of the particular feelings themselves. The strength of the particular emotions at play—abandonment, sadness, emptiness—may be alien, but the feelings themselves are likely quite familiar. Truth be told, people with a Borderline Personality Disorder may fascinate us because we see ourselves in them. Fundamentally, all personality disorder diagnoses describe characteristics and ways of being that are simply extreme versions of common traits and urges. I’ve never heard someone say, for example, “I just love feeling abandoned,” or “I never wonder where I stand with people I care about. I never need assurance.” Tragically, the disproportionate reactivity of the Borderline patient obscures the underlying ubiquity of their emotional experience.
Given all the difficulties that exist in these types of relationships, why would anyone start a relationship with someone with a Borderline diagnosis? Contrary to my friend’s advice, not everyone runs, or even walks away. It’s important to note that while there may be intense and disruptive behavior, Borderline patients often have qualities that produce a rewarding romantic partnership much of the time.
Often warm and kind, they may also be described as fun, exciting, and passionate. Here, people often speak of the disorder in terms of its deficit, like any other organic or medical concern. Even in troubled moments, they will report seeing a flicker of deep recognition and awareness in their partner’s eyes, enough to know that the person they know and love is still there covered beneath their insecurities. I understand the notion of duality. I too have been taken aback and puzzled over the recklessness and irrationality (and astonishing immaturity) I’ve seen among otherwise very high-functioning people. Borderline patients don’t seem to have figured out how to keep their feelings, particularly their anger, in check. This juxtaposition between high and low-functioning can be shocking at times. We may ask ourselves how it’s possible that this composed, professional person, mother, from whom I received a Rockwellian Christmas card the year before, is acting the way she is.
Some are drawn to these patients because they have intense emotions and strong desires for intimacy—and because they themselves have precisely the same emotions and desires. This is often more challenging to recognize and contend with, because, again, the behavior of the Borderline patient positions them in such an obvious position of scrutiny and vulnerability. As it plays out, Borderline patients aren’t often offered much empathy. Many times, they describe feelings of being used, and often do allow themselves to be used by their partners, because of their neediness. Many times, their friends and family admit that if the patient’s acutely descriptive behavior stopped long enough that they could feel safe, they would run for the hills. Not much of an incentive to stop, even as BPD patients recognize they have worn out their supports.
In writing characters with similar diagnoses, it is often too easy to dehumanize the subject and make him or her out to be villainous and completely alien from the rest of us. But in order to craft authentic, believable characters—regardless of his or her psychological well-being— it’s important to understand that character’s psychology, and that it isn’t much different from our own.
In navigating relationships (and, perhaps, storylines) with Borderline patients, acceptance may be our best course. Learning emotional regulation as a couple may be helpful, as may be developing an understanding of common triggers and de-personalizing reactivity. Context helps understanding, and it’s important to bear in mind their (and our) story leading up to the beginning of the relationship. For the relationship to be successful, we have to accept that our partner really does need more emotional reassurance than most. And we have to look in the mirror to examine our own attraction to that particular person, at that particular moment in our lives.
Robert Jacobs grew up in Fort Myers, Florida. He completed his Ph.D. at Texas A&M University and has been a practicing psychologist in Nashville since 2003. Clinically, he focuses on treating anxiety as well as addressing family and couples’ issues. Outside of work, he enjoys athletics, spending time with family, and working on creative fiction. Learn more about his practice at www.robertjacobspsychologist.com.