Victims of Child Abuse, Understanding Borderline Personality Disorder

Understanding Borderline Personality Disorder in Family Law Cases

Research compiled by SMA Institute:

Young children are highly sensitive to other people’s emotions, particularly those of their family members. Witnessing scenes of verbal or physical violence and discord has direct negative effects with long-lasting consequences. Similarly, children who experience parental abuse or neglect are more likely to show negative outcomes that carry forward into adult life, with ongoing problems with emotional regulation, self-concept, social skills, and academic motivation, as well as serious learning and adjustment problems, including academic failure, severe depression, aggressive behavior, peer difficulties, substance abuse, and delinquency

High cortisol and catecholamine levels, which increase as a response to stress that results from abuse, have been linked to the destruction of brain cells and the disruption of normal brain connections, consequently affecting children’s behavioral development.

Adolescents who have experienced abuse might suffer from depression, anxiety, or social withdrawal. In addition, adolescents who live in violent situations tend to run away to what they perceive to be safer environments.

They engage in risky behavior such as smoking, drinking alcohol, early sexual activity, using drugs, prostitution, homelessness, gang involvement, and carrying guns.  Psychiatric disorders are often seen in adolescents who have been abused, which includes personality disorders such as Borderline Personality Disorder, Anti-Social Personality Disorder, and Histrionic Disorders. In one long-term study, 80% of young adults who had been abused met the diagnostic criteria for at least 1 psychiatric disorder by the age of 21.

Emotional effects of abuse often stem from insecure relationships with caregivers and affect child attachment development. Such effects might be destructive to their confidence and self-esteem and to relationships with peers or partners later in life.

There is a documented association between all types of child abuse and development of physical complaints and emotional responses. John presented with somatic symptoms in the form of recurrent abdominal pain; however, he also manifested some psychological problems or even psychiatric disorders. Verbal abuse toward John has produced a strong negative emotional response. Hostility and anger might become obvious in stressful situations, possibly as a result of early neurotransmitter disturbances in John’s developing brain. Severe punishment has also been linked to development of borderline personality disorder, anxiety, and depression in later life. Recurrent abdominal pain is a common somatic symptom seen in children who suffer from stress. Emotions are often expressed as physical symptoms in order to justify suffering or to seek attention. 

Borderline personality disorder is a mental health disorder with many of these types of symptoms: Fear of abandonment, unstable relationships, unstable self-image, impulsiveness, self-harming, wide mood swings, feeling empty, sudden and intense anger, and paranoid thoughts. However, personality disorders (there are ten in the manual) are typically not obvious at first until someone is in a close relationship or involved in a conflict.

Probably the most prevalent personality disorder in family court is Borderline Personality Disorder – more commonly seen in women. BPD may be characterized by wide mood swings, intense anger even at benign events, idealization (such as of their spouse – or attorney).

Usually they developed their personality style as a way of coping with childhood abuse or neglect, abandonment, an emotionally lacking household, or simply their biological predisposition. While this personality style may have been an effective adaptation in their “family of origin,” in adulthood it is counter-productive. The person remains stuck repeating a narrow range of interpersonal relationships to attempt to avoid this distress. A personality disorder does not go away.

Until then, the person may constantly seek a corrective experience through a series of unsatisfying relationships, through their children or through the court process. Through constantly going to court, they are trying to make their past wrongs into rights.  They may continually file motions in the court to help to get the attention they need from the past abuse they suffered.

Because of their history of distress, those with personality disorders perceive the world as a much more threatening place than most people do. Therefore, their perceptions of other people are distorted – and in some cases delusional.

People with personality disorders also appear more likely to make false statements. Because of the thought process of a personality disorder, the person experiences interpersonal rejection or confrontation more deeply than most people. Therefore, the person has great difficulty healing and may remain in the denial stage, the depression stage, or the anger stage of grief – avoiding acceptance by trying to change or control the other person.

Lying may be justified in their eyes to bring justification. (This can be quite convoluted, like the former wife who alleged child sexual abuse so that her ex-husband’s new wife would divorce him and he would return to her – or so she seemed to believe.) Or lying may be justified as a punishment in their eyes. Just as we have seen that an angry spouse may kill the other spouse – it is not surprising that many angry spouses lie under oath. There is rarely any consequence for this, as family court judges often believe the truth cannot be known – or that both are lying.

Just as an active alcoholic or addict blames others for their substance abuse, those with personality disorders are often preoccupied with other people’s behavior while avoiding any examination of their own behavior. Just as a movie projector throws a large image on a screen from a hidden booth, those with personality disorders project their internal conflicts onto their daily interactions usually without knowing it. All the world is a stage including family court.

It is not uncommon in family court declarations for one with a personality disorder to claim the other party has characteristics which are really their own and do not fit the other party. Abusers claim the other is being abusive. Liars claim the other is lying.

Family court is perfectly suited to the fantasies of someone with a personality disorder. There is an all powerful person (the judge) who will punish or control the other spouse.

“The focus of the court process is perceived as fixing blame – and many with personality disorders are experts at blame. There is a professional ally who will champion their cause (their attorney – or if no attorney the judge).

A case is properly prepared by gathering statements from allies – family, friends, and professionals. Seeing to gain the allegiance of the children is automatic – they too are seen as either allies or enemies A simply admonition will not stop  this. Generally those with personality disorders are highly skilled and invested in – the adversarial process.

Those with personality disorders often have an intensity that convinces inexperience professionals – counselors and attorneys – that what they say is true. Their charm, desperation, and drive can reach a high level in this very emotional, bonding process with the professional. Yet this intensity is a characteristic of a personality disorder and is completely independent from the accuracy of their claims.

Judges, attorneys, and family court counselors need to be trained in identifying personality disorders and how to treat them. Mostly, a corrective ongoing relationship is needed – preferably with a counselor. However, they usually must be ordered into this because their belief systems include a lifetime of denial and avoidance of self-reflection.

Often, in romantic relationships with someone with BPD, there is an intense and exciting romance, followed by making fast commitments, then a turn for the worse as conflicts and chaos take over both people’s lives. There is lots of blame, yelling, sometimes hitting and other forms of domestic abuse. All of this is often interspersed with periods of friendly and caring (and sexual) behavior. It can feel like a roller coaster and can be very confusing for both people.

In many cases, only one person has this disorder and the other person doesn’t have this disorder (or another disorder), and is caught by surprise at the suddenly extreme behavior. In reality, the BPD sufferer has a “dual persona.” It’s all part of the same personality, but there is the public persona, which seems really great, and the private persona that may be involved in abusive verbal and/or physical behavior. Sometimes it takes up to a year to realize that a partner has this problem, because they can be very charming, exciting and loving at first. Therefore, people are encouraged to wait at least a year before making major commitments, such as getting married, having children or buying property together.

Why Do People Have BPD?

No one chooses to have BPD. There are three basic potential causes:

1)      Heredity: People are born with a temperament and genetic tendencies. This may be the biggest factor. They may have ancestors who were intensely adversarial in order to survive during wartimes and other adversities. Fearing abandonment may have been a very good motivator for survival, such that holding tightly onto mates and children would have been good for the family’s survival. Fierce jealousy, clinging behavior, anger at a partner’s and child’s independence may have been helpful to keep the family together through thick and thin

2)      Early childhood trauma: The first five years of life are when personality development mostly occurs. Insecure attachments between parent and child can often be identified in the development of borderline personality disorder. A secure attachment is necessary to learn emotional self-control (self-regulation); gain a sense of confidence in oneself and trust in others; recognize differences between people and what others are feeling; learn to tolerate stress; learn give and take in relationships; and to learn how one affects other people in order to adapt and change one’s own behavior for greater social success. With an insecure or abusive parent, these essential lessons are often not learned, and unsuccessful or abusive behaviors are learned instead.

3)      Cultural influences: Our modern entertainment cultural relies heavily on images of dysfunctional relationships in movies, in TV shows, on the news, on social media, etc. These include lots of relationship manipulation, violence, impulsive acting out, yelling, throwing things, storming out of rooms, etc. It’s as if our culture is intentionally teaching borderline personality disorder behaviors. But it grabs our attention and gets us to watch, so it sells advertising and it won’t be changing anytime soon. For someone with genetic tendencies to have BPD traits, or who grew up in a very inconsistent household, these behaviors may be seen as the way to have normal relationships. (She shows her love and commitment to me by keeping track of my every move. He shows his love and protection for me by slapping me when he thinks I’m getting out of line. Isn’t this what everyone does?)

Is There Treatment for BPD?

Yes! Over the past thirty years, treatment methods have been developed that teach daily living and self-management skills and have been having a lot of success with people who are willing to commit to a few years of therapy. The most well-known and wide-spread method is Dialectical Behavior Therapy (DBT). There are therapists in most big cities and some smaller communities who have been trained in this skills-building approach.

Whatever method is used, it’s important to have a therapist who is personally secure and can be emotionally stable in the face of the chaos and anger that those with BPD bring to therapy. Therapists trained in more standard psychodynamic therapy can be good with BPD if they are also good at staying calm and teaching some type of self-help skills. Just supportive therapy can actually make things worse, if they reinforce blaming comments, say their behavior is normal or justified, and join in focusing on the behavior of other people in their lives. Unfortunately, many therapists inexperienced at treating BPD often believe their clients and reinforce their problematic behavior, rather than helping improve it.

Handling a Family Law Case involving BPD

Given the dynamics of borderline personality disorder explained above, there are many mistakes that family law professionals commonly make. Here is a list of 10 Do’s and Don’ts:

1. Don’t try to give someone with BPD insight into themselves and their dysfunctional behavior. This just reinforces their defensiveness, triggers their extreme anger, doesn’t lead to change and makes your relationship worse—because the person thinks you don’t like them as they are. Just forget about it!
2. Don’t focus too much on the past. This also triggers defensiveness and anger, doesn’t lead to behavior change, and you can get stuck there and waste a lot of time. Put more emphasis on the future.
3. Don’t emotionally confront them, with your anger, frustration, irritation, etc. These trigger their emotion dysregulation and it’s hard for them to calm down and focus again. Likewise, don’t ask them how they feel, because it puts them in touch with their chronic feelings of being helpless, vulnerable, weak and like a victim in life.
4. Don’t tell them that they have borderline personality disorder, or any disorder. That’s only for a treating therapist to diagnose and discuss, not a family law professional.
5. Don’t get sucked in if the person tells you that you are wonderful, one of the greatest people they’ve ever know. People with BPD see things in all-or-nothing terms, including people. If you are placed on a pedestal by them, you will soon be knocked down—way down. Just be matter-of-fact and emphasize that how their case goes depends mostly on how well you communicate with each other. Don’t let the focus be on you.
6. Do give them your empathy, attention and respect especially when they are getting angry with you or not doing what you need them to do. If a client appears to have BPD, then frequently using statements that show empathy for them can often help calm them and make it easier to work together.
7. Do focus on what their choices are now and for future action. Try to turn everything into a choice, so that they don’t feel that you are dictating to them what they have to do. This keeps them focused on thinking rather than emotionally reacting to what is going on.
8. Do gather information from them and show your appreciation for their thoughts on the case. They may have really important information, but hold back because they fear you will abandon them if they tell you the full story. Let them know you are open to all information, otherwise you may get caught by surprise when someone else tells you news about them. If the person with BPD is the opposing party, look for information from past failed relationships, as that may often be helpful to your case. For example, they may have a history of other family law cases with similar dynamics to your case.
9. Do encourage ongoing treatment (see above) if your client or the opposing side has been formally diagnosed with borderline personality traits or the disorder. Court-ordered treatment can be effective in some cases, just as court-ordered substance abuse treatment often works in drunk driving programs. Promises to change are pointless when someone has BPD. People should demonstrate that they are making a change before increasing parenting time or other responsibilities. It’s common for family law professionals to naively believe that such a person will improve their behavior with just a simple lecture from a lawyer or judge. They need an ongoing program of change, to practice new skills.
10. Do terminate your relationship carefully, if you need to end it prematurely. Don’t threaten to fire a BPD client, as that will just make their defensive behavior worse. It’s best to take a step-by-step approach, so that you don’t trigger their intense abandonment feelings. These are the clients who may sue their professionals or stalk them if they are abruptly cut off. Don’t make it their fault and don’t make it your fault. Emphasize that your styles, approaches or goals are different. Tell them you’ll help their next professional and let them contact you with brief questions during the transition.

Understanding the emotions, distress and behavior of a client or opposing party with borderline personality disorder will help any family law professional avoid potential major difficulties. By not being too close or too rejecting, you may be able to help the person a lot and, indirectly, help their children too.

There are primarily two personality disorders of interest in forensics: ASPD and Borderline Personality Disorder (BPD). ASPD is of primary focus within the criminal forensic realm, whereas BPD is of considerable interest in the civil arena. BPD retains criminal legal interest when it crosses into symptoms of psychosis and it is often identified as underlying, previously existing psychopathology in civil litigation.

From a practical perspective there are a number of reasons that personality disorders are not well accepted as significant mental illness within the legal system. These include, but are not limited to:

1. The incidence of personality dysfunction is quite high in populations of concern.
2. Personality dysfunction is often a comorbid condition, making it difficult to determine direct causation.Although comorbidity as a clinical concept can increase understanding, in the legal arena it can lead to confusion by making apportionment of responsibility or fault more difficult.
3. The diagnostic subcategories are not clearly or exclusively defined.
4. There is significant overlap with what law individuals would perceive as accepted variation on normal functioning (most individuals have experienced to some degree many of the symptom criteria identified).
5. It is hard to determine where on a continuum personality traits should be defined as illness.
6. The characteristic dysfunction of personality disorders often appears to be under volitional control.
7. Individuals suffering from personality dysfunction often do not self-define their symptoms and behaviors as illness.
8. There is no quick or obviously effective treatment interventions that are likely to result in change, with

some personality disorders (ASPD) often viewed as untreatable.^62,63

9. The most widely understood personality disorder (ASPD) within the legal system too closely mirrors our general concept of criminality. This negative connotation colors the way all personality dysfunction is viewed within the legal system.
10. Personality disorders are rarely viewed as removing an individual’s capacity to make a choice.

In summary, the legal system, to a significant degree, mirrors the clinical conception of personality disorders as:

1. Not severe mental diseases or defects
2. Not likely to change
3. Not in need of special consideration within the medical/psychiatric community as far as resource allocation goes
4. Not preferred patients in either inpatient or outpatient settings
5. Not a primary national research focus.

As clinicians, we can rarely say that in personality disorders the individual has lost the ability to not break the law or to make a reasoned choice.

One reason why many therapists are reluctant to treat people with borderline personality disorder (BPD) is fear of lawsuits. That fear has some foundation. The very dynamics that people with BPD bring int o therapy, especially their emotional hypersensitivity and their tendency to shift from idealization to anger, can lead in two ways to lawsuits or complaints to licensing boards. 

First, therapists’ real or perceived mistakes can set off a negative reaction out of proportion to the precipitating incident. Second, therapists working with BPD clients are highly prone to both extreme positive and negative counter transferences. 

Concerning negative countertransference, studies of malpractice suits against physicians find that patients who perceive their physician as uncaring or uncommunicative are the most likely to file lawsuits. This dynamic may apply to therapists as well. It seems likely that therapists caught in the throes of negative countertransference are far less likely to seem warm and empathic. 

Strong positive countertransference with BPD clients may also present considerable danger of lawsuits. Therapists who experience strong positive countertransference may find themselves trying too hard and promising too much. This kind of emotional overinvestment can not only cloud therapeutic judgment but it can, when the realities of therapy collide with the implicit or explicit promises, lead clients to feel betrayed, victims of false promises or hopes. 

That kind of profound disappointment, especially with clients who are prone to idealization and feelings of betrayal, is a lawsuit waiting to happen.

But perhaps the greatest pitfall of positive countertransference is that it can lead to sexual boundary violations. Writing in the May, 1999 American Journal of Psychiatry, psychiatrist Thomas Gutheil notes that sexual contact with clients is, regrettably, not an uncommon phenomenon, and he suspects that it’s more likely to occur with BPD clients. 

Quoting psychiatrist Alan Stone, he points out that in general “psychotic patients are not seen as attractive, and neurotic patients are clear enough to know better than to become sexually involved. Thus, the field may be left to patients with borderline personality disorder through a kind of diagnostic default.” 

In a 2000 edition of Insights, a risk-management newsletter of the American Professional Agency insurance company, attorney and psychologist Bryant Welch, J.D., Ph.D., describes the risks and safeguards therapists should be aware of when working with BPD clients.

Understanding Borderline Personality Disorder

Selfish. Manipulative. Dramatic.

This is how people (even mental health professionals) describe those who live with Borderline Personality Disorder (BPD).

“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” That’s how BPD specialist Marsha Linehan describes the deeply misunderstood mental health condition.

That badly burned “emotional skin” means people living with BPD lack the ability to regulate their emotions, behaviors and thoughts. In fact, “Dysregulation Disorder” would be a more exact, less stigmatizing name for the condition according to NAMI’s Medical Director, Ken Duckworth.

Like other personality disorders, BPD is a long-term pattern of behavior that begins during adolescence or early adulthood. But what makes BPD unique from other personality disorders is that emotional, interpersonal, self, behavioral and cognitive dysregulation. What does that mean?

Well, put simply: Relationships can deeply affect a person with BPD’s self-image, behavior and ability to function. The possibility of facing separation or rejection can lead to self-destructive behaviors, self-harm or suicidal thinking. If they feel a lack of meaningful relationships and support, it damages their self-image. Sometimes, they may feel as though they do not exist at all.

When entering a new relationship, a person experiencing BPD may demand to spend a lot of time with their partner. They will share their most intimate details early on to quickly create a meaningful relationship. In the beginning, they will show immense love and admiration to their partner. But if they feel as though their lover doesn’t care enough, give enough or appreciate them enough in return, they will quickly switch to feelings of anger and hatred. In this space of devaluing their partner, a person living with BPD may show extreme or inappropriate anger, followed by intense feelings of shame and guilt.

If you or someone you know was recently diagnosed with borderline personality disorder, here are a few first steps to take in managing this difficult condition:

Seek Treatment. Individuals who engage in treatment often show improvement within the first year. People with BPD are often treated with a combination of psychotherapy, peer and family support and medications.

Connect with Others. It can be incredibly helpful to have an emotional support system of people who know what you’re going through. It’s a reminder that you are not alone and you can recover. You can find others living with BPD through peer-support groups or online message boards or groups. 

BPD should not come with a label of “manipulative” or “clingy.” It’s not a personality defect. It’s a serious personality condition that needs attention and care. If you experience this condition, keep in mind that these symptoms are not your fault. You are not behaving or thinking in a certain way because you are a bad or evil person: You are just a person who has a mental illness and you need support and treatment.

This Research Compiled by, Pamela Chambers – SMA Institute