

Borderline Personality Disorder: Profile and Process of Therapy by Paul J. Hannig, Ph.D., MFCC, CCMHC, NCC Sections Abstract

Some Characteristics of Borderline Personalities

Other Aspects of Borderline Personalities

Behavior of Borderline Personalities

Causes of Borderline Personality Disorder

The Process of Therapy

References

ABSTRACT: This paper is a narrative, exploratory, descriptive, and investigative profile of Borderline Personality Disorder (BP). Its purpose is to expand the existing description of behavioral characteristics of this disorder and to include a deeper emotional and interpersonal understanding of borderline symptomatology. The self and object-relations schools are recognized but treated as being limited to the post-birth biographical experiences. This study includes the expanded perinatal, preconception, transpersonal elements and interpersonal aspects of Borderline Personality etiology. BPs are characterized by lack of emotional commitment, hypersensitivity, feelings of emptiness and worthlessness, submissiveness, defense mechanisms of splitting and projection, and a strong need to control. Relationships have an "on the brink" and destructive quality. Repetitive cycles of regressive behavioral patterns are present. Excessive superego demands are combined with a deflated false self. Feelings are not discharged easily. The borderline has a deep, underlying terror of catastrophic annihilation, which may have its earliest roots in trauma surrounding the blastocyst's need to connect to the uterine wall and even to trauma surrounding conception, involving the egg's rejection of the sperm. Consequently borderlines may be hypersensitive to withdrawal and yet insensitive as to how their behavior affects others. Besides prenatal rejection, childhood abuse and generational factors play a part in forming the BP. The process of therapy is long term because of the chronic nature of the disorder, and the therapist must take into account the BP's terror and fragility during the release of Pain. However, treatment can be very successful and motivational and can lead to achieving workable and happy lives. This happens by releasing the Pain, regaining identity in the real self, and, through the therapist's acceptance, eventually gaining the self-acceptance which alone is capable of overcoming the inordinate en utero survival demands and abandonment that they experienced. This article presents a profile of the Borderline Personality Disorder (BP). However, it is not the only one possible. I have chosen to include only the pathological aspects of the disorder because I wish to discuss the therapeutic process as regards those pathological aspects. I do this with full recognition that healthy behavioral aspects of the disorder exist. Some Characteristics of Borderline Personalities Borderline Personality Disorder clients cannot sustain emotional commitment. They change emotions in midstream and have difficulty holding on to feelings of love. Love turns to indifference, estrangement, and perhaps back again to love. This dysfunctional cycle has its roots in early childhood. Borderlines lose their love for the parent of the opposite sex when the idealization of that parent breaks down. As a child, the BP experiences the opposite-sex parent as being narcissistic, cruel, and abusive. The child's love turns to hate and distrust. The opposite-sex parent falls from the idealized pedestal and crumbles in the BP's eyes and heart. In parental relationships the BP feels as though he or she has never really possessed mother. Mother is experienced as the one who abandons and is inaccessible as a real person. For the BP this is experienced as a catastrophic loss and, as a consequence, may ultimately result in a serious depression. The BP feels eternally alone and abandoned. There is an endless search for the love that never was or has died. The BP begins to lose or withdraw feelings of love from current relationships when the impaired self is activated by family frustrations, stress, and so on. The BP is driven to replace lost nurturance and sustenance, whether or not the experience of loss is misperceived or real. Temporary commitment, emotional withdrawal, and the search for a perfect, all-loving, non-exploitive love object is the continuous and dysfunctional emotional cycle of the borderline. Many borderlines have a perfectly working, pleasant, alluring, seductive, competent, superman/woman facade. It is sometimes difficult to differentiate which self is being presented by the borderline - the false front, the authentic self, or the impaired inner child. In many interactions the BP is not emotionally present. Relating is from only pieces or parts of the self. To the trained observer it is obvious that the missing aspects of the personality have not been felt, recovered, and integrated into a solid whole. It is not uncommon for borderlines and narcissists to turn to drugs, alcohol, and sex in order to deny and repress emotional pain. These activities loosen the ego's control on impulses and feelings that otherwise would be too painful to assert. As such, the pleasure principle overrides the reality function of the ego. Borderlines have a strong need to control. For them the loss of control signals the onset of some type of emotional or interpersonal breakdown. When borderlines feel the world threatening to cave in, they become involved in external distractions that symbolically provide support, affiliation, and the promise of salvation. The fear of being controlled by others will make the borderline hypersensitive to a therapist's style and interventions. It is easy to make inadvertent mistakes when relating to borderlines because of their hypersensitivity to parental control. Due to the borderline's hypersensitivity, a therapist's spontaneity may be inhibited for fear of crossing the borderline's diffuse, undifferentiated boundaries. When boundaries are unconscious, sometimes the only way a therapist can discover them is by an inadvertent violation. If this occurs, it can trigger paranoia and a negative transference towards the therapist. Unfortunately, for both client and therapist, the end result can be a "no win" situation with the client generally terminating the therapy prematurely. When such a hypersensitive situation does occur, it is in the best interest of both parties to process their interaction and discover the etiology of the hypersensitivity to control. Other characteristics of BPs include the following:  There may be a pervasive feeling of worthlessness, emptiness, and unfulfillment.

 Relationships have an on again/off again, destructive, and "on the brink", quality.

 There may be a fear of ruining primary relationships. The partner of a borderline may react to the BP's emotional chaos with anger and rejection.

 Borderlines test their partner's level of frustration-tolerance and anger. Borderlines can push partners to the limits of their rage and reactivity.

 There may be a need for an inordinate amount of assurance and affection to compensate for the heavy rejection experienced internally. Emptiness The BP has an empty core at the center of identity. The feeling of emptiness (American Psychiatric Association, 1987) may have its roots in a very early gestational trauma (Hannig, 1981). In this stage the blastocyst-not yet even a embryo-is not attached to the uterine wall. It has no external source of emotional and physical nourishment and may, in fact, exist in an empty world (void) disconnected from its maternal source. The blastocyst's drive to survive depends on the ability to attach itself to mother's body (uterine wall). The need to connect is very strong while the failure to connect en utero may lead to emotional and physical disintegration and death (spontaneous abortion). Trauma during gestational attachment creates disordered adults who have difficulty connecting emotionally with other people. The bad, rejecting, destroying uterus is a real threat. The BP is constantly seeking a connection with the good womb in order to escape or avoid the death womb. As a result, with this type of early trauma, we see the development of the splitting and projecting mechanisms of many borderline-narcissistic characters. These good-womb/bad-womb aspects are projected onto a therapist or a therapy group and thus may create difficulties in the formation of a therapeutic alliance. As a therapist, I have been the object of good-uterus/bad-uterus split projections of clients. In one particular therapy group a borderline female projected the good womb onto me and the group while projecting the bad uterus and bad parent onto her partner. In contrast, her narcissistic partner projected the bad womb onto the group and his wife while the good womb and good parent became his profession. Other Aspects of Borderline Personalities Some of the other aspects of BP Disorder include the following:  Repetitive cycles of regressive behavioral patterns are present The BP may make demands for intimate partners to satisfy a deep need and to alleviate the suffering for a lost, once-loved parent. If these demands are excessive, it may cause distance and eventual rejection.

 To varying degrees, borderlines are able to be in a relationship while being partially or fully detached emotionally from the partner.

 There is an inability to be assertive in a healthy way. When feeling threatened or anxious, the borderline can become hostile, defensive, accusatory, and provocative.

 Borderlines eventually transfer negativity onto their mates; that is, they lose love, withdraw, and become aversive to touch and sex. Borderlines may transfer positively to extramarital symbols that are unavailable, with the hope for fulfillment.

 Pathological fantasizing or obsessing may become an escape from depression, accompanied by paranoia about being helpless, immobile, and unlovable.

 There is a love/hate ambivalence toward the opposite-sex parent and a feeling of abandonment by the same-sex parent This leads to the deflated quality associated with depression. Destructiveness Borderlines can sabotage relationships by clinging, withdrawing, provoking, and acting inappropriately. At times they not only appear to be out of touch with reality but are also competitive, resistant, and perhaps passive-aggressive as well. BPs may be only vaguely aware of their self destructive behavior through the diminishment of their caring, empathy, and sensitivity. Lower-level borderlines have difficulty fully and permanently committing to something or someone. Socially and occupationally, nothing is appealing and a lack of enjoyment/satisfaction may be present in his life. A BP may know what he wants to do but cannot find the motivation to make the move. Satisfaction seems "out there" somewhere. In a regressive phase an aversion to touch, kissing, and sex can occur. A female BP may dishonestly submit to her partner's needs or expectations and then withdraw into gratifying fantasies or obsessions. She may seek symbolic freedom by escaping through an extra-relationship sex or emotional triangulation. Destructive behavior protects the BP from her primal pain and prevents her from fully living her life. The female borderline feels undeserving of love even though she is able to elicit love feelings from others. She blames herself for not getting love from her parents, as if it were her fault, rather than realizing that her parents were incapable of giving love. Any feeling that a client has difficulty expressing can be expressed by the therapist as a means of making the client more aware of what he or she is having difficulty in expressing. Thus, the therapist can role-play the unexpressed feelings of the borderline and have the client express them as affirmations. As real feelings emerge, the borderline becomes terrified of "going crazy' and never being able to come out of it. Many borderlines are angry because they feel their lives have been wasted. Support and empathy from the therapist are necessary to help them come to terms with such issues. Some borderlines express themselves through symbolic images as part of their detachment from real feelings. They may waste valuable therapy-session time by symbolically talking about or explaining their feelings through images while leaving little time for actual feeling. This is part of their self-destructive tendencies. The borderline can place excessive superego demands on himself by not living up to internal ideals for performance. There may be complaints of falling short of social and occupational expectations. The BP's internal critic says, "You are just not good enough." To the borderline, life feels cruel and unfair and there may be an inclination to complain and protest. The Deflated False Self A child needs to feel and express love to the parent of the same sex. If the parent is not available to receive that love due to some distraction - such as death, family illness, work, addictions, care of another sibling, or the narcissistic demands of a mate or parent-then the child will never have the opportunity to fully express love to the same-sex parent. The child will begin to transfer all that need to love on the opposite-sex parent, who then becomes everything to her. If the opposite-sex parent fails to be perfect or is pathological, the child's love turns to hate and devaluation. Feelings of betrayal, abandonment, loss, and loneliness arise which can lead to depression and acting-out behavior to avoid Pain. A high-functioning borderline will choose defensiveness in the form of a false self/facade because of the dominance of buried trauma and childhood Pain. Some borderlines portray a deflated false self by choosing a ragamuffin, orphan-like look in contrast to the ostentatiousness and overdressing of the narcissist. Borderline lifestyle is usually plain and utilitarian, with less importance placed on appearance. In contrast, some narcissists conform to the trendy, outlandish, and the ostentatious, thereby over-valuing their appearance. The narcissist overdoes it. The borderline underdoes it. Some borderlines have a narcissistic front superimposed onto the deflated self, thus revealing how certain aspects of these disorders can overlap and interrelate. However, generalizing should be avoided since there is a wide variety of appearances presented by borderline personalities. The deflated false self of the borderline is unreal (Masterson, 1988). The client is deluded into believing that this horribly low self is the real self. The BP comes from a false-self-oriented family structure which reinforces the belief that the false self is one's true identity. It is as if the child's head is opened up and a depressed, unhappy, disconnected, alienated personality is implanted, completely destroying the real self. The borderline identifies with, and glues himself, to the false, denigrated, and self-loathing personality. This personality is an unreal mask that the BP wants the world and the therapist to accept as the real self. It represents self-deception and denial of the inner person, who therefore remains completely hidden from the self. A real self is a creature of hope, enthusiasm, joy, and love. But the borderline's belief is that the unhappy mask is actually the real person. Because there is a deflated false self, feelings are not fully discharged easily. The natural, innate crying response is weak and whining. Consequently, depression may persist. Some borderlines can discharge rage fully, but when they are in the midst of a breakdown or regressive stage, primitive defenses will prevent the full emotional discharge of Pain or anger. Lower-level borderlines have difficulty discharging Pain and getting clear. Full discharge usually occurs only in the more advanced stages of therapy. At the beginning stages of therapy the borderline has a minimal capacity for forming a therapeutic alliance. The ego is weak and immature, and there is a deficit in alliance-forming capacities. When a narcissistic overlay to the borderline's personality exists, therapeutic alliance becomes more difficult because of grandiose claims-i.e., "There is nothing wrong with me." Even though the borderline's deflated side of the self is aware that something is wrong, the dominating side of the inflated self wants to deny it. The borderline has a deep, underlying terror of catastrophic annihilation and excruciating fears of rejection and loss of object love. Escape feelings are present and bonding may be difficult with the therapist. Many borderlines will go from one therapist or therapy to another, much to their own consternation and the frustration of the therapists. The borderline may possess these wanderlust behaviors and inclinations, thus being unable to root or emotionally bond to people and places. This may involve a narcissistic need for the perfect mate, the perfect place, and the perfect therapy. Many borderline-narcissistic types were raised by a parent or parents who sought to inflate their own egos by over-estimating the perfection of their children. One borderline female relates how her mother reacted when the daughter accomplished something by saying, "Of course, what did you expect . . . she's a Smith!" It is as if perfection is the norm for such a special, gifted family member. Such egoism puts strain on the borderline who feels "not good enough" or feels like a waste in many areas of her life. It is one thing for a parent or grandparent to be impressed when a youngster is behaving cute and precocious. "Oh, he's a genius!" comes as a pleasant surprise rather than as an expectation of parental egoism. The borderline is expected to be special and successful, even though she is not given the emotional nourishment (love) needed to feel good about herself. Some borderlines feel good in their false selves - their facades and defenses while others do not. Distorted views of reality make for unawareness of the damage being done through denial. Destructiveness, conflict, and chaos are the hallmarks of the narcissist/borderline nexus. When confronted on their choices, destructive behavior, and defensive thinking, the borderline perceives the therapist as a disapproving, withdrawing parent. When that happens, the BP goes through a cyclic round of acting out and provocation which may involve criticism, rejection, and devaluation of the therapist, as well as other love objects. Sometimes this cycle of resistance, therapeutic confrontation, and the working through of underlying Pain can continue for years. Behavior of Borderline Personalities Withdrawal Borderlines are super-sensitive and hyper-vigilant when they suspect a love object or partner of withdrawing sexual, libidinal love supplies (Lachkar, 1992). Even if the partner or love object is not withdrawing, the borderline may project displaced maternal withdrawal onto the partner. In some cases there could be an actual partner withdrawal, combined with the borderline's projected withdrawal, that operates to trigger a regressive withdrawal into a symbiotic world of erotic repression. The BP may cease object love and choose symbolic partners, excessive masturbation, pornography, drugs, alcohol, promiscuity, sexual blocking and/or occupational failure. Libido is drawn back into the self and acted out destructively. Withdrawal continues until physical symptoms become manifest. The male BP will be inconsistent and unstable in his thinking and feeling toward the partner (love object). He may feel love, warmth, and satisfaction when the two of them are making good contact. But when he perceives this partner as being preoccupied, it activates primitive withdrawal defenses. He will go into emergency repression to suppress the upwelling of agonizing, brutal, annihilating desertion trauma. Near-psychotic episodes could be imminent if the borderline is not contained in the framework of a therapy that allows for the release and integration of catastrophic Pain. The regression must be handled carefully and expertly. The therapist needs to have a deep understanding of the borderline's Pain. Accurate interpretations and reflections will facilitate the necessary release of emotions while providing support and reassurance to the client. Withdrawal of self, feeling, and libido are hallmarks of BPD. Conversely, assertion and self-retrieval allow the false self to give way to the recovery of the real self. The borderline may activate very painful obsessions towards the good womb, maternal love object. The BP will engage in accusations of rejection, neglect, and abandonment toward parental love objects, especially the therapist. When erroneously perceiving any inadvertent slights, the borderline will believe these so called infractions were intentional and may abruptly withdraw from the field of action by feeling hurt and perhaps angry. Some borderlines form strong therapeutic alliances while others become quite ambivalent when sensing any kind of betrayal, rejection, or abandonment. The terror existing deep within the BP is easily masked by a pseudo-independent, emotionally detached facade. Some borderlines, though not sexually abused, may have formed emotionally incestuous love/hate relationships with the opposite-sex parent. Failure to bond satisfactorily with the same-sex parent (girls with mothers, boys with fathers) could lead to an over-involved, high libidinal investment with the other parent. Guilt and shame usually become strong components within the relationship as the child begins feeling responsible for the parent's well-being. Outward Appearance and Behavior Borderlines may exhibit speech behaviors that unconsciously hide shame-based feelings. Mumbling, impoverishment of speech, circumstantiality, excessive symbolic abstraction, questioning, and intellectualizing are some of the noticeable speech peculiarities of the borderline personality (Othmer and Othmer, 1989). The BP may engage in excessive, long-winded, abstract, cerebral, off-the-point descriptions of feelings without being able to directly label and express personal emotions. Speech tone may be an inaudible whisper, thus forcing the listener to frustratingly request a higher intensity of tone. Hiding feelings behind questions that have little relevance to the current focus can derail the listener and cause defensiveness. A weak and vague speech pattern gives the appearance that the BP is searching frantically for words, thus leaving the listener unimpacted and wondering what is being conveyed. Excessive symbolic, unnecessary verbal elaboration may hold the listener's attention but begs the question, "Where are the feelings?' The borderline may also use distancing, accusatory "you" statements rather than 'I' statements in order to shift the focus away from internal, anxiety-provoking, painful emotions. Physical appearance for some borderlines is bedraggled, not quite put together, and inappropriate in dress and style. Some BPs have no sense of appropriate grooming while others may appear quite neat. There is never the sense of the exquisite, as in the case of some narcissists. Facial expressions vary from depressed to open and cheerful. Biting the lower lip, nail biting, and nail picking are signs of anxiety. Omissions and thought disruptions may be common in borderlines. Omissions are a form of forgetting. Anxiety or depressive thought disorganization can lead to repetitive patterns of destructive behavior, such as losing keys, forgetting to lock and close doors, missed appointments, incomplete communication, and so on. There may be a tendency for some people to follow up and fix the borderline's omissions and forgetfulness, which in itself can be destructive, annoying, and corrosive to relationships. Family members may experience themselves getting tired of the BP's idiosyncratic and peculiar behavior. During the regressive phase of a borderline's near-psychotic breakdown, she will engage in very destructive acting-out behaviors with little or no memory recall of the events, much to the consternation and dismay of the family members. Some borderlines feel they have never fully recovered from such near-psychotic breakdowns. Hypersensitivity to Withdrawal, and Insensitivity Borderlines can be completely devoid of any sensitivity as to how their behavior affects others. Because they are deep into their own worlds, there is very little, if any, capacity for caring about how others may feel towards their interpersonally and emotionally insensitive behaviors. For example, a female BP seems to be intermittently and cyclically at war with an intimate partner and is never quite aware of how she influences and drives him to extreme anger and even destructive rage. The partner may have to explore the depths and range of his own Pain and rage just to become less reactive to the borderline's destructiveness. If that does not work, then complete and total withdrawal from the relationship becomes the only open choice. The borderline is capable of provoking a partner into exploring the depths of hell and the heights of transcendent heaven. This occurs because the borderline lives in the realms of extreme emotional swings, instability, and contradictions. It is common for the borderline to lead a loved one down one emotional direction, and then suddenly and dramatically shift into another direction. Borderlines push emotional soft spots and trigger reactions in other people. The partner of a borderline may constantly have to monitor herself for emotional reactivity to the borderline's hurtful and insensitive behavior. In essence, the BP is a problem waiting to happen. Involvement with a borderline person will eventually lead to a painful emotional roller-coaster ride. It is not uncommon for a partner of a borderline to wonder, "How did I ever get involved in this mess?' One husband of a borderline remarked, "I found myself caught up in a spider web with my wife being the black widow and I was the prey." For this borderline there is so much hurt, devastation, and damage inside that her borderline world is similar to a complicated, intricate spider web. She desperately wants someone to come into her inner world to help unravel the tangles of Pain and destruction. She is lonely and unfulfilled. Only careful, slow, and neutral empathy and expertise can allow her to descend into and recover from the nightmare of the long-lost, damaged child who was never loved fully or appropriately by her family. Then, by feeling her Pain, she can be reborn into a new world with a new self. Submissiveness In a female borderline there can be a submissive side to her personality. She may give overt agreement or dependently collude in permitting others to behave in ways that disturb or even deny her true identity. She may be unable to set limits to behavior that violates her boundaries. Her false self may give the impression that it is alright to hurt her, as she pretends not to be disturbed by such infringements. She may also send wrong or misleading signals to her love object. Thus, in her passive-dependent collusion, she actually reinforces abandonment and betrayal, much to the confusion of her love object. One woman compliantly submits to her husband's sexual demands even though she does not feel sexual. In fact, she resents him for wanting sex when she is actually feeling non-sexual. But she shows no overt displeasure to her husband, who believes therefore that she is agreeable to sex. Guilt about not being a good wife inhibits her from openly discussing feelings with her husband. So she performs undesired sex and avoids working the problem through with him. Another woman works hard all day. Upon coming home, she wants some time to be with herself. Her husband wants to spend all of the remaining day's time with her. He does not know that she desires some time alone. She will not tell him because she wants to be seen as a good wife. Since she does not want to hurt him, she feels guilty for desiring some time alone. She remains passively quiet and submits resentfully. Another woman, who has a sexually promiscuous past, allows her husband to play around sexually with other women. She overtly goes along with his seemingly harmless, recreational, extramarital sex. After all, she engaged in this behavior at one time herself. On the surface she appears agreeable to his sexual escapades. She even believes that she is being altruistic by permitting her husband to have his fun. She wants to be a good wife and feels guilty for having a desire for him to be monogamous. She suppresses her real needs and seems to go along with, comply with and submit to something that she may not feel clear about inside. She later takes revenge on him by being promiscuous again, much to his dismay and confusion. As I have alluded to earlier, there are probably no pure personality types due to considerable overlap and fluidity in personality pathology. With the borderline, as with the narcissist or other disordered selves, submissiveness may be mixed with altruism and guilt. There is true consent, and there is false or pseudo-submissive consent in the dilemma of the personality disordered person. As with dependent and passive-aggressive personalities, the borderline has a desire to please others and tell them what she or he thinks they want to hear. The BP controls a situation through submissiveness, only to eventually turn around and attack accuse, provoke, resent, turn off to, or intensify a situation. To the observer a borderline's efforts to talk about the issues with a partner may seem fruitful because admissions of transgressions and agreements to reform sound very good. But deep personality disturbances cannot be resolved by communication alone. Only by feeling the deeply buried Pain of emotional death before three years of age can the borderline be liberated from the chaotic emotional cycles of highly complicated, dependent relationships. For the female borderline, her pseudo-independent self feels that she can just walk away from a relationship when the Pain gets too great. Conversely, her real self will tell her there is a deep, dark, catastrophic emotional Pain and that by releasing her pent-up, lonely inner child, she will know true peace and stability. Relationships Borderlines can appear to function quite well. Their personas can be quite pleasant, attractive, manipulative, exploitative, and seductive. They can appear to be cocky, highly independent, and self-sufficient. They may function well in a relationship until a stressor-such as childbirth, money problems, or illness-triggers a regressive breakdown into a severely paranoid, sexual-acting-out depression. Borderlines relate from a detached position, which is also the way they relate to the inner child, their impaired real self. There is a true split in the personality: between the lonely, impaired self and the person of efficiency, competence, and warmth. BPs can be brash, cocky, confident, and in control, while feeling quite hollow and dead inside. Through denial, the narcissistic side wants to feel only pleasure and suppress pain. When borderlines cannot trust, they will keep people at a distance and remain inaccessible. When they become involved in relationships, it may be with partners who will support their pathology. Borderline relationships are marked by instability, with back-and-forth emotional cycles of warmth and love followed by loss of love, sexuality, concern, and closeness. Once the borderline experiences injury, he may initiate a gradual deterioration and eventual death of the primary relationship. After then experiencing emotional traumas, the borderline may attempt to resurrect feelings of love and libido in the main relationship again. The false self can feel hopeless, depressed, helpless, and pessimistic about ever recovering anything real in life. A borderline may get caught up in a busy workaholic schedule and thus passively neglect the important emotional work necessary for recovering the real self. Because repressed Pain is so deep, the borderline has to work very hard and long to reach any kind of connection, clarity, or insight. Avoiding the emotional work will keep the BP mired in a failure-oriented, deflated false self. When experiencing narcissistic injury, the borderline suppresses real feelings, only to become aware of them when they are triggered in the future again. Thus a borderline may be unaware of the grudges and resentments that she holds, only to have those feelings damage relationship bonds. The borderline has difficulty experiencing the feeling of mourning for the loss of the real self, the inner child. The BP is unfamiliar, almost a stranger, to himself. Since the parents were emotionally inaccessible and buried behind their own facades, the BP disowns his real self in favor of an acquired, more acceptable false self. The borderline continues the family's pathology of denying the real self and accepting only the acquired, false self. A borderline is hyper-alert to injury and much attention is highly focused on perceived abusers. This makes it difficult to accept responsibility for the way she damages relationship bonds. The BP tends to blame a partner for destroying feelings of love and sexuality. She may also rationalize relationship failures on the grounds that, "We are not right for one another, and it will never work." All of this changes when there is a successful working through of the deeply repressed Pain. Causes of Borderline Personality Disorder Fetal Rejection The male part of the Self begins its physical journey in the body of the father and the female Self comes to life in the body and egg of the mother. In the BP the father's sperm seeks connection, acceptance, and impregnation, but mother's egg does not. The egg vehemently fights to reject the sperm. If the mother does not want the pregnancy and/or rejects the father and his child the child will feel unacceptable and unwanted, and will identify with feelings of nonexistence, such as "I'm not wanted . . . I'm nothing," and so on. As such, for the borderline, conception is not an act of love. A fetus conceived in love and passion will feel wanted and esteemed. But, for the borderline, there has never been this ideal, environmental circumstance attached to conception. The will to live and survive originates from the real self, from a soul existing in perfect being and essence, even before taking physical form. It is the will to survive that allows the infant to endure the life-threatening traumas that are imminently faced in the womb. Childhood Abuse Some borderlines undergo extreme physical punishment at the hand of a parent. For example, after a beating and/or verbal violence, a male child is cast away and left alone, emotionally bleeding. He will feel very abandoned and alone. He may grow into adulthood fearing being alone, and he will always feel compelled to be around people. If the child was further abused by peer groups in school, the fear of being alone and abandoned will be compounded and later projected on to his adult environment. He will stay busy with distractions from feeling. At home he may excessively read the newspaper and watch TV in order to avoid the upsurge of suppressed rage and Pain. At work and in public he will be vulnerable to being provoked and then reacting, often to the detriment of his own welfare. Conflicts with parents and schoolmates will persist into adult life and be displaced on to authority figures, work colleagues, and accidental encounters. Submission and rage will be dilemmas for him. Generational Transmission Process The mother of a borderline may be a borderline personality herself who, through a generational transmission process, has passed on borderline traits to the child. This is accomplished by the internalization and introjection of the mother's feelings into the child's own impaired self system. On entering adulthood, the child may actually reenact a borderline drama similar to the mother's. When this happens, the impaired inner infant of the mother identifies with and bonds with the devastated internal infant of the adult child. This results in an adult mother-child relationship that is fraught with emotional problems. This relationship is marked by a lack of real love-bonding feelings. Alienating feelings like dissatisfaction, devaluation, and hostility may also be present. Unwanted pregnancies may precipitate a borderline character-formation in unborn children. For example, if a mother has other children close in age or the pregnancy occurred too close to the birth of another child, the mother may wish that this unborn baby did not exist. She may submit to having the baby, but in her heart she feels guilty for her thoughts of disavowal. Her own borderline guilt and pretense creates a borderline pregnancy process, which leaves the baby with intense cravings for the mother's body and nourishment. Sometimes babies of borderline mothers are born with a ravenous hunger for breast milk along with a tenacious need to cling to the mother's body. In time this hunger becomes an intense, insatiable need that eventually becomes transferred to love objects in adult life. Because of feelings of nonexistence and threat to one's survival, the borderline clings tenaciously to adult relationships based on intense early need and oral demands. When these relationships threaten to break down, the borderline regresses to an infantile, near-psychotic state. Buried emotional pain gets reactivated along with primitive regressive defenses. Given the nature of this disorder, borderlines never get enough nurturance. When needs are not met, they will intensify demands, threaten withdrawal and/or dissolution of the relationship with a partner. Further complications may later occur due to the underlying intense oral cravings and unmet emotional needs. Bulimia, substance abuse, sexual acting-out, alcoholism, perversions, situational sexual aversion, and debilitating depression with paranoid projections may all be part of the borderline picture. As a mother, the borderline may become heavily attached to and identified with her own child's feelings of rejection, abandonment, and being unwanted. Since the borderline is extensively vulnerable to narcissistic injury, she will fuse with her child into a tight self-protective, defensive bond when she perceives that her child is being rejected or unwanted. She will then project blame onto the offending parties without recognizing how she and/or her child set up others into being unwanting, rejecting, unloving parental objects. Blame may be used to deflect her own possible feelings of being unwanted and perhaps of not wanting her own child en utero. Thus, by defending her own child against feelings of being unwanted, she also deflects her own terror of rejection and her own guilt about being rejecting. In a relationship it is common for the unwanted inner infant of the borderline to feel deeply attracted to bonding and identifying with the hurt, unloved inner child of another person. These people may actually form love relationships based on the empty, unloved inner infant. Attempting to turn the partner into some aspect of one's own unintegrated, disallowed inner parent marks the beginning of borderline upheaval and intensity. Children of borderline mothers and their own subsequent offspring do not know how to build strong, sustained interpersonal object relationships. Through their flightiness and aggressive, injuring behavior, they build interpersonal bonds that are unstable, erratic, and subject to weakening influences. Their fear of sustained, strong commitment and intimacy creates weakening of love bonds through relationship breaks and "moving out to greener pastures" patterns. Though leaving a wake of broken relationships and "dead bodies" (narcissistically injured former partners), they rationalize and justify their tactics by blaming others. At the deepest levels these individuals feel brutalized by early, unformed, broken bonds and the resulting fear and distrust. And the borderline is always unconsciously trying to embroil others (therapist included) in their emotional caldrons. The Process of Therapy The key to therapeutic success in treating the borderline personality is compassionate concern, empathic understanding of the depths of early childhood Pain, and the patience and non-reactivity of a saint. Therapeutic skills and the timing of interventions must take into consideration the borderline's terror and fragility during the release of Pain. The slightest hint of therapist neglect, rejection, or insensitivity will send the BP into painfully negative transference with its accompanying accusations, ambivalence, and attack. He needs constant assurance of the therapist's benevolent intent and will continually test for the slightest hint of inattention. It is also very important for the therapist to monitor his or her own aggressive tendencies and vulnerable, transferential trigger points. The course of treatment is long term, because of the chronic nature of the disorder. Treatment can be very successful and motivational. Cooperative clients can and do achieve workable and happy lives. As the borderline regains a feeling connection to the real self, life progresses. Relapses do occur, however, but are less destructive because the client is more resilient and able to recognize the symptoms and patterns. By working through feelings, the BP can restore tenuous love bonds with partners and family members. Cycles of intense interactions with a significant other may reoccur, reactivating old hurts, but the BP is more capable of dealing effectively with anger in herself and other family members. Paradoxically, the borderline learns how to be more sensitive toward others and less hypersensitive to perceived injury. Treatment can be terminated when the client attains the coping and feeling skills necessary to self-monitor and control unstable, ever-changing bonding emotions. As previously mentioned, borderline phenomena may include the defensive mechanisms of splitting and projection. When the client splits the parental object into good and bad introjects he will usually make a spouse, partner, or close love object into the bad mommy and an external person into the good, loving libidinal parent. Partners of BPs become dismayed and feel rejected when the BP suddenly goes cold sexually and displays an aversion to being touched, kissed, or handled. This type of behavior is not exclusive to borderlines, for it is an indication of personality disorganization as well. Many disordered personalities show a splitting and projection of the good-parent/bad-parent introjects. When a client becomes aversive to being touched by a spouse, we can assume that an old abuse is being reactivated, creating a withdrawal of libido from sexual activity with the once-valued partner. The mate may get seduced into helping fix her spouse's serious problems out of unrealistic altruistic reasons. This is common to many psychological disorders. When someone has a serious personality disturbance, expecting an unqualified, untrained spouse to try to fix or correct the person's long standing illness will have disastrous results. This is especially true because emotional involvement with a disturbed person should not include quasi roles of the pseudo-patient and healing-spouse partner. Relationships and marriages do not heal personality, mood, or anxiety disorders. The clinically disturbed person should seek out a professionally trained therapist and not project the need to be cured onto a partner. When transferences erupt into full bloom in these kinds of pseudo-relationships, the consequences are quite unpleasant. Any spouse, lover, or partner who tries to be a therapist in order to satisfy the other person's therapeutic need is asking for failure. You cannot be a spouse and a therapist at the same time when the other person is seriously impaired. The disordered person may narcissistically want to save face by not openly sharing and discussing the problem. He will avoid going to see a trained therapist. Remember, disturbed people have difficulty forming strong, stable emotional bonds; and this deficiency leads to resistance and avoidance of assuming the appropriate task of forming the therapeutic alliance. One woman I treated stated, I love my husband. All that I want is a marriage partner, not a patient who is looking to me as a savior. He needs a real doctor, and I need a real husband. Instead, I got a sick puppy, a lot of heartache and grief. All of his shit comes flying out at me, and I can't handle it. I need caring for myself. All we do is wrestle and fight with his sick behavior. I keep trying to get both of us to go to a therapist, but he keeps refusing and avoiding it. He insists that somehow we can solve this thing by ourselves. Frankly, I'm tired of it. So I got therapy for myself to see if I could get disentangled from this mess. Since I have gotten stronger in my therapy, my husband has finally agreed to come in. Slowly, painfully, and with the help of our therapist, we are beginning the long road to recovery. She continued, The marriage started out with a lot of false hope on my part. There were some good times, but eventually his sickness drove me crazy and it became a nightmare of depression for me. I learned that I am not equipped to deal with someone else's sickness. I deserve to find out who I am: I am a person and I can love myself. My husband has to take care of himself and must not be so dependent upon me to be his good mommy. When I failed him, guess what I became - his bad womb. He couldn't stand to have me touch him for fear of contamination. I felt terrible, rejected, betrayed, and alone. If it weren't for my therapy and the group support I would not have made it. Today, I am feeling wonderful. I recognize that I could not fix him and that's okay. His illness nearly destroyed our marriage and our lives. I have forgiven both of us, and now I know that he needed a doctor first and a supportive wife second. It wasn't my fault what happened between him and his mother and father. I didn't do it to him. But I got all of the shit that was meant for them and believe me, it hurt. I still bear the scars. Regaining Identity For the woman in the aforementioned situation, there was initially, before treatment, a complete loss of identity. The only part of her that could be real existed in her tears. She had to trust only her tears and to look at everything else about herself as being crazy and unreal. She had to learn to differentiate her false, deflated self who chose such a partner in the first place from her real self. This could only be accomplished by diligently seeking her tears and the self that emerged. Her talk and her words could not initially be trusted, because they were expressions of the false front. She was a fake, because she could convince herself and others that her unreal, low self was the real self. It was a repressed deception of the highest order. The false self possesses pseudo-feelings devoid of real emotion. The false self is a dead person hiding a real person. The borderline may even tire of the tedious rendezvous through the labyrinths of the unfeeling false self. It is as if a BP is trying to get acceptance for the unreal self, an activity that leads nowhere except into the unfeeling world of symptoms. The therapist needs to recognize the deception of the deflated false self, unmask it, and then put the task of feeling the real emotions before the client. This may leave the borderline at first feeling confused, yet relieved. It may also mark the beginning of a genuine commitment to the reality of the borderline's true Pain. Because the false self is unreal, it leads to an unreal life that misses the mark of true happiness and the anchoring of full identity. Commitment to Feeling The borderline accepts and acts out a distracting, non-feeling, busy-making lifestyle. Excuses are made for not putting in the full, complete effort and time necessary for clearing out the de-energized false self and reinstating the real, stable, loving, consistent self. When a full commitment of time and energy is made to working on the self, the BP stands a better chance of gaining full access to very deep, repressed Pain and of fully releasing deadness and making healing connections. Then the BP can recover love and passion and shower it on the love partner. However, the borderline must continually be in a situation where he can feel the difference between the real and the unreal self. The heavily abused borderline splits the mind off from the body and feelings. She may be very analytical, further cutting off from feelings. Automatically going to the head reinforces the non-feeling self. Bodywork can be very effective with people who have difficulty hooking up to their emotions (Lowen, 1985). Clients with weak emotional discharge and poor emotional maintenance benefit greatly from the full presence of a therapist who applies strong pressure to vital, armored physical areas. The inside of the upper thigh is an area of great release when pressed carefully. The close physical proximity of the therapist provides the much needed emotional security for the deep expression of long repressed feelings. For some very repressed borderlines, bodywork utilizing pressure-release points may have to continue over a long period of time in order to get the client used to being in touch with the real self. But the effort can be worth the reward of seeing the client happily smiling after his or her long, dark journey into a psychic hell. Fetal Rejection Overcome By Self-Acceptance Danger and life threat are constant companions for the en utero borderline infant who is always on the borderline of existence and nonexistence. Even so, there may be temporary bonding and unification experiences with mother in the womb. Fortunately, this allows some little piece of the real self to develop. As an adult these events can be re-experienced through certain music, nature scenes, dance movements, and other positive-triggering experiences; thus nurturing the emergence of the real self, even as the unreal self is dismantled. On the other hand, early emotional and environmental deficits will never be overcome by performance demands and expectations imposed by the superego. You cannot will someone to be happy and engage in activities that a severely impaired person shies away from. Because en utero acceptance never occurred, constant superego exhortations and demands will only exacerbate a sense of unacceptability just for being. Therefore, the role of the therapist is to reflect the being/accepting self that was never allowed to be in the borderline. To the decimated self of the borderline, the world and the family represent a toxic womb. People are perceived as being toxic because of bad womb projections. Acceptance of the borderline by the therapist at the level of essence and being allows the borderline to accept her or his real self and become free of the enormous burden to perform "normally" in a symbolic, toxic womb environment. When a mother vacates emotionally from the conception and gestation of her child, it is equivalent to saying to the child, "I am not going to be here for you. You will have to do it all by yourself. You will have no mother, and you will have to raise yourself and be a mother to yourself." This kind of abandonment is so powerful that it leaves the child feeling, "I will have to survive and grow up by myself, without your support, encouragement, and love." This expectation and demand is too great for the child to live up to. Without a mother, the child tries and tries, but can never live up to the demand, "to do it all by yourself." When the borderline female has children of her own, she may feel that she has not been there for the child. Her child inherits the same feelings of "I can't do this by myself . . . I'm all alone and helpless. It's too much pressure to perform at surviving by myself." The motherless raises the motherless and the borderline legacy is passed on. The internal demands leave a child feeling, "I just can't make it." But through long-term, deep feeling work-involving emotionally releasing the Pain, thereby seeing through the facade of the BPs unreal self, thereby allowing the BP to discriminate clearly between her unreal self and her real, feeling self-she can uncover the little pieces of the real self that were allowed to develop en utero. Uncovering and understanding these pieces of the real self, these pleasant womb experiences, they can be re-experienced and made stronger in the personality by choosing positive life experiences that correspond to and thereby trigger them. And since, as Adzema (1993) put it, "A crucial element of the real self is its unconditional acceptance of itself' (p. 4), the BP in growing into her real self can also grow into self-acceptance. And it is only through self-acceptance that the inordinate en utero survival demands of the borderline can ever be overcome. References Adzema, Michael. (1993). Only half a cure: Unconditional acceptance and the primal process. IPA Newsletter: International Primal Association, Summer, 4.

American Psychiatric Association. (1987). DMS-111-R: Diagnostic and Statistical Manual of Mental Disorders. (3rd ed., revised). Washington, DC: American Psychiatric Association.

Hannig, Paul J., Ph.D. (1981). Feeling People: A Revolutionary Concept in Therapy, Lifestyle, and Human Contact. Winter Park, FL: Anna Publishing.

Lachkar, Joan, Ph.D. (1992). The Narcissistic/Borderline Couple. New York: Brunner/Mazel.

Lowen Alexander, M.D. (1985). Narcissism. New York: Collier Books.

Masterson, James, M.D. (1988). The Search for the Real Self. New York: The Free Press.

Othmer, Ekkhard, MD., Ph.D., and Othmer, Sieglinde, Ph.D. (1989). The Clinical Interview Using the DSM-III-R. Washington, DC: American Psychiatric Press, Inc.

PAUL J. HANNIG, PHD., MFCC, CCMHC, NCC, is a licensed California marriage-and-family counselor; a Florida-licensed clinical mental-health counselor, and Director of the Institute for Transformational Therapies in Chatsworth, California. He is nationally certified by both the National Academy of Certified Clinical Mental Health Counselors and the National Board of Certified Counselors. Dr. Hannig holds clinical membership with the California Association for Marriage and Family Therapists and the International Association for Marriage and Family Therapists. Dr. Hannig specializes in (but does not limit himself to) personality disorders; depression; anxiety; phobias; adult survivors of physical, emotional, and sexual abuse; marital and family conflict; deep feeling therapy; and core-identity work. His therapy model is experiential and integrative, combining an individual, interactional, and multigenerational approach to treatment He is author of the book, Feeling People. This article is part of a lengthy chapter on Borderline Personality Disorder in a work-in-progress. Feel free to inquire about the completed paper, as well as papers on Narcissistic Personality Disorder, Obsessive-Compulsive Love Disorder, and other mood, anxiety, and personality disorders. Dr. Hannig is available for networking on personality disorders at (818) 882-7404. He can also be contacted at the Institute for Transformational Therapies; 10170 Larwin Avenue, #4; Chatsworth, CA 91311; and he can be visited at his homepage on the World-Wide Web at URL: http://www.psychotherapyhelp.com. This article was originally published in Primal Renaissance: The Journal of Primal Psychology, Vol. 1, No. 2, Autumn 1995, pp. 54-71.

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