Tough Love is NOT the Answer with BPD

I often peruse the web for articles and posts about dealing with people with Borderline Personality Disorder and what I usually find is incorrect and misguided. I recently stumbled upon a post that can be found here:

http://www.helium.com/tm/339437/individuals-suffering-borderline-personality

In which the author gives some insight and advice about “dealing with” someone with Borderline Personality Disorder. I’d like to look at her advice by excerpting some of her text and then offer a little commentary.

First of all, she says this:

Individuals suffering from borderline personality disorder are very self-destructive and they have great difficulty forming any good relationships. A deep-seeded fear of abandonment is behind every wayward action and prolonged mood swing. It’s [sic] victims are mainly women who show frequent displays of inappropriate anger and who exhibit forms of self-mutilation. They also act on impulse, without regards to consequences and than [sic] hold others responsible for their actions. They are sexually permissive and may indulge in binge eating and drug abuse. Victims of this disorder may shop lift. Hell bent on harming themselves, they live with no discipline or boundary.

While this characterization is generally true, it suffers from what wikipedia calls “weasel words”. Basically, the words that are used slant the information toward being extremely judgmental. What I mean is the use of the words “great difficulty forming any good relationships,” “every wayward action and prolonged mood swing,” “show frequent displays of inappropriate anger,” and “they live with no discipline or boundary” all show us that the author is judgmental toward the sufferer. The idea of “prolonged mood swing” is incorrect as well, since the “moods” of a person with BPD generally last only hours. Also, the idea that “they are sexually permissive” MAY be true for some of the sufferers, but not for all. The idea that a “fear of abandonment is behind EVERY wayward action” is also incorrect. Much of the “actions” are motivated by pain relief and/or shame. Use of the words “no discipline” betrays the authors true feelings about people with the disorder and tells me she doesn’t understand the disorder very well (see below on “Tough Love”).

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The author goes on to say:

Group therapy can resolve self-destructive behaviors. These individuals learn better from their peers because of their resistance to authority. Impulse behavior can be curtailed in this same setting.

Which is basically wrong. Group therapy does work (especially in the context of DBT), but not for the reasons that the author suggests. It is not a “resistance to authority” that drives the effectiveness of group therapy. Instead, seeing that one is not the only sufferer and having the ability to support one another normalizes the disorder. You are not just the broken, shameful person that you feel you are. Interestingly, many people with BPD will criticize others in the group and report that they are not as “crazy” as those people are.

The thing I have the most problem with is this:

Tough love may be needed from family members and loved ones before the person asks for assistance.

This statement is completely false and possibly harmful. Here is the text of a post of mine in the ATSTP group which addresses Tough Love:

Depending on the actual problem with your son(s) the idea of “tough love” might be the worst thing for him (them). While it seems to work for substance abuse, tough love can be an awful mixture for those with ERD-like issues. The problem comes down to the “invalidating environment” as Marsha Linehan puts it. Tough love will invalidate a person’s basic feelings and lead to shame and the feeling of “brokenness”. I have seen this first-hand with one of my daughter’s friends. This friend is 16 now and is a classic BPD/ERD case. She has been kicked out of several “lock down” facilities. Recently her mother sent her to a “tough love”/boot camp. It was a total disaster for the kid and for the family.

A better approach IMO, is emotional validation + a sense of personal responsibility. This combination is built through letting the person know that feelings are not wrong or right, they just ARE. The second half comes through building mastery over their behavior associated with feelings. Bad feelings just exist. This is important because often a person with such issues will use behaviors (like drug abuse or cutting or raging) to make the bad feelings go away as quickly as possible. They need to learn to tolerate the distress and behave in an effective manner. Once this new behavior/reaction to feelings is practiced, they can eventually build mastery over the behaviors. This works backward to help quell the feelings.

It seems that most parents believe that emotional validation = “giving in” (or agreeing with the child or “poor discipline” or whatever). This is NOT the case. It’s difficult for me to express this more firmly. Remember the word “emotional” is important. If you validate invalid behavior, you are enabling. It is important to separate in your mind the emotions (which are natural) from the behavior (which can be painful to all involved). If that separation can be communicated to the person with ERD, it can be worked with. It is difficult, but possible.

Unfortunately, tough love is not the answer.

Related posts:

1. Tough Love is not an effective approach to BPD
2. Tough Love Reconsidered with BPD
3. The power of “When you do this, I feel that”
4. Book Review of WHINE from “Tides of Crazy Love”
5. The Myth of the High-Functioning Borderline
6. Emotional Independence
7. Adopted Children and BPD
8. A Note about BPD and Boundaries And SWOE
9. Courtney Love loses custody of her daughter
10. The DSM-IV and Bon’s view of BPD/ERD – What’s required?

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