by

Rabbi Simcha Feuerman, LCSW and Chaya Feuerman, LCSW

Borderline Personality Disorder is an emotionally painful and debilitating mental illness that wreaks havoc on the lives of individuals, marriages and families. Its main symptoms are extreme emotional states, stormy interpersonal relationships and self-destructive or violent behavior. However, these same individuals can be charming, passionate and highly intelligent with compartmentalized areas of super functionality, so it can be confusing for both the person suffering from the disorder and their loved ones. Frustrated family members cannot quite grasp how such a brilliant, capable person could also act so erratically and irrationally.

Because the Jewish community places a high value on caring for children and spouses, loyalty to family, and revering intelligence almost to the point of worship, this disorder can express itself in unique and problematic ways within the Jewish world. Although there is a lot of talk about middos, we as a community are still dazzled by intelligence and charm. Many favorite stories told of Gedolim fall into the trap of stressing their supernatural intelligence as opposed to their exceptional middos. These revered Torah leaders of these stories must be recognized for all their qualities, specifically paying attention to how they leverage their great knowledge of Torah to enhance their middos.

Unfortunately, on a communal level, we all can recall the occasional and tragic circumstance of a talented, brilliant leader who is later found out to be acting in completely impulsive and immoral behavior. Some of those individuals from recent events may have been suffering from Borderline Personality Disorder and experienced great challenges in controlling their behavior. (We are not absolving them of their moral failings. To what degree different forms of mental illness and addiction mitigate moral responsibility is a fascinating topic, but beyond this article.)

Persons with Borderline Personality Disorder are adept at inducing strong feelings of guilt and anger in the people they know. In a close-knit community this can make it even more difficult to set limits and withstand the pressures and stress that Borderlines bring into the relationship.

On an individual level, if someone has a parent who suffers from Borderline Personality Disorder, the guilt over requirements of kibbud av v'em in the face of verbal abuse and manipulative behavior can be daunting. Indeed, Gemara Kiddushin (31a) tells of a righteous Gentile who was humiliated by his mother publicly in front of the dignitaries of Rome and yet accepted her behavior without disgracing her. In actuality, that Gemara was speaking not so much in terms of obligation but rather as an object lesson of the extent that one can fulfill the mitzvah of honoring parents and thereby merit great reward, if he is able to do so. However, the obligation to honor parents when their abuse causes significant emotional distress is not necessarily binding, and one should consult with a knowledgeable Rav regarding these matters.

Parents can also suffer at the hand of a child who has Borderline Personality Disorder.

If a child is suffering from Borderline Personality Disorder, he or she can appear to the outside world to be quite charming and put together. The crazy mood swings, temper tantrums and verbal abuse may be kept tightly behind closed doors. While a youngster with some of these behaviors can be managed because of his size, a twenty-five year old "child" may not be bearable. Outsiders may jump to quick conclusions upon hearing from various tales of woe, assuming the parents are cruel and despotic. In our close-knit community, it is very difficult to throw any child out, even an adult child, or refuse to let him or her in when they are banging and screaming outside the house at 1am. All the neighbors will see is a cruel scene -- parents throwing a child out of the home, not knowing at all any of what went on inside that precipitated that. Of course we are not justifying cruel behavior or throwing anyone onto the street, but some situations that people see and judge unfairly involve 25 year old "children" who actually have been cruel, manipulative and abusive toward their parents.

Guilt

One of the challenges in working with a person who is suffering from Borderline Personality Disorder is managing the guilt. Although there is some dispute regarding the origins of Borderline Personality Disorder, there is some strong evidence that it is combination of a particular kind of sensitivity and temperament that is then reinforced by a non-validating environment. In layman's terms this means that though parents may not be at fault per se, as a person suffering from Borderline Personality Disorder may be born with a very challenging, hyper-sensitive and insecure nervous system, the parents' role may be in having been too impatient and insensitive to the various emotional needs that this challenging child brought into the relationship. No parent is perfect and really no parent needs to be, nevertheless the anguish and resentment that the child expresses can be intense. But there is more. Because persons suffering from Borderline Personality Disorder can be erratic, violent, needy and demanding in their various stormy relationships, they certainly can induce people to behave toward them in a likewise manner. This is why guilt and extreme distress is a hallmark of Borderline relationships. After being called names and having all his or her "buttons" pushed, a parent may indeed say or do rather shameful things.

The remedy for parents lies in balancing this out with other healthy relationships, so they can get feedback and comfort from people who are calmer and have a more balanced perspective. Sometimes parents have their own stormy relationships that make them more anxious and more guilty. Getting treatment for this is helpful. In addition, genuinely owning op to up to the behaviors that are one's own fault regardless of the other person's role is helpful and a way to reduce guilt. However, do not expect any of this to solve the problems, as a true Borderline will be difficult and unhappy no matter what anyone else does.

Symptoms of Borderline Personality Disorder

According to the DSM-IV Borderline Personality Disorder involves an instability in relationships, problems with self-image, emotions, and impulsivity such as:

1. Frantic efforts to avoid real or imagined abandonment, meaning feeling alone or cut off from other people.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of feeling the person is wonderful and can do no wrong to intense hatred. This is reminiscent of Amnon's behavior toward Tamar, "And Amnon hated her a great hatred - indeed a greater hatred than his original love for her." (Shmuel II 13:15).

3. Unstable or poor self-image or sense of self and chronic feelings of emptiness or feelings of disassociation, meaning feeling disconnected from people and the world around them.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending money, promiscuity, drug/alcohol abuse, reckless driving, binge eating)

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6. Intense anger or difficulty controlling anger or paranoid thoughts

Typically, persons with Borderline Personality Disorder will be needy in relationships, make unrealistic demands and interpret normal limitations as unfair and cruel abandonment.

Not Every Emotional Person is Unhealthy

However, caution must be taken to avoid mislabeling every emotional person as mentally ill or Borderline. The Gemara (Bava Metzia 59a) speaks of how one must be more sensitive to a woman because "Her tears are accustomed to come". The Gemara doesn't blame or pathologize women for crying, rather it warns the men to be more careful in regard to their wives' feelings. In addition, the Steipler Gaon ZT'L warns in his Iggros Kodesh that a husband's neglect of his wife's emotions and wish to be loved can lead her "almost to the point of death, from the great distress she feels." Clearly, the Steipler was not saying that extreme emotional pain be treated as histrionics and be ignored. Furthermore, at times, if the husband is unusually cold and remote, his wife's behavior will appear bizarre and needy when actually it is he who is the ill one. Think of a person who hasn't eaten for three days sitting down to a meal with a group of well-fed mannered individuals. He will appear to be gluttonous and uncivilized to those around him who have no idea what deprivations he went through.

Do I Have Borderline Personality Disorder?

Most people who suffer from Borderline Personality Disorder are not likely to identify themselves as the origin of their problem. They will see others as not being caring enough, fair enough or attentive enough. They may experience their parents and loved ones as judgmental and critical. To some degree, this is true because the extreme emotionality, destructive behavior, rage and neediness exhibited by persons Borderline Personality Disorder can definitely induce others to be critical, controlling, and emotionally remote. This in turn usually exacerbates the feelings of abandonment leading to even more demanding and emotionally extreme behavior.

So, are you a borderline? Well, do you feel that no one loves or cares about you, even though people tell you that they do? Do you have extremes of despair and rage and then engage in some kind of destructive behavior? Do you test the people who you love by provoking them to see if they "really" care? Do you feel a terrible emptiness and sadness inside you? Do you become easily attached or infatuated with persons who you admire until they somehow disappoint you or let you down? If some of these experiences resonate with you, it could be that you have some Borderline features to your personality.

You might be thinking, "But he or she is so mean", or "He or she is so unfair, abusive, arrogant etc." That may be so. Often, there is more than enough blame to go around. However, blaming is not helpful. It is just a convenient distraction. What is helpful is to honestly assess your role in the difficulties you experience and to commit to making changes on our side of the street.

Because the emotional world of a person suffering from Borderline Personality Disorder is extreme and disregulated, the cure lies in a number of simultaneous approaches. There is a form of Cognitive Therapy knows as Dialectical Behavioral Therapy (DBT) which helps people develop the necessary self-maintenance skills and interpersonal skills to soothe raw emotions, manage conflict, address insecurity and become appropriately assertive and appropriately objective. The research has shown that it is effective in managing the symptoms of Borderline Personality Disorder. In addition, sometimes mood stabilizing medication such as SSRI's allow persons who suffer from Borderline Personality Disorder an extra support in their efforts to learn how to manage their emotions. And finally, because the relationships either with parents and children or spouses are complex and resentments build on both sides, it is recommended that family therapy or couples therapy is utilized as well to help correct dysfunctional patterns of relating and build new positive patterns.

A person who is in recovery from Borderline Personality Disorder bravely consented to offer her first-person account of what it is like to suffer from this illness in order to help others understand this condition and be inspired to get help.

What it is Like to be a Borderline

My husband and I planned a special Sunday afternoon/evening for an anniversary celebration. Our plan was to go out to dinner, enjoy each other's company and spend the evening talking. We walked toward the front door and then came the rage, pouring out of me. It was like I was another person. Even while I was screaming, I knew I was being a monster, but I felt like a passenger on a runaway train - I just could not stop it. In retrospect, it was so ridiculous to carry on that way when it was a special anniversary night and no one meant to hurt me.

Here is what happened, as near as I can reconstruct it:

My ten-year-old daughter does not understand the word "no", and rarely even hears it from her father who has a very soft spot for her - you can say she is her father's favorite child. So, just as we were about to leave, she asks her father with a sweet smile and her ever-bright green eyes "can you look at something funny on the computer?". I am thinking, perhaps rather selfishly, "This is our time, MY time to spend with my husband. Why the interruption now? I just spent the whole morning and afternoon taking care of the kids and now I just want some peace and quite and attention from my husband." So, what does my husband say to my daughter, "Sure, let's take a look!". So I stand, waiting, fuming, seething - all dressed up and no place to go. In actuality, my husband spent 90 seconds giving her a little attention and then said, "Hun, I have to go out with Mommy now, so we can look at that more tomorrow." It really was just a short delay, but it felt like years. Worse than that, actually. It felt like years standing on the dark, cold side of the Moon with no air to breathe. I was dying.

You would think then I would be happy to see my husband. In truth, I was. But the Devil in me took over. We got into the car. I began to scream. Bloody murder. I banged on the car door with my fists. I screamed at the top of my lungs. How dare he take two minutes out of our time together as a couple? How dare he switch roles to that of "Dad" in the middle of our roles as spouses and lovers? I must have gone on for 10 minutes until I was exhausted.

I am coming to understand that though often I have good reasons for being hurt, and like everyone, I am not always treated properly by people, I also tend to over-react. These reactions come from my desperate fear of abandonment, rejection and a poor sense of self. I can only feel good about myself in moments when someone else is giving me positive feedback, praising me or offering me their affection, love and acceptance. I crave those moments and need them so badly. Most other days, hours and moments, I am filled with self-hatred, fear and a sense of doom. I do not know how to feel good about myself on my own, I do not know how to cope with negative feelings about myself and I constantly rely on others for approval and love.

This is Borderline Personality Disorder. I've got it. But, unlike many others with this disorder, I know it. I am getting help. I am getting better. I am learning to see myself and others more realistically. I am learning to differentiate my subjective feelings from the reality and I also am learning ways to calm down and reassure myself that I am worthy of love, especially from myself.

As persons with Borderline Personality Disorder are adept at inducing strong feelings of guilt and anger in the people they know, it is often difficult to behave in a normal loving way. It is easy to be drawn into horrible fights, where the behavior of the more healthy individual is indistinguishable from that of the less healthy person. If someone is pushing your buttons, threatening violence to themselves or others, hurling insults and acting provocative in any number of ways, it is hard not to take the bait. Ironically, this only confirms the Persons with Borderline Personality Disorder's core fear that no one loves him or her, and that there will be abandonment.

The first and most important step for a family member is to learn how to stay calm yet still emotionally involved. This is a tricky maneuver because it is easy to become cold, remote and clinical seeing the other person as some sort of maniac. It also is easy to get over involved and become a hero and savior, which will only last as long as you remain "perfect". The moment you disappoint the other, a new set of rageful accusations will ensue. The humane way to handle this is to keep enough detached that you can be calm and see things objectively without taking the insults personally while still being truly empathic and compassionate. Remember, the person suffering from Borderline Personality Disorder genuinely experiences strong feelings of panic and fear of abandonment. It really is a rachmanus and your heart must connect to that aspect, despite the furor and rage that may be directed at you or others. Think of a screaming colicky baby in pain. The infant is surely in a terrible rage and wants everyone to know it. Yet, most mature parents do not feel overwhelmed with an urge to smack the baby, rather they feel compassion. Here too, the Borderline rage, is essentially an infantile one.

Despite the need for compassion, the family member must also find space and place for self care. That is, at times when the behavior is too abusive to have a safety plan where he or she can calm down and avoid becoming drawn into a fight. Of course, this withdrawal will be experienced by the person suffering from Borderline Personality Disorder as a rejection and abandonment, so it won't be received too well. However, rehearsing it in advance may help, as well as saying something reassuring at the time. Meaning, letting the person know that when the situation seems to be in danger of turning into a terrible fight, you would like to take some time to cool off and relax before you say or do something hurtful. Then, before you take this time, let the person know you really care and will come back in a specified amount of time and try to work out the situation.

No one likes to be insulted or accused of being crazy. Nevertheless, if you are living with a person suffering from Borderline Personality Disorder, you will need to draw some line and insist that the person go for help. It helps to find a quiet moment when the person is feeling relatively calm and explain the behaviors and how they hurt you, without diagnosing or judging the person. For example, you could say, "Last week, when I came home 15 minutes late, you were in such a rage. It was as if I disappeared for a week (which, by the way, is how the person suffering from Borderline Personality Disorder experiences the slightest abandonment - don't say this part). When you kept screaming and crying it made it so hard for me to actually listen and make things better. I want us to be close, but I think it is too much emotion and too much rage for me to handle and keep a peaceful home. I would like for us to talk to a professional about how to handle these situations in the future so we both can feel happier." You can start as a suggestion, but make sure that over time, it becomes non-negotiable. In addition, look for a therapist that is experienced with Borderline Personality Disorder because it is not a simple treatment process.

Ó 2011 Rabbi Simcha Feuerman, LCSW Chaya Feuerman, LCSW 718 793-1376 [email protected]. Material may be copied and distributed freely provided that the articles are printed in their entirety and this note is printed on all pages.