Family Dysfunction and BPD Behavior: A Chicken And Egg Situation

 

A new article in a nursing journal discusses the experience of Swedish families of people with members who have borderline personality disorder (BPD), and who have access to something they call “Brief Admission” to the hospital because of recent self-injurious behavior (SIB). In their study, 12 patients, whose age range is not specified in the article, have picked out one of their family-of-origin relatives or spouses for the researchers to interview. The relative is then interviewed by phone by two of the authors and asked to describe their experiences as the parents or spouse of someone with disorder. The two authors basically coordinate with each other so they are basically covering the same types of questions.

The authors mention almost in passing that the interviewers had to remind the relatives repeatedly not to focus their discussion on the patient, but rather talk about their own experiences. Not only that, but they also make the claim that “the burden experienced by families of someone diagnosed with BPD involves greater suffering than those with other mental disorders."

Now of course, if a loved one is acting in ways like SIB that reminds everyone that suicide is an issue, they are going to worry more about that person than they may have before. But how are we to know whether the obsession with the patient that is described by the family members over and over again was not what triggered the self-injurious behavior in the first place? After all, some people with BPD hide the self injury from their families (or at least the families are ignoring the evidence for it), while these research subjects obviously did not.

What distinguishes one from the other? Well, in my clinical experience, there are two reasons for this. When SIB is hidden, it’s sole purpose is to stop the panic attacks that occur when a patient feels helpless to alleviate a family problem. When it is not, the behavior does that and also feeds into the parent’s preoccupation with the patient’s mental health.

Of course, the parents will all claim that it was the patient’s behavior that created their preoccupation. This is the basic reasoning espoused by two support groups for parents of offspring that have BPD (TARA4BPD and NEA-BPD). They say such parents are sick and tired of being blamed by the psychiatric profession for their child’s condition. 

As my readers know, I agree that blaming parents is counterproductive because it sidetracks any and all attempts at actually solving problems that are shared by all members of the family and which were caused by events that took place over at least three generations.

So how do we know which came first: the parents’ preoccupation with the patient, or the patient’s self injurious behavior? A true chicken-and-egg type question. My readers already know my answer: the parents’ anxious and guilty preoccupation comes first, which then leads to their child developing the role of spoiler designed to somewhat control both the guilt and anger they see in their parents. The family members then all continue to simultaneously feed into and make worse one another’s problem behavior, especially over the long run.

The parents’ overblown preoccupation, albeit after the SIB has started, can be seen in comments the authors make throughout the study, starting with the above-mentioned statement comparing it to the parents of people with other psychiatric disorders. 

Other examples: the family members’ fear about the children makes “it difficult for them to prioritize their own well being.” The family members have “a hard time allowing themselves to have fun” – due to their feelings of “guilt and shame,” – not fear for their child’s life. “Constantly prioritizing their loved one and ignoring their own well being meant that many of the families suffered from their own mental illness and fatigue diagnoses…” “In this study, feelings of helplessness and anger and a constant need to monitoring their loved ones...”

It seems doubtful that the interviewers asked certain questions about the parent’s pre-occupation having perhaps pre-existed before their child’s SIB began. At least in their article, there is no mention by the authors about the possibility that this was the case, despite their making the following points: “…children can see if someone is unwell and can withdraw and try to make themselves invisible” (that’s only one of many other possible “helpful” responses). “When a parent suffers from mental illness, the children can become carriers of their anxiety.” “Children of parents with mental illness can take a great responsibility for their ill parents.” “…the families and their loved ones’ lived experiences are considered to be linked and interaction with each other.”

The other big problem with this study was that this was a highly biased set of subjects. As mentioned, the SIB of the subjects was known to their families. Also, recall that the patients had to pick a relative for the authors to interview, and the relative had to agree to it. Parents that were sexually or physically abusive would probably not be suggested by the patients, who often go to great lengths to hide the family’s secrets because of dire consequences. 

They know what will happen if they spill the beans. In the family, such revelations are responded to with denial, or alternatively, with an accusation that the patient was at fault for, say, being molested because of being seductive. Usually, everyone in the family including the victim just pretends it never happened – as illustrated by mothers who had been sexually abused by their father letting that man baby sit their own small children when rest of the family suggests it.

And even if the subjects picked the abusive parent, and the abusive parent agreed to be interviewed, it would be highly unlikely that such abuse would be divulged. After all, if it were indulged, the interviewers might have to turn them in!

Are People with Borderline Personality Disorders Defective at Reading Others, Or Superior?

One of the current theories about what creates borderline personality disorder is that somehow they are defective in their ability to mentalize, or have an accurate “theory of mind.” This means they do a poor job of figuring out what is going on in the heads of other people. In studies, this is mostly found on tests where they are supposed to read faces or interpret videos of people in various activities. 

I always thought this idea was very amusing in light of the fact that, in my extensive experience speaking with other therapists as well as in my own experiences, these very same people are so good at drawing three particular responses from therapists: a sense of anxious guilt, anxious helplessness, or fury. They are so good at it that they make most therapists hate them. They can ascertain the therapist’s weak points, and then go right for the jugular. How can they be bad mentalizers if they can do that?

When you live in an unstable, confusing environment in which double messages are flying back and forth and you can’t really predict what mood a parent is going to be in when they drop in on you, you become better at reading others than most people so you can quickly adjust to any new contingencies. And as I have repeatedly pointed out, error management theory would predict that you would err on the over-reacting rather than under-reacting, because the consequences of minimizing parental guilt and hostility are so frightful. This normal tendency is then mistakenly seen as something pathological.

Another big issue in research in personality disorders that bears upon this issue is that when patients are in studies responding to various stimuli in the study situation, they may be responding with a false self or persona (as described by psychoanalysts Jung and Winnecott)—in this case, the spoiler. This is, as my readers know, a role I believe they are playing to maintain smooth family functioning (family homeostasis). This makes them look impaired when in fact they are not. Performance is not the same as ability, as I described in a previous post. If you are not a good actor in situations in which fooling people is paramount, you wouldn’t be very good at doing so.

And to effectively play the role of spoiler, you have to make yourself to be way more impaired than you actually are. In particular, you have to pretend that you lack the ability to see both the good and bad in people simultaneously (so-called “splitting”), or evaluate both their strengths belied by their reputation among therapists for being master manipulators!! Deficient mentalization, huh?

One new study (Bora, “A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or  meta-social-cognitive impairment?, Psychological Medicine. 51(15):2541-2551, 2021 11). of so-called mentalization “abnormalities” was based on a review of the existing literature. The author just assumes that what the studies see is “maladaptive” and therefore abnormal, but found no evidence of any primary neuro-social cognitive deficit! Hardly surprising in light of what I just wrote about. Instead, the author attributes the imaginary abnormality to their “meta-social cognitive style,” whatever that is. Again, it’s as if these patients exist in some social vacuum where certain assumptions would always be completely highly adaptive for anyone who didn’t have a deficient “theory of mind.”

A second study (McLaren, V. et. al. "Hypermentalizing and Borderline Personality Disorder: a Meta-Analytic Review, American Journal of Psychotherapy 75(1): 21-31) looked at "hypermentalizing" - the tendency to overattribute mental states to other - and found it was common in a wide range of disorders rather than in borderline personality disorder in particular. 

Parents who Feel Both Guilty and Angry About Their Parental Performance

I recently received an e-mail from an irate reader of my blog on Psychology Today. It was in reaction to a post I wrote about parents who were cut off by their adult children acting as if they had no idea why that happened, when in fact the majority of them (but certainly not all of them) have at least a pretty good idea. She told me I was an a**hole who was automatically calling all such parents “dicks” and “a**holes.” I of course actually made no statements like that in the piece.

Of course, if a history of child abuse is involved, which it may or may not be in such cases, parents have the responsibility for that and not their children, at least before the children grow up and have minds of their own. But this was not the subject of the post.

I wrote back to her:

Sorry if the piece sounded like I was calling the parents a**holes. I don't believe that. And of course not all families that have problems like the ones I describe [in the post] are in denial about what's going on. I view everyone in the whole family as all caught within a devilishly-difficult problem to solve that is created by a variety of external factors over at least three generations. 

I never recommend cutting off parents -  even when the parents actually were (unlike you) physically or sexually abusive - and take a lot of heat for advocating that they try to work things out for everyone's eventual benefit (not that it is at all an easy thing to do this).

I of course have no way of knowing anything about particular families like yours without ongoing in-person evaluation and therapy, so what I'm about to say may or may not apply to some degree to your situation. In some families in which parents, in the estimation of the adult children, seem to be frequently beating themselves up with guilt about their worth as parents, the kids worry that they need to fix that. And what they then do is start to piss the parents off on purpose to make them feel angry at them instead of guilty. Hatefulness as a gift of love, as it were..

That last bit referred to how, in the patient with borderline personality disorder’s spoiler role, the adult child is regulating their parents’ de-stabilizing internal conflict over having children (described in this post). When the parent starts to feel too guilty, their children make them angry. When the parents start to get to angry, they lay guilt trips on them.

As I said in my reply, I don’t know if that dynamic applies to the writer and her children or not. So what made me think that it might very well apply? Well, there were certain sentences in the writer’s original inquiry that seemed to indicate a lot of guilt as well as a lot of anger:

Implying guilt:

• “I have admitted and apologized for the times I was a bad parent, naming specific incidents and listening to them to tell me other times they were hurt by me. I try as hard as I can to listen, be supportive, and not be overbearing.”
•  “I don’t know that any parent who needs to be told they’re a dick would accept that from you. It made me feel defensive and hurt, all over again. Trust me, most of us a**hole parents don’t realize we’re being a**holes.”  
• “I really do not know why my kids, especially my younger daughter, hold a grudge against me.  They have never said anything that I didn’t acknowledge, apologize for, and try to make right.”   

Implying anger/defensiveness:

 

·         Calling me an a**hole for allegedly implying she might be an awful person when I hadn’t actually said anything of the sort, and accusing me of “taking sides.”

·         “If they are mad because I turned out not to be perfect, but downright human and not always the best decision maker when it came to parenting, well, I at least know I always loved them immensely and would have, & still would, die for them.”

 

You be the judge.

 

Bringing up a Family Issue, and Parental Defensiveness Ensues

On Psychology Today, “Riles” commented on my blog post: "The Family Dynamics of Patients With Borderline Personality:"

Parents huh? This article is such bullcrap.  Its obvious this therapist does not work with BPD individuals...I am a parent to a BPD son, we have never mistreated or abused our son.  My son, as most BPD feel as though any disagreement even over trash day is emotionally or verbally abusive to them...A 5 minute question session just to ask about their day in their mind eventually gets spewed as a 2 hour session of us yelling at him.  Its such crap that you put this out there blaming parents who are doing everything in their power to understand this disorder and help their children.

This sort of reaction is representative of the fact that bringing up family issues involved in creating BPD is dangerous for their adult children - as well as a minefield for people like myself writing about the situation. Yes, it is true that many parents of BPD offspring are not overtly abusive, as I have often mentioned.

However, let’s look closer at this comment. Let’s assume for the moment that it is an accurate description of what goes on in this family (of course, I have no way of knowing whether it is or is not). I would wonder how old the son was when these two-hour yelling sessions began. Clearly, their son is provoking them, but that is part of the dynamics in families that generate BPD. Spoilers make parents angry when they are too guilty, but then have to make them feel guilty if they start to get too angry.

I would advise these parents to ask themselves, if they can calm down long enough to look at the interactional patterns with their son somewhat dispassionately and honestly, why they continue to engage with their son for two whole hours when he starts to act like this. Chances are, this signals the son to continue doing whatever it is that he had been doing. If the parents say they don’t know how to put a stop to their son’s difficult reactions and/or disengage from him, I would suggest that they watch a few episodes of Supernanny or read a book by parenting advisor John Rosemond. I would also have to warn them that if they follow the advice, their son’s behavior will get worse at first - but then get much better.

Can “How was your day” be a loaded question in these families? Damn right it can. If the parents are usually over-involved (the Buttinsky bunch) or under-involved (the Alfred E. Neuman what-me-worry bunch), or even worse, if the parents vacillate between these two extremes, their asking about their son’s day would for him be an incredibly infuriating entrance to this pattern of interactions.

Psychotherapy with BPD: Another Conundrum

For therapists such as myself who also write about borderline personality disorder (BPD) for the general public, there are several ironies that make it a damned-if-you-do, damned-if-you-don’t proposition. In my post of 2/27 of this year, I discussed the issue of how describing what the parents are doing with their children can make those parents feel even more guilty than they already were, when guilt is what has been driving their problematic behavior in the first place. Therefore, they can get even worse rather than taking any new knowledge they may have gained as a way to reduce their problem behavior.

A similar issue takes place when adult children who have BPD read my discussions of family dynamics. For the role of spoiler that they are playing, part of what drives it is often their parents’ insatiable and unceasing efforts to “fix” what’s wrong with them. Because to all outward appearances their parents seem to want or need to continue to do so, their adult children must remain “broken.” That is, in need of fixing. The people with BPD also think this about their narcissistic romantic partners, who are also constantly trying to fix them - while seeming to feel that they are God’s gift to them. The more the partners try to do the fixing, the more they reinforce their mate’s spoiling behavior.

So guess what happens when an individual with BPD comes to see a therapist? The therapist’s whole purpose for existing is to “fix” what’s wrong with their patients! How can therapists not end up inadvertently enabling their patient’s spoiler role? It’s sort of like coming to see someone whose goal is to “make you independent.” How can someone really be independent if another person is making them do something?

In therapy, the way around this is for the therapist to validate the ample evidence their patients offer (even while sometimes pretending that this is far from the case) that they are smart and capable, and that “their” problem is not a personal defect, but trying to figure out an enigma. They are trying to come up with a way to solve an almost-impossible-to-solve problem: the conflicted, ambivalent dynamics of their family members.

Doing something equivalent to this therapy countermove when writing for the public is a rather devilishly complicated proposition. Even spelling out what I am saying here with disclaimers doesn’t always work because it’s easy for someone coming from a borderline-ogenic family to see that as a ruse to lull them into a false sense of security. 

I had one reader write to me to tell me that something I wrote, rather than being empowering, made her feel so helpless she made a suicide attempt. She didn’t say that what I wrote was wrong, it should be noted, and I would wonder if she already had a history of making suicide attempts. But still, I understand her request that I be more careful about what I write.

Another reason I might make persons with BPD feel helpless is that, if family members were to read my stuff and figure out what they are up to, then the people with BPD might no longer be able to successfully pull off the spoiler role. They would become less powerful because I gave away their "secrets."

Nonetheless, facing the truth is the only thing that can set free everyone involved in family dysfunction. Dysfunctional roles only stabilize families (homeostatsis) over the short run. In the long run, they prevent resolution of ongoing issues.

So there is hope, especially if there are more therapists who understand family dynamics. I continue to hope for potential patients to create a high demand for therapists to start helping them identify interpersonal triggers and find ways to avoid the typical negative consequences of change - rather than just focusing on what is going on inside their patient’s head.

Spoiling Behavior is All an Act, But a Deadly Serious One

Relationships between people are formed through interactions that are two-way and simultaneous. People learn and become different over time as this occurs, and can push one another away.

I recently received an angry letter from a mother whose child apparently has been diagnosed with borderline personality disorder (BPD). She told me that I must have no idea what it is like to raise a child with the disorder, or I would never say what I do about it. She added that kids with the disorder do not respond to the most positive of upbringings, so don’t blame parents!

Having been the direct recipient of the spoiling behavior of adult patients with the disorder when I started out as a therapist - and did not know then how to deal with their in-session behavior effectively - I can say that I have a really good idea about what that is like. And it ain't no picnic. And I agree that unrestrained positivity does not change it. It can even make it worse!

It is also true that not all families that produce kids with the disorder are overtly abusive either physically, sexually, or verbally, although a large and significant majority of them are in fact abusive in those ways – according to every study ever done. Even DBT therapists believe they come from an “invalidating environment,” even though they seem to scrupulously avoid identifying that specific environment as the family of origin.

I would like to suggest that the reader take a look at what the letter writer said in a different way than would be a typical interpretation. (Of course, I can’t know for sure even if her child has even been correctly diagnosed or exactly how positive the family environment is). In just a couple of sentences, she could be understood to be saying that her parenting has nothing to do with how her child turned out. In a phrase, it is only the child who is (completely) screwed up.

           

If I’m hearing this in a short letter, you can bet that the child has heard it. And guess what? If children hear this point of view a lot, they will begin to act in ways that give the parent an easy justification for making the statement so the parents don’t have to feel bad about blaming everything on the kid. But doing this is all an act to placate and stabilize the parents.

I can predict relatively confidently that if the mother continues to exhibit this same attitude much of the time, the child will continue to give her grief, and will not get better.

           

Likewise, if a parent is constantly invalidating a child, the child will begin to act in ways that practically invite invalidation. One leader of a parents of BPD kids' support group once told me that her daughter said bizarre things, such as that she had grown up poor. The family was in fact quite well off financially. The daughter was not psychotic. Her mother is quite bright, so I would have to assume that the daughter is not actually stupid enough to somehow not know that the family was affluent. If she were my patient, I would ask her specifically what she thought the family was poor in. Validating responses, perhaps? Warmth?

           

When I speak of this stuff being an act, I always have to clarify that it is specifically the spoiling behavior which is the act. The way they generally feel, their sense of a poor identity, the impulsiveness and such are all real – but all adaptive or reactive to the family dynamics that produce BPD.

Parents and Adult Children React to My Descriptions of Borderline Family Dynamics

Parents and Adult Children React to My Descriptions of Borderline Family Dynamics

In my post about the family dynamics of Borderline Personality Disorder (BPD), I describe the role of the spoiler. A child or adult child of a family that exhibits the family patterns described in my posts on this subject begins to behave in ways which turns things around. The child invalidates the parents' efforts to "help" or "take care of them" in nasty ways. He or she essentially responds to invalidation by making comments that invalidate the parent right back. 

The reason the children do this is because they believe the parents need a child to be a target for their anger, and volunteer for the gig. They give the parents just cause by behaving in unreasonable and infuriating ways.

When it comes to the people who make comments on my posts on this and similar subjects, it always fascinates me how parents usually think I am putting all the blame on them for the family problems, while the adult children with the disorder react to the exact same post by thinking I am putting all the blame on them! 

Family systems therapists used the term punctuation to describe these types of reactions. People take something that is an ongoing problem created by continual reactions to feedback from two people with each other, and look at just one isolated segment of it - thereby breaking up a process artificially into misleading cause and effect relationships. They then react accordingly.

Of course, there are readers who do see the whole of the patterns in their lives but still do not know how to put a stop to them. In many cases the problems continue in spite of honest declarations of personal responsibility and even apologies -because there continue to be underlying issues that remain unaddressed.

I have reproduced two comments and my replies which illustrate these phenomena quite well. The first comment doubles as a description of spoiling behavior which illustrates it far better than I ever have.

The Blame Game

Submitted by A Mother of a Possibly BPD Child on November 6, 2016 - 11:39am

Regarding blaming the parents for "invalidating" feelings: I think it's a dangerous idea that all feelings are valid. Does anyone truly believe this?

When you are dealing with someone whose thinking is so distorted that they misperceive all your motives and react to your natural withdrawal as abandonment after they have been screaming abuse at you for an hour, you will just distort your own thoughts if you try to get into their head. If I say to my daughter "When you told me X it hurt my feelings," she often perceives that as an attack and starts to mock me: "Oh did that hurt your feelings? POOR YOU!" This can often escalate, and soon she is telling me what a horrible parent I am. That she is in so much pain that she'd lash out at me like this (again) does *not* mean I was abusive to her. She did not learn how to talk that way from us. We would never say something like that, even though she tells other people that's how we talk to her, and she probably believes we do. We did not cause that pain. Her mind did.

And this is the crux of the matter: just because someone perceives something as hurtful does not necessarily mean it's time to blame someone for hurting them. If someone trips and falls on you, and you scream, and they get mad at you for hurting their ears and making them feel ashamed with your tears of pain, should you feel sorry for them, since they honestly feel hurt by what you did? Should you feel mortified at yourself for inflicting such a nasty guilt trip on them with your tears? Some feelings *are* invalid! We invalidate our own feelings all the time. We *have to* if we don't want to be complete narcissists. A non-BPD person might feel a flash of anger at the ear-pain, but they would quell it, and then feel sorry they fell on you, sorry they hurt you accidentally. And if the screamer is non-BPD, they will probably be furious for a second at being fallen on, but then accept the apology and understand that it was an accident, perhaps even apologize for the loud sound they made - and everything will be fine afterward.

But if it isn't like this, the non-BPD screamer might reflect that they shouldn't have screamed and they certainly shouldn't have cried, since that just escalated things with the BPD person. But they were just behaving the way they would to anyone who fell on them. The reason they might think they shouldn't have screamed though, was because it made things into a conflict they didn't want, and they knew they could have avoided it.

This is CRAZY-MAKING.

And here's something else that's important: if (in the scenario with the falling person being BPD) the screamer pretends nothing bad happened afterward and tries to be loving again as if the falling person had been apologetic and understanding, are they *enabling* this bad behavior? Spoiling a tantrum-thrower? And if the falling person is the screamer's child, is the screamer not providing a terrible role model for the child? Should the *child* learn to tolerate this kind of behavior in other people? Should they not stand up for themselves and have high standards for their own behavior and that of other people?

Parents want to teach natural consequences, encourage empathy, and model the way one should behave in certain situations. BPD totally warps this. You start to think it's impossible to teach anything useful. You start to think that *ANY* response you have is doing irreparable harm to the BPD person. Walking on eggs to reduce conflict, or refusing to tolerate bad behavior - it's all bad. So what would be *good* for a BPD person? How would we recognize it?

As parents, we are not mind-readers. However we respond to behavior, it should teach something (how to respond, how not to respond, natural consequences, etc.) If the behavior is terrible and entirely lacking in empathy and remorse (just self-loathing, which doesn't do a darned thing to enact change), and if normal parenting only makes it worse, that cannot be - and is not - our fault for not knowing what would set the kid off this time. Of course we guess, of course we suspect - but we don't *know*. If we knew, we would necessarily be mentally ill too!

If we as parents caused this escalation by "invalidating" some feelings that originated in a distorted version of reality, or if we offended the child by refusing to be her punching-bag, that means LIFE itself would have provoked the same outburst. We just happen to be here trying to get her to have some self-knowledge and resilience. We are trying to help her learn how to deal with the real world. The real world will never be as careful as we are trying to be. The real world will never ask itself "Should I try not to take this personally, since she's clearly in so much pain she doesn't know what she's saying, or should I just react the way I normally react, since those are the natural consequences??"

The real world will react to BEHAVIOR. Often wrongly, often nonsensically, often (sad to say) maliciously. We are supposed to prepare kids for this! And as parents, we are supposed to train our kids to control their behavior and take responsibility for their actions. But what if, despite our best efforts, they don't learn this?

Many of the families that seem to shun someone who stops behaving so abusively were probably put through hell and just can't take any more. It's like they were holding up the car out of sheer adrenaline, and now the car is gone, they are burned out and need a break. Castigating them for shunning the person is asking way too much of them. Those were the natural consequences. Natural consequences usually teach non-BPD people how to control themselves and take responsibility for their actions. But what works with BPD people?

Parents of BPD kids need support and skills, not blame. They need tools to cope with a situation that is literally crazy - and quite possibly crazy-making.

·report

blame game - my response

Submitted by David M. Allen M.D. on November 6, 2016 - 4:21pm

Hi A Mother of a Possibly BPD Child,

"Blaming" and finger pointing are counterproductive, but all adults - both parents and adult children alike - have to take responsibility for their part in the family dynamics if these dysfunctional patterns are ever going to stop.

What you have written is a beautiful description of spoiling behavior by a child (or an adult child) with borderline personality disorder. It is designed on purpose to invalidate YOU. The child thinks for various reasons that you need them to do that, believe it or not.

For an explanation of how this seemingly crazy situation may arise in families even if there is no obvious abuse, see the posts

http://www.psychologytoday.com/blog/matter-personality/201109/the-family-dynamics-patients...

http://www.psychologytoday.com/blog/matter-personality/201205/borderline-personality-disor...,

and

http://www.psychologytoday.com/blog/matter-personality/201205/borderline-personality-disor...

Communication to Estranged Children

Submitted by Ria on November 12, 2016 - 2:10pm

I am so grateful for the comments of adult children on this page. It gave me insight in the feelings and minds of adult children who cut off parents. My daughter has cut me off a year ago - it happened a few times before she had children, I always reached out and tried to mend the relationship, but now the grandchildren are used as pawns. Although I am broken with the loss of my daughter as well as grand children, I have decided it is final this time. I was not the perfect mother, not even a good one. At 64, after many years of therapy, after two marriages, I understand that. 

I know my daughter is angry and anxious and use this cut-off defense after irrational anger outbursts - this time in front of the kids, which was the final straw for me. But you cannot cut off love and wipe out precious memories. I wonder all the time if she is happier without me in her life. Perhaps she has a better chance of growth, sorting out her own anger and pain without me. I want her to be happy and content within herself. It saddens me even more when I read of the bitterness and pain adult children express here and I cannot help to think: is there anything more I can do for her? Can I help her? Or is letting go the better option? I know no one can really answer, but let's talk about this. I know there are really evil people, but many parents were simply damaged as children. When they have children, usually when they are very young, they have no skills or boundaries or knowledge of parenting to care emotionally for their young, especially 38 years ago when information and education was not a given. The result is emotional abuse, neglect, and / or physical abuse. The horrible old cycle - how do we break it?

Communication - my response

Submitted by David M. Allen M.D. on November 12, 2016 - 2:42pm

Hi Ria,

Of course I can't say anything about your situation in particular, but in general, of course it is best for parents to acknowledge their problematic behavior in the past, explain what they had experienced with their own parents, and apologize.

However, if the parent then goes on to continue to feel too guilty and beat themselves up for their past flaws, that may backfire. The adult child may then start to think that the parent is better off without them - just as you say you wonder about your kids being better off without you - because the child sees that his or her presence makes the parent feel really bad. In response, they may continue to avoid the parent so as not to add to the parent's burden. 

Additional point not in my original reply: Alternatively, they may act nasty to feed the parent's guilt because they think the parent wants to be punished for various sins - or they may go back and forth between the two depending on whether the parent seems to need to be punished or then starts to feel too guilty.

Finally a Study on Borderline Personality Disorder That Looks at Family Dynamics

Karlen Lyons-Ruth, Ph.D.

When it comes to the study of personality disorders as described in medical journals, it seems like most of what's been published lately in the field looks at which superficial aspects of personality disorders and personality variables correlate with one another and to what extent, or how often some construct like "impulsive aggression" is found in various populations. Such correlations usually turn out to moderate at best and never ever close to being 100% predictive of anything. 

While group data like this may help therapists prioritize - to a minimal degree - which other issues in a patient's life on which to focus clinical attention whenever they happen to note one of these characteristics, it really tells us nothing about the individual patient. Not to mention that it neglects literally thousands of other important details that may apply only to the patient at hand.

IMO, such studies are just different ways of slicing up the same old bread, when it is the bakery that needs the attention. The bakery is the interpersonal environment in which personality disorder traits develop and flurish.

Of course, as readers of my blog know, it's very difficult to study the bakery "empirically," because a lot of what goes on involves subtexts or unspoken communication in family relationships. These subtexts not only change over time but, especially in the world of personality disorders, the subtexts of family interactions can contradict one another. To make matters even worse, some of these contradictory messages may show up only rarely, but become significant when seen in light of the history of the family over the lifetime of the participants as well as the family's history over several generations. All of this is almost impossible to quantify.

I was pleased to see in a recent issue of the Journal of Personality Disorders that, for the first time in a long time, some researchers tried to address these issues in at least a partially comprehensive way (Karlen Lyons-Ruth, PhD, Laura E. Brumariu, PhD, Jean-Francois Bureau, PhD, Katherine Hennighausen, PhD, and Bjarne Holmes, PhD: "Role Confusion And Disorientation In Young Adult-Parent Interaction Among Individuals With Borderline Symptomatology." Journal of Personality Disorders, 29(5), 641–662, 2015). 

Dr. Lyons-Ruth and her colleagues did their best to look at what they so nicely referred to as the "minute to minute fabric of interaction..."  Their data lent much support to my idea that, as a manifestation of what evolutionary biologists call kin selection, children sacrifice their own needs in order to stabilize unstable parents.

In fact, while I previously thought of so-called parent-child role reversal as applying only in cases in which children act more like parents to their childlike parents than the other way around, I realized one could conceptualize the spoiling behavior seen in borderline personality disorder (See the post The Family Dynamics of Patients with Borderline Personality Disorders) as just another form of children taking care of unstable parents - although a much more subtle and covert form.

In so called "empirical studies" to date, the quality of parent-child interaction has rarely been observed directly. In this study, 120 young adults were assessed for features of borderline personality disorder, for severity of childhood maltreatment through interviews and self-report measures, and for disturbances in parent-child interaction during a videotaped conflict discussion task. The last part addressess a huge criticism of the literature I have been making: no one actually looks directly at what is going on at home.  

Of course, the way the family behaves in a laboratory setting is only an approximation of what goes on when no one is watching, and much important behavior undoubtedly gets omitted under this type of observation (as oppposed to when Supernanny spends a couple of nights in the home) - but at least it is something that can be observed directly. To paraphrase a line from the movie The Big Short that showed how certain people were able to see through the fraud perpetrated by mortgage bankers prior to the burst of the housing bubble in 2008, "If you want to understand a process, actually looking at it is a very good place to start."

The conclusions of the study: Borderline traits, as well as suicidality and self-injury specifically, were associated with more role confusion and more disoriented behavior in interactions with the parent.

The definitions of these terms, quoting more from the article: In infancy, the term disorganized refers to the apparent lack of a consistent way of organizing attachment responses to the parent when under stress. The types of disorganized behaviors observed in infancy include apprehensive, helpless, or depressed behaviors, unexpected alternations of approach and avoidance toward the attachment figure, and other marked conflict behaviors such as prolonged freezing or stilling or slowed “underwater” movements.

Controlling children, on the other hand, “Actively attempt to control or direct the parent’s attention and behavior, and assume a role which is usually considered more appropriate for a parent with reference to a child. Controlling behaviors are thought to represent a compensatory attempt by the child to maintain the involvement and attention of the attachment figure by taking over direction of the parent-child relationship.

Two forms of this controlling behavior were observed. Controlling-caregiving behavior is characterized by organizing and guiding the parent or providing support and encouragement to the parent (e.g. child praises the parent or asks if a parent is all right). Controlling-punitive behavior is characterized by episodes of hostility toward the parent that are marked by a challenging, humiliating, cruel, or defying quality (e.g., child tells parent that the parent is terrible at doing a task). The study found that, among young adults with recurrent suicidality/self-injury, 40% displayed high levels of role confusion compared to 16% of those who were not suicidal. 

Neither form of disturbed interaction mediated the independent effect of childhood abuse on borderline symptoms. In other words, these patterns contributed to the development of the disorder in an additive fashion to the usual culprit of child abuse. As the authors say, "even when present, abuse events are often only the tip of the iceberg and index pervasive difficulties within the family in establishing caregiving routines, managing anger, and maintaining discipline"  (p.643) (Italics mine).

One interesting sidelight was noted on p. 656: with depression controlled (that is, subtracted as a factor in the mix), young adult-parent interaction associated with borderline traits included a particularly contradictory combination of role confused/caregiving behavior and punitive behavior. This contradictory mix is "similar to the mixed forms of childhood controlling behavior toward the parent that predict elevated BPD features in adulthood...", as had been noted by the first author in a previous work from 2013. This odd mixture of punitive and caregiving behavior "converges with the often-described shifts from idealizing to devaluing behavior experienced in therapeutic interactions with borderline patients."

This means that the so-called "splitting" seen in patients with BPD may be triggered by the demand characteristics of interactions with parents as they change over a period of time. This finding is highly consistent with what I have written about extensively.

What Happens if Adults with Borderline Behavior Start to Act Better?

People who have dealt with those who have been diagnosed with borderline personality disorder (BPD) often wonder why those folks persist in their often infuriating as well as self-destructive behavior when it seems so obvious that they are making themselves as well as everyone who cares about them completely miserable. 

When I first started to treat them, I know I did. These patients were not psychotic, nor were they stupid, so why did they persist in dysfunctional behaviors in the face of overwhelming evidence of their consequences. So I started asking the magic, Adlerian question: What would happen if you got better and stayed better?

As I described in that previous post, patients would often answer with the non-answers, "I'd just find some other way to screw things up" or "I cannot even imagine what that would be like." I would not accept those "answers" and pressed on.

When the answers finally started to emerge, I was totally amazed. One thing that might happen was described in my very last post. If a patient with BPD got better, their families would run for the hills. Exile them. Shun them. Abandon them. Anyone wonder why those with BPD have "abandonment issues?" Wonder no more.

But abandonment was far from the worst or the most likely outcome when patients acted beter.

I found that something family therapy pioneer Murray Bowen described was quite real - only that it was the just the first thing that would begin to happen before things got far far worse.

I found that the power of family members to invalidate anything a therapist tries to teach a patient should not be underestimated. As first pointed out by Dr. Bowen, they will literally gang up on a patient with messages that scream, roughly translated, "You're wrong! Change back!"  Previously uninvolved family members may come out of the woodwork, and previously sympathetic family members may suddenly turn on the patient and scream things like, "HOW CAN YOU TREAT YOUR MOTHER LIKE THAT!?!" 

I dubbed this phenomenon "clustering." Try to imagine what it would be like if everyone you know and loved started to come after you like that. If you don't think you would wilt, you are kidding yourself. And that would be true even if you came from a family that was relatively functional to begin with. Imagine having been invalidated like that for your whole life.

As I said earlier, however, that would only be the first thing that would happen if someone with BPD started to act better. The next thing that happens is that the parents start to act out in alarming and frightening ways. I'm talking about things like parents making suicide threats or actual attempts, increasing drug or alcohol abuse to alarming levels, worsening domestic violence, family members getting thrown out on the streets penniless, or any children left in the home starting to be abused, neglected or molested. You know, minor, inconsequential stuff.

Furthermore, as first pointed out by Lorna Smith Benjamin, in "borderline families" all these problems would be blamed on the patient, who would be subtly expected to somehow exert control over them.

Think you'd be able to turn your back on your family if all this happened to you? Very few can. Even if you could, it would only be because your family would, through their own behavior, engineer your dismissive attitude - so that you would continue to not only be their scapegoat, but so they could also label you as an uncaring son of a bitch as well. 

Americans like to think that they don't care what their families think of them. Horse manure!

In response to all of this, individuals with BPD usually start to actively undermine ("spoil") any efforts anyone might make to encourage them to continue with their "good" behavior - without telling anyone (including a therapist if they have one) about any of their family's behavior - and revert right back to the way they had always been.